TREATMENTS &
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Treatments for Pain
Contents
Treatments of Pain: Online Medical Books
16 MEDICAL BOOKS ONLINE! Review the full text of medical books online, free, without registration, for more information about the treatments of Pain.
Chronic Pain:
Treatment
(In a Page: Signs and Symptoms)
- NSAIDs are often used, especially for inflammation
- Narcotics are usually reserved as adjuvant therapy after more conservative measures have failed; concern about addiction is a common barrier to use
- Tricyclic antidepressants and anticonvulsants are useful for neuropathic pain
- SSRIs are effective for fibromyalgia
- Spinal delivery of pain medication may be useful for radicular pain and reflex sympathetic dystrophy
- Tramadol is often used as a bridge between NSAIDs and narcotics
- Physical/occupational therapy is often very useful in a variety of conditions, especially reflex sympathetic dystrophy, low back pain, and fibromyalgia
- Alternative therapies may be useful as primary treatment or adjuvant therapy for chronic pain syndromes
- Psychiatric evaluation may be indicated for potential primary psychiatric conditions and co-morbidities
- Consider referral to a pain specialist
Low Back Pain/Swelling:
Treatment
(In a Page: Signs and Symptoms)
- In absence of red flag symptoms, return to activity as soon as possible; rest has not been shown to improve recovery
- Acetaminophen, NSAIDs, opioids, and/or muscle relaxants for pain; epidural corticosteroid injections may be indicated for resistant pain
- Patient education (weight loss, exercise, proper back biomechanics and ergonomics)
- Physical therapy, including pain relief modalities (ice, heat, ultrasound), stretching, strengthening, aerobic conditioning, and relaxation therapy
- Surgery may be indicated for refractory disease, large neurologic deficits, unbearable pain, or significant limitations
Abdominal Pain in Lower Quadrants:
Treatment
(In a Page: Signs and Symptoms)
-
Hemodynamically unstable patients require immediate resuscitation
–Replace volume with normal saline and possibly a blood transfusion
–Evidence of hemorrhage (e.g., ruptured AAA, ruptured ectopic pregnancy) or early sepsis (e.g., perforated diverticulitis, perforated bowel) may be a life-threatening emergency that requires urgent surgical intervention - Place nasogastric tube for obstruction or persistent vomiting
- Administer broad-spectrum empiric antibiotics if a perforated viscus or intra-abdominal infection is suspected
- Direct treatment toward the specific condition
- Consider gynecology or surgery referral
Abdominal Pain in Upper Quadrants:
Treatment
(In a Page: Signs and Symptoms)
- Rule out or treat serious causes of pain (e.g., bowel obstruction, cholangitis, MI, PE)
- Urgent surgical intervention may be indicated for aortic aneurysm, splenic infarct, perforated viscus, and intestinal obstruction or infarct
-
Esophagitis, gastritis, PUD, and GERD are primarily treated with lifestyle changes (e.g., avoid causative foods or medications) and PPIs or H2 blockers
–Rule out malignancies in older patients or those with suggestive histories - Pancreatitis: Aggressive IV hydration for lost fluids and third spacing; antibiotics; nasogastric tube insertion if vomiting; bowel rest; and narcotics for pain
- Gastroenteritis: Rehydration, correct electrolytes
- Intestinal obstruction: Bowel rest, surgery
- Cardiac and pulmonary etiologies are treated per protocols (e.g., supplemental O2, aspirin, β-blocker, nitrates for MI; O2, heparin and/or thrombolytics for PE; O2, appropriate antibiotics for pneumonia)
Abdominal Pain with Rebound Tenderness:
Treatment
(In a Page: Signs and Symptoms)
-
Hemodynamically unstable patients require immediate resuscitation
–Replace volume with normal saline and/or blood transfusion
–Evidence of hemorrhage (e.g., ruptured AAA, ruptured ectopic pregnancy) or early sepsis (e.g., perforated diverticulitis, perforated bowel) may represent a life-threatening emergency that requires urgent surgical intervention
–Definitive surgical repair of ruptured aneurysm, bowel perforation, ectopic pregnancy, or other pathology
–Bowel rest and possible colon resection for diverticulitis or bowel obstruction
Breast Pain & Discharge:
Treatment
(In a Page: Signs and Symptoms)
-
Fibrocystic changes
–Caffeine avoidance is often effective in decreasing pain
–Aspirate cysts or medical therapies (e.g., danazol, oral contraceptives, tamoxifen, bromocriptine, evening primrose oil, GnRH agonists, vitamin E) for pain relief
–Routine follow up is sufficient unless cytologic atypia is present
Elbow Pain/Swelling:
Treatment
(In a Page: Signs and Symptoms)
- General principles of fracture management include immobilization, analgesia, NSAIDs, and elevation
- Immediate anatomic reduction is required in cases of neurovascular compromise
- Nondisplaced fractures should be immobilized with the elbow flexed at 90°
- Displaced or intra-articular fractures usually require open reduction with internal fixation
- Joint aspiration may relieve pain if effusion is present
- Epicondylitis is treated with rest, NSAIDs, and physical therapy
- Elbow dislocation requires reduction followed by splint immobilization
- Splinting may be beneficial
- Reduction of a subluxed radial head (nursemaid's elbow) is performed by placing the thumb over the radial head while supinating, then flexing, the forearm
Flank Pain/CVA Tenderness:
Treatment
(In a Page: Signs and Symptoms)
- Disk disease: NSAIDs and physical therapy; surgery is rarely indicated
- Muscle spasm: Rest, physical therapy, analgesics
- Renal calculi: Increased fluid intake, analgesics, consider surgery
- Pyelonephritis, cystitis, and perirenal abscess: Antibiotics and increased fluid intake
- Pancreatitis: Analgesics, antibiotics, consider surgery
- Glomerulonephritis: Antibiotics (if poststreptococcal), loop diuretics, antihypertensive agents
- Polycystic kidney disease: Manage blood pressure
- Renal infarction: Surgery, antihypertensive, streptokinase
- Papillary necrosis: Dialysis, treat underlying cause
- Cholelithiasis: Cholecystectomy, analgesics
- Appendicitis and ectopic pregnancy: Surgery
- Renal and bladder cancer: Surgical resection, chemotherapy, and radiation
Jaw Pain/Swelling:
Treatment
(In a Page: Signs and Symptoms)
- Dental or periodontal pathology, oral lesions, salivary pathology, and oral neoplasms require specialized treatment by dental specialist or oral surgeon
- TMJ: Initial treatment includes pain management, bite block (night guard), cold/warm compresses, intra-articular steroid/lidocaine injections, and avoidance of jaw clenching and gum chewing
- Temporal arteritis: Temporal artery biopsy and high- dose steroids
- Headache: Pain relievers, stress reduction, migraine-specific therapy (e.g., triptans), and manipulation
- Neuralgia and neuropathies may be treated with NSAIDs, anticonvulsants (e.g., valproic acid, gabapentin), medical pain management and/or directed therapy (e.g., nerve block)
- Treat underlying systemic etiologies and behavioral disease as necessary
Knee Pain/Swelling:
Treatment
(In a Page: Signs and Symptoms)
- Conservative therapy is usually sufficient
- OA: Lifestyle modification (e.g., weight loss, exercise); anti-inflammatory medications (e.g., NSAIDs, COX-2 inhibitors); joint injections may benefit some people (e.g. corticosteroids, hyaluronic acid); surgery may be necessary for those who fail conservative treatment
- Ligamentous injuries: ACL injuries may require definitive treatment via reconstructive surgery; PCL injuries are usually not repaired
- Meniscal tears may require repair or excision; however, most meniscus injuries are asymptomatic or mild and require no treatment
- Patellofemoral syndrome often responds to physical therapy and exercise
- Joint infection (e.g., septic arthritis) is a surgical emergency; irrigation, debridement, and antibiotic administration should be considered
Neck Stiffness/Pain:
Treatment
(In a Page: Signs and Symptoms)
- Trauma: Soft-collar immobilization is no longer routinely recommended
–Cervical spine fractures may be treated with surgical fixation, halo brace immobilization, or careful observation
–Soft-tissue injuries to the neck and torticollis are treated symptomatically with NSAIDs and muscle relaxants (e.g., benzodiazepines, cyclobenzaprine)
–Subarachnoid hemorrhage is often treated surgically - Infection
–Bacterial meningitis requires immediate broad-spectrum antibiotics (e.g., ceftriaxone and vancomycin); steroids may decrease the morbidity associated with the inflammatory response to infection
–Viral meningitis is treated supportively (IV fluids, NSAIDs)
–Abscess requires antibiotics and drainage - Inflammatory arthropathies typically respond to NSAIDs, steroids, or antirheumatic agents
Pelvic Pain - Female:
Treatment
(In a Page: Signs and Symptoms)
- Primary dysmenorrhea: NSAIDs; consider oral contraceptives to suppress ovulation in severe disease
- Positive pregnancy test: Determine last menstrual period; obtain quantitative β-hCG; confirm intrauterine pregnancy
-
In patients at high risk for STDs, treat empirically for PID (to cover gonorrhea and Chlamydia)
–Ofloxacin 400 mg PO BID for 14 days plus metronidazole 500 mg PO BID for 14 days, or
–Ceftriaxone 250 mg IM single dose plus doxycycline 100 mg PO BID for 14 days -
Endometriosis: Treat with hormonal medications or surgical
laparoscopy
–Oral contraceptives for 3–4 months, or
–Provera 39 mg QD for 2 months, or
–Danazol 200–800 mg QD for 6 months, or
–GnRH agonist (e.g., leuprolide)
Shoulder Pain/Swelling:
Treatment
(In a Page: Signs and Symptoms)
- Slings may be used for comfort but early range of motion (24–48 hours) is necessary to prevent adhesive capsulitis
- Conservative therapy is beneficial for most cases of shoulder pain: Rest, ice, NSAIDs, and opioid narcotics
- Subacromial cortisone injection if other anti-inflammatory methods fail; however, multiple injections are discouraged because of possible tissue atrophy
-
Physical therapy is generally the mainstay of treatment
–Conditioning and strengthening
–Progressive range of motion exercises for adhesive capsulitis - Full thickness rotator cuff tears may require surgical repair
- Adhesive capsulitis may require surgical lysis of adhesions
- Prevent future injuries by promoting strength and flexibility
Wrist & Hand Pain/Swelling:
Treatment
(In a Page: Signs and Symptoms)
- Corticosteroid injection for carpal tunnel improves symptoms in more than half of patients; surgical intervention to release the transverse ligament and decompress the nerve entrapment may be indicated
- NSAIDs reduce inflammation and use of cock-up splints applied during activities and while sleeping reduces strain from repetitive use and reduces symptoms
- Corticosteroid injection along tendon sheaths and wearing a thumb spica splint treat tenosynovitis
- Ganglion cysts are treated by draining the thick fluid and injecting with steroid; surgical removal is occasionally necessary
- Casting of suspected fractures and repeat X-ray in 7–9 days prevents complications of occult fracture
- Antihistamines and steroids treat swelling from stings
- Treat rheumatologic and medical causes
- Biofeedback and relaxation may be beneficial in selected cases