RTS Pain - musculoskeletal conditions Flashcards
what are the 3 different types of headache?
Tension
migraine
cluster
describe the symptoms of a tension headache
pain - mild to moderate
generalised dull ache
band around head or pressure on head
bilateral
describe the symptoms of a migraine headache
mild- moderate severe pain - throbbing, worse when moving unilateral blind spots flashing lights photophobia nausea vomiting
describe the symptoms of a cluster headache
intense pain
unilateral
orbital pain
runny nose/eyes the same side as the pain
what are the common patient groups for each type of headache?
tension - most age groups
migraine - women more likely than men, (if first one and >50 refer)
Cluster- men more likely
how long are each type of headache generally?
tension - self limiting, can get worse as day goes on(rest helps)
migraine - lasts hours > 3 days, recurring
Cluster - 10 mins - 3 hours, same time of day and recurring
What types of medication could trigger headaches?
Nitrates (open up blood vessels)
contraceptive pill
HRT
overuse of painkillers
what sort of things can trigger migraines?
foods, activity, situation, stress, caffeine, cheese alcohol
what are the common causes of headaches?
stress, dehydration, fatigue, infection, eye strain, toothache, period, ears
name the locations of each type of headache
tension - back of head
migraine - one sided
cluster - eye area
red flags associated with headaches
ongoing severe pain lasting >4 hours sudden onset recent trauma suspected depression cluster headache severe eye pain vomiting,confusion, malaise migraine occurring for first time aged >50 treatment fail
what is dental pain?
Intense throbbing pain in tooth or gum that may come suddenly and gradually get worse- pain can spread to ear/jaw worse when laying down redness/swelling face red gums bad breath
symptomatic relief for dental pain
ENCOURAGE TO SEE DENTIST ASAP
Oral analgesics - 1st line - NSAIDS if no CI, then paracetamol or combination
Can also have a combination containing a mild opioid e.g co codamol - neurofen or dihydrocodeine - paramol
Other options-
- orajel - benzocaine 2-% w/w - numbs, anaesthetic
- anbesol liquid or gel - lidocaine hydrochloride 0.9%, chlorocresol 0.1%
Differentiate between acute and chronic pain
Acute:
- provoked by a disease or injury
- associated with muscle spasm/nerve activation
- self limiting
- serves a biological purpose
Chronic:
- Considered a disease state
- can arise from psychological state
- outlasts the normal time of healing
- serves no biological purpose
Define - sprain, strain, bruising
Sprain - overstretching or twisting ligaments
Strain - muscle or tendon injury with swelling & pain
Bruising - damage to capillaries causing blood leakage
what are the 3 phases of the healing process?
- inflammation - lasting approx 72 hours - PRICE
- tissue repair - lasts up to6 weeks
- Change of scar tissue to a more ordered arrangement
What things should be considered when taking a patient history for musculoskeletal conditions?
improvement In 72 hours?
what caused it?
Has it happened before? previous injury? did it heal?
Drug history - recent new meds? e.g statins side effects are muscle pain, or blood pressure medications that lower BP light headed?
symptomatic treatment of musculoskeletal and what not to be used?
- oral analgesics - para with topical NSAID
- NSAIDS - topical analgesics BUT do not use topical NSAID with oral NSAID
DO not use aspirin
why should aspirin not be used in treatment of musculoskeletal ?
it affects clotting and bruising as it causes blood to become runny and pool in the area affected
what is the pain ladder for musculoskeletal?
mild /mod pain 2-5/10 - non opioids e.g paracetamol /NSAID
5-8/10 - mild opioids e.g codeine, dihydrocodeine & cocodamol
8-10 - strong opioids e.g morphine
In the first 72 hours of injury. - what should be done?
PRICE and HARM
what is PRICE?
p - protect from further damage e.g. support
r - rest
I- ice - reduces swelling and bruising - 15 mins every 2-3 hours, don’t apply directly to skin
c - compress- elastic bandage, limit swelling, but not in sleep
e -elavate above heart level and support
what is HARM?
Do not do these -
H- heat - this increases blood flow and swelling
A- alcohol - increases bleeding and swelling
R- running - further damage
M- massage - swelling & bleeding as it breaks BV
what is rubefa and give examples?
causes warming of skin via vasodilation
masks the perception of heat
e.g
Methyl salicylate, nicrotinates, menthol, camphor, turpentine, capsaicin
