Chronic musculoskeletal pain
Musculoskeletal pain lasting more than 3 months. Includes back, joint and soft tissue pain. Management is multimodal: short courses of NSAIDs, physical activity, physiotherapy, and psychological therapy for chronification.
ICD-10 M79.13 drugs
Also known as: Chronic MSK pain
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DLornoxicamNot recommended · Non-steroidal anti-inflammatory drug, oxicamIn Russia lornoxicam is often prescribed as long courses and infusions for chronic back pain, sometimes for weeks on end. The AEMPS Lornoxicam Rapid Meiji label limits the drug to short-term treatment of acute pain, and the Spanish register holds no injectable forms. NICE NG59 on low back pain and sciatica says the same in other words: an oral NSAID is prescribed at the lowest effective dose for the shortest possible period, and for sciatica it warns separately about limited evidence of benefit and the risk of harm. A long course does not make the effect stronger; it accumulates ulcers, bleeding and kidney injury, especially in older patients and alongside a diuretic, an ACE inhibitor or an anticoagulant. If a lornoxicam course has been planned in weeks, consider seeking a second opinion.
- FMetamizole sodiumNot recommended · Analgesics and antipyretics. PyrazolonesMetamizole is not used for long-term chronic pain therapy. Cumulative agranulocytosis risk, lack of anti-inflammatory effect and the availability of safer alternatives (paracetamol, ibuprofen, non-pharmacological approaches, occasionally weak opioids) make prolonged use clinically unjustified.
- FNimesulideNot recommended · Antiinflammatory and antirheumatic agents, non-steroids. Other NSAIDsNimesulide is not used in chronic musculoskeletal pain. Courses beyond 15 days carry a cumulative risk of hepatotoxicity, including fulminant hepatic failure with fatal outcome or need for transplantation. EMA 2011 explicitly limits course duration, and chronic use falls outside the regulation.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit