Responding to Symptoms of Pain Lecture PDF

Lecture 24 Responding to symptoms of pain Dr Gazala Akram RW 401f 1  Issues specific to pain Mainly two types of pain - body telling you something is wrong!!! 1. Acute- usually self limiting, activity related (i.e musculoskeletal du...

Lecture 24 Responding to symptoms of pain Dr Gazala Akram RW 401f 1  Issues specific to pain Mainly two types of pain - body telling you something is wrong!!! 1. Acute- usually self limiting, activity related (i.e musculoskeletal due to sports injury) 2. Chronic conditions – caused by ‘other’, largely treated by POMs But pain itself is subjective – individuals have varying pain thresholds Need to establish cause, severity & if it can be self- managed (this depend on the level of discomfort. 2  Treatment Managed by a limited range of OTC analgesics Analgesics (paracetamol, aspirin, NSAIDS e.g ibuprofen). Compound Analgesics (paracetamol/codeine, aspirin/codeine, paracetamol/dihydrocodeine + caffeine) Topical NSAIDs – less side effects (localised action) Rubefacients e.g salicylates - vasodilation, disperse Counter chemical mediators of pain ↓ perception of pain.Plus Intelligence Local anaesthetics 2023 book! 3 Common ‘Pain’ Conditions Activity related / sports injuries (soft tissue injury?) Dysmenorrhoea (also known as ‘period pain’) Toothache Headache Back pain- tends to be self limiting, sitting, lifting carrying etc-dull pain in lower back area (lumbago)- mostly 30-55 yrs or 50-90% of pregnant women. If shooting pain across from buttock down leg (sciatica) – refer. British pain society : www.britishpainsociety.org/patient_home 4  Activity related injuries- sprains and strains Questions to ask- (who is patient- age, gender) 1. When did it happen? – might just need First Aid? 2. What are symptoms? – marked swelling/bruising/tenderness? 3. Nature of injury – onset? Force? 4. Range of motion – marked reduction? 5. Nature of pain – sharp, acute?- referred pain suggests nerve root compression) 5 Non drug treatment of soft tissue injuries RICE Rest: immobilisation, enhanced healing and reduced blood flow Ice: If injury feels warm- apply until skin becomes numb (repeat hourly) Compression: crepe bandage/tubigrip etc Elevation: to help fluid drain away from injury (Pharm J, 10th August 2016). Advising patients on prevention and management of sporting injuries in the pharmacy) 6 OTC treatments for soft tissue injury NSAIDS – ibuprofen, aspirin (avoid in first 48hrs) Paracetamol – preferably on its own (but public influenced by advertising of combination products) Various formulations oral tabs, melts, solutions, gel/creams, lotions, sprays- be aware of different strengths/doses for OTC and P products. Not for 30yrs Nature of pain: Cramping – NOT dull continuous or diffuse. Severity: decreases as bleeding occurs Onset: before bleeding (lasts 3-4 days) Refer all heavy or unexplained bleeding, fever, sharp pain or anything unexplainable- refer. 8  Treatment NSAIDS (including naproxen 250mg tablets – pack size of 9 tablets) Good marketing ploy. But it sjust ibuprofen’s sister. Buscopan (Antispasmodic- prevents cramping) https://www.buscopan.com/about_abdominal_pain/m enstrual_pain/treating_menstrual_pain.html Complementary Therapies- Vitamins E & B, Fennel Hot water bottle, rest. 9  Oral /Dental Pain Tend to be local anaesthetics- mainly Lidocaine/ benzocaine- ‘apply to affected area’. Teething in children- usually from 3 months onwards (check individual products). Also used in throat sprays and in conditions which require ‘numbing’ of the surface i.e back of the throat. Mouth ulcers (usually also an antiseptic) COMT- clove oil, chamomile (Ashtons & Parsons® tincture of matricaria) 10  Headache Headache is pain or discomfort in the head or face area. Headaches vary greatly in terms of pain location, pain intensity, and how frequently they occur Different types of headache exist –mainly see tension, cluster and migraine type headaches in community pharmacy. Most OTC products are for acute management of these types of headaches. International Headache society:  Tension Headache Most common type of headache-usually caused by stress and muscle tension. Common features are: Slow onset Bilateral -head usually hurts on both sides Pain is dull or feels like a tight band or vice across the forehead and back of head (aching pain) Can be accompanied by tenderness on scalp, neck and shoulder muscles Pain is mild to moderate, but not severe Wont cause nausea, vomiting, or sensitivity  Cluster Headache Usually occur in a series that may last weeks or months, and the headache series may return every year or two. Severe pain on one side of the head, usually behind one eye The eye that is affected may be red and watery with a droopy lid and small pupil Swelling of the eyelid Runny nose or congestion Swelling of the forehead People often experience symptoms differently – if suspected - Refer  Secondary Headache Usually another underlying reason for occurring- REFER These can include: Trauma/Injury to neck or whiplash, head knock – concussion? Infection - Infected sinusitis, otitis media, dental abscess, eye infection Secondary to facial pain (sinus/mouth/eyes) Psychiatric disorders – panic attacks Cerebral Vascular disorder i.e haemorrhagic stroke (thunderclap) rapid onset, ADRs –most medicines list headache as a side effect i.e nitrates, sildenafil etc  Migraines Usually caused by certain ‘triggers ‘ Stress and other emotions (hormonal component) Environmental conditions, i.e light (glaring or flickering) or smells, noise. Fatigue and changes in one's sleep pattern Weather changes –extreme cold Certain foods and drinks Some people also experience an ‘aura’- Sensory disturbance that includes flashes of light, blind spots, and other vision changes or tingling in your hand or face Advis to keep a migraine diary to log ‘trigger factors’ - identify headache management strategies.  Migraine with or without Aura Migraine headache is usually frontotemporal (children/adolescents also report it to be bilateral, less in adults. Migraines can last for hours/days (untreated or unsuccessfully treated) 2 of the following characteristics: 1. unilateral location 2. pulsating quality 3. moderate or severe pain intensity 4. nausea and/or vomiting 5. photophobia and phonophobia https://migrainetrust.org/ 17  OTC Treatment options Paracetamol - acts in inhibition of prostaglandin production in pain pathway. Also in activation of descending serotonergic pathways Ibuprofen – act on COX -1 and COX-2 receptors to inhibit production pf prostaglandins in pain pathway Codeine – acts centrally, limited effectiveness at doses available OTC, often in combination products Buclizine – antihistamine with anti-emetic properties, also sedating Prochlorperazine – anti emetic Triptans - selective 5-HT serotonin receptor agonists (cause cranial vasoconstriction). Sumatriptan is P  Headache – non pharmacological interventions drink plenty of water get plenty of rest if you have a cold or the flu try to relax – stress can make headaches worse Avoid trigger factors e.g alcohol, particularly red wine or foods that contain nitrates Sleep Maintain good sleep hygiene Check /correct posture – On the screen  Pain in children Aspirin contra-indicated- Reye’s syndrome (encephalopathy) AVOID in 3days then refer, recurring, becoming more severe Actions – no response to OTC analgesia, non- pharmacological actions Medicines/Medical conditions – possible ADRs and may inform recommendation