Muscle Pain Management: What Helps Beyond Painkillers?

What causes muscle pain?

Muscle pain can occur for many reasons, ranging from everyday activities to certain health conditions. Some common causes include: ^[1]

• Overuse or unfamiliar physical activity: Exercising more intensely than usual or performing repetitive movements can leave muscles feeling sore.
• Muscle strains or injuries: Overstretching or tearing muscle fibres can cause pain, tenderness and sometimes swelling.
• Prolonged sitting or repetitive movements: Staying in the same position for long periods or repeatedly using certain muscles may contribute to discomfort.
• Stress-related muscle tension: Emotional stress can cause muscles to tighten, particularly around the neck and shoulders.
• Certain illnesses or health conditions: Viral infections, such as influenza, and conditions such as fibromyalgia may cause muscle aches.
• Changes in body salts (electrolytes) or certain medicines: Abnormal levels of electrolytes, such as potassium or calcium, and side effects from some medicines can contribute to muscle pain.

What are the different ways to manage muscle pain?

There is no single approach that works for every type of muscle pain. The most suitable option depends on the cause, severity and duration of the pain, as well as your overall health.

For mild muscle aches, simple measures such as adjusting daily activities, gentle movement or heat and cold therapy may help. Other situations may require medicines, physiotherapy or further medical assessment.

Muscle pain management at a glance

Which medicines may help muscle pain?

Pain-relief medicines may help manage muscle discomfort, depending on its cause and severity. These include oral medicines, such as tablets or capsules, and topical medicines, such as gels or creams applied to the affected area.

Common options include paracetamol, which helps relieve pain, and non-steroidal anti-inflammatory drugs (NSAIDs), which can reduce both pain and inflammation. ^{[7, 8]}

For adults with recent muscle, ligament or other soft-tissue injuries (excluding lower back injuries), clinical guidelines recommend topical NSAIDs, such as anti-inflammatory gels, as a first-line treatment when appropriate. Oral NSAIDs or paracetamol may also be considered, depending on the individual's needs and medical history. ^[4]

However, not every medicine is suitable for everyone. Factors such as existing health conditions, allergies, pregnancy and other medicines being taken should be considered before choosing a pain-relief option. ^{[7, 8]}

What non-drug approaches can help?

Medicines are not the only way to manage muscle pain. Depending on the cause, simple changes to daily activities and self-care habits may help relieve discomfort and support recovery. Some approaches that may help include: ^{[1, 2, 5]}

• Adjust your activities: Temporarily reduce activities that worsen the pain, while avoiding unnecessary prolonged rest.
• Try heat or cold therapy: Choose the approach that suits the type and timing of your muscle pain.
• Keep moving gently: Resume comfortable movements as tolerated. Avoid forceful stretching, particularly after a recent injury.
• Return to exercise gradually: Increase activity and strength-building exercises progressively rather than returning to strenuous activities too quickly.
• Consider physiotherapy: A physiotherapist can assess your condition and recommend suitable exercises, particularly if pain keeps returning or affects daily activities.
• Improve your working habits: Adjust your workstation, change positions regularly and take movement breaks when sitting or standing for long periods.
• Prioritise sleep and stress management: Adequate sleep and relaxation techniques may help support pain management, particularly when stress contributes to muscle tension.

Should you use heat or cold for muscle pain?

Both heat and cold therapy may help relieve muscle discomfort, but the most suitable choice depends on the cause and timing of the pain. ^{[1, 5]}

Cold therapy may help relieve pain following a recent muscle strain or injury, particularly when swelling is present. ^[5]

Heat therapy may help soothe tight or stiff muscles and improve comfort, especially when there is no significant swelling. ^[1]

Whichever method you choose, protect your skin by wrapping the hot or cold pack in a towel. Avoid applying extreme temperatures directly to the skin and limit each application to a short period, following the product instructions. Stop if you experience skin irritation, burning or unusual discomfort. ^{[1, 5]}

If you have reduced skin sensation, poor circulation or certain medical conditions, seek professional advice before using heat or cold therapy. ^{[1, 5]}

Can stretching and exercise help muscle pain?

In many cases, gentle movement and appropriate exercise can help reduce stiffness, maintain muscle strength and improve mobility. ^{[1, 2]}

However, the right type of activity depends on the cause of the pain. For example, gentle movement may be helpful for muscle soreness after exercise, while a recent muscle strain may require temporary activity modification before gradually returning to normal movement. ^{[1, 5]}

Stretching should be gentle and should not cause sharp or worsening pain. If you are unsure which exercises are suitable, a physiotherapist can recommend a programme based on your condition and physical abilities. ^{[1, 5]}

For people with persistent or recurring muscle pain, appropriate exercise and physiotherapy may form part of a broader pain management plan. The type and intensity of activity should be tailored to the underlying condition, physical abilities and individual goals. ^[2]

What is TENS, and does it work?

TENS (transcutaneous electrical nerve stimulation) is a method of pain relief that uses a small device to send mild electrical impulses through pads placed on the skin near the painful area. These impulses produce a tingling sensation and may help reduce pain temporarily. The intensity can be adjusted to a comfortable level and should not be painful. ^[6]

A large systematic review involving 381 clinical trials found that TENS may help reduce pain during or immediately after treatment compared with placebo (a treatment that looks or feels similar but does not deliver the active treatment) in the relevant studies. However, the research included different types of pain, not just muscle pain. Its effectiveness may therefore vary depending on the condition and individual response. TENS may be considered an option for temporary pain relief in some situations, but it does not treat the underlying cause of muscle pain. ^[9]

Is TENS safe for everyone?

TENS is not suitable for everyone. People with pacemakers or other implanted electronic medical devices should not use TENS unless its safety has been confirmed by the appropriate healthcare professional. People with epilepsy and those who are pregnant should also seek professional advice before considering TENS. ^[6]

Electrode pads should not be placed on broken, infected, irritated or numb skin, over the front or sides of the neck, or on the chest and back at the same time. ^[6]

If you are unsure whether TENS is suitable for you, consult a healthcare professional before use.

Why does long-term painkiller use require care?

Painkillers can be helpful when used appropriately, but taking them regularly or for prolonged periods may increase the risk of side effects. ^{[7, 8]}

For example, non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may cause stomach irritation, ulcers or bleeding. They can also affect kidney function and increase cardiovascular risks in some people, particularly when taken at higher doses or for longer periods. ^{[7, 8, 10]}

Paracetamol is generally well tolerated when taken as directed, but exceeding the recommended dose can cause serious liver damage. ^[7]

Different painkillers carry different risks. It is therefore important to follow the recommended dosage and avoid combining pain-relief medicines without checking with a pharmacist or doctor. ^{[7, 8]}

If you find yourself needing painkillers frequently, or if the pain keeps returning despite treatment, speak with a pharmacist or doctor. Persistent or recurring muscle pain may have an underlying cause that requires further assessment. Managing the cause, where possible, is just as important as relieving the discomfort. ^[1]

Why combine medication with non-drug approaches?

Medicines and non-drug approaches can complement each other in managing muscle pain. While medicines may relieve discomfort, suitable exercise, physiotherapy and changes to daily habits may help improve movement and daily function. The most appropriate combination depends on the underlying cause and individual needs. ^[2]

When should you seek medical help for muscle pain?

Many mild muscle aches improve with simple self-care. However, some symptoms may indicate an underlying problem that requires medical assessment.

Speak with a healthcare professional if:

• Muscle pain persists longer than expected, keeps returning or gradually worsens.
• The pain is unexplained or does not improve with appropriate self-care.
• The affected area becomes swollen, red, warm or increasingly tender.
• Muscle pain begins after starting a new medicine or changing its dose.
• The pain interferes with your sleep, movement or daily activities.

Seeking medical advice can help identify the possible cause and determine whether further assessment or treatment is needed. ^[1]

When is muscle pain an emergency?

Although most muscle aches are not serious, certain symptoms may indicate a condition requiring immediate medical attention.

Useful resources

• Ministry of Health Malaysia – Pain Management Handbook – Malaysian guidance on different approaches to pain management, including self-care, physiotherapy and TENS.
• MedlinePlus – Muscle aches – Overview of common causes, home care and warning signs for muscle pain.
• CDC – Nonopioid therapies for pain management – Evidence-based overview of nonopioid medicines and non-drug approaches to pain.
• NHS – TENS – Practical guidance on how TENS works and who should take extra care.
• NHS – Sprains and strains – Self-care guidance for common muscle and ligament injuries.

Frequently asked questions about muscle pain management

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