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Treatments for Pain



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

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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
'>>'>

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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

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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)

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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
  • 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 underlying condition
    –Definitive surgical repair of ruptured aneurysm, bowel perforation, ectopic pregnancy, or other pathology
    –Bowel rest and possible colon resection for diverticulitis or bowel obstruction
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    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
  • Breast cancer: Surgery, radiation, chemotherapy, and/or hormonal therapy as indicated by stage
  • Mastitis: Warm compress, antibiotics to cover Staphylococcus aureus and streptococci (e.g., cephalexin); consider inflammatory breast cancer if no response after 5 days in a nonlactating female
  • Abscess: Incision and drainage, antibiotics
  • Cyst: Aspiration; cytology of aspirated fluid if bloody or recurrent
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    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

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    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

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    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
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    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

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    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

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    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)
    '>>

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    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

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    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

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    Ankle Pain/Swelling: Treatment
    (In a Page: Signs and Symptoms)

    • PRICE
      –Protection from additional strain/injury
      –Relative rest (stretching is okay) ±crutches
      –Ice for initial 24–48 hours after trauma
      –Compression (elastic wrap or ankle support)
      –Elevation of foot (higher than the pelvis)
    • Casting is often indicated for fractures and significant ankle sprains
    • Short-term bracing may reduce risk of reinjury
    • Surgery may be indicated (e.g., bimalleolar fracture, trimalleolar fracture)
    • Physical therapy referral to improve strength, range of motion, and proprioception
    • NSAIDs or other analgesic

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    Scrotal Pain: Treatment
    (In A Page: Pediatric Signs and Symptoms)

      • Torsion
        –To salvage the testis, detorsion must take place within 6 hours of the onset of symptoms
        –Surgical exploration and detorsion is the approach of choice for children with suspected testicular torsion
        –With torsion of one testicle, the surgeon may elect to surgically fix the contralateral testicle to prevent future torsion
    • Torsion of the appendix testis is treated conservatively
    • Antibiotics, typically doxycycline, are used to treat epididymitis
    • Inguinal hernias are reduced surgically; surgical exploration of the contralateral side is often performed
    • Orchitis is treated supportively
    • HSP is treated supportively and sometimes with systemic corticosteroids
    • Varicoceles may not require treatment, but may interfere with fertility

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    Otalgia (Ear Pain): Treatment
    (In A Page: Pediatric Signs and Symptoms)

    • Establish appropriate specific diagnosis as promptly as possible
    • If infectious process, initiate antimicrobial therapy
      –Topical (intraotic) antibiotic drops for otitis externa or otitis media with either a perforation or patent tympanostomy tube
      –Systemic (oral) for otitis media, nonviral pharyngitis, sinusitis
      –Parenteral antibiotics for abscess, mastoiditis
    • If odontogenic, dental referral
    • Adequate follow-up to ensure resolution of otalgia

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    Abdominal Pain: Treatment
    (In A Page: Pediatric Signs and Symptoms)

    • If concerned about “surgical abdomen,” consult surgery
      –Appendicitis, ovarian torsion, hydrometrocolpos
    • Treat infections with antibiotics
    • Eliminate offending carbohydrate in intolerance
      –Lactase supplementation for lactose intolerance
      • Irritable bowel syndrome or functional pain
        –Identifying stressors may be helpful
        –Antispasmodics have similar action to placebo
        –Tricyclic antidepressants at low doses are helpful particularly if pain is associated with diarrhea
    • Counseling may be needed for chronic pain
    • Stop offending drugs if possible
    • Constipation
      –Disimpaction if significant fecal mass
      –Stool softeners/laxatives, increased dietary fiber
    • Drain abscess
    • PUD/GERD: Acid blockade therapy
    • Pancreatitis: Bowel rest, pain management

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    Back Pain: Treatment
    (In A Page: Pediatric Signs and Symptoms)

    • Muscular strain: Muscle relaxants, NSAIDs, rest, and reduction of exacerbating activities
    • Disk herniation: Physical therapy, surgery is rarely indicated in children and adolescents
    • Spondyloarthropathy: NSAIDs, exercise
    • Scoliosis: Conservative management with observation, NSAIDs, bracing or surgery if more severe
      • Gynocologic etiologies
        –Menstrual cramps: NSAIDs, OCPs for severe cases
        –PID: Appropriate cultures, treatment with antibiotics
        –Endometriosis: hormonal therapy such as OCPs may be effective, surgical ablation is rarely required
    • UTI: Antibiotics
    • Urolithiasis: Pain management followed by high fluid intake
    • Infection: Diskitis requires 4–6 weeks of IV antibiotics
    • Tumors: Referral to oncologist

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    Chest Pain: Treatment
    (In A Page: Pediatric Signs and Symptoms)

    • Most patients/families with chest pain simply want reassurance that symptoms are not cardiac in origin
    • A careful history and physical exam are most important; however, a normal CXR and ECG provide therapeutic reassurance to the patient/family
    • Further cardiology consultation is rarely required but should be considered with patients experiencing chest pain with exercise, a history of Kawasaki disease, Marfan syndrome (this is an emergency), and for those patients with persistent chest pain
    • Costochondritis: Treated with NSAIDs until resolved
    • Pericarditis: Treated with aspirin or NSAIDs; requires cardiology follow-up until resolved, rarely requires pericardiocentesis
    • Appropriate therapy of identified pulmonary, gastrointestinal, or musculoskeletal problems

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    Hip Pain: Treatment
    (In A Page: Pediatric Signs and Symptoms)

    • Septic arthritis, femoral neck fracture, and irreducible traumatic hip dislocation require immediate surgical intervention
    • Infectious disease consult for septic joint
    • Once surgical emergencies are ruled out, keeping the patient non-weight bearing on the affected extremity will allow continued investigation without further injury
    • SCFE: Prevent further slippage by percutaneous pinning or screw fixation
    • Legg-Calvé-Perthes: Treatment goals include restoring ROM, improving symptoms, and containing the femoral epiphysis during reossification phase; accomplished by limiting activity, traction, Petrie casting, and surgical procedures for containment
    • DDH: Pavlik harness, closed reduction and casting, open reduction for irreducible hip dislocation, or femoral and/or pelvic osteotomy depending on status and age of developing hip

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    Knee Pain: Treatment
    (In A Page: Pediatric Signs and Symptoms)

    • Septic arthritis requires immediate surgical intervention and, unlike hip sepsis, the knee may be easily ruled out by aspiration in either emergency room or clinic
    • Generally rest, ice, NSAID therapy, and short course of physical therapy to improve strength is the treatment of choice for many of the more common ailments, including bipartite patella, bursitis, patella subluxation, small osteochondritis dissecans lesions, ligament sprain, Osgood-Schlatter and Sinding-Larsen-Johanssen disorders
    • Knee immobilization is warranted in acute injuries and non-weight bearing when fracture or ligament injury is suspected, to allow time for diagnostic evaluation to be performed while keeping the patient comfortable and protected from further injury
    • Knee arthroscopy is minimally invasive and helpful with diagnosis or treatment in case of ligament repair, Osteochondritis dissecans repair and realignment procedures

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    Abdominal pain: Emergency interventions
    (Handbook of Signs & Symptoms (Third Edition))

    If the patient is experiencing sudden and severe abdominal pain, quickly take his vital signs and palpate pulses below the waist. Be alert for signs of hypovolemic shock, such as tachycardia and hypotension. Obtain I.V. access.

    Emergency surgery may be required if the patient also has mottled skin below the waist and a pulsating epigastric mass or rebound tenderness and rigidity.

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    Back pain: Emergency interventions
    (Handbook of Signs & Symptoms (Third Edition))

    If the patient reports acute, severe back pain, quickly take his vital signs, and then perform a rapid evaluation to rule out life-threatening causes. Ask him when the pain began. Can he relate it to any causes? For example, did the pain occur after eating? After falling on the ice? Have the patient describe the pain. Is it burning, stabbing, throbbing, or aching? Is it constant or intermittent? Does it radiate to the buttocks or legs? Does he have leg weakness? Does the pain seem to originate in the abdomen and radiate to the back? Has he had a pain like this before? What makes it better or worse? Is it affected by activity or rest? Is it worse in the morning or evening? Does it wake him up? Typically, visceral-referred back pain is unaffected by activity and rest. In contrast, spondylogenic-referred back pain worsens with activity and improves with rest. Pain of neoplastic origin is usually relieved by walking and worsens at night.

    If the patient describes deep lumbar pain unaffected by activity, palpate for a pulsating epigastric mass. If this sign is present, suspect a dissecting abdominal aortic aneurysm. Withhold food and fluid in anticipation of emergency surgery. Prepare for I.V. fluid replacement and oxygen administration. Monitor the patient's vital signs and peripheral pulses closely.

    If the patient describes severe epigastric pain that radiates through the abdomen to the back, assess him for absent bowel sounds and for abdominal rigidity and tenderness. If these occur, suspect a perforated ulcer or acute pancreatitis. Start an I.V. for fluids and drugs, administer oxygen, and insert a nasogastric tube while withholding food.

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    Chest pain: Emergency interventions
    (Handbook of Signs & Symptoms (Third Edition))

    Ask the patient when his chest pain began. Did it develop suddenly or gradually? Is it more severe or frequent now than when it first started? Does anything relieve the pain? Does anything aggravate the pain? Ask the patient about associated symptoms. Sudden, severe chest pain requires prompt evaluation and treatment because it may herald a life-threatening disorder. (See Managing severe chest pain, pages 134 and 135.)

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    Eye pain: Emergency interventions  
    (Handbook of Signs & Symptoms (Third Edition))

    If the patient's eye pain results from a chemical burn, remove contact lenses, if present, and irrigate the eye with at least 1 L of normal saline solution over 10 minutes. Evert the lids and wipe the fornices with a cotton-tipped applicator to remove any particles or chemicals. Eye pain from acute angle-closure glaucoma is an ocular emergency requiring immediate intervention to reduce intraocular pressure (IOP). If drug treatment doesn't reduce IOP, the patient will need laser iridotomy or surgical peripheral iridectomy to save his vision.

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    Flank pain: Emergency interventions
    (Handbook of Signs & Symptoms (Third Edition))

    If the patient has suffered trauma, quickly look for a visible or palpable flank mass, associated injuries, CVA pain, hematuria, Turner’s sign, and signs of shock, such as tachycardia and cool, clammy skin. If one or more is present, insert an I.V. line to allow fluid or drug infusion. Insert an indwelling urinary catheter to monitor urine output and evaluate hematuria. Obtain blood samples for typing and crossmatching, a complete blood count, and electrolyte levels.

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    Neck pain: Emergency interventions
    (Handbook of Signs & Symptoms (Third Edition))

    If the patient’s neck pain is due to trauma, first ensure proper cervical spine immobilization, preferably with a long backboard and a Philadelphia collar. (See Applying a Philadelphia collar, page 430.) Then take his vital signs, and perform a quick neurologic examination. If he shows signs of respiratory distress, give oxygen. Intubation or tracheostomy and mechanical ventilation may be necessary. Ask the patient (or a family member, if the patient can’t answer) how the injury occurred. Then examine the neck for abrasions, swelling, lacerations, erythema, and ecchymoses.

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    Pain disorder: Treatment
    (Professional Guide to Diseases (Eighth Edition))

    In pain disorder, treatment aims to ease the pain and help the patient live with it. Thus, long, invasive evaluations and surgical interventions are avoided. Treatment at a comprehensive pain center may be helpful. Supportive measures for pain relief may include hot or cold packs, physical therapy, distraction techniques, and cutaneous stimulation with massage or transcutaneous electrical nerve stimulation. Measures to reduce the patient’s anxiety may help, as may an antidepressant medication such as a tricyclic antidepressant.

    A continuing, supportive relationship with an understanding health care professional is essential for effective management; regularly scheduled follow-up appointments are helpful.

    Analgesics become an issue because the patient believes that she has to “fight to be taken seriously.” She should clearly be told what medication she will receive in addition to supportive pain-relief measures. Regularly scheduled analgesic doses can be more effective than scheduling medication as needed. Regular doses combat pain by reducing anxiety about asking for medication, and they eliminate unnecessary confrontations. The use of placebos will destroy trust when the patient discovers deceit.

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    Complex regional pain syndrome: Treatment
    (Professional Guide to Diseases (Eighth Edition))

    Treatment typically includes a combination of therapies such as drug therapy, with an anti-inflammatory, antidepressant, vasodilator, and analgesic used singly or in varying combinations, depending on the patient and the severity of symptoms. Steroids may be given in some patients; others may be given bone loss medications such as Actonel. Physical therapy to the injured area, application of heat and cold, the use of a transcutaneous electrical nerve stimulator unit, biofeedback, and psychological support are helpful for some patients.

    Treatment may also include techniques for interrupting the hyperactivity of the sympathetic nervous system, such as nerve or regional blocks. Surgical sympathectomy — radical surgery that involves cutting the nerves to destroy the pain — may be done in severe cases; however, this method is rarely used because other sensation may be destroyed in the process.

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    Breast pain [Mastalgia]: Patient counseling
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Advise the patient to wear a bra that cups and supports the entire breast and has wide shoulder and back straps. Warm or cold compresses may be helpful. Teach the patient how to perform breast self-examination, and instruct her to call the physician immediately if she detects any breast changes.

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    Eye pain [Ophthalmalgia]: Emergency interventions
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    If the patient’s eye pain results from a chemical burn, remove contact lenses (if present) and irrigate the eye with at least 1 L of normal saline solution over 10 minutes. Evert the lids and wipe the fornices with a cotton-tipped applicator to remove any particles or chemicals. Eye pain from acute angle-closure glaucoma is an ocular emergency requiring immediate intervention to decrease intraocular pressure (IOP). If drug treatment doesn’t reduce IOP, the patient will need laser iridotomy or surgical peripheral iridectomy to save his vision.

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    Abdominal pain: Emergency interventions
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    If the patient is experiencing sudden and severe abdominal pain, quickly take his vital signs and palpate pulses below the waist. Be alert for signs of hypovolemic shock, such as tachycardia and hypotension. Obtain I.V. access.

    Emergency surgery may be required if the patient also has mottled skin below the waist and a pulsating epigastric mass or rebound tenderness and rigidity.

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    Arm pain: Patient counseling
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Advise a patient with a cast to notify his physician if he detects worsening swelling, purple discoloration of fingers, or numbness or tingling because these signs may represent vascular compliance due to a tight cast. Also, inform a patient with angina that arm pain, usually left-sided, may represent an ischemic event, especially if accompanied by diaphoresis, nausea, vomiting, and anxiety.

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    Back pain: Emergency interventions
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    If the patient reports acute, severe back pain, quickly take his vital signs; then perform a rapid evaluation to rule out life-threatening causes. Ask him when the pain began. Can he relate it to any causes? For example, did the pain occur after eating? After falling on the ice? Have the patient describe the pain. Is it burning, stabbing, throbbing, or aching? Is it constant or intermittent? Does it radiate to the buttocks or legs? Does he have leg weakness? Does the pain seem to originate in the abdomen and radiate to the back? Has he had a pain like this before? What makes it better or worse? Is it affected by activity or rest? Is it worse in the morning or evening? Does it wake him up? Typically, visceral-referred back pain is unaffected by activity and rest. In contrast, spondylogenic-referred back pain worsens with activity and improves with rest. Pain of neoplastic origin is usually relieved by walking and worsens at night.

    If the patient describes deep lumbar pain unaffected by activity, palpate for a pulsating epigastric mass. If this sign is present, suspect dissecting abdominal aortic aneurysm. Withhold food and fluid in anticipation of emergency surgery. Prepare for I.V. fluid replacement and oxygen administration.

    If the patient describes severe epigastric pain that radiates through the abdomen to the back, assess him for absent bowel sounds and for abdominal rigidity and tenderness. If these occur, suspect a perforated ulcer or acute pancreatitis. Start an I.V. line for fluids and drugs, administer oxygen, and insert a nasogastric tube while withholding food.

    READ FULL BOOK TEXT ONLINE »

    Chest pain: Emergency interventions
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Ask the patient when his chest pain began. Did it develop suddenly or gradually? Is it more severe or frequent now than when it first started? Does anything relieve the pain? Does anything aggravate it? Ask the patient about associated symptoms. Sudden, severe chest pain requires prompt evaluation and treatment because it may herald a life-threatening disorder. (See Managing severe chest pain, pages 162 and 163.)

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    Facial pain: Patient counseling
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    If appropriate, instruct the patient with trigeminal neuralgia to avoid stressful situations, hot and cold foods, and sudden jarring movements, which can trigger painful attacks.

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    Flank pain: Emergency interventions
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    If the patient has suffered trauma, quickly look for a visible or palpable flank mass, associated injuries, CVA pain, hematuria, Turner’s sign, and signs of shock (such as tachycardia and cool, clammy skin). If one or more of these signs is present, insert an I.V. line to allow fluid or drug infusion. Insert an indwelling urinary catheter to monitor urine output and evaluate hematuria. Obtain blood samples for typing and crossmatching, complete blood count, and electrolyte levels.

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    Jaw pain: Emergency Interventions
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Ask the patient when the jaw pain began. Did it arise suddenly or gradually? Is it more severe or frequent now than when it first occurred? Sudden severe jaw pain, especially when associated with chest pain, shortness of breath, or arm pain, requires prompt evaluation because it may herald a life-threatening disorder. Perform an electrocardiogram and obtain blood samples for cardiac enzyme levels. Administer oxygen, morphine sulfate, and a vasodilator as indicated.

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    Leg Pain: Emergency Interventions
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    If the patient has acute leg pain and a history of trauma, quickly take his vital signs and determine the leg’s neuro-vascular status. Observe the patient’s leg position and check for swelling, gross deformities, or abnormal rotation. Also, be sure to check distal pulses and note skin color and temperature. A pale, cool, and pulseless leg may indicate impaired circulation, which may require emergency surgery.

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    Neck pain: Emergency Interventions
    (Professional Guide to Signs & Symptoms (Fifth Edition))

     If the patient’s neck pain is due to trauma, first ensure proper cervical spine immobilization, preferably with a long backboard and a Philadelphia collar. (See Applying a Philadelphia collar, page 546.) Then take vital signs, and perform a quick neurologic examination. If he shows signs of respiratory distress, give oxygen. Intubation or tracheostomy and mechanical ventilation may be necessary. Ask the patient (or a family member, if the patient can’t answer) how the injury occurred. Then examine the neck for abrasions, swelling, lacerations, erythema, and ecchymoses.

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    Rectal pain: Patient counseling
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Teach the patient how to apply hot, moist compresses. Teach him how to give himself a sitz bath; this will ease his discomfort by helping to relieve the sphincter spasm associated with most anorectal disorders. Stress the importance of following a proper diet and drinking plenty of fluids to maintain soft stools and thus avoid aggravating pain during defecation.

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    Throat pain: Patient counseling
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    If the patient is taking antibiotics, stress the importance of completing the 10-day course of treatment, even if symptoms improve after only a few days. Tell the patient that he’s presumed noninfectious after 24 hours of antibiotic coverage. Suggest gargling with salt water to soothe the throat.

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    Complex regional pain syndrome: Treatment
    (Handbook of Diseases)

    Treatment options include drug therapy (such as an anti-inflammatory, an antidepressant, a vasodilator, and an analgesic), physical therapy to the injured area, and psychological support.

    Techniques for interrupting the hyperactivity of the sympathetic nervous system, such as nerve or regional blocks, may also be included.

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    Abdominal pain: Nursing considerations
    (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

    Help the patient find a comfortable position to ease his distress. A supine position, with his head flat on the table, arms at his sides, and knees slightly flexed, will relax the abdominal muscles. Monitor him closely because abdominal pain can signal a life-threatening disorder.

    ALERT: Be particularly vigilant for such indications as tachycardia, hypotension, clammy skin, abdominal rigidity, rebound tenderness, a change in the pain’s location or intensity, or sudden relief from the pain, which indicate a ruptured abdominal aortic aneurysm. Notify the physician immediately and prepare the patient for emergency surgery. Initiate oxygen therapy, verify that a patent I.V. line is in place, and administer fluids or blood products as ordered.

    Withhold analgesics to avoid masking symptoms that may help to determine the diagnosis; also, withhold food and fluids because the patient may require surgery. Prepare for I.V. infusion and insertion of a nasogastric or other intestinal tube. Peritoneal lavage or abdominal paracentesis may also be required.

    Patient teaching

    Inform the patient that pain relief medications may not be ordered immediately because such agents can mask findings that would facilitate diagnosis. Analgesics can also interfere with surgical medications and might therefore be withheld until it’s determined whether surgery will be necessary. Teach the patient how to use positioning to help alleviate discomfort. Inform him about what to expect from diagnostic testing, which may include pelvic and rectal examinations, X-rays and computed tomography scans, barium studies, and collection of blood, urine, and stool samples. Ultrasonography, endoscopy, and biopsy may also be performed. If surgery is needed, provide preoperative teaching.

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    Back pain: Nursing considerations
    (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

    Monitor the patient closely if the type and location of back pain suggest a life-threatening cause. Stay alert for increasing pain, altered neurovascular status in the legs, loss of bowel or bladder control, altered vital signs, sweating, and cyanosis.

    Until a tentative diagnosis is made, withhold analgesics to avoid masking symptoms. Withhold food and fluids until it’s determined whether the patient requires surgery. Once a medical emergency is ruled out, make him as comfortable as possible by elevating the head of the bed, placing a pillow under his knees, and administering pain medications. Prepare the patient for a rectal or pelvic examination, routine blood tests, urinalysis, computed tomography scan, biopsies, and X-rays of the chest, abdomen, and spine.

    Fit the patient for a corset or lumbosacral support. Refer him to a physical therapist, occupational therapist, massage therapist, or psychologist, as indicated.

    Patient teaching

    Explain all tests and procedures. Instruct the patient not to wear a lumbosacral support in bed. Describe such pain-relief measures as cold therapy, warm baths, mattress choices, and backboards. Instruct the patient and his family about relaxation techniques, such as deep breathing, biofeedback, and transcutaneous electrical nerve stimulation.

    If the patient has chronic back pain, reinforce instructions about bed rest, analgesics, anti-inflammatory medications, and exercise. (See Exercises for chronic low back pain, page 41.) Help him recognize the need to make lifestyle changes, such as losing weight or correcting poor posture. Advise the patient with acute back pain secondary to a musculoskeletal problem to continue his daily activities as tolerated rather than staying on total bed rest.

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    Chest pain: Nursing considerations
    (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

    As needed, prepare the patient for cardiopulmonary studies, such as an ECG and a lung scan. Perform a venipuncture to collect a serum sample for cardiac enzyme and other studies. Assess the cardiovascular system frequently. Interpret changes in cardiac rhythm. Be prepared for emergency procedures.

    Keep in mind that a patient with chest pain may deny his discomfort, so stress the importance of reporting symptoms to allow adjustment of his treatment.

    Patient teaching

    Explain the purpose and procedure of each diagnostic test to the patient to help alleviate his anxiety. Prepare him if cardiac catheterization or fibrinolytic therapy is indicated. Explain the purpose of any prescribed drugs and make sure that he understands the dosage, schedule, and possible adverse effects. Teach the patient with coronary artery disease to recognize the typical features of cardiac ischemia as well as symptoms that require prompt medical attention. Teach him how to administer sublingual nitroglycerin and advise him to seek medical attention if the pain lasts more than 20 minutes, fails to respond to nitroglycerin, or has a different pattern than the usual angina.

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    Eye pain: Nursing considerations
    (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

    To help ease eye pain, have the patient lie down in a darkened, quiet environment and close his eyes. Prepare him for diagnostic studies, including tonometry and orbital X-rays. Prepare to irrigate the eye, as ordered.

    Patient teaching

    Tell the patient that it’s important to seek medical help for eye pain and stress the importance of meticulous compliance with drug therapy to prevent an increase in IOP.

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    Flank pain: Nursing considerations
    (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

    Administer pain medication. Continue to monitor the patient’s vital signs, and maintain a precise record of the patient’s intake and output.

    Diagnostic evaluation may involve serial urine and serum analysis, excretory urography, flank ultrasonography, computed tomography scan, voiding cystourethrography, cystoscopy, and retrograde ureteropyelography, urethrography, and cystography.

    Patient teaching

    Provide information on the importance of increased fluid intake, unless contraindicated. Explain signs and symptoms that are imperative to report. Emphasize the importance of taking drugs as prescribed. Stress the importance of keeping follow-up appointments.

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    Jaw pain: Nursing considerations
    (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

    If the patient is in severe pain, withhold food, liquids, and oral medications until the diagnosis is confirmed. Administer an analgesic. Prepare the patient for diagnostic tests such as jaw X-rays. Apply an ice pack if the jaw is swollen, and discourage the patient from talking or moving his jaw.

    Patient teaching

    Instruct the patient on measures to relieve jaw discomfort depending on the source of the pain. Inform patients of the link between sudden severe jaw pain and cardiac dysfunction and to seek medical assistance immediately.

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    Neck pain: Nursing considerations
    (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

    Promote the patient’s comfort by giving an anti-inflammatory and an analgesic, as needed. Prepare him for diagnostic tests, such as X-rays, computed tomography scan, blood tests, and cerebrospinal fluid analysis.

    Patient teaching

    Inform the patient about the need for activity restrictions. Teach him how to apply the cervical collar, if needed. Reinforce the importance of performing exercises, as indicated.

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    Abdominal pain: Emergency Actions
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    If the patient is experiencing sudden and severe abdominal pain, quickly take his vital signs and palpate pulses below the waist. Be alert for signs of hypovolemic shock, such as tachycardia and hypotension. Obtain I.V. access. Emergency surgery may be required if the patient also has mottled skin below the waist and a pulsating epigastric mass or rebound tenderness and rigidity.

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    Arm pain: Patient counseling
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Advise a patient with a cast to notify his physician if he detects any worsening swelling, purple discoloration of fingers, or numbness or tingling because these signs may represent circulatory impairment due to a tight cast. Also advise patients with angina that arm pain, usually left-sided, may represent an ischemic event, especially if accompanied by diaphoresis, nausea, vomiting, and anxiety.

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    Back pain: Patient counseling
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    If the patient has chronic back pain, reinforce instructions about bed rest, analgesics, anti-inflammatories, and exercise. Also, suggest that he take daily warm baths to help relieve pain. Help the patient recognize the need to make necessary lifestyle changes, such as losing weight or correcting poor posture. Advise patients with acute back pain secondary to a musculoskeletal problem to continue their daily activities as tolerated, rather than staying on total bed rest.

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    Breast pain: Patient counseling
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Advise the patient to wear a brassiere that cups and supports the entire breast with wide shoulder and back straps. Warm or cold compresses may be helpful. Teach the patient how to perform breast self-examination, and instruct her to call the physician immediately if she detects any breast changes.

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    Chest pain: Patient counseling
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Teach patients with coronary artery disease about the typical features of cardiac ischemia as well as the symptoms that should prompt them to seek medical attention. If the pain fails to disappear after sublingual nitroglycerin, lasts more than 20 minutes, or has a different pattern from the usual angina, the patient must be evaluated immediately.

    Explain the purpose and procedure of each diagnostic test to the patient to help alleviate his anxiety. Also explain the purpose of any prescribed drugs, and make sure that the patient understands the dosage, schedule, and possible adverse effects.

    Keep in mind that a patient with chest pain may deny his discomfort, so stress the importance of reporting symptoms to allow adjustment of his treatment.

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    Eye pain: Emergency Actions
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    If the patient’s eye pain results from a chemical burn, remove contact lenses, if present, and irrigate the eye with at least  1 L of normal saline solution over 10 minutes. Evert the lids and wipe the fornices with a cotton-tipped applicator to remove any particles or chemicals. Eye pain from acute angle-closure glaucoma is an ocular emergency requiring immediate intervention to decrease intraocular pressure (IOP). If drug treatment doesn’t reduce IOP, the patient needs laser iridotomy or surgical peripheral iridectomy to save vision.

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    Facial pain: Patient counseling
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    If appropriate, instruct the patient with trigeminal neuralgia to avoid stressful situations, hot or cold foods, and sudden jarring movements, which can trigger painful attacks. Tell the patient with a history of coronary artery disease to report episodes of jaw pain.

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    Flank pain: Emergency Actions
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    If the patient has suffered trauma, quickly look for a visible or palpable flank mass, associated injuries, CVA pain, hematuria, Turner’s sign, and signs of shock (such as tachycardia and cool, clammy skin). If one or more is present, insert an I.V. line to allow fluid or drug infusion. Insert an indwelling urinary catheter to monitor urine output and evaluate hematuria. Obtain blood samples for typing and crossmatching, complete blood count, and electrolyte levels.

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    Jaw pain: Emergency Actions
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Sudden severe jaw pain, especially when associated with chest pain, shortness of breath, or arm pain, requires prompt evaluation because it may herald a life-threatening disorder. Perform an electrocardiogram and obtain blood samples for cardiac enzyme levels. Administer oxygen, morphine sulfate, and a vasodilator as indicated.

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    Leg pain: Emergency Actions
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    If the patient has acute leg pain and a history of trauma, quickly take his vital signs and determine the leg’s neurovascular status. Observe the patient’s leg position, and check for swelling, gross deformities, or abnormal rotation. Also be sure to check distal pulses and note skin color and temperature. A pale, cool, and pulseless leg may indicate impaired circulation, which may require emergency surgery.

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    Neck pain: Emergency Actions
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    If the patient’s neck pain is due to trauma, first ensure proper cervical spine immobilization, preferably with a long backboard and a Philadelphia collar. (See Applying a Philadelphia collar.) Then take vital signs and perform a quick neurologic examination. If he shows signs of respiratory distress, give oxygen. Intubation or tracheostomy and mechanical ventilation may be necessary. Ask the patient (or a family member, if the patient can’t answer) how the injury occurred. Then examine the neck for abrasions, swelling, lacerations, erythema, and ecchymoses.

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    Rectal pain: Patient counseling
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Teach the patient how to apply hot, moist compresses. Also teach him how to give himself a sitz bath; this will ease his discomfort by helping to relieve the sphincter spasm associated with most anorectal disorders. Stress the importance of following a proper diet and drinking plenty of fluids to maintain soft stools and thus avoid aggravating pain during defecation.

    READ FULL BOOK TEXT ONLINE »

    Throat pain: Patient counseling
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    If the patient is taking antibiotics, stress the importance of completing the full course of treatment, even if symptoms improve after only a few days. Tell the patient that he’s presumed noninfectious after 24 hours of antibiotic coverage. Suggest gargling with salt water to soothe the throat.

    READ FULL BOOK TEXT ONLINE »

    Breast pain [Mastalgia]: Nursing considerations
    (Nursing: Interpreting Signs and Symptoms)

    ▪ Provide emotional support for the patient.

    ▪ Prepare the patient for diagnostic tests, such as mammography, ultrasonography, thermography, cytology of nipple discharge, biopsy, or culture of any aspirate.

    Patient teaching

    ▪ Explain the importance of clinical breast examination and mammography following the American Cancer Society guidelines.

    ▪ Teach the patient how to perform breast self-examination.

    ▪ Explain the use of warm or cold compresses.

    ▪ Instruct the patient on the correct type of brassiere.

    ▪ Teach the patient about the cause of her breast pain and the treatment plan after a diagnosis is established.

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    Eye pain [Ophthalmalgia]: Nursing considerations
    (Nursing: Interpreting Signs and Symptoms)

    ▪ To help ease eye pain, have the patient lie down in a darkened, quiet environment and close his eyes.

    ▪ Prepare the patient for diagnostic studies, including tonometry and orbital X-rays.

    Patient teaching

    ▪ Stress the importance of following instructions for drug therapy.

    ▪ Teach the patient about ways to protect the eyes.

    ▪ Tell that the patient that he should seek medical attention for any eye pain.

    ▪ Explain the underlying cause of the patient's eye pain and its treatment.

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    Abdominal pain: Nursing considerations
    (Nursing: Interpreting Signs and Symptoms)

    ▪ Place the patient in a position of comfort.

    ▪ Monitor him for tachycardia, hypotension, clammy skin, abdominal rigidity, rebound tenderness, a change in the pain's location or intensity, or sudden relief from the pain since abdominal pain can signal a life-threatening disorder.

    ▪ Administer analgesics, as ordered, and evaluate their effect.

    ▪ Withhold food and fluids because surgery may be needed.

    ▪ Prepare for I.V. infusion and insertion of a nasogastric or other intestinal tube.

    ▪ Anticipate the need for peritoneal lavage or abdominal paracentesis.

    ▪ Prepare the patient for diagnostic procedures, such as a pelvic and rectal examination; blood, urine, and stool tests; imaging studies; barium studies; ultrasonography; endoscopy; and biopsy.

    Patient teaching

    ▪ Explain the diagnostic tests the patient will need.

    ▪ Explain the underlying disorder and treatment plan.

    ▪ Explain which foods and fluids the patient shouldn't have.

    ▪ Tell the patient to report any changes in bowel habits.

    ▪ Instruct the patient how to position himself to alleviate symptoms.

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    Arm pain: Nursing considerations
    (Nursing: Interpreting Signs and Symptoms)

    ▪ If you suspect a fracture, apply a sling or splint to immobilize the arm, and monitor the patient for worsening pain, numbness, or decreased circulation distal to the injury site.

    ▪ Monitor the patient's vital signs, and be alert for tachycardia, hypotension, and diaphoresis.

    ▪ Withhold food, fluids, and analgesics until potential fractures are evaluated.

    ▪ Promote the patient's comfort by elevating his arm and applying ice.

    ▪ Clean abrasions and lacerations and apply dry, sterile dressings, if necessary.

    ▪ Prepare the patient for X-rays or other diagnostic tests.

    ▪ Administer analgesics, as appropriate, and evaluate their effectiveness.

    ▪ Treat the underlying cause, such as MI, appropriately.

    Patient teaching

    ▪ Explain the signs and symptoms of circulatory impairment caused by a tight cast that requires immediate treatment.

    ▪ Discuss the signs and symptoms of an ischemic event.

    ▪ Teach the patient about the cause of arm pain and the treatment plan after the diagnosis is determined.

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    Back pain: Nursing considerations
    (Nursing: Interpreting Signs and Symptoms)

    ▪ Monitor the patient closely if the back pain suggests a life-threatening cause.

    ▪ Be alert for increasing pain, altered neurovascular status in the legs, loss of bowel or bladder control, altered vital signs, sweating, and cyanosis.

    ▪ Withhold food and fluids in case surgery is necessary.

    ▪ Administer analgesics, as ordered, and evaluate their effect.

    ▪ Make the patient as comfortable as possible by elevating the head of the bed and placing a pillow under his knees.

    ▪ Encourage relaxation techniques such as deep breathing.

    ▪ Anticipate diagnostic testing, such as routine blood tests, urinalysis, a computed tomography scan, magnetic resonance imaging, appropriate biopsies, and X-rays of the chest, abdomen, and spine.

    ▪ Fit the patient for a corset or lumbosacral support.

    ▪ Provide heat or cold therapy, a backboard, a convoluted foam mattress, or pelvic traction, as ordered.

    ▪ Refer the patient to other professionals, such as a physical therapist, an occupational therapist, or a psychologist, if indicated.

    Patient teaching

    ▪ Explain pain-relief measures to the patient.

    ▪ Teach him about alternatives to analgesic drug therapy, such as biofeedback and transcutaneous electrical nerve stimulation.

    ▪ Provide information about use of anti-inflammatory drugs and analgesics.

    ▪ Discuss lifestyle changes, such as weight loss or correcting posture.

    ▪ Teach relaxation techniques such as deep breathing.

    ▪ Instruct the patient on correct use of corset or lumbosacral support.

    ▪ Explain diagnostic tests and procedures.

    ▪ Teach the patient about the cause of his back pain and the treatment plan.

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    Chest pain: Nursing considerations
    (Nursing: Interpreting Signs and Symptoms)

    ▪ Prepare the patient for cardiopulmonary studies, such as an electrocardiogram, chest X-ray, magnetic resonance imaging, and a lung perfusion scan.

    ▪ Collect a serum sample for cardiac enzyme and electrolyte levels.

    ▪ Provide emotional support because chest pain produces increased anxiety.

    Patient teaching

    ▪ Explain the purpose and procedure of each diagnostic test to the patient to help alleviate his anxiety.

    ▪ Teach the patient about the cause of his chest pain once a diagnosis is established.

    ▪ Explain the purpose of any prescribed drugs, and make sure that the patient understands the dosage, schedule, and possible adverse effects.

    ▪ Stress the importance of reporting symptoms to allow for the adjustment of treatment.

    ▪ Teach the patient with coronary artery disease about the typical features of cardiac ischemia as well as the symptoms that should prompt him to seek immediate medical attention.

    ▪ Discuss lifestyle changes that can reduce the risk of coronary artery disease.

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    Flank pain: Nursing considerations
    (Nursing: Interpreting Signs and Symptoms)

    ▪ Administer pain medication and evaluate effect.

    ▪ Monitor the patient's vital signs.

    ▪ Maintain a precise record of his intake and output.

    ▪ Prepare the patient for tests, such as serial urine and serum analysis, excretory urography, flank ultrasonography, a computed tomography scan, voiding cystourethrography, cystoscopy, and retrograde ureteropyelography, urethrography, and cystography.

    Patient teaching

    ▪ Teach the patient about the underlying cause of flank pain.

    ▪ Describe the treatment plan and the need for follow-up care.

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    Jaw pain: Nursing considerations
    (Nursing: Interpreting Signs and Symptoms)

    ▪ If the patient is in severe pain, withhold food, liquids, and oral medications until the diagnosis is confirmed.

    ▪ Administer an analgesic as ordered, and monitor effect.

    ▪ Prepare the patient for diagnostic tests such as jaw X-rays.

    ▪ Apply an ice pack if the jaw is swollen, and discourage the patient from talking or moving his jaw.

    Patient teaching

    ▪ Explain the disorder and the treatments to the patient.

    ▪ Teach the patient the proper way to insert mouth splints.

    ▪ Discuss ways to reduce stress.

    ▪ Explain the identification and avoidance of triggers.

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    Leg pain: Nursing considerations
    (Nursing: Interpreting Signs and Symptoms)

    ▪ If the patient has acute leg pain, closely monitor his neurovascular status by frequently checking distal pulses and evaluating the legs for temperature, color, and sensation.

    ▪ Monitor thigh and calf circumference to evaluate bleeding into tissues from a possible fracture site.

    ▪ Prepare the patient for X-rays.

    ▪ Use sandbags to immobilize his leg; apply ice and, if needed, skeletal traction.

    ▪ If a fracture isn't suspected, prepare the patient for laboratory tests to detect an infectious agent or for venography, Doppler ultrasonography, plethysmography, or angiography to determine vascular competency.

    ▪ Withhold food and fluids until the need for surgery has been ruled out.

    ▪ Administer an anticoagulant and antibiotic as needed.

    Patient teaching

    ▪ Explain the use of anti-inflammatory drugs, ROM exercises, and assistive devices.

    ▪ Discuss lifestyle changes that should be made.

    ▪ Teach appropriate positioning to enhance blood flow and venous return.

    ▪ Discuss the need for physical therapy.

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    Neck pain: Nursing considerations
    (Nursing: Interpreting Signs and Symptoms)

    ▪ Promote patient comfort by giving an anti-inflammatory and an analgesic, as needed.

    ▪ Assist the patient to find positions that make him most comfortable.

    ▪ Prepare him for diagnostic tests, such as X-rays, a computed tomography scan, blood tests, and cerebrospinal fluid analysis.

    Patient teaching

    ▪ Teach the patient how to apply a cervical collar, as appropriate.

    ▪ Explain any activity restrictions.

    ▪ Check that the patient knows how to perform any prescribed exercises correctly.

    ▪ Teach about medications and their adverse effects.

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    Rectal pain: Nursing considerations
    (Nursing: Interpreting Signs and Symptoms)

    ▪ Apply analgesic ointment or suppositories.

    ▪ Administer a stool softener if needed.

    ▪ If the rectal pain results from prolapsed hemorrhoids, apply cold compresses to help shrink protruding hemorrhoids, prevent thrombosis, and reduce pain.

    ▪ If the patient's condition permits, place him in Trendelenburg's position with his buttocks elevated to further relieve pain.

    ▪ Prepare the patient for an anoscopic examination and proctosigmoidoscopy to determine the cause of the rectal pain, if indicated.

    ▪ Because the patient may feel embarrassed, provide emotional support and as much privacy as possible.

    Patient teaching

    ▪ Explain the disorder and treatment plan.

    ▪ Instruct the patient on measures to ease discomfort.

    ▪ Discuss proper diet and fluid intake.

    ▪ Explain the use of stool softeners.

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    Throat pain: Nursing considerations
    (Nursing: Interpreting Signs and Symptoms)

    ▪ Provide analgesic sprays or lozenges to relieve throat pain.

    ▪ Prepare the patient for throat culture, complete blood count, and a Monospot test.

    Patient teaching

    ▪ Explain the underlying disorder and treatment plan.

    ▪ Explain the importance of taking the full course of antibiotics, as ordered.

    ▪ Discuss ways to soothe the throat.

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    Medications used to treat Pain:

    Note:You must always seek professional medical advice about any treatment or change in treatment plans.

    Some of the different medications used in the treatment of Pain include:

    • Etodolac
    • Lodine
    • Lodine XL
    • Aspirin
    • Acetylsalicylic acid
    • ASA
    • Added Strength Analgesic Pain Reliever
    • Adult Strength Pain Reliever
    • Aggrenox
    • Alka-Seltzer Effervescent Pain Reliever and Antacid
    • Alka-Seltzer Night Time
    • Alka-Seltzer Plus
    • Alka-Seltzer Plus Cold
    • Anacin
    • Anacin Maximum Strength
    • Anacin w/Codeine
    • Ancasal
    • APC
    • APC w/Codeine
    • APO-ASA
    • Arthritis Pain Formula
    • Arthritis Strength Bufferin
    • A.S.A. Enseals
    • Asasantine
    • Ascriptin
    • Ascriptin A/D
    • Aspergum
    • Aspirin PROTECT
    • Asprimox
    • Astrin
    • Axotal
    • Azdone
    • Bayer Aspirin
    • Bayer Children's Chewable Aspirin
    • Bayer Enteric Aspirin
    • Bayer Plus
    • BC Powder
    • Buffaprin
    • Bufferin
    • Bufferin Arthritis Strength
    • Bufferin Extra Strength
    • Bufferin w/Codeine
    • Cama Arthritis Pain Reliever
    • Cardioprin
    • Carisoprodol Compound
    • Cope
    • Coricidin
    • Coryphen
    • Coryphen-Codeine
    • C2 Buffered
    • Darvon Compound
    • Dorect Fpr,I;aru As[orom
    • Dristan
    • Easprin
    • Ecotrin
    • 8-Hour Bayer
    • Empirin
    • Empirin w/Codeine No. 2,4
    • Entrophen
    • Excedrin
    • Excedrin Extra Strength Geltabs
    • Excedrin Migraine
    • Fiorinal
    • Firoinal-C
    • Firoinal w/Codeine
    • Genacote
    • Genprin
    • Goody's Headache Powder
    • Halprin
    • Hepto
    • Lortab ASA
    • Low Dose Adult Chewable Aspirin
    • Marnal
    • Maximum Bayer Aspirin
    • Measurin
    • Midol Caplets
    • Momentum
    • Norgesic
    • Norgesic Forte
    • Norwich Aspirin
    • Mpvasem
    • Orphenadrine
    • PAP w/Codeine
    • Percodan
    • Percodan-Demi
    • Phenaphen
    • Phenaphen No. 2, 3, 4
    • Propoxyphene Compound
    • Riphen-10
    • Robaxisal
    • Robaxisal-C
    • Roxiprin
    • 692
    • SK-65 Compound
    • Soma Compound
    • St. Joseph Children's Aspirin
    • Supasa
    • Synalgos
    • Synalgos-DC Tablet
    • Triaphen-10
    • 217
    • 217 Strong
    • 292
    • Vanquish
    • Verin
    • Wesprin
    • Zorprin
    • Clonidine - usually used as a combination treatment for cancer pain
    • Apo-Clonidine - usually used as a combination treatment for cancer pain
    • Catapres - usually used as a combination treatment for cancer pain
    • Catapres-TTS - usually used as a combination treatment for cancer pain
    • Combipres - usually used as a combination treatment for cancer pain
    • Dixarit - usually used as a combination treatment for cancer pain
    • Duraclon - usually used as a combination treatment for cancer pain
    • Novo-Clonidine - usually used as a combination treatment for cancer pain
    • Nu-Clonidine - usually used as a combination treatment for cancer pain
    • Alamine Expectorant
    • Ambenyl Expectorant
    • Ambenyl Syrup
    • Codeine
    • A.B.C. Compound w/Codeine
    • Accopain
    • Actagen-C
    • Actifed w/Codeine
    • Alamine-C
    • Anacin 3 w/Codeine #2-4
    • Atasol-8,-15,-30
    • Ban-Tuss
    • Benylin Syrup w/Codeine
    • Bitex
    • Bromanyl Cough Syrup
    • Bromotuss
    • Bromphen DC
    • Brontex
    • Butalbital Compound
    • Chemdal Expectorant
    • Chem-Tuss NE
    • Cheracol
    • Chlor-Trimeton Expectorant
    • Coactifed
    • Codecon-C
    • Codehist DH
    • Codehist Elixir
    • Codeine Contin
    • Coricidin w/Codeine
    • Co-Dimetane Cough Syrup-DC
    • Dimetane Expectorant-C
    • Dimetapp-C
    • Dimetapp w/Codeine
    • Empracet-30,-60
    • Empracet w/Codeine No. 3,4
    • Emtec-30
    • Exdol-8,-15,-30
    • Extra Strength Acetaminophen with Codeine
    • Glydeine
    • Isoclor Expectorant
    • Lenoltec w/Codeine No. 1,2,3,4
    • Mersyndol
    • Naldecon-CS
    • Normatane
    • Novadyme DH
    • Novahistex C
    • Novo-Gesic
    • Nucochem
    • Nucofed
    • Omni-Tuss
    • Oridol-C
    • Panadol w/Codeine
    • Paveral
    • Pediacof
    • Penntuss
    • Phenaphen w/Codeine No. 2,3,4
    • Phenergan w/Codeine
    • Poly-Histine
    • Promethazine CS
    • Pyra-Phed
    • Robaxacet-8
    • Rounox w/Codeine
    • SK-Apap
    • Tamine Expectorant DC
    • Tecnal C
    • Terpin Hydrate and Codeine
    • 318 AC&C
    • Triafed w/Codeine
    • Triaminic Expectorant w/Codeine
    • Triatec-8,30
    • Tussaminic C Forte
    • Tussaminic C Ped
    • Tussi-Organidin
    • Tylenol w/Codeine
    • Tylenol w/Codeine No. 1,2,3,4
    • Tylenol w/Codeine Elixir
    • VC Expectorant w/Codeine
    • Veganin
    • Celecoxib - mainly used for nonarthritic pain
    • Celebrex - mainly used for nonarthritic pain
    • Rofecoxib - mainly used for nonarthritic pain
    • Vioxx - mainly used for nonarthritic pain
    • Valdecoxib - mainly used for nonarthritic pain
    • Bextra - mainly used for nonarthritic pain
    • Fenamate
    • Meclofenamate
    • Meclodium
    • Meclofenaf
    • Meclomen
    • Mefenamic Acid
    • Apo-Mefanamic
    • Novo-Mefanamic
    • Ponstel
    • Ponstan
    • Hydrocodone
    • Dihydrocodeinone
    • Allay
    • Alor 5/500
    • Anaplex
    • Anexsia
    • Anexsia 7.5
    • Anolor
    • Atuss
    • Ban-Tuss-HC
    • Biohisdex DHC
    • Biohisdine DHC
    • Chemdal-HD
    • Codone
    • Detussin
    • DHC Plus
    • Dicoril
    • Dimetane Expectorant-DC
    • Endal-HD
    • Entuss-D
    • Histinex-HC
    • Histussin HC
    • Hycodan
    • Hycomine
    • Hycomine Compound
    • Hycomine Pediatric Syrup
    • Hycomine-S
    • Hycomine Syrup
    • Hycotuss Expectorant
    • Lorcet-HD
    • Lorcet Plus
    • Lortab
    • Medipain 5
    • Norcet 7
    • Novahistex DH
    • Novahistine DH
    • Polygesic
    • Protuss
    • Robidone
    • Ru-Tuss
    • T-Gesic
    • Triaminic Expectorant DH
    • Tussaminic Expectorant DH
    • Tussend
    • Tussend Expectorant
    • Tussionex
    • Tycolet
    • Vanex
    • Vicodin
    • Vicodin ES
    • Vicoprofen
    • Zydone
    • Meperidine
    • Demerol
    • Demerol APAP
    • Mepergan
    • Pethadol
    • Pethidine
    • Morphine
    • Astramorph
    • Astramorph PF
    • Avinza
    • Duramorph
    • Epimorph
    • Infumorph
    • Kadian
    • M-Eslon
    • Morphine H.P
    • Morphitec
    • M.O.S
    • M.O.S.-S.R
    • MS Contin
    • MS-IR
    • OMS Concentrate
    • Opium Tincture
    • Oramorph SR
    • Paregoric
    • RMS Uniserts
    • Roxanol
    • Roxanol 100
    • Roxanol SR
    • Statex
    • Oxicams
    • Alti-Piroxicam
    • Apo-Piroxicam
    • Brexidol
    • Dom-Piroxicam
    • Feldene
    • Med-Pirocam
    • Novo-Pirocam
    • Nu-Pirox
    • Oxycodone
    • Endocet
    • Endodan
    • Oxycocet
    • Oxycodan
    • OxyContin
    • Percocet
    • Percocet-Demi
    • Roxicet
    • Roxicodone
    • Roxilox
    • SK-Oxycodone
    • Supeudol
    • Tylox
    • Pentazocine
    • Talacen
    • Talwin
    • Talwin Compound
    • Talwin Compound-50
    • Talwin Nx
    • Propionic Acid
    • Fenoprofen
    • Nalfon
    • Flurbiprofen
    • Ansaid
    • Apo-Flurbiprofen
    • Froben
    • Froben-SR
    • Novo-Flurbiprofen
    • Ocufen
    • Ibuprofen
    • Aches-N-Pain
    • Actiprofen
    • Advil
    • Advil Migraine
    • Amersol
    • Apo-Ibuprofen
    • Arthritis Foundation Pain Reliever/Fever Reducer
    • Bayer Select
    • Children's Advil
    • Children's Motrin
    • Children's Motrin Drops
    • Children's Motrin Suspension
    • CoAdvil
    • Dimetapp Sinus
    • Dologesic
    • Dristan Sinus
    • Excedrin IB
    • Genpril
    • Guildprofen
    • Haltran
    • Ibu
    • Ibuprohm
    • Junior Strength motrin Caplets
    • Medipren
    • Medi-Profen
    • Profen-IB
    • Rufen
    • Superior Pain Medicine
    • Supreme Pain Medicine
    • Tab-Profen
    • Ketoprofen
    • Actron
    • Apo-Keto
    • Apo-Keto E
    • Orudis
    • Orudis E-50
    • Orudis E-100
    • Orudis KT
    • Orudis SR
    • Oruvail
    • Oruvail ER
    • Oruvail SR
    • Rhodis
    • Rhodis EC
    • Rhodis EC Suppository
    • Naproxen
    • Aleve
    • Anaprox
    • Anaprox DS
    • Apo-Naproxen
    • Naprelan
    • Naprelan Once Daily
    • Naprosyn
    • Naxen
    • Neo-Prox
    • Novo-Naprox
    • Nu-Naprox
    • Synflex
    • Oxaprozin
    • Daypro
    • Tramadol
    • Ultram
    • Ultracet
    • Direct Formulary Aspirin
    • Halfprin
    • Novasen
    • Anacin 3 w/Codeine No. 2-4
    • Acetaminophen
    • Acephen
    • Aspirin Free Anacin Maximum Strength
    • Cetafen
    • Cetafen Extra
    • Comtrex Sore Throat Maximum Strength
    • ElixSure Fever/Pain
    • Fever ALL
    • Genapap
    • Genapap Children
    • Genapap Extra Strength
    • Genapap Infant
    • Genebs
    • Genebs Extra Strength
    • Mapap
    • Mapap Arthritis
    • Mapap Children's
    • Mapap Extra Strength
    • Mapap Infants
    • Redutemp
    • Silapap Children's
    • Silapap Infants
    • Tylenol
    • Tylenol 8 Hour
    • Tylenol Arthritis Pain
    • Tylenol Children's
    • Tylenol Extra Strength
    • Tylenol Infants
    • Tylenol Junior Strength
    • Tylenol Sore Throat
    • Valorin
    • Valorin Extra
    • Abenol
    • Apo-Acetaminophen
    • Atasol
    • Pediatrix
    • Tempra
    • Actafen
    • Androx
    • Datril
    • Magnidol
    • Neodol
    • Neodolito
    • Sedalito
    • Sinedol
    • Temperal
    • Tylex
    • Capital and Codeine
    • Ratio-Emtec
    • Ratio-Lenoltec
    • Triatec-8
    • Triatec-8 Strong
    • Triatec-30
    • Tylenol Elixir with Codeine
    • Tylenol No. 1
    • Tylenol No. 1 Forte
    • Tylenol No. 2 with Codeine
    • Tylenol No. 3 with Codeine
    • Tylenol No. 4 with Codeine
    • Acetaminophen and Pseudoephedrine
    • Alka-Seltzer Plus Cold and Sinus Liqui-Gels
    • Cetafen Cold
    • Genapap Sinus Maximum Strength
    • Mapap Sinus Maximum Strength
    • Medi-Synal
    • Omex
    • Omex Maximum Strength
    • Sinus-Relief
    • Sinutab
    • Sinutab Sinus
    • Sudafed Sinus and Cold
    • Sudafed Sinus Headache
    • SudoGest Sinus
    • Tylenol Cold, Infants
    • Tylenol Sinus, Children's
    • Tylenol Sinus Day Non-Drowsy
    • Dristan N.D
    • Dristan N.D., Extra Strength
    • Sinutab Non Drowsy
    • Sudafed Head Cold and Sinus Extra Strength
    • Tylenol Decongestant
    • Tylenol Sinus
    • Acetaminophen, Aspirin and Caffeine
    • Excedrin Extra Strength
    • Fem-Prin
    • Genaced
    • Goody's Extra Strength Headache Powder
    • Goody's Extra Strength Pain Relief
    • Pain-Off
    • Vanquish Extra Strength Pain Reliever
    • Acetaminophen, Dextromethorphan and Pseudoephedrine
    • Alka-Seltzer Plus Flu Liqui-Gels
    • Comtrex Non-Drowsy Cold and Cough Relief
    • Infants' Tylenol Cold Plus Cough Concentrated Drops
    • Contac Severe Cold and Flu/Non-Drowsy
    • Sudafed Severe Cold
    • Triaminic Cough and Sore Throat Formula
    • Tylenol Cold Day Non-Drowsy
    • Tylenol Flu Non-Drowsy Maxium Strength
    • Vicks DayQuil Multi-Symptom Cold and Flu
    • Contac Cough, Cold and Flu Day & Night
    • Sudafed Cold & Cough Extra Strength
    • Tylenol Cold Daytime
    • Aspercin
    • Aspercin Extra
    • Bayer Aspirin Regimen Adult Low Strength
    • Bayer Aspirin Regimen Children's
    • Bayer Aspirin Regimen Regular Strength
    • Bayer Extra Strength Arthritis Pain Regimen
    • Bayer Women's Aspirin Plus Calcium
    • Buffinol
    • Buffinol Extra
    • Ecotrin Low Strength
    • Ecotrin Maximum Strength
    • Sureprin 81
    • Asaphen
    • Asaphen E.C
    • ASA 500
    • Coraspir
    • Aspirin and Codeine
    • Empirin with Codeine
    • Cetacaine - mainly used as a topical anaesthetic
    • Benzocaine, Butyl Aminobenzoate, Tetracaine and Benzalkonium Chloride - mainly used as a topical anaesthetic
    • Orabase with Benzocaine - mainly used as a topical anaesthetic
    • Benzocaine, Gelatin, Pectin and Sodium Carboxymethycellulose - mainly used as a topical anaesthetic
    • Buprenorphine
    • Buprenex
    • Subutex
    • Temgesic
    • Butalbital, Aspirin, Caffeine and Codeine
    • Fiorinal with Codeine
    • Phrenlin with Caffeine and Codeine
    • Fiorinal-C 1/2
    • Fiorinal-C 1/4
    • Tecnal C 1/2
    • Tecnal C 1/4
    • Butorphanol
    • Stadol
    • Apo-Butorphanol
    • PMS-Butorphanol
    • Stadol NS
    • Diflunisal
    • Dolobid
    • Apo-Diflunisal
    • Novo-Diflunisal
    • Nu-Diflunisal
    • Duloxetine - mainly used to treat pain associated with diabetic neuropathy
    • Cymbalta - mainly used to treat pain associated with diabetic neuropathy
    • Floctafenine
    • Idarac
    • Hydromorphone
    • Dilaudid
    • Dilaudid-HP
    • Palladone
    • Dilaudid-HP-Plus
    • Dilaudid-XP
    • Hydromorph Contin
    • Hydromorphone HP
    • PMS-Hydromorphone
    • PlusDilaudid Sterile Powder
    • Levorphanol
    • Levo-Dromoran
    • Magnesium Salicylate
    • Doan's Doan's Extra Strength
    • Keygesic
    • Methotrimeprazine
    • Apo-Methoprazine
    • Novo-Meprazine
    • Nozinan
    • Levocina
    • Sinogan
    • Nalbuphine
    • Nubain
    • Bufigen
    • Nalcryn
    • Oxymorphonement
    • Numorphan
    • Pentazocine Compound
    • Piroxicam and Cyclodextrin
    • Brexidol 20
    • SalsalateAmigesic
    • Mono-Gesic
    • Salflex
    • Amigesic
    • Sodium Salicylate
    • Ziconotide
    • Prialt
    • Alfentanil
    • Rapifen
    • Palfium
    • Dextromoramide
    • Dextropropoxyphene
    • Doloxene
    • Capadex
    • Digesic
    • Paradex
    • Rubesal
    • Diethylamine Salicylate
    • Aceta
    • Anacin-3
    • Apacet
    • Banesin
    • Dapa
    • Dorcol
    • Halenol
    • Neopap
    • Valadol
    • 222 AF
    • Tantaphen
    • Algitrin
    • Analphen
    • Febrin
    • Minofen
    • Sinedol 500
    • Cilag
    • Winasorb
    • Tylex 750

    Unlabelled alternative drug treatments include:

    • Alprazolam - mainly used in combination with various narcotics to treat