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Trigger point injections relieve pain and reduce muscle tightness

About the significance of periodic monitoring of blood vitamin concentrations to determine if vitamin deficiencies or excesses are developing

Yeung et al., 2014

Uses Musculoskeletal pain (e.g., arthritis, back pain, sprains) Rheumatoid arthritis and osteoarthritis Gout attacks Dysmenorrhea (painful periods) Post-operative pain Migraine (in some formulations) Mechanism of Action Inhibits cyclooxygenase (COX-1 and COX-2) enzymes Prostaglandin synthesis inflammation, pain, and fever Forms Available Oral tablets (immediate or slow-release) Topical gels/creams Suppositories Injections (IM) Eye drops Side Effects Common: Stomach pain, indigestion Nausea Headache Dizziness Serious: Gastric ulcer or bleeding Kidney impairment Elevated liver enzymes or liver damage Hypertension Cardiovascular risk (increased risk of stroke/MI with long-term use) Contraindications History of peptic ulcer or GI bleeding Severe renal or hepatic impairment Asthma or allergy triggered by NSAIDs Pregnancy (especially 3rd trimester) Severe heart failure Cautions Use with PPIs (e.g., omeprazole) in long-term therapy to protect the stomach Avoid combining with other NSAIDs or anticoagulants Monitor renal function in long-term use Monitoring Renal function Liver enzymes (LFTs) Blood pressure Signs of GI bleeding (e.g., black stools) Dr