Other Pain Syndromes

• Inflammation responds to NSAIDs but may need support from a low-efficacy opioid.

• Arthritis: see Chapter 15.

• Minor trauma, e.g. many sports injuries, is commonly treated by local skin cooling (spray of chlorofluoromethanes), counterirritants (see p. 302) and NSAIDs, e.g. diclofenac, systemically or topically.

• Severe trauma including postsurgical pain (p. 347) usually needs narcotic analgesics.

• Peripheral vascular insufficiency should be treated with non-narcotic analgesics but may eventually require low efficacy opioids; vasodilator drugs may, but equally may not, provide benefit.

• Malignant disease requires the full range of analgesics and adjuvant drugs and procedures (see Palliative care, below).

• Bone pain, including cancer metastases, requires NSAIDs alone and with opioids. Bisphosphonates, e.g. sodium pamidronate, sodium clodronate, relieve pain from osteolytic bone metastases from breast cancer and multiple myeloma.

• Nerve compression can be relieved by local corticosteroid (prednisolone) or nerve block (local anaesthetic); nerve destruction can be achieved by alcohol, phenol.

• Dysmenorrhoea, see page 730.

• Mastalgia may benefit from gamolenic acid (in evening primrose oil), danazol and bromocriptine; or from a combined contraceptive pill.

In sickle cell anaemia crises avoid pethidine as the metabolite norpethidine may accumulate; hydroxyurea reduces the frequency (see p. 599).

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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