Responding to symptoms for pain- 24

Question 1

What are the two types of pain.

Answer 1

Acute- self limiting, activity related
Chronic- caused by other, largely treated by POMs

Question 2

OTC treatments for pain.

Answer 2

Analgesics (paracetamol, aspirin, NSAIDS e.g ibuprofen).

Compound Analgesics (paracetamol/codeine, aspirin/codeine, paracetamol/dihydrocodeine + caffeine)

Topical NSAIDs – less side effects
(localised action)

Rubefacients e.g salicylates - vasodilation, disperse chemical mediators of pain ↓ perception of pain.

Local anaesthetics(lidocaine)

Question 3

What are common pain conditions.

Answer 3

Sports/Soft tissue injuries
Dysmenorrhea
Toothache
Headache
Back pain

Question 4

Questions to ask related to sprains and strains.

Answer 4

When did it happen-might just need first aid.
What are symptoms
Nature of injury- onset, force)
Range of Motion
Nature of pain- sharp, acute

Question 5

What are non drug treatments for soft tissue injuries.

Answer 5

Rest- immobilisation, enhanced and reduced blood flow
Ice- If the injury feels warm- apply until the skin becomes warm,
Compression- Crepe, bandage, tubigrip
Elevation- helps fluid drain away from the injury.

Question 6

OTC treatments for soft tissue injuries

Answer 6

NSAIDs- ibuprofen aspirin (avoid in first 48 hours)
Paracetamol- preferibly on its own
Various oral tabs, melts solutions, gel, creams, lotions, sprays

Not for <12yrs or asthmatics

Question 7

What are the primary and secondary causes of dysmenorrhea.

Answer 7

Primary- menstrual pain without organic pathology
Secondary- a pathologic condition (pain is identified)

Essentially an overproduction of uterine prostaglandins

Question 8

How long does dysmenorrhea last for.

Answer 8

3-4 days before bleeding.

Question 9

What is the nature of the pain.

Answer 9

Cramping in nature NOT dull or continuous

Question 10

What are the referral symptoms for dysmenorrhea

Answer 10

Refer all heavy or unexplained bleeding, fever, sharp pain or anything unexplainable.

Question 11

Treatment for dysmenorrhea

Answer 11

NSAIDS- naprocen 250mg tablets

Buscopan( anti-spasmodic prevents cramping)

Hot water bottle, rest

Question 12

Treatments for oral/dental pain

Answer 12

Tends to be local anaesthetics- mainly lidocaine
Teething in children- from 3 months onwards use anbesol baby

Question 13

What is the underlying pathology for a headache.

Answer 13

The brain doesnt have nociceptors, instead they are found in the dura and pia (the protective layer of the brain) this is where pain is found.

Question 14

What is a tension headache

Answer 14

The most common type of headache usually caused by stress and muscle tension
Features are:

Slow onset
Bilateral (head hurts on both sides)
Pain is dull or feels like a tight band across forehead and back of head
Pain is mild to moderate but not severe

Wont cause nausea vomiting or sensitivity to light.

Question 15

What is a Cluster headache

Answer 15

Usually occur in a series that may last weeks or months

Severe pain on one side of the head, usually behind one eye
The eye that is affected may be red or watery
Swelling of the eyelid
Runny nose or congestion
Swelling of the forehead

Is suspected refer.

Question 16

What is a secondary headache.

Answer 16

Caused by:

Trauma/injury to neck or whiplash, head knock
Infection- infected sinusitis, otitis media
Medicines- most medicines list headache as a side effects
Dehydration- comorbidity

Question 17

What is the cause of a rebound headache

Answer 17

Overuse of painkillers when not needed, caffeine can be heavily implicated

Question 18

What can be triggers of migraines.

Answer 18

Stress and other emotions
Environmental conditions
Fatigue and changes in ones sleep patterns
Weather changes
Certain foods and drinks
Some people also experience auras

Question 19

What are the symptoms of migraines.

Answer 19

Migraine headaches are usually frontotemporal

Migraines can last for hours/days
With the following characteristics
Unilateral location
Pulsating quality
moderate or severe pain intensity
nausea and or vomiting
photophobia and phonophobia

Question 20

What are the 4 stages of a migraine attack

Answer 20

Prodrome(few hours to days)
Irritability
Food Cravings
Sensitivity to light and sound
Nausea

Aura(5-60mins)
Visual disturbances
Temporary lost of sight

Headache (4-72 hours)
Throbbing, drilling, burning, nausea, vomiting, isnomnia, depressed mood

Postdrome (24-48 hours)
Inability to concentrate
Fatigue
Depressed Mood
Lack of Comprehension

Question 21

OTC treatments for migraine

Answer 21

Paracetamol - acts in inhibition of prostaglandin production in pain pathway. Also in activation of descending serotonergic pathways

Ibuprofen – act on COX -1 and COX-2 receptors to inhibit production pf prostaglandins in pain pathway

Codeine – acts centrally, limited effectiveness at doses available OTC, often in combination products

Buclizine – antihistamine with anti-emetic properties, also sedating (in migralieve pink)

Prochlorperazine – anti emetic

Triptans - selective 5-HT serotonin receptor agonists (cause cranial vasoconstriction). Sumatriptan is P med with restrictions

Question 22

Non-pharmacological interventions for headaches

Answer 22

Drink plenty of water
Get plenty of rest
Try to relax
Avoid trigger factors (alcohol, red wine)
Maintain good sleep hygeien
Check/correct posture

Question 23

What are considerations for pain in children.

Answer 23

Aspirin contra-indicated- Reye’s syndrome (encephalopathy) AVOID in <16yrs.

Other NSAIDS have specific conditions to their use in this age group e.g ibuprofen- for post immunisation

Children have softer bones – can easily fracture on outer part of the bone (parent liability? Abuse?)

Underlying reason for the pain?- not uncommon to present with ‘sore tummy’ to avoid school when being bullied, [separation anxiety].

Question 24

Considerations for pain in the elderly

Answer 24

More susceptible to side effects from all meds – caution with

NSAIDS (risk of bleeding) and compound products ( potential interactions with Rx meds)

Organ functionality- decrease in renal/hepatic function

Osteoarthritis/osteoporosis – risk factors for fractures?

Tolerance to pain and to certain medication over the lifespan (change in dose)

Question 25

Danger symptoms for headaches.

Answer 25

thunderclap, recurring, non-responsive, vomiting, arms/legs feel weak, pins and needles, blood/bleeding, upon awakening

How long - > 3days then refer, recurring, becoming more severe
Actions – no response to OTC analgesia, non-pharmacological actions