11MUSCULOSKELETAL DISORDERS

The Food and Drug Administration (FDA) warning on nonsteroidal anti- inflammatory drugs (NSAIDs). Cardiovascular: NSAIDs may cause an increased risk of serious

cardiovascular thrombotic events, myocardial infarction and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk. [FDA 2005]

Gastrointestinal: NSAIDs cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events. [FDA 2005]

In July 2015 the FDA further strengthened the cardiovascular warning to indicate that NSAIDs can increase the chance of a heart attack or stroke, either of which can lead to death. Those serious side effects can occur as early as the first few weeks of using an NSAID, and the risk might rise the longer people take NSAIDs.[FDA 2015]

In October 2020 the FDA issued a warning that use of NSAIDs around 20 weeks or later in pregnancy may cause rare but serious kidney problems in an unborn baby. This can lead to low levels of amniotic fluid surrounding the baby and possible complications.[FDA 2020]

Corticosteroid injections Corticosteroid injections have been commonly used treatments for chronic tendon lesions.[Speed 2001] However recent analysis of the evidence base found that while corticosteroids show some effectiveness for short term pain, long term use in tendinopathies is deemed ineffective and at times contraindicated.[Irby 2020] Common reported side effects include tissue atrophy, facial flushing, postinjection flare, and hypersensitivity reactions.[Speed 2001]

Intra-articular injection of corticosteroids is also a common treatment for osteoarthritis of the knee, see Osteoarthritis section for more details.

Prevention of complications is one of the most important aspects of patient care in pain management. The most common complications associated with joint, tendon, and muscle injections appear to be infections that have been associated with virtually all of these injections.[Cheng 2007]

Traumeel®: promoting inflammation resolution a different approach There is scope for improvement in the management of acute musculoskeletal injury. As much soft tissue pathology represents a failure to repair tissue adequately after injury, improving the healing response seems an appropriate strategy for improving outcomes.[Del Valle Soto 2013] Inflammation resolution is not merely a passive cessation of proinflammatory mechanisms. It is a complex, tightly regulated system of processes that is critical for tissue healing and restoration of function.[Sugimoto 2016, Serhan 2014, Feehan 2019, Jones 2016, De Oliveira 2016]