Pain and Fever Fall 2012 (1)

Treatment nonpharmacologic warming up and stretching

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Treatment: Nonpharmacologic Warming-up and stretching prior to physical activity Hydration RICE therapy (rest, ice, compression, elevation) Heat therapy for noninflammatory pain
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Non-Pharmacologic Treatment Strategies RICE ( R est, I ce, C ompression, E levation) Helps  swelling and inflammation of muscle and joint injuries, especially for strains/sprains Rest injured area Can use slings or splints if needed Ice In 10-min increments 3-4 times/day x 12-24 hr (48-72 hr if injury more severe) Apply compression to injured area with elasticized bandage (e.g. ACE bandage) Elevate the injured area at or above the level of the heart
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Non-Pharmacologic Treatment Strategies Heat Can be used if pain is non-inflammatory May  pain by  blood flow to area Should not be used on: Recently injured or inflamed areas (< 48 hr)  May worsen tissue damage Open wounds Areas of  sensation Apply for 15-20 min 3-4 times/day Can use heating pad, hot water bottle, heat-generating adhesive products (e.g. Thermacare)
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Treatment: Pharmacologic NSAIDs and acetaminophen commonly used Scheduled doses, taper over 1-3 days Limit to 7 days of self-care Osteoarthritis of the hip and knee Acetaminophen 1st line therapy Ibuprofen MAX dose 3.2 grams (Prescription)
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Topical Products Adjunct to pharmacologic and nonpharmacologic therapy Properties Analgesic Anesthetic Antipruritic Counterirritant
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Counterirritants Applied to relieve minor aches and pains of muscles and joints Pain relief from nerve stimulation, not depression Producing a less severe pain to counter a more intense one Four groups Rubefacients Cooling sensation Vasodilators Incite irritation without rubefaction Directions: Apply no more than 3-4 times a day x 7 days
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Rubefacients Methyl salicylate Occurs naturally as wintergreen oil or sweet birch oil Produces a mild, local, inflammatory reaction Responsible for the “hot” feeling Example products: Bengay Flexall
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Cooling Sensation: Camphor Naturally found in the camphor tree Depresses cutaneous receptors (0.1-3%) Higher concentrations (>3%) stimulates nerve endings in the skin and induces relief of pain and discomfort by masking deeper visceral pain Example product: JointFlex Pain Relieving Cream
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Cooling Sensation: Menthol Prepared synthetically or extracted from peppermint oil Concentrations <1% - depresses cutaneous receptor responses Concentrations >1% - stimulates cutaneous receptor responses Example products: Aspercreme gel Icy Hot gel/patch
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Capsicum Preparations Capsaicin, capsicum, and capsicum oleoresin Capsaicin is the major ingredient of hot (chili) pepper Elicits a warm feeling, through stimulating the TRPV1 receptors Example products: Capzasin cream Zostrix cream
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Case 1 C.L. is a 29 year old female who is a recent law school graduate and has started a job at a reputable law firm working 12+ hour days.
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