Musclepain Flashcards
What are Common Musculoskeletal Injuries?
Strain, Sprains, Tendonitis, Bursitis, Myalgia, Contusions resultant of blunt trauma, muscle soreness
Patient presentation for Acute Injuries?
-Diffuse, dull, constant ache or pain
-Onset is acute with injury
-Aggravated or worsened after use -> reduced at rest
-swelling, bruising, erythema, possible joint stiffness
-Duration depends on the severity of the injury
Patient Presentation: Overexertion Injuries:
-Diffuse, dull, constant ache or soreness
-Onset is delayed - 8hr after injury
-Weakness/fatigue of muscles
-last for days - peak at 24-48 hr
What are important pain transmitters?
Generation of pain:
-Prostaglandin, Bradykinin, inflammatory cytokines
-Neurotransmitter: GABA, substance P, CGRP
TNF alpha, IL production -> pain transmission facilitated
-microglia and astrocytes
What is the Gate control theory?
Stimulation of the skin can reduce the overall perception of the actual injury itself
What is RICE therapy?
-Rest 1-2 days
-ICE for ASAP for 10-15 min (no longer bc over icing), 3-4x a day for 1-3 days (constrict the vascular to prevent inflammatory agents to come in
-Compression: wrap the injured area
-Elevation -> at or above the level of heart 2-3 hr per day
Explain Heat therapy:
-used in non-inflammatory pain, chronic injuries
-48hr after injury -> reduce pain by increasing the blood flow to flush away the p
-do not put it on top of other topical agents or on inflamed areas
don´t use it with a warming agent
-15-20 min, 3-4x a day -> don’t use too long -> overheat
Which analgesics are preferred for non-inflammatory VS inflammatory injuries?
Non-inflammatory injuries: Acetaminophen (Tylenol)
Inflammatory injuries: NSAIDs
Which analgesic is the first to prefer for osteoarthritis?
Acetaminophen (Tylenol)
When after an injury should analgesics be administered?
-Soon after the injury, then taper down the dose and interval as injury improves (1-3 days)
-OTC for 10 days
What are the mechanisms topical products work?
-Topical Counterirritant (Gate control theory) -> most of them
-Topical NSAIDs
-Anesthetics
-Topical analgesics
-> they are used in addition to Non-drug treatment and systemic analgesic
-> often combination products
Example of a topical NSAID:
Diclofenac
-used for arthritis pain at joints
-applied up on up to two joints, 4x a day / max 7 days
-adverse effects: redness, swelling, skin irritation, used in caution in people with aspirin allergy
How do counterirritants work?
-Paradoxal pain relieving effect (Gate control theory) -> less severe stimulus to counter a more intense pain stimulus
-often for older kids and andults
-3-4x a day for 7 day max
-wash hands after using
How do counterirritants work?
-Paradoxal pain relieving effect (Gate control theory) -> less severe stimulus to counter a more intense pain stimulus
-often for older kids and adults
-3-4x a day for 7 day max
-wash hands after using
-don’t tightly wrap bc it causes more heat -> more irritating
Example of a Counterirritant: Rubefacient
Methyl salicylate
-causes vasodilation and redness -> hot action
-common side effects: skin irritation, systemic absorption possible
-HEAT exposure INCREASES absorption by 3x
-Brand extensions: may have different ingredients with different effects (menthol - cooling AND methyl salicylate-heat)
Example of a Counterirritant: Cooling Agent
Menthol
-Anesthetic and counterirritant
-has a cooling effect first (MAIN) -> warm sensation later
-increases absorption of other meds
-Well tolerated, in case of irritation, rash, burning stop using it
Example of a Counterirritant: Cooling Agent
Camphor
-may cause redness when applied rigorously - rubefacient
-toxic if digested (CNS), tonic-clonic seizures, respiratory depression
Topical Counterirritants: causing Vasodilation
Histamine dihydrochloride
dilates blood vessels -> impact on prostaglandin biosynthesis to cause vasodilation in an increase of skin temperature
-Side effects: bc of vasodilation it can cause drop in blood pressure when used on huge parts of the body in people with heart condition
Topical Counterirritant: Capsaicin
-from chili pepper -> HOT
-depletes pain transmitter substance P -> less pain transmission
-> takes time to deplete it -> delayed effect of 14 days -> so not the best for acute injuries, better for chronic injuries
-side effects: burning, stitches, high concentration may cause cough
not for kids bc it is long acting
(CHRONIC injuries are usually not treated with OTC)
What are topical anesthetics?
-Numbing agent blocks pain transmission
Topical anesthetics: Licodaine
-Formulations: creams, sprays, patches
-3 to 4h a day - may 8hr
-not for kids younger than 12
-side effects: local irritation, rash, itching - only on clean dry skin and not with other products (accumulative effect)
Topical anesthetics: Trolamine Salicylate
-targets prostaglandin and inflammation
-insufficient data available about safety and efficacy
-side effects: similar drug interactions and counterindication like aspirin
Examples of Natural products/ Homeopathics
Hyland´s leg cramps
-target cramping
-they are overseen by Homeopathic pharmacopeia
-safety issue: Cinchona and Viscum
Drug interaction Cinchona -> anitpletletes, anticoagulant, carbamezepine, phenobarbital
Viscum -> has a narrow therapeutic range -> Prgenancy, may stimulate contractions
Examples of Natural products/ Homeopathics
Hyland´s leg cramps
-target cramping
-they are overseen by Homeopathic pharmacopeia
-safety issue: Cinchona and Viscum
Drug interaction Cinchona -> anitpletletes, anticoagulant, carbamezepine, phenobarbital
Viscum -> has a narrow therapeutic range
-> Prgenancy, may stimulate contractions
