Bed Rest More than 2 days not recommended Manipulation shown to be beneficial
PRACTICAL TIPS IN PAIN MANAGEMENT
- Empathise : Patients often complain that GP’s do not take their pain seriously
- Reassure and Educate: Often pain creates anxiety as to its cause. Use Animations on the website
- Paracetamol and NSAIDs : have an addictive effect.
- Opiates: Use sparingly , in adequate doses for acute pain. Refer before starting long term opiates for chronic pain. It’s quite difficult to get patients off these opiates later on. Beware addiction.
- Watch for constipation and Rx.
- Try Fentanyl or Morphine patches for better tolerance and compliance.
- For radicular pain try Amitryptilline or Gabapentin.
- Use of short term (4 week) tapering dose of steroids good for acute back/neck pain with or without sciatica. Try Prednisolone 30mg OD for 7 days, then 20mg OD for 7 days , then 10mg OD for 7 days and finally 5mg OD for 7 days and stop. If dose not tolerated, try a smaller dose.
- Use Lansoprazole 30mg OD for 4 weeks with the steroids.
A HIGH INDEX OF SUSPICION IS NEEDED TO AVOID MISSING SPINAL INFECTIONS
Via fax on 01642 889564
A high index of suspicion is needed to avoid missing these cases