Nociceptive Pain - Block 2 Flashcards
What are the types of musculoskeletal injuries?
Acute soft-tissue: strains, sprains, low back pain
Repetitive strain injury: tendonitis, bursitis, low back pain
What is the difference between sprain and strain?
Sprain: overstretching of supporting ligaments -> partial or complete tear
Strain: overstretching of the muscle tendon units -> damage in muscle fibers or tendons without ligament tearing
What is bursitis?
Inflammation of the bursa (a fluid-filled sac near the joint where the tendons and muscles pass over the bone) often caused by overuse of the joint
What is tendonitis?
Inflammation precipitated by small tears in the tendon
What is low back pain?
Pain of musculoskeletal origin that extends from the lowest rib to the gluteus and may result in referred somatic pain into the thigh to just above the knee
What are the s/s of acute soft-tissue injury?
- Discomfort ranging from tenderness to pain may occur at rest or with motion
- Swelling and inflammation of the affected area
- Bruising
- Loss of motion
- Mechanical instability
What are the s/s of repetitive strain or overuse injury?
- Pain and stiffness that occur either at rest or with motion
- Localized tenderness on palpation
- Mild swelling of the affected area
- Decreased range of motion
- Muscle atrophy
What are the s/s of lower back pain?
- Low back pain is often chronic, but some cases may present acutely
- Pain is often nonspecific and may be accompanied by stiffness upon waking
- Walking or standing may worsen pain
- In some cases, pain may radiate to the hip or thigh
How can we diagnose musculoskeletal pain?
- Radiograph
- MRI
- Ultrasound
- Electomyogram
- Pain
What are the tx for muscluloskeletal pain?
Non-Pharm: RICE (except for low back pain)
Analgesics (PO or topical)
Prevention: lifestyle or behavioral
What is rice?
Rest: Analgesia, Anti-inflammatory, Prevent further injury
ICE: 10–20 minutes; for the first 72 hours (Analgesia, anti-inflammatory)
Compression: Not tight (Anti-inflammatory, adjunctive)
Elevation: Above heart level (anti-inflammatory)
How long should MCS therapy persist?
If >7-10 days of acute pain, see physician
What do we montior in MCS pain?
- Pain level at rest and with movement
- ROM and functionality
- Adherence and duration of therapy
- ADR
- Preventative measures
What is the non-pharm for acute and subacute lower back pain?
Superficial heat application, spinal manipulation, massage, acupuncture, exercise
What is the non-pharm for chronic lower back pain?
Exercise, multidisciplinary rehabilitation, acupuncture, massage, psychological stress reduction, spinal manipulation
What is the pharm for acute and subacute lower back pain?
NSAIDs or muscle relaxants (anti-spasmodics)
What is the pharm for chronic lower back pain?
NSAIDs, duloxetine, opioids
What joints are the most affected by OA?
Knee, joint, hip, hand
RF of OA?
- Older age
- Obesity
- Male sex
- Occupation (heavy work)
- Participation in certain sports
- Hx of joint injury or surgery
- Genetic preddisposition
- Race
What is OA?
Progressive destruction of articular cartilage -> Involves the entire diarthrodial joint, including articular cartilage, synovium, capsule, and subchondral bone
OA most commonly begins with?
Damage to articular cartilage
What are the clinical presentations of OA?
- Pain
- Deep, aching
- Pain on motion
- Stiffness in affected joints
- Resolves with motion, recurs with rest
- Usually duration <30 minutes
- Related to weather
- Limited joint motion
- Limitations of daily living
- Instability of weight bearing joints
Pain from OA derives from where?
Not related to the destruction of cartilage but arises from the activation of nociceptive nerve endings within the joint by mechanical and chemical irritants
Signs of OA in hands?
- DIP
- PIP
- First metacarpal joins
Signs of OA in knees?
- Pain climbing the stairs
- Transient joint effusion
- Genu varum (bow legged)
Signs of OA in hips?
- Groin pain with weight-beiring exercises
- Stiffness
- Limited joint movement
Signs of OA in spine?
- Lumbar involvement (L3 and L4)
- Paresthesia
- Loss of reflexes
Signs of OA in feet?
First metatarsophalangeal joint
What is the diagnosis of clincal OA?
based on physical exam and patient history
What is the diagnosis of radiographic OA?
determined by x-ray or other imaging
What is the diagnosis of symptomatic OA?
Based on patient hx and physical exam plus x-ray
What is the difference between primary and secondary OA?
Primary: no identifiable cause
Secondary: known cause such as inflammation, trauma, metabolic, endocrine dx, and congenital facotrs
What are we looking for in a joint exam?
- Bony proliferation or occasional synovitis
- Local tenderness
- Crepitus
- Limited ROM
- Deformity
What are we looking for in a radiologic eval?
Early mild: radiographic changes are absent
Progressive: Joint space narrowing, subchondral bone sclerosis, marginal osteophytes
What is the tx goal fo OA?
Relieve pain or improve function, but doesn’t reverse preexisting damage to the joint
What are the types of tx for OA?
- Education
- Behavioral interventions
- Psychosocial interventions
- Physical interventions
- Topical medications
- PO medications
- IA meds
Why is exercise recommended for non-pharm?
Increases circulation and reduces comorbidities?
Non-pharm recommendations?
What is the recommendation for weight loss in OA?
Loss of ≥5% of body weight
What are the recommended pharm tx?
Why shouldn’t use topical products for hip OA?
Requires deep penetration
What are the recommneded topical NSAIDs?
How are oral NSAIDs?
Initial dose for Celecoxib?
100 mg QD
Intitial dose for diclofenac?
XR: 100 mg QD
IR: 50 mg BID
Etodolac initial dose
300 mg BID
Ibuprofen initial dose?
200 mg TID
Indomethacin initial dose?
IR: 25 BID
SR: 75 mg QD
Meloxicam initial dose?
7.5 mg QD
Naproxen initial dose?
250 mg BID
OA TX
What occurs during follow up and monitoring of OA?
- Weight loss, exercise tolerance, QoL
- Pain control
- ADR
- Progression of dx
Nonpharm appropiate for hand/knee/hip OA?
Exercise and Self efficacy/management programs
Nonpharm appropiate for knee and hip OA only?
exercise
weightloss
self-management
tai chi
cane
Non pharm not recommneded for knee and hip OA?
TENS
Pharm for all OA?
PO NSAIDs
APAP
Duloxetine
Tramadol
IA triamcinolone or methylprednisolon
Which pharm options are recommended for all OA’s? Knee and Hip? Just Knee?
all - oral NSAIDs
knee/hip - intraarticular steroids
knee - topical NSAIDs
