Question 1

What is the first-line treatment for musculoskeletal pain?

Accepted Answer

There is no single first-line medicine for all musculoskeletal pain, because treatment follows the diagnosis and education, activity modification and rehabilitation are often the main treatment. For osteoarthritis, current UK guidance offers a topical NSAID for the knee and considers one at other joints, with an oral NSAID and gastroprotection if topical treatment is ineffective or unsuitable.

Question 2

Do NSAIDs slow down healing?

Accepted Answer

The evidence is mixed. Laboratory work raises a concern about bone healing, but human studies conflict, and this does not justify avoiding NSAIDs in every fracture or bone stress injury. A short course to control pain and support rehabilitation can be reasonable, while prolonged or high-dose use is avoided where bone healing is a particular concern. Effects on tendon, ligament and muscle healing are less clear.

Question 3

What is the role of opioids in musculoskeletal pain?

Accepted Answer

A limited, condition-specific one. For osteoarthritis, weak opioids are not offered routinely and strong opioids are not offered. Opioids are not offered for chronic low back pain, and a weak opioid may be considered in acute low back pain only if an NSAID is unsuitable or ineffective. Dependence is a real risk, so rehabilitation and non-drug treatment matter more.

Question 4

Which pain-relieving drugs are restricted for athletes?

Accepted Answer

Most NSAIDs and paracetamol are permitted at all times. Glucocorticoids are prohibited in competition by injectable, oral or rectal routes, including intra-articular injection, so the washout for the product is checked. Narcotics including tramadol are prohibited in competition, while codeine is not on the Prohibited List but is monitored in competition. Whether a therapeutic use exemption is needed depends on competition level.

Analgesia and Anti-Inflammatories

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