Managing Chronic Musculoskeletal Pain: From NSAIDs to Muscle Relaxants

Musculoskeletal conditions — osteoarthritis, rheumatoid arthritis, low back pain, and post-surgical pain — represent the leading cause of disability worldwide. Clatan's ortho pain range addresses each clinical scenario with a specific mechanism: OTOXIA 90 (Etoricoxib 90mg) for chronic inflammatory arthritis, Cladol SP (Aceclofenac 100mg + Paracetamol 325mg + Serratiopeptidase 15mg) for post-operative and soft tissue pain, OTOXIA TH4 (Aceclofenac 100mg + Thiocolchicoside 4mg) for spasm-related musculoskeletal pain, and Cladol MR (Aceclofenac 100mg + Tizanidine 2mg) for acute muscle spasm with sustained hypertonia.

OTOXIA 90: Selective COX-2 Inhibition with Etoricoxib 90mg

Etoricoxib selectively inhibits COX-2 while sparing COX-1, which maintains the gastric mucosal lining and platelet function. This selectivity translates to dramatically fewer GI events compared to non-selective NSAIDs like diclofenac or ibuprofen. Once-daily dosing makes OTOXIA 90 ideal for chronic conditions — osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and acute gouty arthritis. Faster onset occurs when taken without food, particularly valuable in acute gout flares.

Cladol SP: Triple-Action with Serratiopeptidase 15mg

Cladol SP combines Aceclofenac 100mg (preferential COX-2 inhibitor with superior GI tolerability) + Paracetamol 325mg (central and peripheral analgesia) + Serratiopeptidase 15mg. Serratiopeptidase is a proteolytic enzyme that breaks down fibrin at injury sites and accelerates oedema resolution. Unlike NSAIDs that only suppress inflammation, Serratiopeptidase actively removes the fibrin debris that prolongs swelling — making it especially effective for post-operative tissue recovery and rheumatoid arthritis.

OTOXIA TH4: Aceclofenac + Thiocolchicoside for Spasm-Related Pain

OTOXIA TH4 pairs Aceclofenac 100mg with Thiocolchicoside 4mg — a centrally-acting muscle relaxant that works by inhibiting GABA and glycine receptors in the spinal cord. This dual action addresses both the inflammatory and spastic components of musculoskeletal pain simultaneously, a common clinical picture in cervical spondylosis, lumbar radiculopathy, and sports injuries where muscle guarding compounds the underlying inflammatory pain. Twice-daily dosing provides sustained coverage for both pathways.

Cladol MR: Aceclofenac + Tizanidine for Muscle Relaxation

Cladol MR combines Aceclofenac 100mg with Tizanidine 2mg — an alpha-2 adrenergic agonist that reduces spasticity by inhibiting excitatory amino acid release in spinal interneurons. Unlike Thiocolchicoside which primarily addresses acute spasm, Tizanidine is better suited to conditions with sustained muscle hypertonia: chronic low back pain, torticollis, and spastic conditions following injury. Tizanidine also has central sedative properties, making Cladol MR particularly effective when nocturnal muscle cramps or spasm-related insomnia is part of the clinical picture. Patients should be counselled to avoid driving due to possible sedation.

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"OTOXIA TH4 and Cladol MR fill a critical gap in the pain formulary — the spasm component of musculoskeletal conditions is often undertreated with pure NSAIDs alone. Adding a centrally-acting muscle relaxant transforms the clinical outcome, especially in low back pain with significant guarding." — Orthopaedic Surgeon

Choosing the Right Formulation

• check_circleChronic OA/RA with GI risk: OTOXIA 90 — selective COX-2, once-daily, minimal gastric impact
• check_circlePost-operative pain with swelling: Cladol SP — NSAID + analgesic + fibrin-clearing Serratiopeptidase 15mg
• check_circleAcute spasm-related pain (cervical/lumbar): OTOXIA TH4 — Aceclofenac + Thiocolchicoside, dual anti-inflammatory and centrally-acting muscle relaxant
• check_circleLow back pain with sustained muscle hypertonia: Cladol MR — Aceclofenac + Tizanidine, especially effective for nocturnal spasm