External Analgesics (Exam 2)

what age is a self-treatment exclusion for external analgesics

<2 years

can pregnant patients use external analgesics

NO

myalgias caused by _________, ________, or _________ are exclusions for external analgesic self-treatment

infection, chronic disorders, or medications

an injury with _______ or ________ in the joint would be an exclusion for external analgesic self-treatment

abnormal movement or visible deformity

are pts experiencing myalgias/generalized muscle pain form overuse candidates for self-treatment with external analgesics

YES

what are the exceptions that allow external analgesic self-treatment in pts with myalgias caused by infection/chronic/medications

diagnosis by HCP

or osteoarthritis

are pts with acute lower back pain candidates for self-treatment with external analgesics

YES (<6 weeks)

pts with acute lower back pain lasting more than ________ are NOT candidates for self-treatment with external analgesics

6 weeks

pain from soft tissue injuries to ligaments, muscles, or tendons lasting more than ________ are NOT candidates for self-treatment with external analgesics

6 weeks

are pts with grade 1 soft tissue injuries to ligaments, muscles, or tendons candidates for self-treatment with external analgesics

YES (<6 weeks)

any pt experiencing severe pain, higher than __ on a 1-10 scale, are NOT candidates for self-treatment with external analgesics

6

pain for more than ________ is an exclusion for external analgesic self-treatment

>10 days

(or >6 weeks for acute lower back pain)

pain that persists for _______ days after trying self treatment would be an exclusion for external analgesic self-treatment

>7 days

for a patient with back pain, loss of _____ or ______ function would be an exclusion for external analgesic self-treatment

bladder or bowel

what are common medications associated with musculoskeletal pain

ANTI-OSTEOPOROSIS AGENTS (risedronate, denosumab, ibandronate)

fluoroquinolones (ciprofloxacin, levofloxacin)

statins

fibric acid derivatives (gemfibrozil, fenofibrate)

oral & inhaled corticosteroids (fluticasone, prednisone)

anti-psychotics (haloperidol, clozapine, olanzapine)

what does the P stand for in the PQRST of assessing pain

precipitating factors: is he pain related to specific activity

patients should be referred to PCP if they report pain after long periods of ________

immobilization

what does the Q stand for in the PQRST of assessing pain

quality: describe the pain & ask about any other symptoms

are neurologic pain & swelling/redness self-treatment exclusions for external analgesics

YES

—> refer to PCP

what does the R stand for in the PQRST of assessing pain

region: where is the pain & is the pain localized

should a pt with shooting pain be referred to PCP

YES

should a pt with non-localized pain be referred to PCP

YES

what does the S stand for in the PQRST of assessing pain

severity

what does the T stand for in the PQRST of assessing pain

time: pain duration & how often it occurs

what is the most important non-drug therapy for patients complaining of musculoskeletal pain

RICE

what does the R in the non-drug therapy acronym RICE stand for

rest: stop, avoid, immobilize

what does the I in the non-drug therapy acronym RICE stand for

ice: first 12-24 hours after injury

heat: after 24 hours

what does the C in the non-drug therapy acronym RICE stand for

compression: bandages or wraps

what does the E in the non-drug therapy acronym RICE stand for

elevation: elevate injured area at or above heart

patients with a ______ allergy should NOT use wintergreen oil (methyl salicylate) for musculoskeletal pain

aspirin or salicylate

patients with an aspirin or salicylate allergy should NOT use _______ for musculoskeletal pain

wintergreen oil (methyl salicylate)

capsaicin cream is generally used for ________ musculoskeletal pain

chronic (not good for acute pain)

should group D (substance P depletors/capsaicin) for chronic use should be applied 3-4 times daily on a scheduled basis or PRN

scheduled basis (not PRN)

group D (substance P depletors/capsaicin) have a _______ onset

slow

can group D (substance P depletors/capsaicin) be used PRN

NO

why shouldn’t capsaicin cream be used acutely (~3 days) for musculoskeletal pain

substance P release can cause MORE PAIN

chronic (long-term) use of capsaicin cream will cause substance P ________ which can help to relieve pain

depletion

what other meds should be avoided when using any counterirritants

antipruritic (Benadryl)

skin protectants

topical anesthetics (lidocaine)

what patch strength for lidocaine is available OTC

4% (5% is Rx only)

what kind of pain are lidocaine patches used for

localized musculoskeletal pain

what are some important counseling points for topical analgesics for musculoskeletal pain

-do NOT apply to broken skin, eyes, or genitals

-do NOT use with heating pads

-do NOT bandage area tightly

what is the only FDA approved agent for osteoarthris

diclofenac

diclofenac is the only FDA approved agent for _________

osteoarthritis

what is one of the most important counseling points for external analgesics regarding children

KEEP OUT OF REACH!

pts on BP medications should not use which group of counterirritants

vasodilators= GROUP C

(histamine dihydrochloride & methyl nicotinate)

is systemic absorption completely avoided in topical counterirritants

NO (possible systemic absorption)