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pain pt1
| Question | Answer |
|---|---|
| What are topical counterirritants? | Products that relieve pain by stimulating nerves, creating mild irritation or temperature sensations to distract from deeper pain. (Like scratching near a mosquito bite to forget the itch.) |
| How do counterirritants work? | They trigger nerve endings causing warmth, coolness, or redness to override pain signals in the brain. (Like focusing on background music instead of a loud noise.) |
| List the four classes of counterirritants. | Rubefacients (increase blood flow), Cooling agents, Vasodilators, Irritants. (Like different settings on a massage gun: heat, cool, vibration, pressure.) |
| Examples of rubefacients and their action. | Methyl salicylate, ammonia water; cause local inflammation and vasodilation (“hot” feeling). (Like using icy-hot patches for sore muscles.) |
| Examples of cooling agents. | Camphor (3–11%), menthol (1.25–16%) — stimulate sensory nerves for a cooling sensation. (Like peppermint toothpaste giving a cold feeling.) |
| Examples of vasodilators used topically. | Histamine dihydrochloride (0.025–0.1%), methyl nicotinate (0.25–1%). (Like loosening pipes to let more water flow.) |
| Examples of irritant-type counterirritants. | Capsicum, capsaicin, capsicum oleoresin (0.025–0.25%). (Like chili pepper heat on your skin.) |
| How often should counterirritants be applied? | 3–4 times daily for up to 7 days. (Like a week-long trial run.) |
| Side effects of methyl salicylate. | Allergy (especially if aspirin-allergic), redness, blistering, avoid with heat pads, occlusive dressings, or open wounds. (Like not double-heating leftovers—they’ll burn.) |
| Side effects of camphor and menthol. | Camphor: toxic if swallowed, especially in children; menthol: possible rash or irritation. (Like too much mint burning your lips.) |
| Capsaicin mechanism of action. | Depletes substance P (pain mediator) by stimulating TRPV1 receptors, causing warmth and pain relief with regular use. (Like unplugging a buzzing alarm after repeated pushes.) |
| How long does capsaicin take to work? | Pain relief usually begins in 14 days but can take up to 4–6 weeks. (Like waiting for a new exercise routine to pay off.) |
| Common capsaicin side effects. | Burning, redness, stinging (decreases with use), coughing. (Like chopping jalapeños and touching your eyes.) |
| What are the FDA recommendations for counterirritant use? | Avoid use on broken skin; don’t apply heat; stop use if blistering occurs; avoid contact with eyes and genitals. (Like reading the warning before using hot glue.) |
| What are topical anesthetics used for pain? | Lidocaine 0.5–4%, applied every 6 hours up to 3 times/24 hours, for ≤7 days. (Like a numbing cream for mosquito bites.) |
| Lidocaine precautions. | Use only on intact skin; stop if rash or irritation occurs. (Like sunscreen—works only if skin is healthy.) |
| List components of RICE therapy. | Rest, Ice, Compression, Elevation. (Like the first aid kit for sprains.) |
| How long should ice be used after injury? | 10–15 minutes, 3–4 times daily, for up to 3 days. (Like quick cooldowns, not deep freezes.) |
| When to use heat therapy? | After 48 hours of injury, for non-inflammatory conditions (e.g., low back pain, osteoarthritis). (Like a warm shower after muscle soreness, not right after twisting your ankle.) |
| How to apply compression properly? | Start distally, overlap by ⅓ to ½, loosen as wrapping moves upward. (Like wrapping a burrito evenly—not too tight.) |
| Elevation in RICE therapy means what? | Keep the injured area at or above heart level 2–3 hours daily. (Like propping a swollen ankle on pillows.) |
| Who should not self-treat pain/inflammation? | Pain >10 days, worsening pain, pain >7 days with topical use, visible deformity, fracture, pregnancy, <2 years old, fever/infection, bowel/bladder loss with back pain. (Like when home remedies aren’t enough—time to call the doctor.) |
| What are the goals of pain therapy? | Reduce pain and duration, restore function, prevent re-injury and chronic pain. (Like fixing the leak, not just mopping it up.) |
| What are systemic OTC pain relievers? | Acetaminophen and NSAIDs. (Like two main tools in your pain toolbox.) |
| Acetaminophen mechanism. | Central inhibition of prostaglandin synthesis; works in CNS, not peripherally. (Like turning off the alarm in your brain, not fixing the wiring.) |
| Maximum OTC daily dose for acetaminophen. | 3250 mg/day (reduced from 3900 mg/day). (Like a speed limit lowered for safety.) |
| Acetaminophen toxicity risk. | >4 g/day causes liver damage; leading cause of acute liver failure in the U.S. (Like overcharging a phone until it explodes.) |
| NSAID mechanism. | Inhibit COX enzyme → decreased prostaglandin synthesis → reduced inflammation. (Like closing the tap that feeds the fire.) |
| Important NSAID counseling tip for patients on aspirin. | Take aspirin 1 hour before or 8 hours after NSAID to preserve cardioprotection. (Like watering plants before turning off the faucet.) |
| Common NSAID adverse effects. | GI upset, heartburn, nausea, ulcers, increased MI/stroke risk, kidney damage. (Like great for pain but rough on your stomach and heart.) |
| Who is at high risk for NSAID-related ulcers? | Age >60, prior ulcers, anticoagulant use, long duration, alcohol use. (Like older pipes bursting sooner.) |
| FDA NSAID label update (2015). | Warns of increased risk of heart attack or stroke as early as first weeks of use. (Like a “danger ahead” sign early on.) |
| What is the safe maximum OTC dose for ibuprofen? | 1200 mg/day (200–400 mg every 4–6 hrs). (Like four standard tablets max daily.) |
| What is the safe maximum OTC dose for naproxen? | 660 mg/day (220 mg twice daily). (Like morning and evening routine.) |
| Topical NSAID example and dose. | Diclofenac 1% gel, apply up to 4 times daily (max 32 g/day). (Like spreading evenly, not slathering.) |
| Why avoid bathing within 1 hour of diclofenac use? | To prevent washing away and reducing absorption. (Like letting paint dry before touching it.) |
| What are common signs of fever? | Rectal >100.4°F, Oral >99.7°F, Axillary >99.3°F, Tympanic >100°F, Temporal >100.7°F (infants). (Like reading different thermometers correctly.) |
| What causes fever? | Pyrogens trigger PGE2 production in the hypothalamus, raising the body’s temperature set point. (Like turning up the thermostat.) |
| Difference between fever and hyperthermia. | Fever: regulated; hyperthermia: malfunction of temperature control. (Like AC working too hard vs. completely broken.) |
| When should fever be treated? | If temperature >104°F, patient <6 months, or if symptoms cause discomfort or risk for heart/lung strain. (Like cooling a car engine before it overheats.) |
| Preferred antipyretics for fever. | Acetaminophen and ibuprofen. (Like the go-to duo for fevers.) |
| Acetaminophen fever dose in children. | 10–15 mg/kg every 4–6 hrs (max 5 doses/day). (Like measured by weight, not age.) |
| Ibuprofen fever dose in children. | 5–10 mg/kg every 6–8 hrs (max 4 doses/day). (Like slightly longer lasting.) |
| Ibuprofen age restriction for fever. | Do not use in infants under 6 months old. (Like waiting until the immune system matures.) |
| Duration limit for self-treating fever. | Do not treat for longer than 3 days without medical advice. (Like setting a 3-day limit before calling for help.) |
| Why avoid alternating acetaminophen and ibuprofen? | Increases complexity and dosing errors in children. (Like juggling too many balls at once.) |
| When to refer for fever in children? | Temp ≥104°F, persistent >3 days, seizure, dehydration, lethargy, vomiting, rash. (Like danger lights flashing—get help.) |
| Why avoid alcohol baths or ice water for fever? | Causes shivering and alcohol toxicity in children. (Like cooling too fast and breaking the system.) |
| Nonpharmacologic treatment for fever. | Fluids, lightweight clothes, comfortable room temp (68°F). (Like cooling your phone by turning off background apps.) |
| Mechanism of antipyretic action. | Block COX in CNS → reduce PGE2 → lower hypothalamic set point. (Like lowering the thermostat back down.) |
| Why older adults may have lower fevers with infection. | Their thermoregulation response is blunted. (Like an old thermostat reacting slowly.) |
| What causes febrile seizures? | Fever in children 6 months–5 years without brain infection; not prevented by antipyretics. (Like a sudden short-circuit but self-limiting.) |
Created by:
eskay264