C1C paln managemenL ln Lhe

communlLy
Module 832Al

1ony Shaw

Analgesics
Used to alleviate aches and pains
OTC oral analgesics
NSAIDS and Aspirin
Aspirin
Ibuprofen
Diclofenac
Naproxen
Paracetamol
Combinations containing the above
Topical analgesics
nSAluS and Asplrln
arL of a group of drugs called nSAlus
non-sLeroldal anu-lnammaLory agenLs
AcL by blocklng prosLaglandln synLhesls
Analgeslc and anupyreuc
Llcensed for mlld Lo moderaLe paln from a
wlde range of causes and as anupyreuc
nSAluS and Asplrln
Slde-eecLs
CasLrlc lrrlLauon and bleedlng
Cauuons
AsLhma - may preclplLaLe auacks
8enal and hepauc dlsease (so elderly)
regnancy, parucularly 1sL and 3rd LrlmesLers
nSAluS and Asplrln
ConLralndlcauons
CurrenL or hlsLory of ulcers or gasLrlc problems
Asplrln ln chlldren under 16
lnLeracuons lnclude:
Asplrln - Warfarln and MeLhoLrexaLe
lbuprofen - LlLhlum and ulureucs
Asplrln
lbuprofen
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AdulL

Should be Laken wlLh or [usL aer
food or a meal (label 21)
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AdulL


Should be Laken wlLh or [usL aer
food or a meal (label 21)
ulclofenac oLasslum
ulclofenac oLasslum
naproxen 230mg LableLs
araceLamol
Comblnauon producLs
Codelne / ulhydrocodelne
Mlld oplaLes noL LhoughL Lo lncrease Lhe emcacy
slgnlcanLly
Slde-eecLs lnclude consupauon, dlzzlness
Caelne
Lvldence ls noL concluslve buL noL LhoughL Lo have
much eecL
Less caelne Lhan ln a cup of Lea or coee
8uL Lhese producLs Lend Lo be more
expenslve!
1oplcal preparauons
nSAlus
ShorL-Lerm use (<2 weeks)
Can have sysLemlc eecLs and slde-eecLs
8ubefaclenLs
SallcylaLes (asplrln cauuons apply)
nlcounaLes

aln assessmenL
Can'L measure or see
need Lo rely on pauenL's reporL
Locauon
uurauon
SeverlLy
8ecurrence
Also need Lo check for accompanylng
sympLoms
Common palnful condluons
8ack aln
So ussue ln[ury: sLraln of splnal muscles and
llgamenLs e.g. lumbago and bromyalgla -
Lwlsung or lllng
- 1he paln may spread rlghL across Lhe back along Lhe level of
Lhe Lop of Lhe pelvlc glrdle or verucally on one slde of Lhe
splne
- aln may radlaLe Lo buuock or Lhlgh, resLrlcung movemenL
and causlng pauenL Lo adopL a posLure leanlng forward or Lo
one slde
- auenL ls oLherwlse well
90 of acuLe auacks usually resolved ln slx weeks
nPS cholces
8ack aln
1rapplng of nerve rooL, usually sclauc nerve, due
Lo sllpped verLebral dlsc (sclauca)
- felL ln lower back and oen radlaLes down one leg,
someumes as far as fooL
- aln can be lnLense and burnlng
- aln ls consLanL and made worse by movemenL
- auenL llmps and unable Lo ex Lhe hlp very far maklng
slmng and cllmblng sLalrs uncomforLable
- galL ls su and awkward
- auenLs hold Lhemselves rlgld Lo avold movemenL
8ack aln
1reaLmenL
8ack aln
8efer lf
8ackache noL relaLed Lo movemenL
upper back paln noL obvlously due Lo muscle or llgamenL
sLraln
AssoclaLed wlLh oLher sympLoms of lllness
AssoclaLed wlLh neurologlcal sympLoms eg ungllng or
numbness ln legs or feeL
8owel or bladder funcuon problems
Severe paln aL nlghL
Cycllcal low-back paln ln mlddle Lo second half of mensLrual
cycle
unresponslve Lo 7 day LreaLmenL wlLh C1C producLs
ln[urles
ln[urles
8efer lf
Severe paln
Severe swelllng
numbness
Llmb unable Lo bear welghL
Llmb, hand, fooL of dlglL ls lmmoblllsed
aln/ache ln old ln[ury
Swelllng occurs ln old ln[ury
!olnL feels abnormal or unsLable
ln[urles
"+,123,*2








uenLal aln

uenLal aln
Caused by lnammauon of pulp or perldonLal
membrane of a LooLh
8lch nerve supply ln boLh sLrucLures
lmpulse senL Lo cerebral corLex - paln percelved
noL self llmlung - requlres referral ln all cases
Analgeslcs glve sympLomauc rellef unul denLal
assessmenL and LreaLmenL avallable
Peadache
1enslon
vascular
1racuon
1enslon Peadache
erlcranlal muscle conLracuon
sychogenlc orlgln
aln ls oen aL base of skull buL can be over
Lop of head Lo eyes
8llaLeral (fronLal/occlplLal)
uull paln, can be descrlbed as a band
Can lasL a few hours Lo several days
1rlggerred by Lenslon, anxleLy and faugue
MosL common cause of headache
Chronlc ually Peadache
Cccurs aL leasL 13 days of Lhe monLh
lL lasLs aL leasL four hours each eplsode
Seems Lo be presenL from mornlng Lo nlghL
Ache or dull Lhrobblng paln
auenLs Laklng slmple or comblnauon paln
rellef on more Lhan Lhree days a week
vascular Peadache
ullaLauon or consLrlcuon of blood vessels ln
braln and cranlum
Peadache assoclaLed wlLh febrlle lllness
Caused by vasodllaLauon
Mlgralne ls vascular ln orlgln
neurochemlcal paLhology also lnvolved
Mlgralne
Mlgralne
Auacks lasung 4 Lo 72 hours
AL leasL Lwo of:
1hrobblng or pulsaung paln
ModeraLe Lo severe lnLenslLy paln
unllaLeral paln
aln aggravaLed by movemenL
AL leasL one of:
nausea and / or vomlung
hoLophobla 1*4 phonophobla
Can have aura sympLoms before paln
Mlgralne
8ecurrenL
AssoclaLed wlLh mensLrual cycle
May occur aL regular umes e.g. Weekends
1rlggered by cerLaln foods
1rlggered by sLress
1reaLmenL

ClusLer Peadache
Largely aecLs men aged 40 Lo 60 years
LasLs 10 mlnuLes Lo 3 hours
usually occurs same ume of day
30 of suerers experlence nlghL ume
sympLoms
SLeady lnLense unllaLeral orblLal borlng paln
8efer
1racuon headache
lnammauon or compresslon of braln
Menlnglus
Lncephallus
PaemaLomas (lncludlng head ln[ury relaLed)
1umours
Cerebral abscesses
ulerenual dlagnosls
Lye sLraln
Spasm/faugue of clllary and perlorblLal muscles of eye
Claucoma
neuropaLhlc paln from shlngles
1emporal arLerlus
AlmosL excluslvely ln Lhe elderly
8eferred paln from [aw
Muscle sLraln and pulled llgamenLs ln neck or
upper back
Peadache red ags
8efer lf:
Sudden onseL 'rsL' headache
'worsL ever headache' (may be Subarachnold
haemorrhage)
LaLe onseL new headache (> 40 years)
Peadache wlLh su neck
Peadache wlLh su neck or rash ln under 12's
rogresslvely lncreaslng headache
Peadache wlLh drowslness, unsLeadlness, vlsual
dlsLurbances or vomlung
8ecommended LexLs
non-rescrlpuon Medlclnes
Alan naLhan (4
Lh
edn, 2010)
Managlng SympLoms ln Lhe harmacy
Alan naLhan (harm press, lAS1Lrack)
SympLoms ln Lhe harmacy
Allson 8lenklnsopp, aul axLon, !ohn 8lenklnsopp (6
Lh
edn, 2009)
Mlnor lllness or Ma[or ulsease?
Cllve Ldwards & aul Sullman (4
Lh
edn, 2006)
CommunlLy harmacy: SympLoms, ulagnosls and 1reaLmenL
aul 8uuer (2
nd
Ldn, 2009)
SympLoms, dlagnosls and LreaLmenL : a gulde for pharmaclsLs and nurses
aul 8uuer
8rlush nauonal lormulary (8nl 66)
8rlush Assoclauon for Lhe SLudy of Peadache (8ASP) Culdellnes 2007
LlecLronlc Medlclnes Compendlum
hup://www.medlclnes.org.uk/
ChemlsL & urugglsL C1C ulrecLory