Pain and Analgesia

Question 0

What is the difference between a migraine and tension type headache?

Answer 0

Migraine - moderate to severe, usually unilateral, pulsating (throbbing), aggravated by normal activities such that patient has to stop. Other symptoms and trigger factors.

Tension headache - mild to moderate, bilateral, non-pulsating and not aggravated by normal activities.

Question 1

Treatment of minor musculoskeletal disorders

Answer 1

R est
I ce
C ompression
E levation 
And an analgesic
Use heat (rubefacients) after 72 hours of sprain or strain.

Question 2

What are the different types of musculoskeletal injuries?

Answer 2

Injuries to ligaments (sprains) and muscles (strain) - following unusual strenuous activity or sport - usually treatable.

Lower back pain - moderate: following gardening (muscle strain) - treatable.
Severe lower back pain - with restricted mobility or pain (numbness) radiating down legs may suggest a slipped disc with entrapment of the sciatic nerve (sciatica) - refer.
Middle or upper back pain - less likely to be muscular - if pain persists or accompanied by other symptoms - refer.

Question 3

What can middle and upper back pain be caused by?

Answer 3

Middle back pain - pelvic inflammatory disease, urinary tract infection or renal colic, malignant secondary tumours but take full history to identify any need to refer.

Upper back pain - angina, strained intercostal muscles - uncommon site of pain - always refer unless trivial cause is found.