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M103 > W20 Pain conditions > Flashcards

W20 Pain conditions Flashcards

1
Q

What is the definition of pain?

A

An unpleasant sensory and emotional
experience associated with actual or potential tissue damage.

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2
Q

What is:
An analgesic?
Anti-pyretic?
Anti-inflammation?

A

A medication to reduce pain
Lowers body temp (fever)
Anti inflammatory- reduces inflammation

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2
Q

What is:
An analgesic?
Anti-pyretic?
Anti-inflammation?

A

A medication to reduce pain
Lowers body temp (fever)
Anti inflammatory- reduces inflammation

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3
Q

Example of an
anti-inflammatory?
Analgesic?
Anti-pyretic

A

NSAID e.g. Aspirin/Ibuprofen
Paracetamol/Codeine/NSAID
Paracetamol, NSAID

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4
Q

What does paracetamol do?
What are the features?

A

Reduces the production of prostaglandins
(PG) in the brain and spinal cord

-Child= suspension – easier to swallow + taste
-Soluble tablets – easier to swallow & Soluble tablets – easier to swallow & absorbed more quickly absorbed more quickly
-Safe in pregnancy and breastfeeding
-Dose based on narrow age bands – not practical for consumers to calculate dose based on body-weight (mg/kg)

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5
Q

What are some brands/formulations of paracetamol (acetaminophen)

A

Medical
Disprol effervescent tablets
Panadol tablets
Hedex tablets
Alvedon suppositories
Paracetamol oral suspension (Calpol)

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6
Q

Paracetamol 500mg caplets:
Dosage?

A

Adults, the elderly and children over 16
years of age:
Take 1-2 caplets up to four times a day, as
required. Do not take more than 8 caplets in required.

Children 10 to 15 years:
Take 1 caplet up to four times a day, as
required. Do not give more than 4 caplets in 24 hours.

Do not give to children under 10 unless
otherwise advised by your doctor

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7
Q

Paracetamol Suspension

A

Suitable for children:
- From 2 months for post-immunisation pyrexia
- From 3 months for fever and pain
- Shake the bottle before use
e.g. 120mg/5ml (infant)
250mg/5ml (sixplus)

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8
Q

Uses of Paracetamol:

A

For mild to moderate pain e.g.
- Headache
- Migraine
- Toothache
- Dysmenorrhoea
- Fever
- Osteoarthritis

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9
Q

Uses of Paracetamol:

A
  • For mild to moderate pain e.g.
  • Headache
  • Migraine
  • Toothache
  • Dysmenorrhoea
  • Fever
  • Osteoarthritis
  • Less GI irritation compared with NSAIDs
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10
Q

Cautions of paracetamol?

A
  • In people with liver or kidney dysfunction
  • In those taking WARFARIN- Can increase the risk of bleeding if taken regularly
  • Overdose- nausea and vomiting then liver failure (after 4-6 days)
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11
Q

Examples of Non-selective NSAIDS

A
  • Ibuprofen
  • Aspirin
  • Naproxen
  • Diclofenac
  • Indomethacin
  • Mefenamic acid
  • COX-2 inhibitors e.g.
  • Etoricoxib
  • Celecoxib
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12
Q

NSAID Mechanism of action

A

Inhibit prostaglandin (PG) synthesis by
reversibly inhibiting cyclo-oxygenase
(COX) enzymes — COX-1 and COX-2
* COX-1 produces PG that help to maintain COX-1 produces PG that help to maintain gastric mucosal integrity and platelet-initiated
blood clotting
* COX-2 produces PG that mediate pain and
inflammation

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13
Q

Uses of NSAIDS:

A

For mild to moderate pain
Sprains, Strains
Headache
Dysmenorrhoea
Toothache
Colds and flu
Arthritis

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14
Q

NSAIDs
May not be suitable for people with:

A
  • Asthma (can induce asthma attack in 10%)
    Class effect
  • Kidney impairment (dec renal function)
    -CVD and Hypertension
  • Prev stomach ulcers (inc bleeding risk)
  • Inflammatory bowel disease e.g. Crohn’s disease or Ulcerative colitis
  • Lupus
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15
Q

Contraindications of NSAIDs

A
  • Hypersensitivity to NSAID
  • Active peptic ulceration or gastro intestinal bleeding
  • Severe heart, renal or liver failure
  • Pregnancy- Non-selective NSAIDs
  • Contraindicated after 30 weeks of pregnancy (Do not sell in pregnancy)
  • Breastfeeding-Aspirin contraindicated
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16
Q

Interactions of NSAIDs

A
  • Anticoagulants/antiplatelets
  • Other NSAIDs
  • Ciclosporin
  • Diuretics
  • ACE inhibitors
  • Lithium
  • Methotrexate
  • SSRIs
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17
Q

NSAIDs-Ibuprofen

A
  • Adult oral dose= 200mg-400mg up to 3 times a day (no more frequently than every 4 hours)
  • Max dose= 1200mg in 24 hours
  • Take with or after food
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18
Q

NSAIDs-Naproxen:
Used for?
Instructions- How to use?

A

-Licensed for period pain and menstrual
cramps for ≥15 – 55 years of age
- No more than THREE 250mg tablets per day
- Take with or just after a meal or snack
- Not to be taken for more than three days
in any one cycle
- Do not take with another NSAID

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19
Q

NSAIDs- Aspirin (acetylsalicylic acid)

A
  • For mild to moderate pain in adults and children over 16
    -Contraindicated in <16 years – can cause
    Reye’s syndrome (resulting in serious liver
    and brain damage)
    -Usual adult oral dose = 300mg – 600mg every
    4 to 6 hours. Max dose = 3600mg / 24 hours
    -Disclaimer = Aspirin 75mg for cardiovascular
    risk - not for pain - prolonged effect as an anti-
    platelet
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20
Q

Aspirin uses?

A

Migraine
Headache
Toothache
Dysmenorrhoea
Cold and flu like symptoms
Fever

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21
Q

Can Codeine/Dihydrocodeine be purchased OTC?

A
  • Adults + children over 12 years of age
    -Can’t buy codeine as a single ingredient OTC
  • Combination product OTC e.g.
    -Co-codamol 8mg/500mg = Paracetamol 500mg + Codeine 8mg
    -Nurofen plus = Ibuprofen + Codeine
    *Tolerance and dependence risk – OTC supply limited to 3 days
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22
Q

How does codeine work?

A
  • Activates and binds to Mu opioid receptors in the brain and spinal cord (CNS)
    *Metabolised by liver enzymes (CYP2D6) into morphine
    *Genetic variability in metabolism
    -Unpredictable effect
    -Some will have little effect / big effect (fast metabolisers)
23
Q

Uses of Codeine?

A
  • Acute moderate pain (not anti-pyretic & not anti-inflammatory)
  • Acute lower back pain
  • When simple analgesics (e.g. Paracetamol, Ibuprofen or Aspirin), have not been effective or tolerated
24
Q

Codeine cautions!

A
  • Common side effects = constipation, nausea, drowsiness
  • Although can be used in Pregnancy – would not sell OTC = refer to GP
  • Contraindicated in breastfeeding
25
Q

How does Dihydrocodeine work?

A
  • Acts directly on Mu opioid receptors
  • Not metabolised to active moiety
    -More predictable effect?
  • Only in combination with paracetamol, OTC
  • Similar indications/ cautions/Contraindications to codeine
26
Q

Caffeine

A

A weak stimulant that is thought to enhance the analgesic effect & increase absorption(?)

27
Q

Antihistamines

A

Can act as muscle relaxants and can help with sleep e.g. Diphenhydramine, doxylamine

28
Q

Dysmenorrhoea

A

Primary (16-25)
- A few hours before/during menstruation
Secondary (30-45)
- Ofter starts after several years of painless periods
-Pain not consistently related to menstruationbut is exacerbated by it.

29
Q

Sprain vs Strain
Symptoms?

A

Sprain = a torn, stretched or twisted ligament. Symptoms = bruising, swelling, inability to move the joint. e.g., sprained ankle or knee

Strain = The stretch or tearing of muscles or tendons. Symptoms = tenderness and swelling

30
Q

Sprains and Strains
When to refer / Danger symptoms

A

Fracture or dislocation- inability to weight bear
Severe pain on movement
Persistent pain even when at rest
Numbness
Symptoms that have not improved after 48 hours

31
Q

Treatment of sprains and strains

A

Protection
Rest
Ice
Compression
Elevation
= PRICE

32
Q

Strains and Sprains: Treatment

A
  • Cold products in the first 48 – 72 hours after injury
  • Paracetamol or topical NSAID (1st line –CKS)
  • Ibuprofen oral
  • Rubefacient and heat not be applied until 72 hours after an injury
33
Q

Back pain

A
  • Most lower back pain is non-specific
  • Most often seen in those aged 35 to 55 years
  • Up to 60% of adults have lower back pain at some point in their lives
  • Common cause of absence from work
34
Q

Risk factors of Back pain

A

Non modifiable:
- Age
- Genetics

Modifiable:
- Fitness
- Weight
- Mental Health
- Job related activities
- Smoking

35
Q

What is Sciatica?
Symptoms?

A

Irritation or compression of sciatic nerve, (runs from the back of the pelvis through the buttocks and down both legs)

Symptoms = tingling sensation, may be described as shooting or stabbing pain
5-10% of people with non-specific lower back pain also have sciatica

36
Q

Management of Sciatica

A
  • Most effective treatment is to keep moving
    -Exercise - Group exercise programme (biomechanical, aerobic, mind-body, combination of these)
  • Analgesics unlikely to eradicate pain but may help to reduce pain to a level to enable the person to stay active
  • Psychological support if high risk of poor outcome
37
Q

Pharmacological Management of Lower back pain

A

1st line - Oral NSAIDs e.g. Ibuprofen or Naproxen
-Consider risk factors
-Use lowest effective dose for shortest duration
-Limited evidence of benefit for sciatica

Codeine + Paracetamol
-Only consider if NSAID contraindicated, not tolerated or ineffective (for acute back pain only)
-Paracetamol alone not recommended (evidence)

38
Q

Back pain- Red flags

A

Possible fracture:
- Major trauma
- Minor trauma in elderly, or osteoporotic
Possible tumour, or infection
- Age <20 or >50 years old
- History of malignancy
- Fever, chills, weight loss
- Recent bacterial infection
- IV drug use
- Immunosuppression
- Pain worsening at night, or when supine

39
Q

Osteoarthritis

A
  • Affect knees, hips & small joints of the hand
  • Loss of cartilage with joint remodelling
  • Activity related pain
  • Typically aged >45 years
  • No early morning stiffness (or stiffness lasting no longer than 30 minutes)
  • Functional impairment- movement limited
40
Q

Osteoarthritis
Pharmacological management

A

Pharmacological management:
- Paracetamol or topical NSAID = first line
- Consider oral NSAID if simple analgesia ineffective (topical NSAID should then be discontinued)
- Consider weak opioid e.g. codeine when required if NSAID not tolerated or not effective

Encourage non-drug measures:
- e.g. weight management and exercise physio

41
Q

Tension Headache

A
  • All age groups & both sexes equally- may last days
  • Muscles around the head and neck tighten, resulting in pain
  • Bilateral symptoms: Dull aching pain- forehead, temples, back of neck. Described ‘like a band around the head’ or a heavy weight pressing down on top of the head’. Non-pulsating
  • Symptoms worsen as day progresses
42
Q

What are the causes of tension headache

A

May:
-Stress
-Anxiety
-Bad posture
-Tiredness
-Eye strain

43
Q

What is a Sinus Headache?

A
  • Caused by build up of pressure in the sinuses e.g. during or after a cold
  • Unilateral initially
  • People may present with
  • Throbbing pain- worse during head movement
  • Toothache
  • Pain in jaw on eating
  • Pain that is worse in the morning
  • Increased mucus
  • More pain when bending forward
  • May last days
44
Q

Medication Overuse Headache:

A
  • Caused by overuse of pain medication
    -As the effect of the pain medication wears off, the withdrawal triggers the next headache
    -Treatment = to gradually reduce the pain medication
    -Stop for minimum 1 month
    -Headaches may take weeks to resolve
  • Headache on 15 or > days/ month in a person with a pre-existing headache disorder and
  • Regular overuse for > 3 months of:
  • For ergotamine, triptans, opioids and combination analgesics intake must be 10 days or more per month
  • For NSAID & paracetamol, intake must be 15 days or more per month
  • Headaches not due to other reasons
45
Q

Describe a Migraine
-symptoms
-causes

A
  • Severe headache that is often associated with other symptoms e.g. nausea, vomiting, visual disturbances, increased sensitivity to light (photophobia) or sound (phonophobia) and/or smells (osmophobia)
    -May be related to serotonin levels in the brain
    -With low levels, blood vessels contract
    -Headaches occur when blood vessels dilate again
    -Average attack last 24hours
46
Q

Migraine with aura

A

Aura- A warning signal before a migraine begins:
- Visual disturbances e.g. zig zag patterns, flashing lights, blind spots
- Tingling sensations or stiffness in neck,
shoulders, limbs
- Co-ordination issues or problems with speaking

47
Q

Migraine wihtout aura:
Symptoms can include-

A
  • Nausea and vomiting
  • Photophobia, phonophobia and/or osmophobia
48
Q

Possible Migraine Triggers:

A

Changes in routine e.g. sleep
Hormonal changes e.g. menstrual cycle
Emotional changes e.g. stress, anxiety
Medicines e.g. oral contraceptives
Dietary Factors e.g. missed/irregular meals
Physical Factors e.g; poor posture, low glucose
Environmental Factors e.g. bright flickering lights or screens, noise, smoking

49
Q

Migraine treatment options:

A
  • Paracetamol, Aspirin or Ibuprofen
  • Gut motility can slow down during a migraine attack- products may take longer to absorb
  • Different formulations are available that can disperse in the stomach and are absorbed quicker
50
Q

Migraine treatment:

A
  • Co-codamol= Not recommended as codeine can make nausea and vomiting worse
  • Migraleve pink= licensed for migraine- contains parcetamol and codeine with buclizine (an antihistamine that helps to prevent nauseous feeling)
51
Q

Sumatriptan

A
  • Triptan” - 5HT1 agonist - not an analgesic
    Licensed (18 – 65yo) where clear diagnosis of migraine
  • One tablet ASAP after migraine onset
    Dose can be repeated after symptoms recur after min 2 hours
  • Acts on vascular 5-HT1D receptor found predominantly in cranial blood vessels leading to vasoconstriction
52
Q

Sumatriptan: Contraindications

A
  • Allergy to sumatriptan
  • Myocardial infarction
  • Ischaemic heart disease
  • Coronary vasospasm (Prinzmetal’s angina)
  • Peripheral vascular disease
  • Hypertemsion
  • Stroke
  • Liver impairment
53
Q

When to refer Migraines to a GP?

A
  • Sudden, severe, frequent or cluster headaches
  • Migraine headaches for the first time
  • Headaches in children
  • People experiencing headaches:
  • following a head injury
  • with slurred speech
  • with confusion
  • with a rash, stiff neck or vomiting
54
Q

Meningitis symptoms:

A

Fever, cold hands and feet
Refusing food and vomiiting
Drowsy, difficult to wake
Stiff neck, dislike bright lights
Convulsions, seizures
Severe headache

M103 (46 decks)

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