Pain Flashcards
Which opioids are available OTC?
Codeine as co-codamol
Dihydrocodeine as co-drydamol
How long is OTC use of opioids licensed for?
3 days supply
What side effects should you counsel on for opioids?
Risk of addiction - stop after 3 days.
Constipation - drink plenty of water, stay active, eat high fibre foods.
Drowsiness - avoid driving.
What are some key counselling points for NSAIDs?
Take 2 tabs tds.
Take after food - risk of GI bleeds and gastric ulcers.
Use with caution if asthmatic - risk of bronchospasm.
Interacts with lithium, prednisolone, MTX, ACEis, diuretics, and anticoagulants.
What is the maximum OTC ibuprofen strength?
400mg.
What is the maximum strenth of Naproxen OTC?
250mg enteric coated tablets.
What is the available dose of aspirin for pain?
300mg
What are some things to consider when giving aspirin OTC?
Age - Reyes syndrome in under 16s
Take with food - higher risk of GI bleeds.
Soluble or EC aspirin lower risk of GI issues.
When can sumatriptan be given OTC?
50mg strength only.
For migraine with or without aura as diagnosed by doctor.
If on COC, refer.
How should OTC sumatriptan be taken for relief of migraines?
Take 1 tablet as soon as symptoms or aura occurs.
If symptoms recur, take another tablet after 2 hours.
No more than 2 in 24 hours.
If first tablet didn’t work, don’t take a second.
What are the symptoms of a tension headache?
Dull pain.
How should tension headache be treated?
Paracetamol
Hydration
Reduce stress
What are the symptoms of a cluster headache?
Excruciating pain in one side of the head around the eye.
How should a cluster headache be managed?
Refer - OTC pain relief insufficient.
More common in smokers, stop.
What are some symptoms of sinusitis?
Headache with cold or allergy such as hay fever.
Usually around the eyes
What causes sinusitis?
Inflammation response to illness/allergy can cause swelling of the mucus lining. This in turn means mucus is not draining resulting in a buildup of pressure.
How should sinusitis be managed?
Paracetamol
Cold - decongestant to relieve pressure
Allergy - antihistamine/steroid nasal spray to relieve pressure
What are some symptoms of a migraine?
Aura: nausea, vomiting, increased sensitivity to light or sound.
Followed by throbbing pain on one side of the head which lasts for 4-72 hours.
What are some red flag symptoms with headaches which warrant referral?
Trauma or injury to the head and/or neck.
Severe headaches that has lasted more than 4 hours.
Recent expose to hazards e.g. carbon monoxide, substance abuse etc.
Systemic and neurological features such as fever, neck stiffness, weakness, visual disturbance, rash.
Person is not normal in self e.g. confused, drowsy etc.
Pregnant and severe headaches, particularly if any swelling of hands, feet etc. (pre-eclampsia signs)
A headache that is worse in morning that and/or a headache that is made worse by lying down (could suggest a raised intracranial pressure)
Sudden severe headaches – particularly if start at back of head. (Could suggest Subarachnoid haemorrhage although this is very rare)
Numbness in face,arm or leg on one side. Confusion, difficulty speaking, vision loss, dizziness, lack of coordination (could be stroke)
What is first line treatment for back pain?
Ibuprofen, paracetamol is less effective unless in combination
What are some red flag symptoms for back pain?
GP:
No improvement after 1-2 weeks of appropriate treatment.
Severe pain or getting worse, or preventing you from daily activities.
Urgent GP or 111:
Pain doesn’t improve on resting
Pain worse at night
Unexplained weight loss
Fever
Pain at top of back between shoulders.
A&E/999:
Pain/tingling/weakness/numbness in both legs
Numbness/tingling around genitals
Chest pain
Trauma
Difficulty urinating, or loss of bladder/bowel control
What are some lifestyle advice for backpain?
Try to keep active and not spend extended periods in bed
Avoid heavy lifting
Use ice packs and heat packs
Try doing some stretches for back pain
What causes medication overuse headache?
Use of painkillers or triptan medicines regularly for headaches and migraines.
What advice can be offered for medication overuse headache?S
Stop painkiller/triptan.
Worse and more frequent headaches will occur for around a week but then they will return to normal.
Also withdrawal symptoms such as nausea, restlessness, and GI issues.
If NSAID isn’t cause of headache, can give a short course in the meantime.
Advise not using painkillers for 8 weeks and then after this, no more than 2 days per week.
