General muscular aches and pains are often caused by either unaccustomed use or overuse of muscles.
However, more severe muscle pain accompanied by swelling and restricted movement may mean that muscles, tendons or ligaments have been damaged, torn, sprained or strained, possibly in a sports or other accidental injury.
Before treating, consider whether the problem is due to general aches or pains caused by overuse or something more serious, such as an injury. If an injury is involved, follow the RICE(R) approach immediately (see ‘Treatment tips’ further below).
When to see a pharmacist or other medical professional
Patients should see a pharmacist or other medical professional if:
- the pain or ache is accompanied by serious loss of movement
- the pain is severe, there is swelling or the area feels warm
- the pain or discomfort has not improved after treatment
- the problem is due to a back injury, or the pain is in the lower back and spreads to the legs
- worsens during the day, such as knee or hip pain
- there are other symptoms, such as morning joint stiffness, fever or numbness
- if the muscular pain is associated with a medical condition
- the patient is taking certain medicines known to be associated with muscle pains, such as treatments used to lower cholesterol levels
- the person is a child or elderly – they may be more sensitive to some medicines
- the sufferer is pregnant or breastfeeding, as certain medicines will not be suitable
- the pain persists beyond seven days.
If any of these apply, investigation of muscle aches and pains by a health professional is recommended, even if it confirms there is nothing seriously wrong.
General muscle aches, stiffness or soreness caused by overuse may be relieved by anti-inflammatory gels or ‘heat rubs’. Where general muscle soreness and stiffness are the problem, gentle exercise, massage and medicine help restore mobility. Avoid heat, alcohol, exercise or massage for the first 72 hours, as they may limit healing.
Check with a doctor or physiotherapist before starting heat treatments and physical activity to avoid the risk of further injury.
If back pain is the problem, the patient should make sure they adopt good posture and appropriate lifting techniques to prevent back ache in future.
Treatment tips for sprains, strains and soft tissue injuries
It is important to use what is known as ‘RICE(R)’ therapy in the first 48 hours following injuries, following an injury such as a sprain.
Each of the letters in ‘RICE(R)’ has a meaning as follows:
- R – Rest: the patient should have no further exercise
- I – Ice: apply ice or a bag of frozen vegetables, wrapped in a towel to protect the skin, for 10–30 minutes every two hours
- C – Compress: wrap with a firm, elastic bandage, although this should be loosened if there is a sensation of tingling or numbness
- E – Elevate: keep the injured limb raised on a chair or cushion
- (R ) – Refer: see a doctor or physiotherapist for a precise diagnosis and ongoing care, as this will made a full recovery with less scarring more likely.
General muscle aches and pains can be relieved by a range of medicines, though it may be better to avoid certain medicines immediately following an injury first injured – so check this with a pharmacist.
Take pain relievers regularly for the first few days, rather than waiting for the pain to subside.
Oral pain relief medicines (analgesics)
Paracetamol, aspirin and NSAIDs (non-steroidal anti-inflammatory drugs) relieve pain. Aspirin, ibuprofen and diclofenac also reduce inflammation (swelling).
Paracetamol is a safe choice for most people but it is important not to take more than recommended. It is an ingredient in many cold and flu remedies so if a patient is taking one these, it is essential to avoid taking a double dose.
The maximum daily dose of paracetamol for an adult is 4g (8 x 500mg tablets) – and no more than 1g (two tablets) every four hours.
Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) are not suitable for everyone.
Children under 12 years old must not take aspirin because it can cause Reye’s syndrome, which is a serious condition. It should also be avoided by adolescents under 16 years old who have a viral illness. Children and young people under 14 years should not take diclofenac.
Patients should check with a pharmacist before taking aspirin or NSAIDs if they:
- have a history of stomach problems, such as ulcers or indigestion
- have asthma – some people with asthma find their condition is made worse by these types of medicines
- have kidney problems or a heart condition
- take other medications
- have an allergy to aspirin or NSAIDs
- are pregnant or breastfeeding
- are elderly – older people may be at more risk of side effects
- are dehydrated.
Aspirin and NSAIDs can cause side effects. If indigestion develops or the patient has unusual or increased bleeding or bruising they should stop taking these treatments and and talk to the pharmacist.
Topical NSAIDs (non-steroidal anti-inflammatory drugs)
These are gels, creams, mousses or sprays applied direct to the affected area that contain benzydamine, diclofenac, felbinac, ibuprofen, ketoprofen or salicylic acid. They may help relieve general aches, sprains and strains, and are applied and rubbed gently over the affected area.
The medication can be absorbed into the bloodstream so it is important to check that NSAIDs are suitable for the patient (see above).
If large amounts of treatment are used or the patient is sensitive to NSAIDs, side effects may occur (see above). If the patient’s skin becomes irritated the treatment should be stopped.
Topical NSAIDs should not be applied to open wounds or the lips, or anywhere near the eyes, and whoever applies the treatment should wash their hands after use.
NSAIDs are not recommended for pregnant or breastfeeding women, or children.
Heat rubs and sprays (rubefacients)
This group of treatments contain methyl salicylicate, methyl nicotinate, capsicum, turpentile oil, camphor and menthol.
They work by masking pain by creating warmth in the area they are applied, and most should be massage-in for better effect. Heat sprays should not be massaged-in, however.
Heat rubs should not be applied to open wounds, eyes, mouth or nose. In some patients they may irritate the skin, and their use should be stopped if this happens.
Some heat rubs are not suitable everyone – check with the pharmacist before use.
Treatments containing heparinoid may be used to reduce swelling and bruising in an injured area.
NHS Choices http://www.nhs.uk/conditions/sprains
Edited by Alan Nathan, autumn 2009. Mr Nathan is a pharmacist and an expert on the treatment of minor illnesses and over-the-counter medicines, and has published books and many articles on these topics. He is also a visiting lecturer at the Department of Pharmacy, King's College London.