True or false?

Analgesics do not change the underlying disease process but can provide considerable improvement in daily life for people suffering from pain.

True

*can also help by removing the pain barrier to beneficial exercise*

What is the difference between anaesthetic and analgesic?

analgesic: selectively blocks pain without blocking other modalities

anaesthetic: blocks all sensation

antipyretic medication (↓ fever) = acetaminophen/paracetamol/tylenonol

*paracetamol is the active ingredient*

*often lumped into NSAIDs category*

acetaminophen/tylenol/paracetamol acts centrally to relieve mild → moderate pain.

*not effective at treating soft-tissue injuries (ie: does not ↓ inflammation)*

no.

side effect

-toxic to liver/kidneys (≤ 12 tablets/24 hrs

-alcohol enhance toxic effect @ moderate levels

-moderate doses for heavy drinkers = liver damage

NSAID/ non-steroidal anti-inflammatory drugs interrupt formation of prostaglandins

*act on peripheral pain processes initiated in response to tissue injury or inflammation*

Ibuprofen (derivative of ASA

*more potent than ASA*

Naproxen (derivative of aspirin)

*most potent vs ASA or Ibuprofen*

Reyes syndrome

*S/S: recurrent vomiting 1 week after onset*

*child recovers 2 days or lapse into coma*

*worse case scenario: death from edema (cerebral herniation)*

*ASA additional side effect: kidney problems*

How long will you have to take high doses of NSAID for it to become dangerous?

Consumption of high doses of NSAID for more than a year

*4000 mg of aspirin/day to obtain anti-inflammatory effect for serious cases of arthritis*

*NSAID can cause upset stomach and GI bleeding*

COX aka cyclooxygenase enzymes

Cox-2 prostaglandins: contributes to sensitization of nociceptors

*NSAIDs inhibits both cox-1 and cox-2 prostaglandins*

Client education

*educate client that NSAIDs are different from acetaminophen and that there are risks with higher dosages

Between acetaminophen and NSAIDs, which is more likely to cause stomach problems?

NSAIDs

*

Opiods (morphine and codeine)

*stimulate descending pain inhibiting pathways*

cortisol: released in adrenal cortex

adrenaline

*↑ BP and prepare body for a fight/flight response*

Cortisone

*can be administered intravenously or cutaneously*

Cortisone targets inflammation

*pain decreases as a result of decreased inflammation*

*immediate relief by side effect show up many months later*

Complete the sentence

Cortisone has many side effects such as spreading bacterial infection d/t ↓ resistance, damaged to the cells in the 1)... resulting in impaired learning, ↓ bone density and leading to 2)...

Cortisone flare = apply ice in injected area

*cortisone flare: injected cortisone crystallizes and cause a period of pain worse than before the shot*

*lasts a day or two on a flare*

muscle relaxants

*early in course of back pain*

*short-term basis to relieve low back pain from m spasm*

*relieve spasticity in neuromuscular disease*

Complete the sentence

Botulin is an enzyme that interferes with release of .... at the NMJ causing paralysis

Botulin is an enzyme that interferes with release of acetylcholine at the NMJ causing paralysis

*trademark name is Botox*

Botox aka Botulin

*intended to relieve uncontrollable muscle spasm but being used for cosmetic purposes to paralyze muscles and conceal wrinkles*

Morning soreness

*massage liberates fluid from muscle tissue, flush out algogenic products as new circulation is brought to the area*

endorphins

*associated with feeling of well-being clients report following a massage*

*produce + effects on limbic system and cerebral cortex*