Most people will experience some form of musculoskeletal pain in their lifetime, but there are plenty of ways to avoid and ease it, and community pharmacy can help

The Covid-19 pandemic has seen most people confined to their homes to help limit its spread, but restrictions on their ability to move around and exercise, coupled with some people working from home, could be having a detrimental effect on their bodies.

With sedentary lifestyles becoming the norm even before the pandemic, plenty of research points to a rise in people reporting problems with musculoskeletal (MSK) pain. According to a recent report from the charity Versus Arthritis, three in 10 adults suffer with MSK pain, and the British Pain Society says almost 10 million Britons suffer pain almost daily, resulting in a major impact on their quality of life and more days off work. 

The Versus Arthritis report says depression is four times more common among people in persistent pain compared to those without pain and around 63 per cent of working-age adults with an MSK condition are in work compared to 82 per cent of people with no health condition.

Sitting ducks

According to GP Dr Dawn Harper, there is a growing body of evidence highlighting the link between sedentary lifestyles and back pain. She says this is “likely to continue to rise as a result of prolonged periods of inactivity, combined with an ageing and increasingly obese population”.

Research from Mentholatum’s ‘Mind Your Back’ campaign shows that three out of five respondents (57 per cent) sit down for four or more hours of their working day, and remain seated for another two to four hours once work is over. In addition, the study identifies bad posture as a trigger for muscular pain for two out of three adults (68 per cent). What’s more, the nation’s so-called ‘walk-shy’ lifestyles have left two out of five people (39 per cent) experiencing MSK problems at least once a week, over a third (35 per cent) of adults experience more back pain than they did a year ago, and two out of three adults (68 per cent) have experienced pain as a result of their posture.

Back to basics

Dr Michael Flynn is a medical doctor and chairman of Nova Medical Solutions Limited, and has spent much of his professional life developing and evaluating new pharmaceutical products and medical devices. He says bad posture can be a key component of back pain, but it can be addressed. “Slouching with a bent back while working is not a natural posture,” he explains. “But it is not difficult to maintain a straight back, provided the chair is the right height so that the feet can be tucked under the chair from time to time, which enables one to easily sit upright with a straight back and minimum effort.”

Experts in ergonomics advise anyone whose job involves sitting for long periods to take a one- or two-minute break to stand up and move around every 20 to 30 minutes. Another approach is for desk-based workers to break up their day with standing-based work, or switching to a sit-stand desk, where available.

Maintaining good posture is also important for people with arthritis, as it puts less strain on joints, according to Versus Arthritis, and this can help the body feel more relaxed.

However, Emma Davies, advanced pharmacist practitioner in pain management at Cwm Taf Morgannwg University Health Board, says it’s inactivity more than posture that plays a role in MSK pain. “Actually, posture is not thought to be particularly connected to, for example, back pain”, she says. “It’s a myth that organisations such as the Chartered Society of Physiotherapy (CSP) are trying to dispel”. 

Because being inactive results in deconditioning – where muscles become less active, tire quickly and lose mass and strength – Emma says if you already have pain and are then inactive, “it often results in movement becoming increasingly painful as you are forcing deconditioned muscles, and so on, to move”.

For people with very restricted movement or particular concerns that certain movements are more painful than they think they should be, Emma’s advice is to see a physiotherapist for professional advice on how to improve strength and fitness. “If they believe that posture is an issue, then they will advise appropriately and in the context of the individual,” she says. “That said, things like yoga and pilates can be helpful for everyone, in terms of improving strength and flexibility, and over time, that might lead to gentle changes in posture as general conditioning improves.”

The study identifies bad posture as a trigger for muscular pain for two out of three adults

Analgesic advice

Now, more so than usual, community pharmacies are one of the only available healthcare settings that people can access for face-to-face advice. This gives pharmacy teams a great opportunity to help customers dealing with MSK pain.

Oral painkillers are one of the first choices for managing and preventing pain. “If people have pain and it isn’t due to a known underlying condition or illness such as flu or coronavirus then simple analgesia might be helpful,” explains Emma. “Non-steroidal anti-inflammatories (NSAIDs) are generally first line, but paracetamol can be trialled for people who are unable to use NSAIDs due to other conditions or medicines.” 

However, she stresses that customers have to be made aware that the reason to take analgesics of any sort is to try to reduce the intensity of pain enough to allow them to continue to with daily life. “So, if someone takes the analgesics and it doesn’t allow them to do more – for example to continue to undertake activity or to increase the amount of activity each day or week – then it is probably not worth continuing to take the medicines,” she says.

Of course if an individual’s pain persists beyond a few days, they should be advised to talk to their GP.

Topical pain relief 

“Topical products can be a valuable option when people are suffering muscle and joint pain, but are unable or unwilling to take oral medication,” says Kaye Mackay, senior brand manager and new product development at Mentholatum. “The non-medicated patches and roll-on gels and lotions available can give effective relief without compromising other medication.”

For suitable customers, topical analgesics have a number of advantages: they deliver targeted, effective relief at the point of pain; because they do not enter the bloodstream they do not pass through the internal organs and may be associated with fewer gastric side effects; and there are many drug-free options on the topicals fixture, ideal for patients who are concerned about taking drug-based medication.

Topical NSAIDs are also a short-term alternative for people for whom oral NSAIDs might be a higher risk – for example, due to renal function, heart failure, or the use of other medications such as ACE inhibitors. However, they are not without risk and the same cautions apply as for oral NSAIDs, particularly in terms of overuse.

Topical products can be a valuable option when people are suffering muscle and joint pain

Hot and cold therapy

Another way to help manage pain symptoms is with hot and cold therapy. As a general rule of thumb, ice helps acute injuries or pain, along with inflammation and swelling, and heat eases muscle pain or stiffness. 

“We instinctively seek something warming or cooling when we experience muscle pain,” says postural alignment specialist Jan Keller. “Heat may work by improving circulation and relaxing muscles, while cold may numb the pain, decrease swelling, constrict blood vessels and block nerve impulses to the joint.”

Emma’s advice is to try it and see. “If it works for you and helps keep you active, then carry on. If it doesn’t help, don’t do it,” she says.

Alternative treatments

The British Pain Society says many complementary therapies have also been found to be useful as part of an overall pain management regime, stating: “Hypnotherapy, including self-hypnosis, can be used as part of a relaxation technique, [and] acupuncture and acupressure may be helpful in the management of chronic headaches, migraine and muscle pain syndromes.” 

However, the organisation warns that “there are a large number of other therapies which are being offered at a variety of costs. Many of them have not been proven to be of any benefit, and the majority of these have not been subjected to clinical trials to show whether or not there is any benefit. It is also important to tell your doctor if you are using any form of herbal medicines as these may interact with other prescribed drugs [and] remember that when using natural remedies, natural does not mean safe.”

The key, therefore, is advising all customers to do their research and get expert help where necessary.

Self care measures

Self care is vital for effective pain management, whether in the short or long term, so it makes sense to provide self care advice with every sale of an analgesic product for body pain.

Although historically doctors recommended bed rest for back pain, Dr Harper says the current guidelines are clear: “Getting mobile as quickly as possible, and keeping on the move, is the best way to relieve and prevent problems.”

Indeed, Dr Flynn says some MSK conditions can sometimes be avoided or mitigated by attention to lifestyle, in particular eating a healthy diet and taking regular exercise. “Keeping physically active may reduce back and joint pain by 25 per cent, and hip fractures and falls by approximately 75 per cent,” he says. “Related to this is the fact that seven out of 10 people with long-term musculoskeletal conditions are overweight and particularly prone to osteoarthritis of the knee and back pain.”

Dr Flynn says an easy regular exercise is brisk walking or gentle jogging for 30 minutes each day – although he advises paying “special attention when jogging to have good shoes and avoid uneven surfaces to avoid knee damage”. During self-isolation, “if jogging around the sitting room, special care is needed at the corners to avoid falling over and defeating the objective”, he adds.

As exercise stimulates the body’s natural painkillers – endorphins – to create a feeling of achievement and vitality, Emma says a good tip is for individuals to find an activity or activities that they enjoy. “Making sure that the activity you choose is something you can do, can be fitted around other things in life that you need, and [is something] you enjoy so you stick with it is really important,” Emma explains. “Sometimes, you might not feel that something makes a big difference to the pain itself but if [it] gives you some pleasure and improves quality of life, it is more likely that over time, the pain will take a less prominent role in your day-to-day activity.”