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- Pain in adults: diagnostic and therapeutic updates
Pain in adults: diagnostic and therapeutic updates
Oral pain therapy should be used whenever possible. Combinations of different drugs are sufficient (eg, Paracetamol and NSAIDs; Paracetamol and codeine).
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.