Week 4 Flashcards
What is the definition of chronic pain?
Chronic pain persists for more than 3 months
What is chronic primary pain?
Chronic primary pain has no clear underlying condition or is out of proportion to any observable injury or disease.
Chronic secondary pain and primary pain can co-exist.
What is chronic secondary pain? Give some examples of causes:
Chronic secondary pain is a symptom of an underlying condition. E.g.
- Endometriosis
- Ankylosing spondylitis
- IBS
- RA
- PMR
- Sciatica
- Crohn’s disease
- UC
Etc
What are some red flag symptoms for chronic pain? What should be done if they are present?
Red flags depend on the location of the pain e.g. head pain, back pain, abdominal pain.
Any sign of serious underlying pathology e.g. weight loss, night sweats, loss of appetite, fatigue etc.
Refer urgently or arrange immediate assessment
Give some examples of chronic primary pain:
Fibromyalgia
Chronic primary headache and Orofacial pain
Chronic primary musculoskeletal pain
Chronic primary visceral pain
What is the management of primary chronic pain?
Exercise programmes and physical activity
Psychological therapy e.g. CBT or acceptance and commitment therapy (ACT)
Acupuncture
Pharmacological management e.g. duloxetine, amitriptyline, citalopram, fluoxetine, paroxetine or sertraline for ages 18 and over. - these antidepressants are used to help with QoL, pain, sleep and psychological distress even in the absence of depression.
Do not initiate pain relief e.g. paracetamol, NSAIDs, opioids etc as this doesn’t help - explain to the patient.
When should you refer a patient with chronic pain?
Arrange specialist referral for people with chronic pain (the urgency depending on clinical judgment) if:
There are red flag signs and symptoms that may indicate serious underlying pathology.
Non-specialist management is failing.
Chronic pain is poorly controlled.
There is significant distress.
Where specific specialist intervention or assessment is required.
Chronic regional pain syndrome is suspected.
What are some signs/symptoms that could indicate its more likely a bacterial cause rather than viral in terms of URTI?
Higher fever
Symptoms persist for longer than expected (viral typically lasts 10-14 days)
Fever worsens rather than improves after a few days
Coloured nasal discharge or sputum - green/yellow
Swollen lymph nodes
White pus (feverpain) for tonsillitis
What are red flags on head pain?
New severe or unexpected headache (thunderclap)
Progressive or persistent headache, or headache that has changed dramatically.
Papilloedema - space occupying lesion or raised ICP
Vomiting
Visual disturbance
Worse when leaning forward
Worse in the morning
New onset focal neurological deficit, change in personality, altered conscious - stoke or TIA
Associated features such as:
Fever, impaired consciousness, seizure, neck pain/stiffness, or photophobia may indicate central nervous system (CNS) infection such as meningitis or encephalitis; neck stiffness may indicate subarachnoid haemorrhage.
Red flags of abdominal pain?
Dysphagia
Weight loss
Fever
GI blood loss
Sudden onset
Haematemesis
Change in bowel habit
Distended abdomen
Red flags of back pain?
Night pain
Fever
Weight loss
Neurological deficit
History of cancer
Saddle anaesthesia
Bowel/bladder dysfunction (most commonly urinary retention)
Over 50 or under 18
Raised inflammatory markers
What is the management for otitis externa?
Otomize is commonly given - this contains dexamethasone, neomycin sulfate and acetic acid
Advise - keep ear dry, avoid swimming/water sports for at least 7-10 days during treatment
Ibuprofen or paracetamol for pain relief
Management any risk factors
Follow up if no improvement after 48-72 hours after starting treatment or if symptoms don’t fully resolve after 2 weeks
