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2 results

  • Neck and back pain – mechanical strain

  • from Chief complaints and diagnoses
  • Edited by Stephen H. Thomas
  • Book:
    Emergency Department Analgesia
    Published online:
    18 December 2009
    Print publication:
    25 September 2008, pp 263-267

  • Summary

    This chapter addresses relief of abdominal cramping and related symptoms (e.g. pelvic pain, backache) associated with the menstrual cycle. It focuses on analgesic control of dysmenorrhea symptoms, rather than hormonal regulation of the ovulatory cycle. Prostaglandin inhibition by NSAIDs is responsible for their decades of successful use as the mainstay of dysmenorrhea treatment. An RCT in patients undergoing fractional curettage demonstrated the potent analgesic effects of NSAIDs on uterine pain. Due to the need for chronic use, the COX-2 selective NSAIDs are sometimes recommended as a treatment for dysmenorrhea. Data show that valdecoxib, administered in a single dose of 40 mg PO, provides dysmenorrhea pain relief within 30 minutes that lasts for up to 24 hours. The novel analgesic flupirtine is suggested by some to have utility in dysmenorrhea, but this centrally acting agent is not recommended owing to limited evidence and frequent side effects.

  • Gastroesophageal reflux disease

  • from Chief complaints and diagnoses
  • Edited by Stephen H. Thomas
  • Book:
    Emergency Department Analgesia
    Published online:
    18 December 2009
    Print publication:
    25 September 2008, pp 225-231

  • Summary

    This chapter focuses on pharmacological approaches to chronic low-back pain (CLBP). In CLBP, one of the major issues for the ED caregiver is use of opioids. The utility of opioids in CLBP is limited not only by their marginal analgesic efficacy, but also by the risk of addictive behavior. Although studies of truly CLBP are lacking, it is reasonable to use NSAIDs provided that potential side effects risks are incorporated into therapeutic decision-making. Some authors recommend avoiding the potential cardiovascular risk with COX-2 selective NSAIDs by instead prescribing dual therapy with a non-selective NSAID and a proton pump inhibitor. A 2003 meta-analysis found five RCTs demonstrating some CLBP relief with cyclic anti-depressants. The benefits of these cyclic anti-depressants are independent of their anti-depressant effects, since studies demonstrating the agents' efficacy excluded patients with clinical depression.