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31 Cards in this Set
- Front
- Back
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What are the common causes of back pain? |
-osteoporosis -osteoarthritis -sciatica -muscle strain -slipped disk |
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What are some other diseases that result in referred back pain? |
-renal condition -UTI -prostate -disorder of the large bowel |
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Is back pain all physiological? |
No, psychological aspects can actually worsen back pain |
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What is the main goal of back pain management? |
-not finding the definitive diagnosis, but rather use simplistic methods to alleviate/treat pain |
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Why do we want to avoid early x-rays for back pain? |
-X-rays reveal everything -may show some things wrong with the back which are not necessarily the cause of the pain --> unnecessary surgery -wait until 6th week |
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Symptoms of back pain |
-tightness in lower back/muscle spasms (protective of nerve) -description of pain is not typically useful to the pharmacist = don't know what to expect, just used to determine whether to refer or not |
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What is the difference between neuropathic pain vs nociceptive pain? |
Neuropathic - damage to or dysfunction of the nerves (NSAIDs/opiates not effective) Nociceptive - injury to body tissues |
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What is the PQRST mnemonic? |
p - precipitating or palliating q - quality r - region or radiating s - severity t - time |
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What is the role of pharmacists in back pain? |
-very minimal -decided which safe med. to use -know when to refer |
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What are RED FLAGS of back pain? |
- pain located high in the spine (i.e. whiplash?) --> 2 days of new onset - trauma (shorter height for older age) --> ASAP -fever --> ASAP -pain worsens when lying down --> 2 days -numbness in bum area --> ASAP -bladder dysf. --> ASAP -leg pain > back pain --> make appt. -oral steroids (withdraws Ca from bone) --> ASAP |
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What is CSM? |
Cervical Spondylotic Myelopathy (spinal cord compression) -neck condition -hallmark of CSM = weakness/stiffness in the legs |
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Management of back pain |
Usually resolves itself Episodes: 30 days - 2/3 recover 3 months - 90% full recovery Chronic - 10% suffer |
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How much rest post injury? |
-best to return to normal activities (but not ones that strain back too much) -muscles deteriorate fast --> work through the pain |
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What are patterns of back pain? Relation to pharmacists? |
- Patterns = different types/degrees of back pain (different stretches for diff patterns) -Pharmacists --> no knowledge =/= recommendations (i.e stretches) |
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OTC/Prescription Analgesics - drug management of back pain |
-Acetaminophen (up to 4 g/day) -Acetylsalicylic acid (up to 4 g/day) -Ibuprofen (OTC 1200 mg) -Naproxen (OTC 440 mg) |
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Acetaminophen in back pain |
(Tylenol) -not an NSAID - drug of choice, why? few side effects -may not be as effective as we think -analgesia -no anti-inflammatory prop. |
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ASA in back pain |
(Aspirin) NSAID -analgesia -anti-inflammatory prop. --> work better than acet. ? (choice for > 18 year olds) |
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Ibuprofen and Naproxen in back pain |
(Advil and naproxen) NSAIDs -analgesia -potential anti-inflammatory prop. -patient can take more than OTC max (not legally tell them though) |
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What are some concerns with NSAIDs? |
-Cardiovascular (ibuprofen) -GI (naproxen) = all NSAIDs --> bleeding -Asthma -Renal |
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How are antidepressants useful in back pain? |
-psychological aspects (perception of pain) -neuropathic pain |
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Muscle Relaxants in back pain |
-not anti-spasmodic -MOA --> sedation? -i.e. Robaxacet, robaxacin, robaxisal |
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Robax products (most common) |
All have methocarbamol 500 -Robax (ibup 200) -Robaxacet (acet 325), extra strength 500) -Robaxisal (ASA 500) -Robaxin (just methocarbamol) -Motrin (methocarbamol 500 + ibup 200) combination ones preferred b/c analgesic effects -Robaxisal --> higher GI SE but higher analgesic effect (alleviate back pain?) |
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Other than methocarbamol, what are other muscle relaxants? |
-doxylamine -orphenadrine -chlorzoxazone all just as effective -all come as combo with analgesics (only robaxacin is single relaxant ) |
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Selecting an agent for management of back pain |
1. Type of Muscle Relaxant 2. Pain analgesic or muscle relaxant or combo -pain analgesic preferred |
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Heat and cold in management of back pain |
-first 48 hours --> generally want cold (avoid incr inflammation) -recurring chronic LBP - either is fine, heat can be anti-spasmodic |
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Topical external analgesics management in back pain |
- MOA: counter irritant, massage/blood flow, psychological (odor - menthol) - methyl salicylate (heat), menthol (cooling) Rub A535 - slightly burns skin, can't handle both stimulants, tricks brain --> less pain, good for muscle soreness, not so much back (complex) ICY/HOT - triggers ,cold receptors first, then same as counter irritant |
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How much menthol gives a cooling effect? |
> 1% |
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Topical Diclofenac for back pain |
(voltaren) extra strength is just convenience dosing (BID vs QID) -best for muscle/joint injuries, and sprains/strains -less SE than oral analgesics, not as effective for back area -LBP - use in tandem with oral NSAIDs |
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Herbals for management of back pain |
-none of great use -glucosamine good for arthritis of simpler muscles/joints (months of treatment0 -Omega 3-fatty acids = anti-infl. |
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Pharmacist prescribing for back pain management |
- Ibup (3200 mg/day) and Nap (1500 mg/day) Cyclobenzaprine = muscle relaxant (neuropathic) blocks nerve impulses -short-term use, fix underlying problem |
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What are the SE of cyclobenzatropine? (Flexeril) |
-Dry mouth, Drowsiness (fatigue/headache less common) |
