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Presentation on theme: "APSA/SIA PAIN MANAGEMENT Project"— Presentation transcript:

Pain Consultations 101 Melissa Durham, Pharm.D. September 14th, 2011

2 Acute vs. Chronic Pain Characteristic Acute Pain Chronic Pain
(No Self-Treatment) Relief of Pain Highly Desirable Dependence & Tolerance to Medication Unusual Common Psychological Component Usually Not Present Often a Major Problem Organic Cause Often Not Present Environmental Contributions & Family Involvement Small Significant Insomnia Common Component Treatment Goal Cure Functionality

3 Assessment of Pain SCHOLAR
Symptoms Describe the symptoms you are experiencing Characteristics/Course Is the pain throbbing, sharp, dull, tingling? Rate the pain on a scale of 1-10 History How does it compare to other pain experienced? Has it gotten worse over time? Onset When did the pain start? Location Where is the pain located? Does it stay localized to one area or does it spread? Aggravating factors What makes the pain worse? Relieving factors What makes the pain better?

4 Common Indications for NonRx Analgesics
Temporary relief of minor aches and pain associated with the common cold Reduction of fever Sore throat Headache (Episodic Tension, Migraine, Sinus) Muscle aches Minor aches and pains of arthritis Acute back pain Menstrual pain

5 NonRx Pain Medications
Acetaminophen, AKA APAP (Tylenol) Mild-moderate pain, fever, headaches NSAIDs Ibuprofen (Motrin, Advil) Naproxen sodium (Aleve) Mild-moderate pain, headaches, muscle pain, menstrual pain Salicylates Aspirin AKA ASA (Ecotrin, Bayer) Mild-moderate pain, muscle pain, menstrual pain, cardioprotection Topicals (IcyHot, Bengay) Muscle soreness, muscle pain, osteoarthritis

6 Acetaminophen (APAP) Brand Name – Tylenol®, FeverAll®
Class – Analgesic/Antipyretic Not effective as an anti-inflammatory Very few side effects Liver toxicity a major concern with chronic high doses Very few drug interactions Warfarin, alcohol DOC in pregnancy/breastfeeding

7 Aspirin (ASA) Used mostly for primary and secondary prevention of thrombotic events Ex. Aspirin 81mg/day Has anti-inflammatory properties, but only at high doses Major side effects are bleeding, GI ulcers, bronchospasm in patients with asthma More DDIs than APAP NOT for use in pregnancy/breastfeeding Counseling point: TAKE WITH FOOD

8 NSAIDS Ibuprofen, naproxen sodium
More effective than APAP and ASA for most pain conditions Analgesic and anti-inflammatory effects Major side effects are bleeding, GI ulcers, bronchospasm in patients with asthma, increased blood pressure, fluid retention Generally avoid in pregnancy but OK in breastfeeding Counseling point: TAKE WITH FOOD

9 Topical Analgesics/Counterirritants
Used for minor aches and pains of muscles and joints, muscle soreness, osteoarthritis, lower back pain, neuropathy Ben-gay, Icy-hot, Salonpas Methyl salicylate, camphor, menthol, capsaicin Combinations Apply 3-4 times daily for a max of 7 days Do not apply immediately after a hot shower or bath, do not use with a heating pad Wash hands after applying

10 Types of Headache

11 Triggers of Tension Headache
Stress Anxiety Depression Emotional conflicts Fatigue Repressed hostility

12 NonRx Options for Episodic Tension Headache
Excedrin® Tension Headache 500mg Acetaminophen + 65mg caffeine APAP Ibuprofen Naproxen Other combo products

13 Nonpharmacologic Treatment of Tension Headache
Physical therapy Relaxation exercises Massage Topical Peppermint oil Applied to forehead and temples

14 Migraine Triggers Stress Fatigue Oversleeping Fasting, missing a meal
Alcohol Changes in barometric pressure or altitude Menses Hormone changes Magnesium deficiency Foods with nitrites, tyramine, phenylalanine, MSG, caffeine

15 Non-Rx Pharmacologic Therapy for Migraine Headache
Excedrin® Migraine Acetaminophen 250mg/Aspirin 250mg/Caffeine 65mg 2 tabs at onset, no more than 2 tabs per 24 hours Advil® Migraine Ibuprofen 200mg (liquid filled) 2 caps at onset, no more than 2 tabs per 24 hours Other analgesics will work, NSAIDs probably best Initiate NSAIDS 2 days before menses for menstrual migraine Self-treatment is only for patients who have been diagnosed with migraine by a physician

16 Nonpharmacologic Therapy for Migraine Headache
Regular sleeping & eating schedule Avoidance of triggers (food, stress) Cold packs + pressure Lie in a dark, quiet room Keep a headache journal

17 Go see MD! Symptoms of cluster headache
Symptoms of migraine headache with no formal diagnosis Chronic tension headache (>15 days/month for > 6 months) Severe pain (pain score 8-10) Signs of infection (fever, purulent discharge, altered mental status) Headache that Lasts more than 10 days Occurs more than 3 times a week Not managed by NonRx dosing

18 Acute Low Back Pain Possible causes Inactive lifestyle Poor posture
Improper shoes Excess body weight Poor mattress Poor sleeping posture Improper lifting techniques

19 Acute Low Back Pain Chronic low back pain ( > 4 weeks) - Refer
Most back pain disappears with home treatment and self-care Treatment options NSAIDs Topical analgesics Alternating heat/cold Massage Chiropractic manipulation Moderate physical activity when not acutely injured Chronic low back pain ( > 4 weeks) - Refer

20 Sprains & Strains Strains – injury to muscle or tendons
Sprains – injury to ligaments Overextension of the joint Ankle inversion most common Strains – injury to muscle or tendons Overuse or improper use Symptoms: Pain, bruising, loss of some function, stiffening Treatment RICE Therapy NonRx NSAIDS

21 Compress the area with elastic support.
Rice Therapy Rest the injured area. Ice the area in 10 minute intervals, 3 – 4 times a day for 1 – 2 days. Compress the area with elastic support. Elevate the area above the heart for hours to decrease swelling and pain.

22 Muscle Pain (Myalgia) NSAIDS ATC
Delayed-onset muscle soreness most common and is self-treatable Other types - Refer NonRx treatment: NSAIDS ATC Topical Preparations (Salicylates, Camphor, Menthol)

23 Osteoarthritis Nonpharmacologic Therapies NonRx Therapies
Low-impact exercise Weight-loss Shock-absorbing shoes Physical and occupational therapy Acupuncture NonRx Therapies Tylenol is drug of choice NSAIDS Glucosamine & Chondroitin: Not for people with shellfish allergy, may raise blood sugar in diabetics, may increase the effect of warfarin Topical analgesics/counterirritants

24 Menstrual Pain OTC treatment options: Midol® Menstrual Complete:
(Acetaminophen 500mg/Caffeine 60mg/Pyrilamine 15mg) Midol® Extended Relief (Naproxen sodium 220mg) Midol® Cramps and Body Aches (Ibuprofen 200mg) Midol® Teen Formula (APAP 500mg/Pamabrom 25mg) NonRx NSAIDs are the treatment of choice at MAX OTC doses

25 Nonpharmacologic Treatment for Menstrual Pain
Heating pads Regular exercise Loose clothing Massage Smoking cessation

26 Do’s and Don’ts Do Don’t Give advice and make suggestions
Determine if nonprescription medications will help Provide resources Suggest options and let people know their pain may be managed Use common sense Don’t Say something you are not sure about Diagnose or suggest specific prescription therapy Recommend self-treatment when not appropriate Give false hope

27 Community Resources USC pain center: 323-442-6202 Referral Sources:
American Chronic Pain Association ( American Pain Foundation ( American Headache Society ( Arthritis Foundation ( Referral for pain management: American Chronic Pain Association at Local hospice or cancer center  often know good pain specialists USC/Norris Comprehensive Cancer Center (323) , ask for referral to pain specialist USC pain center: For those without a doctor or insurance: Local hospital’s social services department or local health department LA Social Services Info Line at LAC/USC Referral Line at Patient Advocate Foundation at Poison Control:

28 Questions?

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