10 - OTC Pain Management Flashcards
What are the two kinds of pain?
Nociceptive
- Somatic
- Visceral
Neuropathic
_____ pain: due to the activation of pain pathways by ongoing tissue damage
Nociceptive
Define somatic pain
- Pain arising in the tissues of the body
- Sharp, sometimes burning, aching, relatively localized
- Osteomyelitis, osteoarthritis, bone fractures
ex. ankle sprain, tooth being pulled out
Define visceral pain
- Pain arising in the organs of a body cavity
- Deep, aching, cramping, diffuse and poorly localized
- Could have nausea, sweating, and CV changes involved (i.e. systemic symptoms)
- Endometriosis (pelvic), Chron’s disease (abdomen), angina (thorax)
- Not often managed with OTC agents (Referral)
Define neuropathic pain
- Caused by direct nerve damage or may be due to abnormal “processing” of a pain signal in the CNS pain pathways due to sensitization of pain neurons
- More commonly chronic, but can be acute
- Can be paroxysmal or spontaneous
- Generally described as burning, tingling, shock-like or shooting
Hyperalgesia
Altered perception such that stimuli which would normally induce a trivial discomfort cause significant pain
Allodynia
Pain due to a stimulus that does not normally evoke pain
Phantom pain
Pain in a limb that is no longer there
Acute Pain:
Cause
Tissue damage often associated with inflammation
Acute Pain:
Duration
Days to weeks (2-4 weeks)
Sub-acute = 4-12 weeks
May depend on the cause
Acute Pain:
Course or prognosis
Predictable
Acute Pain:
Emotional response
Anxiety or overt pain behaviours (grimacing, limping, etc)
Acute Pain:
Treatment
Primarily analgesic
Chronic Pain:
Cause
Neuronal or CNS abnormality (sensitization)
Chronic Pain:
Duration
> 12 weeks (3 months)
Associated with a pattern of recurrence over months or years
May be associated with chronic disease (Rheumatoid arthritis, back pain)
Chronic Pain:
Course or prognosis
Unpredictable
Chronic Pain:
Emotional response
Quiet, depressed
Flat affect
May also have anxiety issues
Chronic Pain:
Treatment?
Multimodal
-Have to try different options, different HCP’s, different therapies, etc.
What is break-through pain?
- Temporary increase in pain to greater than moderate intensity that occurs on a baseline pain of moderate intensity or less
- Causes increased level of psychological distress and significant decrease in function
What is incident pain?
A type of breakthrough pain that is made worse by movement
List some tools for assessing pain
1) Numerical Rating Scale (NRS)
- Patients rate their pain on a scale of 0-10
2) Visual Analogue Scales (VAS)
- 100mm horizontal line, with the left side marked no pain and the right side marked the worst pain
3) Wong-Baker FACES Pain Rating Scales
- Faces ranging from happy to sad based on how they are feeling
* Good for children or people who don’t speak english
What are the 4 main pieces that are essential to pain information gathering?
- Severity of pain
- Location of pain
- Onset and how long the pain lasts
- Quality of pain (description of pain - dull ache, sharp pain, tingling or burning)
What is the role of OTC Pain medication
- Effective when treating mild-moderate somatic pain from skin, muscle and joints
- Also effective in treatment of dysmenorrhea and headache
- Less useful in treatment of visceral pain (refer)
- Effectiveness in neuropathic pain often demonstrates variable response
- Treatment of neuropathic pain may involve a wide range of therapy
List the types of non-prescription pain medications
1) NSAIDs
- ibuprofen
- ASA
- naproxen
2) Acetaminophen
3) Opioids
- Codeine (8mg)