year-old man with chronic low back and leg pain. • Involved in serious motor vehicle crash. 3 years ago. • Operated on by local orthopedic surgeon. A man with chronic recurrent headaches using codeine. DIARMUID McCOY, Nicholas Lintzeris, Richard Stark. Case studies. Pain Management Today.
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It is entirely supported by charitable donations, fund raising and specific research grants. Toggle navigation. Directly or indirectly supported or facilitated by the Foundation. Autoantibody pain. Primary dysmenorrhea is an idiopathic condition thought to be related to the release of prostaglandins and leukotrienes, inflammatory mediators that are associated with uterine vasoconstriction, ischemia, and pain during menstruation.
DK reports experiencing adverse gastrointestinal GI side effects secondary to the use of ibuprofen, but NSAIDs such as ibuprofen are the agents with the best evidence to support their use for treating menstrual pain. At maximum daily doses, acetaminophen has been shown to be less effective than ibuprofen in clinical trials for menstrual pain relief,3 and doses up to mg 4 times per day may be necessary for adequate pain relief. Recommend that DK continues to use ibuprofen to mg every 4 to 6 hours as needed for pain up to mg per day , but she should take it with food to minimize GI upset.
DK should take the medicationon a scheduled rather than an as-needed basis for the first 24 to 48 hours of menstruation, when levels of inflammatory mediators are the highest. The application of heat has a faster onset of action than oral analgesics and may also augment their effects. Counsel DK on the importance of adequate rest and routine physical activity, which may also help to minimize her symptoms. Case 2—Commuter Headache PJ is a year-old man looking for arecommendation for a headache medicine. PJ massages his temples, where he describes experiencing a constricting, band-like pain around his head.
He experienced similar headache pain approximately 2 times per week for the past few weeks, which he attributes to the stress of starting a new job in a nearby city and to his long commute.
Based on the type of headache PJ is likely experiencing, identify an appropriate analgesic medication for alleviating his pain. Answer PJ is likely experiencing episodic tensiontype headaches, with characteristic bilateral,band-like pain that extends over the top of the head and toward the base of the skull. Tension-type headaches can be associated with stress, anxiety, depression, and other emotional stimuli. In the case of PJ, any of these agents would be reasonable recommendations for alleviating his pain; however, acetaminophen may carry a more favorable safety profile, given the presence of cardiovascular disease risk factors in his case eg, hyperlipidemia, hypertension.
According to the American Heart Association, patients who are at high risk for cardiovascular disease should avoid NSAIDs if possible, due to an increased risk of myocardial infarction, stroke, heart failure, and hypertension. Recommend the use of acetaminophen to mg every 4 to 6 hours as needed up to mg per day. Remind PJ to limit alcohol consumption to prevent acetaminophen-induced hepatic damage.
References: 1. What Are Menstrual Cramps? What Causes Menstrual Cramps?