Inflammatory or Non-inflammatory

             a) Myofacial pain        f) bursitis

             b) Muscle cramp        g) tendonitis

             c) low back pain        h) osteoarthritis

             d) muscle spasm        i) fibromyalgia

             e) sprain                    j) strain

            a) Myofacial pain-Non        f) bursitis-I

             b) Muscle cramp-Non        g) tendonitis-I

             c) low back pain -I       h) osteoarthritis-Non

             d) muscle spasm-N       i) fibromyalgia-Non

             e) sprain -I                   j) strain-I

Exclusions for self treatment

a) pain longer than_____

b) pain located______

c) Children less than____

d) ____trimester of pregnancy

e) suspected______
f)pain for more than______days after treatment

a) pain longer than 2 weeks

b) pain located pelvis or abdomen

c) Children less than 2

d) 3rd trimester of pregnancy

e) suspected fracture, visually deformed joint
f)pain for more than 7 days after treatmen

Rest until pain reduced

Ice- 10-15min 3-4x.day

Compression- reduce swelling

Elevation-2-3 hrs/day reduce swelling

When should heat be used for an injury?

When shouldnt' heat be used?

Should- chronic pain or acute pain

NOT if associated with inflammation

What analgesics are good for non-inflammatory injuries?

Inflammatory?

Non: acetaminophen

Inflam.: NSAIDs (Ibuprofen or Naproxen)

T/F

Topical products may be used with heat to decrease healing time

FALSE

Heat should not be used with topical products

What is the administration time of counterirritants?

How do they work?

3-4x/day up to 7 days

Cause a pain/sensation less severe than the injury

Rubefacients

a) MOA

b) products

c) Strength if applicable

a) cause vasodilation of cutaneous vasc. that provides sensation of warmth

b) Methyl salicylate, Allyl isothiocyanate, Ammonia water, turpentine oik

c) Oil of wintergreen (10-30%)

Agents that cause Cooling Sensation

a) Products

b) MOA of each

Menthol: depresses cutaneous receptors and acts as anesthetic

Camphor: (0.1-3%)depresses cutaneous receptors and acts as anesthetic, antipuritic and analgesic

(3-11%) acts as counterirritant

Histamine dihydrochloride

Methyl Nicotine

a)What is the agent that is an irritant without rubefaction?

b) its the major ingredient of?

c) MOA

d) Other uses

e) Strengths

f) Other formulations

a) Capsaicin

b) hot peppers

c) deplete substance P from sensory neurons (sub. P causes warmth

d) Postherpetic neuralgia, diabetic neuropathy

e) 0.025, 0.075, 0.25%

f) Patch: Qutenza 8% Rx

Combination product will provide what effect?

a) Bengay: methyl salicylate, menthol and camphor(4%)

b) Sloan's Liniment: turpentine oil, capsaicin

a) Methyl salicylate (rubifacient), menthol (cooling sensation) camphor 4% (counterirritant)

b) turpentine oil (rubefacient) capsaicin (counterirritant w/o rub.)

a)What is trolamine salicylate?

b) is it absorbed?

c) strength

a) salicylate salt, not counterirritant

b) Yes, comprable to aspirin

c) 10%

a) what are the CAM for muskuloskeletal pain?

b) What is a side effect?

a) Glucosamine Sulfate,  Chondroitin Sulfate, S-adenosyl-L-methionine (SAMe) Methyl-sulfonyl-methane(MSM)

b) GI AE

a) What is cyclobenaprine used for?

b) What is a common ADE?

c) usual dosage?

a) Muscle spasms (muscle relaxant)

b) anticholinergic effects (dry mouth, sedation)

c) 5-10mg 3x/day

What is Carisoprodol used for?

what is it closely related to

doasge?

muscle relaxant

antianxiety agent meprobamate

250-300mg 3/day and HS

Pregabalin (lyrica)

Duloxetine (Cymbalta)

Milnacipran HCl (Savella)

Pregabalin

a) other uses

b) dose for fibromyalgia

a) postherpetic neuralgia, adjuctive therapy for seizures, diabetic peripheral neuropathy

b) 75mg BID then 150mg BID then 225mg BID

Duloxetine

a) MOA

b) Other uses

c) dose for fibromyalgia

a) SNRI

b) depressive disorder, anxiety disorder and neuropathic pain

c) 60mg QD

Milnacipran HCl

a) MOA

b) Dosage

a) SNRI more potent inhibition of Norepi

b) 12.5mg increased to 100mg