Muscular Injuries and Back Pain Assessment
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Questions and Answers

What does the WWHAM questioning method stand for in the context of assessing a patient's muscular injury?

Who is the patient? What are the symptoms? How long have the symptoms been present? Action taken? Medication being taken?

List two specific symptoms that might warrant a referral in cases of muscular injury.

Severe pain and immediate swelling.

What does the acronym PRICE represent in the treatment of muscular injuries?

Protect, Rest, Ice, Compression, Elevate.

At what ages should patients with back pain typically be referred for further assessment due to increased risk of serious conditions?

<p>Patients under 15 years and those older than 50 years.</p> Signup and view all the answers

What could insidious onset and progressive nature of pain suggest in a patient with muscular injury?

<p>It could suggest a degenerative disease.</p> Signup and view all the answers

What is the common misconception about the use of arnica in treating bruising?

<p>It is often claimed to help reduce bruising and inflammation, but studies show it has minimal clinical significance.</p> Signup and view all the answers

What is a key consideration for a patient under 15 years presenting with back pain?

<p>There is a higher incidence of potentially serious causes, warranting referral.</p> Signup and view all the answers

Why might referred pain indicate a serious issue in patients with muscular injuries?

<p>It suggests potential nerve root compression.</p> Signup and view all the answers

What are two critical signs that indicate a referral for sciatica is necessary?

<p>Evidence of trauma and persistent, progressively worsening pain.</p> Signup and view all the answers

Identify the typical onset pattern for primary dysmenorrhoea pain.

<p>Primary dysmenorrhoea pain typically starts shortly before or within 24 hours of menstruation.</p> Signup and view all the answers

What treatment is recommended if simple analgesia does not improve back pain after 7-10 days?

<p>Referral for further evaluation is recommended.</p> Signup and view all the answers

Who is at a higher risk for experiencing primary dysmenorrhoea related symptoms?

<p>Adolescents and women in their twenties are at a higher risk.</p> Signup and view all the answers

What type of pain is most commonly associated with primary dysmenorrhoea?

<p>Cramping pain that lasts for 2-3 days.</p> Signup and view all the answers

List one condition that requires the referral of a patient with primary dysmenorrhoea.

<p>Heavy or unexplained bleeding.</p> Signup and view all the answers

What role do NSAIDs play in the treatment of primary dysmenorrhoea?

<p>NSAIDs are very effective in reducing pain for 80-85% of women with this condition.</p> Signup and view all the answers

What is one of the factors contributing to the pain experienced in primary dysmenorrhoea?

<p>Overproduction of uterine prostaglandins E2 and F2-alpha.</p> Signup and view all the answers

Name one clinical symptom that would necessitate a referral for back pain.

<p>Numbness.</p> Signup and view all the answers

What is the primary action of Hyoscine Butylbromide?

<p>It is an antispasmodic licensed for spasm of the gastrointestinal tract.</p> Signup and view all the answers

What is one prescribed NSAID commonly used for treating primary dysmenorrhoea?

<p>Mefenamic acid.</p> Signup and view all the answers

List two types of headaches that warrant referral.

<p>Headaches in children under 12 with a stiff neck/rash and new severe headaches in people over 50 years.</p> Signup and view all the answers

What are three common triggers for tension headaches?

<p>Mental stress, alcohol use, and eye strain.</p> Signup and view all the answers

Describe the typical pain characteristics of a migraine.

<p>Migraine pain is unilateral, severe, throbbing, and lasts for 4 to 72 hours.</p> Signup and view all the answers

What symptom is common to 90% of auras experienced during migraines?

<p>Visual disturbances.</p> Signup and view all the answers

What should be included in a headache diary?

<p>Recording headache frequency, triggers, symptoms, and treatment response.</p> Signup and view all the answers

What age and symptom combination requires particular caution in headache assessment?

<p>Headaches in patients over 50 years old with sudden onset or severe symptoms.</p> Signup and view all the answers

What is the recommended treatment for tension headaches?

<p>Simple analgesics, heat application, and stress reduction techniques.</p> Signup and view all the answers

Which vitamins are mentioned in relation to headache management?

<p>Vitamin E, Vitamin B1, and Vitamin B6.</p> Signup and view all the answers

Name one environmental trigger for migraines.

<p>Stress.</p> Signup and view all the answers

What are the key risk factors that can justify the restriction of combined oral contraceptive use in women with migraines?

<p>Key risk factors include heavy smoking, hypercholesterolaemia, obesity, diabetes, and a family history of early heart disease.</p> Signup and view all the answers

What defines medication overuse headache, and what threshold differentiates it from typical headache occurrences?

<p>Medication overuse headache is defined as headaches occurring on 15 or more days per month due to regular use of headache medications for more than three months.</p> Signup and view all the answers

In what scenario should sumatriptan be withheld and not administered further, according to the guidelines?

<p>Sumatriptan should be withheld if chest pain or tightness occurs after administration, suggesting possible ischaemic heart disease.</p> Signup and view all the answers

What changes in migraine patterns might indicate the need for a new treatment approach?

<p>Indicators include a change in symptoms, increased frequency or severity of attacks, and failure to recover completely between attacks.</p> Signup and view all the answers

What should be done for patients experiencing headaches more than 15 days a month after using simple analgesics?

<p>Patients should be referred to a doctor to address the issue of potential medication overuse headache.</p> Signup and view all the answers

What symptoms may indicate that a patient has a migraine?

<p>Severe or throbbing headache on one side, sensitivity to light and sound, and reduced ability to work or socialize.</p> Signup and view all the answers

List three simple analgesics mentioned for migraine treatment.

<p>Paracetamol, Ibuprofen, and Excedrin®.</p> Signup and view all the answers

What is the active ingredient in Nurofen Plus® and Solpadeine®?

<p>Codeine.</p> Signup and view all the answers

What role do triptans play in migraine treatment?

<p>They act as 5HT1 agonists to constrict blood vessels and reduce pain signaling.</p> Signup and view all the answers

What is the maximum dose of Sumatriptan that can be taken within a 24-hour period?

<p>100mg.</p> Signup and view all the answers

Name two common side effects of Sumatriptan.

<p>Dizziness and nausea.</p> Signup and view all the answers

What must be assessed by a pharmacist before supplying Sumatriptan OTC?

<p>The risk of cardiovascular events/IHD.</p> Signup and view all the answers

What is the recommended dosage of Sumatriptan for individuals aged 18-65 years?

<p>50mg at the onset of the first sign of migraine.</p> Signup and view all the answers

What supportive treatment should be monitored in case of Sumatriptan overdose?

<p>Supportive treatment and monitoring for at least 10 hours.</p> Signup and view all the answers

What are the specific receptors that triptans target for their action?

<p>5HT1B and 5HT1D receptors.</p> Signup and view all the answers

Study Notes

Muscular Injuries

  • Consider referral for swelling, bruising, severe pain, unable to bear weight, or a sudden onset after a traumatic event
  • Assess range of motion, nature of pain (referred pain suggests nerve root compression), and age (children: greenstick fractures, elderly: osteoporosis, osteoarthritis)
  • Treatment advice includes PRICE (Protect, Rest, Ice, Compression, Elevate), simple analgesia, and topical products
  • Arnica may have a small benefit for bruising but its effectiveness has not been proven

Back Pain

  • Consider referral for back pain in children under 15, chronic back pain (>6 weeks), pain radiating away from the lower back, pain above the lumbar region, worsening pain after 4 weeks, fever, weight loss, numbness, and incontinence
  • Age of patient is important (under 15: referral mostly, 15-30: trauma and pregnancy, 30-50: osteoarthritis, over 50: osteoporosis and malignancy)
  • Treatment advice includes simple analgesia (refer if no improvement after 7-10 days), topical products, and heat and cold compress
  • Bed rest for back pain may be counterproductive

Period Pain (Primary Dysmenorrhoea)

  • Pain experienced before menses, pain that increases at the onset of menses, heavy or unexplained bleeding, signs of systemic infection (fever, malaise), and severe or disabling symptoms require referral
  • Primary dysmenorrhea (PD) is common in adolescents and women in their twenties
  • PD typically starts shortly before (6 hours) or within 24 hours of menses and rarely lasts for more than 3 days
  • Treatment options include NSAIDs (80-85% effective), Hyoscine Butylbromide, paracetamol, and hot water bottle

Headache

  • Referral required for headaches after recent trauma, nausea/vomiting in the absence of migraine symptoms, neurological symptoms, severe headache onset in people over 50, headache unresponsive to simple analgesics, and a headache lasting more than two weeks

Tension Headache

  • Tension headache is more common in women and is described as a bilateral pain over the top of the head, often feeling like a band around the head or a weight pressing down
  • Triggers include mental stress, physical stress, alcohol use, eye strain, caffeine, fatigue, smoking, and dental problems
  • Treatment advice includes simple analgesia, heat (e.g. microwavable bags), exercise, headache diary, massage, biofeedback, acupuncture, cognitive behavioral feedback, and adequate hydration

Migraine

  • Symptoms of migraine include unilateral, severe, throbbing pain lasting for 4-72 hours with nausea and vomiting. Auras occur in 20% of cases, most commonly visual disturbances.
  • Triggers include stress, dietary factors, environmental factors, hormonal factors, drugs, physical factors, and emotional factors
  • Treatment options include simple analgesia (paracetamol, ibuprofen, Excedrin®), codeine-containing products (Nurofen Plus®, Solpadeine®, Migraleve®), and Sumatriptan

Sumatriptan

  • Sumatriptan is a 5HT1 agonist that acts as a vasoconstrictor and reduces pain signal transmission.
  • Key facts include: mode of action, dose, side effects, overdose, and requirements and contraindications for OTC sale
  • Sumatriptan is deregulated to pharmacy OTC status since October 2018 and pharmacists must assess suitability criteria before supplying

Medication Overuse Headache

  • Medication overuse headache is defined as headache occurring on 15 or more days per month due to regular use of headache medication for more than three months
  • This type of headache requires referral to a physician for management.

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Description

This quiz covers the assessment and treatment of muscular injuries and back pain. It highlights critical referral criteria, common treatment practices like PRICE, and considerations for different age groups. Test your knowledge on recognizing, assessing, and managing these conditions effectively.

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