Pain in adults: diagnostic and therapeutic updates

Types of pain

Sensation pain

Common, acute or chronic pain. The nervous system is not damaged.

Skin pain: originates in the skin and deep tissues and is easier to locate than visceral pain: musculoskeletal pain, back pain, headache, arthritis.

Visceral pain: Originating from internal organs. Often vague and can be more difficult to pinpoint bladder pain, prostate pain, irritable bowel syndrome, endometriosis, dysmenorrhea, kidney failure, abdominal pain.

Nerve pain

Less often. Nerve damage. Recurrent acute attacks of pain, such as paraesthesia or burning, are often accompanied by sensory disturbances.

Some forms of pain can be a combination of nociceptive drugs and neurological disease, for example, toothache.

Treatment

Oral form should be used whenever possible

Combinations of different drugs are sufficient (eg, Paracetamol and NSAIDs; Paracetamol and codeine).

Do not use weak and strong opioids simultaneously.

Dosage and duration of treatment are guided by an assessment of the type, intensity, and location of the pain.

Treatment of specific pain cases

Musculoskeletal pain

Paracetamol or/and NSAIDs.

Lubricating and thermal ointments are very helpful.

Acute back pain accompanied by neuralgia

Consider first acute treatment (Diclofenac 75 mg) followed by an oral NSAID.

Do not prescribe benzodiazepines (eg, diazepam).

Osteoarthritis pain

Paracetamol or/and NSAIDs.

Do not prescribe glucosamine or chondroitin products.

Topical NAIDs have been shown to be effective in treating knee and shoulder pain.

Kidney pain

Diclofenac 75 mg each followed by an oral NSAID and SPASMOLITICS.

If nausea or vomiting occurs, metoclopramide 10 mg then orally as needed.

Dysmenorrhea

Naproxen.