Joint Pain (Arthritis/
Rheumatism)
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OsteoArthritis – inflammation of joints – osteoarthritis is commonly associated with older populations.
Rheumatoid Arthritis – has a younger age of onset than Osteoarthritis; the body’s immune system starts to attack tissues, including joint tissues, which causes inflammation and pain.
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Analgesics (pain relievers), from Paracetamol to opiates.
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Non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen & ibuprofen (Nurofen), ketoprofen (Orudis)
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Corticosteroids (taken by tablet or injection) (prednisolone, cortisone injection)
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Disease-modifying anti-rheumatic drugs (DMARDS) – suppress the immune system (biological DMARDS block substances that cause inflammation). Halting the inflammation reduces pain (Orencia, Humira) (Arthritis Information Sheet: Medicines and arthritis, 2012)
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Chronic back or neck problems
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Commonly pain in the lower back but can be in the neck.
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Analgesics, including opioids
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NSAIDs
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Muscle Relaxants (benzodiazepines such as Valium or Xanax)
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Antidepressants (Bogduk, 2004)
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Frequent or severe headaches
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Most common form of chronic headache pain is Migraine – chronic, moderate-severe headache & nausea.
Nerve Pain (Neuralgias) can also occur as a headache.
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NSAIDS, including Naproxen or ketorolac injections
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Triptan (Seratonin antagonist) such as Sumatriptan
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Antidepressants (Tricyclic or SSRI’s) may help prevent migraines
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Corticosteroid injection
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Ergot alkaloid - Ergotamine (vasoconstrictor alkaloid often combined with caffeine for treatment of migraines, i.e. Cafergot)
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Combination of paracetamol, codeine and antihistamine doxylamine (Dolased or Mersyndol) (Duckro, 1999) (Consumer Medicine Information: Mersyndol, 2007) (Consumer Medicine Informaiton: Dolased Analgesic, 2004)
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Generalised Pain
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Common chronic generalised pain conditions (pain throughout the body) include:
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Complex Regional Pain Syndrome (CRPS) – intense, burning chronic pain caused by nerve damage
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Reflex Sympathetic Dystrophy (CRPS1) – chronic nerve disorder occurs most often in arms or legs after a minor injury
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Causalgia (CRPS2) - caused by injury to the nerve
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Fibromyalgia – chronic widespread pain, fatigue and heightened and painful response to pressure.
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Chronic fatigue syndrome – chronic muscle pain, joint pain, or headaches are some of the symptoms of this disorder.
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Analgesics (including opioids)
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NSAIDS
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Antidepressants such as Duloxetine used for control of neuropathic pain conditions like Fibromyalgia.
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Anticonvulsants such as Lyrica are also used for neuropathic pain conditions Fibromyalgia (Consumer Medicine Information: Lyrica, 2011) (Eustice, 2008)
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Visceral Pain
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Pain that is felt inside the body. Pain from the organs. Some common conditions involving visceral pain include:
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Endometriosis – a condition affecting women caused by an excess of cells in the uterine cavity. Major symptom of this condition is recurring pelvic pain
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Chronic Pancreatis - inflammation of the pancreas
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Opioids are a common treatment for visceral pain (Giamberardino, 2005).
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Other Neuropathic Pain Conditions
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Neuropathic pain is caused by damaged or malfunctioning nerves. It is often described as different from other forms of pain and is often described as: electric shocks, burning, or “heavy” sensations. It can occur by itself or along with other forms of pain in many conditions. Some examples include:
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Alcohol dependence and Diabetes can contribute to peripheral neuropathy (pain at extremities such as hands and feet)
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Phantom pain – pain from a part of the body that has been lost, common experience of amputees and can become chronic.
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Operations such as mastectomies or thorocotomy or amputations can leave ongoing chronic neuropathic pain at the affected site.
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Neuropathic pain is difficult to treat compared to somatic pain. A combination of treatments can be used:
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Antidepressants of the Tricyclic type
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Anticonvulsants (Gabapentin)
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Analgesics like opioids (may be ineffective but pain that does not respond to other treatments may respond to opioids)
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Local anaesthetics
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Ketamine (Helme, 2006)
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