Pain

Question 1

Generic referral points

Answer 1

HEADACHES
-Lasting over 2 weeks
-On contraceptive pill
-Worse in morning then improves
-Children under 12
-New headaches over 50 years old
-Symptoms of meningitis 
-Waking up at night from sleep
-Not responding to painkillers
-Exertion worsens it
-Trauma
-Very rapid onset
-Suspected stroke 
INJURY
-Not improving
-Elderly
-Suffers from osteoporosis 
-Unable to bare weight
-A lot of swelling quickly
-Looks abnormal (maybe broken)
BACK PAIN
-Numbness
-Incontinence
-Below lumbar region
-Referred pain
-Worsening
-4+ weeks
DENTAL
-Always refer dental pain but offer simple analgesia

Question 2

Headaches - what are the key questions to ask to find out the type of headache?

Answer 2

• WHERE IS THE PAIN?
  Around forehead (tension), Orbital or supraorbital or temporal pain (cluster),
  -DESCRIBE THE PAIN?
  Throbbing/pulsating (migraine), Pressure (tension)
  -IS IT ON ONE SIDE OF HEAD OR BOTH?
  Unilateral (migraine or cluster), Bilateral (tension)
  -HOW LONG DO THESE HEADACHES LAST?
  4-72 hours (migraine), 45-180 minutes (cluster), 30mins-1 week (tension)
• ARE YOU HAVING ANY VISUAL DISTURBANCES? FLASHING LIGHTS? MOTOR WEAKNESS? PINS & NEEDLES?
  Could mean a migraine
  -ANY NAUSEA/SICKNESS
  Could mean a migraine
  -IS IT MADE WORSE BY MOVEMENT?
  Could mean migraine if there is, or tension if not
  -ARE YOU UNDER ANY STRESS?
  Could mean a tension
  -HOW SEVERE IS THE PAIN?
  Severe (cluster), Moderate to severe (migraine), Moderate (tension)
  -ANY VIRAL RESPIRATORY INFECTIONS RECENTLY?
  Could mean a sinus headache
  -ARE YOU TAKING ANY REGULAR MEDICATION?
  Medication overuse headache

Question 3

How can you treat headaches?

Answer 3

-Simple analgesia
Paracetamol
Ibuprofen
*should be taken as soon as possible with a migraine to allow time to work, or use dispersible tablets as they absorb into body quicker
*Avoid co-codamol as this can sometimes cause headaches
-Try to reduce stress in your life if you feel this is causing it, e.g. exercise, mindfulness
-Apply hot or cold appliances
-Sleep it off
-Drink plenty of water
-Make use of diary to identify any headache triggers

Migraines

• Could offer migraleve
• Triptans - cause blood vessels around brain to narrow to reverse widening that is part of migraine process
• need to be diagnosed by GP first
• Anti emetics - to treat nausea associated with migraine
• Triptan and ibuprofen often very effective

Question 4

Sprains vs Strains - what is the difference?

Answer 4

Sprains
-ligaments stretched, twisted and torn, usually from excessive force
-ankles, knees, wrists, thumbs
Strains
-muscle fibres stretch or tear
-legs, back

Question 5

Lower back pain

Answer 5

Usually lower back pain will get better by itself, but try to keep active, use simple analgesia and heat wraps

Question 6

What advice can you give for sports injuries?

Answer 6

-PRICE
Protection
Rest (48-72 hours)
Ice (15-20mins every 2-3hours for 1-2 days)
Compression
Elevate

-Avoid HARM
Heat
Alcohol
Running
Massage
Avoid ibuprofen for 48hrs as inflammation is a good response to infection

Question 7

A patient comes into the pharmacy with a headache looking to buy some ibuprofen. Provide your usual care.

Answer 7

Can you describe the pain to me? Pressure, band around forehead
Whereabouts is this pain - forehead, back of head? Forehead
Are you experiencing any other symptoms like visual disturbances or nausea? No
Have you tried anything for it? Has it worked? No
How long have you had this headache? About a week
Is it made worse by movement? No
Are you under any stress? Yes - work related
Do you take any regular medication? Inhalers for asthma
Do you suffer from any medical conditions? Asthma
Any allergies? No
Are you taking the contraceptive pill? No

Based on what you have told me this sounds like a tension type headache. This could be happening because of the stress you are under at work at the moment. As you have asthma I cannot sell you ibuprofen as it can worsen your asthma symptoms. I think you should try paracetamol for the time being to see if this improves your headaches. Take two tablets every 4-6 hours and take no more than 8 in 24 hours. It is important to deal with the stress you are experiencing, maybe speak to someone at work about it or try and have a break if possible. Keep hydrated and rest whenever you can. Hot or cold compresses can work depending on your preference.

If you have no improvement after two weeks or your headaches worsen speak to your GP.