12 - External Analgesics Flashcards
BENGAY
Ingredients & Indication & Dose
MENTHOL
some might have camphor / methyl salicylate
- *AAA 3-4 times a day**
- do NOT use with heating pads / devises*
Minor Aches
Pains of muscles & joints associated w/
arthritis / backaches / strains / sprains / bruises
BENGAY
ADR / CI / PC
Do not apply to open / broken skin
avoid contact w/ eyes / mucous membranes
no bandages / heating pads
7 DAYS AT MOST
rare allergic reactions
Capzasin-P & -HP
Ingredients / Indication / Dose
- *CAPSAICIN**
0. 35% / 0.1% - some combos might have menthol*
AAA 3-4 times a day
Temporary relief of pain from:
RA / OA
Neuralgias (Shingles / DM neuropathy)
Capzasin-P & -HP
ADR / CI / CP
AVOID contact with eyes / broken skin
do NOT use occlusion
Contact MD if no improvement in
28 days or gets worse
effects may take
up to 2 weeks to be noticed
- *Transient burning/stinging will occur**
- dissapears after several days of use*
Okay to self treat vs EX-ST
Myalgias
External Analgesics
Myalgia / General Muscle pain from overuse
- *Delayed onset** = ~8 hours
- *Peaks @ 24-48 hours** after overexertion
- *Bursitis / Tendonitis / Repetitive** strain injury
EXCLUDED FOR MYALGIAS CAUSED BY:
Systemic Infections
Chronic disorders
Medications (statins)
Okay to self treat vs EX-ST
SOFT-Tissue Injury
External Analgesics
Okay to Treat for Soft Tissue injury to:
- *LIGAMENTS / MUSCLE / TENDONS**
- *GRADE 1** = Excessive stretching
AVOID IF INJURY WITH:
Abnormal joint movement
visible joint deformity
Okay to self treat vs EX-ST
Osteoarthritis / Chronic Neuronogic Pain
External Analgesics
Okay to treat ONLY AFTER HCP DIAGNOSIS
Osteoarthritis
Diabetic Neuropathy / Post-Herpetic Neuralgia
only treat AFTER DIAGNOSIS
Conditions Approved to SELF TREAT
with external analgesics
- *Acute Lower Back Pain**
- except if >6 weeks*
- *Myalgia / Overuse Injuries**
- not from chronic / medication / systemic infections*
- *Grade 1 Soft Tissue Injuries**
- no visible/abnormal joints*
- *Osteoarthritis / Chronic Neurologic Pain**
- only AFTER being DIAGNOSED by HCP*
Symptoms that EXCLUDE SELF CARE
for external analgesics
Food-Intake related
ulcer / gastritis
- *Pain -> r**adiates to LEFT arm or UP jaw “CRUSHING”
- ANGINA / MI*
- *Erythema / Wamth** around joint
- infections / inflammatory arthritis*
Systemic Symptoms
SOB / Fever / NVD
- *Swelling** / tenderness / WARMTH
- DVT*
- *Pelvic** or AB-pain (other than dysmenorrhea)
- Appendicitis / Pelvic Inflammatory disease / Pyelonephritis*
General EX-ST
External Analgesics
<2 y/o & pregnancy
OTC toxicity / systemic absorption
Severe pain
>6 pain score on 1-10 scale
Pain presistance
- *>10 days** , except for acute lower back pain <6 weeks okay
- *>7 days AFTER treatment/self care**
- *worsening** of severity or nature of pain
Back pain** w/ **loss of bladder/bowel fxn
PQRST
Assessment Questions for External Analgesics
Precipitating Factor
is pain related to specific activity?
Quality
describe the pain + other symptoms
Region
localization / JOINT?
Severity
Time
When to REFER for
P
in PQRST
Precipitating Factor
Is the pain related to a specific activity?
Refer if:
pain occured
after a prolonged period of IMMOBILIZATION
plane&car ride / bedridden / hospitilization
When to REFER for
Q
in PQRST
Quality
Can you describe the pain?
Are there any other symptoms?
Refer if:
Pain is neurologic in nature or if systemic symptoms
( burn/ tingle/ electrical/ numb) / (limb weakness / swelling/redness)
When to REFER for
R
in PQRST
REGION
Where is the pain / Localized?
is the pain in or around a JOINT?
Refer if:
Pain follows a nerve path = Shooting pain
if pain in non-localizable = generalized pain
if there is joint redness / tenderness / swelling
if there is prolonged/pronounced STIFFNESS after period of inactivity
if there is joint deformity / abnormal movement
When to REFER for
S
in PQRST
Severity
how severe is the pain?
Refer if:
If pain is constant and doesnt abate with rest of AA
if pain is moderate - severe = >6 on 1-10 scale
When to REFER for
T
in PQRST
TIME
How long has the pain been present
How Often does the pain occur
REFER if:
pain is present for >10 days
if lower back pain >6 weeks
>7 days after treatment / self care
if pain intensity increases / resolves->reoccurs
RICE
Non-Drug Therapy for External Analgesics
REST
Stop offending activity / avoid using are / use immobiling techniqiues
- *ICE**
- *Post Injury:** Apply for first 12-24 hours = 10 min 4-6x a day
- *Non-Acute:** use HEAT/moist heat for 20 min every 2-4 hours
- do not use on INFLAMMED areas or w/ counter irritants*
COMPRESSION
use bandages / wraps
ELEVATION
elevate injured area @/above level of heart
Counter-Irritant External Agents
general info
Prduce acute analgesic benefit in appropriate musculoskeletal conditions
minimal efficacy for chronic pain
4 GROUPS
_Although all are applied topically:_
there is some systemic absorption
serious toxicity after EXCESSIVE use esp in children
<2 y/o, no FDA approved agents
RUBEFACIENTS
Group A
External Analgesics
Produce redness & warmth with mild inflammation due to
VASODILATION“rubefAAAcients” = redness/warmth/inflammation
Methyl Salicylate
(wintergreen oil)
may have systemic effects,
DNU in children + _asprin/salicylate ALLERGY_
Other agents:
Ammonia water / allyl isothiocyanate / turpentine oil = Vicks/Sloans
Group B
External Analgesics
Produce COOLING SENSATION“B-Cool”
Menthol
commonly used on its OWN = Bengay / biofreeze
Camphor
typically used w/ menthol = tiger balm
smell / avoid use in infants / young children
Group C
External Analgesics
Induce VASODILATION
“vasCodilation”
Histamine Dichloride
Australian dream pain relief
Methyl Nicotinate
found in new combo products
Group D
External Analgesics
Substance P Depletors
“D-epletors”
do NOT cause redness / vasodilation
Acute use –> release substance P = NT for pain perception
Chronic use –> depletes substance P = decreased pain perception
- *CAPSAICIN / Capsicum /** Capsicum olersin
- *Zostrix / Capzasin** HP Lotion / Cream
Substance P Depletors
Indications
Depletors = Group D external analgesics
- *Acute** use: found in combo products, limited data
- *Chronic Disorders**
- *DM** Neuropathy / Post-Herpetic Neralgia (shingles=herpesZ)
Arthritic Conditions = reduce PAIN, not inflammation
only for HAND OA
Substance P Depletors
Instructions
Depletors = Group D for CHRONIC USE:
Apply 3-4 times QD on a SCHEDULED BASIS, not PRN
onset is SLOW
Arthritis pain = 1-2 weeks
Neurologic Pain = 2-4 weeks
pain relief MAY persist for several weeks AFTER d/c
may INITIALLY cause increased pain/burning = 72 hours
DO NOT USE ON BROKEN SKIN
