How to Treat Myositis: Self-Care or Doctor

What Are the Drug Categories for Treating Myositis?

How to treat myositis? Many people wonder what medicine to take. Medicines used to treat myositis fall into 3 main groups based on how they work.

• General painkillers (Analgesics) — paracetamol, for basic pain relief
• Anti-inflammatory painkillers (NSAIDs) — such as ibuprofen, which relieve both pain and inflammation
• Muscle relaxants — which ease a tight, spasming muscle

Each group has its own strengths and limits, and some cases call for combining them for the best result. Here is a closer look at each group.

Paracetamol — The Basic Pain Reliever

Paracetamol is the pain reliever most Thais are familiar with, and it is easy to find at any pharmacy.

How it works

Paracetamol works by blocking prostaglandin production in the central nervous system, helping to relieve pain and reduce fever, but it has no direct anti-inflammatory effect on the muscle itself.

Who is it suited to?

• Mild to moderate muscle pain
• General aches with no swelling or redness
• Anyone with a stomach condition or peptic ulcer who cannot take NSAIDs

Limitations

• Does not reduce inflammation — if the muscle is swollen and red as well, paracetamol alone may not be enough
• Never exceed the recommended dose — overdose can cause serious liver damage
• Do not drink alcohol with it, as this raises the risk to the liver

NSAIDs — Relieving Pain and Reducing Swelling

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) work to relieve pain, reduce fever, and reduce inflammation all at once, which makes them better suited to myositis than paracetamol.

How they work

NSAIDs block the Cyclooxygenase (COX) enzyme that produces the prostaglandins responsible for pain, swelling and inflammation, acting both in the central nervous system and directly at the site of inflammation.

Commonly used NSAIDs

• Ibuprofen — the most widely used NSAID, suited to mild-to-moderate pain with inflammation. Gofen, which contains ibuprofen, is available at Intimo Life
• Diclofenac — available as both an oral tablet and a topical form
• Naproxen — has a longer duration of action than ibuprofen

Who is it suited to?

• Myositis with swelling, redness or warmth
• Pain from a sprain or a muscle tear
• Back, neck or shoulder pain from office syndrome

Precautions

• Take with or after food to reduce stomach irritation
• Avoid using continuously for more than 10 days without consulting a doctor
• Avoid if you have a peptic ulcer, kidney disease, heart disease, or are pregnant

📖 Read more: How to treat myositis — a full guide covering medicine, compresses and physical therapy.

Paracetamol vs NSAIDs Compared

Research published in the European Journal of Pain (2015), drawing on 16 systematic reviews, found that ibuprofen relieves pain consistently better than paracetamol across a range of conditions, including acute pain and pain from osteoarthritis.

A further study on PubMed (2021) also found that a fixed-dose combination of ibuprofen and paracetamol reduced the chance of muscle pain becoming chronic more effectively than using either painkiller alone.

Muscle Relaxants — Easing Spasm and Tightness

Muscle relaxants act on the central nervous system to reduce spasm, tightness and contraction in a muscle — symptoms that often accompany myositis.

Why Use a Muscle Relaxant?

When a muscle is inflamed, the body responds by tightening the area to guard against further injury. But that tightening presses on small blood vessels, reducing blood flow to the muscle and causing localised ischaemia, which makes the pain worse and creates an unending pain-spasm-pain cycle.

A muscle relaxant breaks this cycle, letting the muscle relax, improving blood flow, and reducing pain.

💡 Read more: Myositis symptoms — learn the symptoms at each muscle site so you can choose the right medicine.

Muscle Relaxants Available in Thailand

Several muscle relaxants are commonly used in Thailand, each with its own strengths.

Eperisone — acts on the central nervous system to reduce muscle spasm, and also widens blood vessels to improve blood flow to the tightened muscle. Its advantage is causing little drowsiness, which suits people who need to work during the day. Available as Myonal

Tolperisone — works similarly to Eperisone by blocking mono- and polysynaptic reflex signalling in the spinal cord, and has a lidocaine-like local-anaesthetic effect that also helps relieve pain. It likewise causes little drowsiness and does not weaken the muscle. Available as Mydocalm and Biocalm

Orphenadrine — a muscle relaxant combined with paracetamol in one formula, so a single tablet both relaxes the muscle and relieves pain, suiting anyone who wants the convenience.

Comparing Different Muscle Relaxants

Research in the Asian Spine Journal (2012) found that Tolperisone was effective for acute lower back pain, reducing pain both at rest and on movement significantly better than the comparison group (p = 0.0001), without causing drowsiness.

For Eperisone, a study in the European Review for Medical and Pharmacological Sciences (2008) found gastrointestinal side effects in only 5% of users, significantly lower than with other muscle relaxants.

Can You Take Painkillers Together With a Muscle Relaxant?

Yes — and in many cases the combination works better than using either one alone.

Research in Pain and Therapy (2019) found that combining a muscle relaxant with an NSAID relieved pain better than an NSAID alone: 94.08% of the combination group rated the result "good to very good", compared with 77.33% for those on a painkiller alone.

A more recent systematic review in the European Spine Journal (2025), covering 50 studies with 7,531 participants, confirmed that combining a muscle relaxant with an NSAID outperformed an NSAID alone on global efficacy (RR: 0.62, p = 0.01).

How to Combine Them

• NSAID + muscle relaxant — suited to myositis with pain, swelling and spasm together
• Paracetamol + muscle relaxant — suited to anyone who cannot take NSAIDs (for example, due to a stomach condition)
• Orphenadrine + paracetamol (combination formula) — such as Norgesic, which combines a muscle relaxant and a painkiller in one tablet, so there is no need to take several medicines

How to Choose the Right Medicine for Your Symptoms

💡 Read more: How long does myositis take to heal? — recovery time by severity, and what affects it.

Precautions When Using These Medicines

Precautions for NSAIDs

• Always take with food to reduce stomach irritation
• Avoid using NSAIDs continuously for more than 10 days without consulting a doctor
• Avoid them if you have a history of peptic ulcer, kidney disease, heart disease, or are pregnant
• Never take more than one type of NSAID at the same time, as this raises the risk of side effects

Precautions for Muscle Relaxants

• Some muscle relaxants can cause drowsiness — take care before driving or operating machinery
• Do not drink alcohol while taking a muscle relaxant, as it increases the sedative effect
• Use for a short period only (no more than 2–3 weeks), as advised by a doctor or pharmacist

Precautions for Paracetamol

• Never exceed the recommended dose (no more than 4,000 mg per day)
• Watch for accidental double-dosing — many products already contain paracetamol (such as cold and fever medicines)
• Do not drink alcohol with it, as this raises the risk of liver damage

📖 Read more: Hot or cold compress for myositis? — choose the right method to help the medicine work better.

A Note From the Author

This article is compiled from medically reviewed information. It is not intended to replace advice from a doctor or pharmacist. If your symptoms are severe or you are unsure, consult a health professional.