Musculoskeletal Pain Lecture Flashcards
What are the six types of musculoskeletal pain?
Myalgia Tendonitis/Bursitis Sprains/Strains Cramps Osteoarthritis Rheumatoid Arthritis
What is myalgia?
Muscle pain
Dull, constant ache, possibly accompanied by weakness or fatigue
Often caused b some type of trauma but can be alcohol-drug induced
Made worse by contracting or using affected muscles
What is tendonitis/bursitis?
Inflammationof the tendon or the bursa
Overuse of joint or tendon
Site can be warm, swollen, possible crepitus
Can either be an acute injury or caused by excessive wear and tear on a joint
What is a sprain?
Joint/ligament (bone-to-bone)
Caused by hyperextension of the ligament
Usually caused by an acute injury
ACL tear
What is a strain?
Muscle/Tendon (muscle-to-bone
Caused by extensive strech of the muscle
Usually caused by an acute injury
Pulled hamstring
What is a cramp?
Overexertion of the muscles
Affected muscle is often firm to the touch but visibly distorted
Commonly occurs at night or when working in a hot environment
What is osteosrthritis?
Occurs in weight-bearing joints
Caused by the destruction of the cartilage between bones
Don’t always see inflammation, but have crepitus
Unilateral injury
What is rheumatoid arthritis?
Autoimmune disorder
Symmetrical swelling in the fingers, wrists or feet
Occurs over weeks or months for no reason
What are exclusions for self-treatment?
Severe pain
Pain lasting longer than 2 weeks
Pain continues for 10 days after starting treatment
Increased intensity or change in pain
Pelvic or ab pain
Accompanying nausea, vomiting, fever or other signs of infection
Deformed joint, limb weakness or other fracture
Third trimester of pregnancy
Less than 7 yo
Nonpharmacologic therapies?
Rest Eliminate underlying cause of pain Light exercise and weight loss Protective wraps/cane/crutches RICE therapy
What is RICE therapy?
Rest
Ice
Compression
Elevation
Heat (15-20 mins, 3-4 times daily)
What are systemic meds?
NSAIDs, acetaminophen, salicylates
What are topical meds?
Methyl salicylate Camphor Menthol Capsaicin "counter-irritants"
NSAIDs are preferred with what conditions?
Inflammatory
Acetaminophen is better with what conditions?
Non-inflammatory
MAX duration of self therapy is?
10 days
osteoarthritis - 1 month at max dose
How do topical counterirritants work?
Causing mild, local, inflammatory reactions --> ignore the original pain Mainly for acute injuries NO heat Apply 3-4 times a daily for up to 7 days
What is methyl salicylate?
Oil of Wintergreen
10-60% strength
MOA: Rubefacient
Children may think it is candy due to its sent
No aspirin or salicylate allergy or children with asthma
What is MOA of rubefacient?
Causes vasodilation of cutaneous vasodilation
Increases blood flow at the site of application, which increases the temp, which causes the counterirritant effects
what is camphor?
3-11% strength
Stimulates nerve endings in skin
Helps mask the deeper pain in the skin to provide relief
Rubefacient when applied vigorously
Camphor side effects and warning?
Nausea, vomiting, colic, headache, dizziness, delirium, convulsions, and coma
Putting camphor in nostrils of infant would cause immediate respiratory collapse
What is menthol?
Derived from peppermint oil
1.25-16% strength
Stimulates the nerves in the skin that sense cold
After the feeling of coolness, you then get a feeling of warmth at the site
Children could think its candy due to smell
Stop menthol if?
Develops a rash, excessive burning, stinging, swelling at site of use
What is capsaicin?
Substance P
.025-.25% strength
Chronic-use med
Works by causing a warm-burning sensation at the site of use
After 1-6 weeks of regular application, the patient can experience more complete pain relief
Arthritis or nerve pain disorders
Side effects of capsaicin?
Burning sensation at site
40-70% of patients but goes away after a few weeks
What is glucosamine?
Endogenous: synthesis of cartilage
- glucosamine sulfate used in osteoarthritis
Dose: 1500 mg daily
Doesn’t start working for 8 weeks
Caution for glucosamine?
Shellfish allergies, diabetes, and bleeding disorders
What is chondroitin?
Cartilage formation –> slow breakdown of cartilage
Dose: 800-1200 mg daily
Can cause bleeding in patients taking anticoagulants
