Responding to symptoms for pain- 24 Flashcards
What are the two types of pain.
Acute- self limiting, activity related
Chronic- caused by other, largely treated by POMs
OTC treatments for pain.
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)
What are common pain conditions.
Sports/Soft tissue injuries
Dysmenorrhea
Toothache
Headache
Back pain
Questions to ask related to sprains and strains.
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
What are non drug treatments for soft tissue injuries.
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.
OTC treatments for soft tissue injuries
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
What are the primary and secondary causes of dysmenorrhea.
Primary- menstrual pain without organic pathology
Secondary- a pathologic condition (pain is identified)
Essentially an overproduction of uterine prostaglandins
How long does dysmenorrhea last for.
3-4 days before bleeding.
What is the nature of the pain.
Cramping in nature NOT dull or continuous
What are the referral symptoms for dysmenorrhea
Refer all heavy or unexplained bleeding, fever, sharp pain or anything unexplainable.
Treatment for dysmenorrhea
NSAIDS- naprocen 250mg tablets
Buscopan( anti-spasmodic prevents cramping)
Hot water bottle, rest
Treatments for oral/dental pain
Tends to be local anaesthetics- mainly lidocaine
Teething in children- from 3 months onwards use anbesol baby
What is the underlying pathology for a headache.
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.
What is a tension headache
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.
What is a Cluster headache
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.
What is a secondary headache.
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
What is the cause of a rebound headache
Overuse of painkillers when not needed, caffeine can be heavily implicated
What can be triggers of migraines.
Stress and other emotions
Environmental conditions
Fatigue and changes in ones sleep patterns
Weather changes
Certain foods and drinks
Some people also experience auras
What are the symptoms of migraines.
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
What are the 4 stages of a migraine attack
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
OTC treatments for migraine
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
Non-pharmacological interventions for headaches
Drink plenty of water
Get plenty of rest
Try to relax
Avoid trigger factors (alcohol, red wine)
Maintain good sleep hygeien
Check/correct posture
What are considerations for pain in children.
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].
Considerations for pain in the elderly
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)
Danger symptoms for headaches.
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
