PAI Flashcards
Spread across back, radiate to butt / thigh
Top of pelvic / one side of spine
Worse on movement
Spread down leg
Trigger:
Injury during work
BACKPAIN
When to refer BACKPAIN
Not related to movement
Bowel / bladder problems, blood in urine
Numbness
Severe at night
7 day OTC no help
Treatment of BACKPAIN
Nurofen 200mg tabs - 1 or 2T tds
Paramol - 1 or 2T every 4-6 hrs
Do not use paracetamol alone
Rubefacients
Rest, continue work on improvement
Heat pad / water bottle (+towel)
Light exercise, massage
Get better within 7 days
Advice for BACKPAIN
Avoid bending / stooping
Keep back straight
Swollen and painful joints
Worse on movement
Eased on rest
Worse at end of day
OSTEOARTHRITIS
Treatment of OSTEOARTHRITIS
1st: Paracetamol / topical NSAIDS + PPI: take regularly to control pain
2nd: Oral NSAIDS (Aspirin - >16 yrs)
3rd: Paracetamol / topical NSAIDS + oral NSAIDS
Rubefacients (Deep Heat)
Do NOT use topical NSAIDS together with oral NSAIDS
Advice for OSTEROARTHRITIS
Advice:
exercise (muscle strengthening)
weight loss
suitable footwear (support and comfortable)
Pain, stiff
Joint swelling
Joint deformity
Improve on movement
RHEUMATOID ARTHRITIS
Treatment for injury (sprain, strain)
Rest, Ice (10-15mins every 2 hr), Compress, Elevation (reduce swelling)
Oral Analgesics - paracetamol, NSAID + aspirin (>16 yrs)
Don’t take anything else with paracetamol
Topical Analgesics
Topical Rubefacient
When to refer for INJURY
Severe pain
Swelling
Numbness
Cannot bear weight
Immobalised
Old injury
Advice for INJURY
Avoid overwork
If go gym have rest day between
Treatment & Advice for DENTAL PAIN
Treat: paracetamol / ibuprofen
Help symptoms:
Rinse mouth with salt water
Eat soft food
Avoid chew at injured area
Prevent tooth ache:
Twice yearly checkup
Reduce sugar intake
Brush twice daily at least 2 mins with fluoride toothpaste
Floss
Sore and red gums
Dribbling
Common in babies around 6 mths
TEETHING IN BABIES
When to refer TEETHING
Stiff neck
Rash
Tiredness
Dehydration
Fever
How to treat TEETHING
Paracetamol 120mg/5ml suspension
Do not give more than 3 days
Give after meal
Seek GP if not better after 3 days
Shake bottle
Bonjela teething gel
Advice for TEETHING
6mths or older: raw fruit/ vege to chew to soothe gum
Wipe away dribble to prevent rash
Can give teething ring
Earache
Fever
Itchy around ear
Rub / pull ear
OTITIS MEDIA
Earache
Fever
Itchy around ear
Rub / pull ear
OTITIS MEDIA
When to refer OTITIS MEDIA
Severe pain
Doesn’t get better in 3 days
Fluid coming from ear
Treatment for OTITIS MEDIA
Last 3-7 days, self-limitting
Children: Paracetamol 250mg/5ml
Calpol suspension
Every 4-6hrs when required up to 4 doses in 24 hrs
Spoon / oral syringe
Adult: Paracetamol / Ibuprofen
Take when required
Advice for OTITIS MEDIA
Avoid cotton buds
No need for eardrops
Remove discharge by wiping the ear with cotton wool
Last 4-72 hrs
Throbbing, pulsating pain
N&V
Stress
Tired
Caffeine
MIGRAINE
When to refer MIGRAINE
Attack last >24 hrs
Frequent, symptoms change
>3 attack per month, don’t recover
>50yrs old & first attack
<12 yrs with stiff neck
Prev trauma injury
Caused by meds
Treatment of MIGRAINE
NSAID + Aspirin - Nurofen 200mg tablets
Paracetamol - Panadol Advance 500mg tablets
Compound analgesic - Migraleve Complete (not under 12 yrs) *may cause addiction due to codeine
Migraintan (Sumatriptan) (for 18-65 yrs)
Advice for MIGRAINE
Keep migraine diary
Track triggers + Avoid
Manage stress
Base of skull, top of head, eyes
Bilateral
Band-like
Few hrs → days
Tension
Anxiety
Fatigue
TENSION-TYPE
When to refer TENSION TYPE
Attack last >24 hrs
Frequent, symptoms change
>3 attack per month, don’t recover
>50yrs old & first attack
<12 yrs with stiff neck
Prev trauma injury
Caused by meds
Treatment of TENSION TYPE
NSAIDS + Aspirin - Nurofen 200mg tab
Paracetamol - Paracetamol Advance 500mg tab
Paracetamol - NSAID - opioids
Advice for TENSION TYPE
Headache diary
Identify trigger
Rest - 6-8 hrs of sleep
> 50yrs, 1st time
<12yrs, stiff neck, rash
Visual disturbance, drowsiness, vomit
1-3 mths trauma injury
NO improvement with analgesic
Chronic migraine
SECONDARY HEADACHE (REFER)
Period pain occurs suddenly after years of painless periods, pain before, during, after menstruation
REFER (secondary period pain)
Pain before menstruation, regular, up to 72 hrs, headache, N&V
DYSMENORRHOEA
When to refer DYSMENORRHOEA
Period heavier than usual
Breakthrough period (bleeding between period)
Bleeding after sex
Smelly vaginal discharge
All above may be caused by IUD
Treatment of DYSMENORRHOEA
Feminax Express
12yrs & above
1-2T every 4 hrs
MAX 6T in 24 hrs
Feminax Ultra
15-50 yrs
2T day 1, 1T 6-8 hrs later if necessary
1T every 6-8 hrs day 2&3
MAX 3 days
SE: headache, constipation
Panadol Period Pain (paracetamol + caffeine)
12yrs & above
Advice for period pain
Gentle exercise: brisk walking
Heat packs
Warm bath/shower
Hydrated
Relaxation: yoga
How to use and change TRANSDERMAL PATCH
How to Use:
Choose a hairless, dry, non-exposed area (upper arm, outer arm, upper back)
Open sachet & take out patch
Peel off one part of the transparent protective foil
Stick patch on area, remove remaining foil
Press patch onto skin & hold for 30 secs
How to Change:
Take off old patch
Fold it in half with sticky side inwards
Open new sachet, take out new patch
Put old patch in sachet and discard
Counselling points for NSAIDS (3)
Avoid in patient with history of gastro problems
Avoid in patient with asthma
Must be taken with/after meal
Paracetamol Counselling Point (1)
Avoid other meds containing paracetamol
Counselling point for opioids (morphine, oxycodone) [3]
Constipation is a common side effect, does not go away
Stimulant laxative can be taken
Increase fluid intake, fibre and exercise to improve gut motility
