Week 3 - Musculoskeletal Pain Flashcards
What is acute pain?
- Typically nociceptive and resolves when tissue heals
- e.g. tendonitis, sprains, strains; serves to warn of damage/ problem
- usually last less than 4 weeks
What is chronic pain?
–Pain that extends beyond the healing period of an acute; pain lasting at least 3 months
–Disrupts ADL and QOL e.g. degenerative joint disease, osteoarthritis, or chronic tendonitis(e.g. carpal tunnel syndrome)
–Serves no adaptive purpose
What is cancer pain?
–Disease itself
–Aggressive management warranted
What is musculoskeletal pain?
–Somatic Pain
–Throbbing, constant, dull, well localized
–Responds well to analgesics
Where is musculoskeletal pain?
Includes muscles, tendons, ligaments, cartilage, synovial bursae and bone
What is myalgia?
- pain in a muscle or group of muscles
- could be a result of systemic infection, chronic disorder and medication
- Can result from medication, exercise, trauma
What is tendonitis?
- Result of trauma, rheumatic process, infection, repetitive use
-inflammation of the tendon - Etiology-Overuse, injury, or aging
What are the common sites of tendonitis?
Shoulder, elbow, hip, thumb, knee, heel
What is the treatment of tendonitis?
–NSAIDs, corticosteroids, joint rest and immobilization
What are the signs of inflammation?
Fluid on the affected joint
What are the signs of pain?
Swelling, redness, heat
What is bursitis?
- Result of trauma, rheumatic process, infection
- inflammation of bursa, sac filled with synovial fluid located near joints
- Etiology-Overuse, injury, or aging
- Pain is tender and constant
What are the common sites of bursitis?
Shoulder, elbow (tennis elbow), hip, thumb, knee, heel
What is the treatment for bursitis?
–NSAIDs, corticosteroids, joint rest and immobilization
What is a sprain?
- Trauma to joint causes ligament damage
- Treatment: cold therapy for 24-48 hours then heat
- Elevate and/or joint immobilization if necessary
Etiology: Hyperextension
What are the signs and symptoms of a sprain and strain?
Swelling and bruising causing loss of function and numbness
What is a strain
Etiology: overstretching of a muscle
Treatment: joint rest
What is osteoarthritis?
Localized disease with cartilage deterioration and formation of new bone at joint surface
What are the risk factors of osteoarthritis?
Age, trauma to joints, fracture, infection
What is the treatment for osteoarthritis?
Acetaminophen, NSAIDs, hyaluronate injections, glucosamine/chondroitin, opioid analgesics
What are the signs of osteoarthritis?
Evidence of joint degeneration
Visible deformities of fingers
What are the symptoms of osteoarthritis?
Pain/joint tenderness
Morning stiffness
Limited ROM
Crepitus
What is rheumatoid arthritis?
- Systemic disease with inflammation of synovial tissues
- Need diagnosis from MD and prescription
- Unknown cause, unidentified risk factors
What is the treatment for rheumatoid arthritis?
–Disease-modifying antirheumatic drugs (DMARDs)
–NSAIDs, adjunctive corticosteroids
What are the signs of rheumatoid arthritis?
- Rheumatoid factor
- Radiographic changes
- Swan-neck or boutonniere deformities
- Subcutaneous nodules
What are the symptoms of rheumatoid arthritis?
- Morning stiffness
- Arthritis of 3+ joint areas
- Arthritis of hand joints
- Symmetric arthritis
What is the non-charm treatment of musculoskeletal pain?
R = rest injured area
I = ice ASAP in 10-20mins intervals 3-4 times daily for 12-24 hours
C = compression of injury using an elastic support or bandage
E = elevation of injured area at or above the level of the heart to decrease swelling
Massage
Acupuncture
Heat
Ultrasound
Physical therapy
What are the selected dietary supplements for arthritis?
Glucosamine
Chondroitin
SAMe
Cetyl myristolate
What are the lifestyle changes for arthritis?
Physical therapy
Weight loss
What are some topical analgesic for muscle pain?
- Cooling sensation (Camphor and menthol)
- Vasodilation (Histamine dihyrochloride)
- Warming (Capsaicin)
- Lidocaine
- Trolamine salicylate
- Methyl salicylate(in several combo products)
What is Capsaicin characteristics and dosing?
- Produces loss of sensitization to pain receptors
- Has a heating sensation
- Patch: Apply to affected area up to 3-4 times/day for up to 8 hours for 7 days
- Topical products (cream, gel, liquid, lotion): Apply to affected area 3-4 times/day
- Usually used for arthritis or chronic joint pain
- Can really irritate skin
- Available in gel, cream, patch and lotion form
- Sold under brand capzasin, zostrix,
What are Trolamine salicylate characteristics and dosing?
- Trolamine is a salicylate and works very similarly to NSAIDs in that it inhibits the COX enzyme.
- Relief of pain of muscular aches, rheumatism, neuralgia, sprains, arthritis on intact skin
- Available in a cream and lotion
- Apply to affected area as needed up to 3-4 times/day
What is lidocaine?
- local anesthetics work by blocking the permeability of sodium ions leading to ‘numbing’ of the affected area.
- Cream: Apply 2-4 times daily
- Patch: Place for up to 12 hours in any 24hour period
Examples of capsaicin heat products?
- Capzasin
- Zostrix
Examples of trolamine salicylate products?
trolamine salicylate
Natrucin T
Examples of lidocaine products?
Aspercreme
Examples of camphor cooling products?
Joint Flex
Examples of cooling menthol products?
IcyHot
Aspercreme
Mineral Ice
Bengay
Combo products menthol and camphor?
Salonpas
Arthritis Rub
Flexall Plus
Tiger Balm
What are the side effects of camphor?
High doses can cause nausea, vomiting, headache, dizziness, convulsions
What are the side effects of menthol?
Sensitization may occur
What are the side effects of capsaicin?
Can really irritate skin
What is PQRST?
Palliative/Provoking Factor - Precipitating factors
Quality
Region- radiation
Severity
Temporal Factors
What are the questions for Palliative/Provoking Factor - Precipitating factors?
What makes pain better/worse?
What brings on the pain?
What are the questions for quality?
Describe the pain
What are the questions for region - radiation
Where is the pain?
Can you put your finger on it?
Does the pain spread to other areas?
What are the questions for severity?
Where is the pain?
Can you put your finger on it?
Does the pain spread to other areas?
How bad is the pain? (use assessment tools)
Has pain changed your lifestyle?
Do you have any other symptoms while in pain?
What are the questions for temporal factors?
How long does the pain last?
When does the pain occur?
How long have you been experiencing the pain?
When would self care be excluded?
High level of pain (pain score above 6)
Pain that last greater than 10 days
Pain that last greater than 7 days with a topical analgesic
Increased intensity or change in the characteristics of the pain
Pelvic or abdominal pain other than dysmenorrhea
Pain with other s/s like nausea, vomiting, s/s of systemic infection or disorder
Deformed joint, numbness or suspected fracture
Pregnancy
Children less than 2 years old
Back pain and loss of bowel or bladder control
What are some subjective considerations of muscle pain?
Previous treatment
Behavioral/cognitive aspects
Potential abuse for medications
Functional disability caused by pain
Realistic expectations
Socio-cultural information
Emotional response to pain
Economic impact
What is the objective assessment for muscle swelling?
Suggests inflammation or fluid on a joint
May be acute (sudden) or chronic (continuous)
Medications can cause fluid retention (Some calcium channel blockers/ estrogen/oral contraceptives/ Corticosteroids)
What is the objective assessment for stiffness/range of motion?
↓ ROM from trauma, stiffness, swelling, or neurologic problems
