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).

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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