People lead busy lives and it is almost inevitable that there will be a time when painkillers like Panadol are used to help kill the pain, at least for now. The pain settles and then they carry on with life. Yet the reason or cause of that pain hasn't been looked at. Not surprisingly the pain gets worse even with the painkillers, whether due to further muscle/tendon tears, strains or even fractures. At this point something else has to be done to manage the pain. So what about cortisone injections? surgery?
There is a reason that the pain is there, it can be a warning signal that the body is under actual harm, or senses potential harm (Caneiro et al., 2021). Painkillers in essence numb that warning signal and is exactly like ignoring a check engine light on your car.
Panadol/paracetamol can be useful to help relieve severe pain and is relatively quite safe on the stomach. Again, further investigation into the reason for that physical pain should be done in conjunction.
Cortisone injection is another intervention used mainly to reduce the pain caused by excess inflammation in the body. There are merits in using this especially when pain is severe and cannot be relieved through other means. However like Panadol, it should not be used as a blanket intervention to kill pain as the reason of the inflammation or pain has not been addressed. There are side effects which accompany this injection including degrading the tendon quality in the region. In rare cases rupture of the tendon and reduction of bone density in the medium-long run (Voscopoulos & Lema 2010). There are occasions as mentioned where due to extreme pain or lack of other options warrant the injection, however these should be considered on a case by case basis with the healthcare team.
Common musculoskeletal issues such as lower back pain (disc strain, facet joint sprains, sciatica), neck pain, shoulder (subacromial bursitis) and hip bursitis can be treated through a number of ways (physiotherapy, medication or cortisone injections).
Physiotherapy can address the cause of these physical issues, work out the limiting factors (weakness, balance, pain, inflexibility?) to that person's presentation and provide strategies for prevention of future recurrence.
Where medications and injections may be a 'band-aid solution,' physiotherapy offers a non-invasive/low risk approach to addressing the root issue. The risk of side effects is reduced, the length of time to recover reduced and that person can have actual improvements.
Sean Hua
Director and Physiotherapist
Frontline Family Physio Pty LTD.
References:
Caneiro, J. P., Smith, A., Bunzli, S., Linton, S., Moseley, G. L., & O’Sullivan, P. (2021). From Fear to Safety: A Roadmap to Recovery from Musculoskeletal Pain. Physical Therapy, 102(2). https://doi.org/10.1093/ptj/pzab271
Voscopoulos, C., & Lema, M. (2010). When does acute pain become chronic? British Journal of Anaesthesia, 105(1), i69–i85. https://doi.org/10.1093/bja/aeq323
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