Pain And MSK Flashcards
What are the analgesics ways of treating pain
- non-opioids: e.g. paracetamol
- opioids: OTC medicines co-codamol - codeine + dehydrate codeine
- NSAIDs
What types of drugs can be to treat pain other than analgesics
- triptans: for migraine
- ergots
- antidepressants: for neuro pathway pain
- antiepileptics
- gabapentinoids: for neuropathy pain
- contraceptives: for period pain
- anaesthetics
What are the non-drug measures for treating pain
- heat / ICE
- tens
- excerise
Lower back pain overview
- specific causes e.g. slip disk
- non specific causes
Best thing is to keep moving
Risk factors for low back pain
- obesity
- inactivity
- occupational issues: work related - manual handling/ sitting in one position
- depression
What are the red flags for low back pain
- motor weakness
- urinary retention
- incontinence
- signs of infection
- signs of cancer
What should DO NOT be used to treat low back pain
- paracetamol alone
- opioids routinely or long term
- antidepressants e.g. SSRIs, TCAs, SNRIs
- antiepileptics
- gabapentinoids e.g. pregablin, gabapentin
What SHOULD be done/used to treat low back pain
(Give anti inflammatory)
- ibuprofen +/- PPI
- self management:
Address concerns, heat, exercise, keep active
- 2nd line: NSAID + codeine +/- paracetamol
- referral to group excerises, physiotherapist, CBT - if high risk of poorer outcome
What are the causes of strains, sprains + bone fractures
- trauma
- overuse
- genetic factors
- iatrogenic causes
What are the questions to ask for an examination of MSK injuries in pharmacy
Through history + examination of affected area and joint
- location of injury on body
- how it occured
- force and direction of impact
- history of similar injury
- any sound upon injury
- other symptoms e.g. headache, nausea, vomitting
What does the MSK injuries lead to
- unable to weight bear
- obvious deformity
- numbness or tingling (disrupt blood vessels)
- severe pain + disproportionate swelling
- no improvement after 48 hours
- any doubts at all about severity
Sprains + how many grades are there
Ligament or joint capsule stretched beyond elastic limit
3 grades
Grade 1 of sprains
Minor tissue damage with no joint laxity
Grade 2 of sprains
Some joint laity, connective tissue intact
Grade 3 of sprains
Rupture. Surgical repair may be necessary
Strains
Muscle stretched beyond elastic limit (pulled muscle)
Genuine strain - tear or complete rupture of muscle
Contusion
Otherwise known as
Direct blow to muscle - localised damage + bleeding
Bruises
What are non-pharmacological way to treat soft tissue injuries
- RICE: rest it, ice it, evaluate it, compress it (if necessary, start to move
- balance between optimal loading and rest
- rapidly changing area for recommendations
What are the pharmacological ways to treat soft tissue injuries
Oral
- paracetamol
- NSAIDs but NOT in the first 4 hours of injury (inflammatory response is necessary for healing)
- use opioid not necessary or recommended
Topical
- NSAIDs
- rubefacients
Osteoarthritis
- disorder of synovial joints commonly affects the knees, hips, small joints of the hand
- joint damage by injury or repeated excessive loading and stress of a joint over time = getting older
- causes - not fully known: genetic, biological, biomechanial
- pain loss of mobility
What is the repair processes that alter structure of joint in ostroarthritis
- localised loss of cartilage
- re-modelling of adjacent bone
- formation of osteophytes at joint margins
- mild synovitis
What are the non-pharmacological treatment for osteoarthritis (primary)
- weight management
- excerise: strengthens muscle so less pressure on the joints
- manual therapy e.g. physio
- assistive devices
- information and support
What are the pharmacology (adjunctive) treatment for osteoarthritis
- topical NSAIDs
- oral NSAIDs - PPI cover
- intra-articular injections (not first line)
What are the factors that needs to be considered for medication for osteoarthritis
- co-morbidities
- cautions
- contra-indications
- drug interactions
