Items in AFP with MESH term: Analgesics

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Osteoarthritis of the Hip - Clinical Evidence Handbook


ICSI Releases Guideline on Chronic Pain Assessment and Management - Practice Guidelines


Treatment of Acute Migraine Headache - Article

ABSTRACT: Migraine headache is a common and potentially debilitating disorder often treated by family physicians. Before diagnosing migraine, serious intracranial pathology must be ruled out. Treating acute migraine is challenging because of substantial rates of nonresponse to medications and difficulty in predicting individual response to a specific agent or dose. Data comparing different drug classes are relatively scarce. Abortive therapy should be used as early as possible after the onset of symptoms. Effective first-line therapies for mild to moderate migraine are nonprescription nonsteroidal anti-inflammatory drugs and combination analgesics containing acetaminophen, aspirin, and caffeine. Triptans are first-line therapies for moderate to severe migraine, or mild to moderate migraine that has not responded to adequate doses of simple analgesics. Triptans should be avoided in patients with vascular disease, uncontrolled hypertension, or hemiplegic migraine. Intravenous antiemetics, with or without intravenous dihydroergotamine, are effective therapies in an emergency department setting. Dexamethasone may be a useful adjunct to standard therapy in preventing short-term headache recurrence. Intranasal lidocaine may also have a role in relief of acute migraine. Isometheptene-containing compounds and intranasal dihydroergotamine are also reasonable therapeutic options. Medications containing opiates or barbiturates should be avoided for acute migraine. During pregnancy, migraine may be treated with acetaminophen or nonsteroidal anti-inflammatory drugs (prior to third trimester), or opiates in refractory cases. Acetaminophen, ibuprofen, intranasal sumatriptan, and intranasal zolmitriptan seem to be effective in children and adolescents, although data in these age groups are limited.


Guidelines from the American Geriatric Society Target Management of Chronic Pain in Older Persons - Special Medical Reports


Guidelines on Migraine: Part 2. General Principles of Drug Therapy - Practice Guidelines


Guidelines on Migraine: Part 3. Recommendations for Individual Drugs - Practice Guidelines


Guidelines on Migraine: Part 4. General Principles of Preventive Therapy - Practice Guidelines


Evaluation and Management of Corneal Abrasions - Article

ABSTRACT: Corneal abrasions are commonly encountered in primary care. Patients typically present with a history of trauma and symptoms of foreign body sensation, tearing, and sensitivity to light. History and physical examination should exclude serious causes of eye pain, including penetrating injury, infective keratitis, and corneal ulcers. After fluorescein staining of the cornea, an abrasion will appear yellow under normal light and green in cobalt blue light. Physicians should carefully examine for foreign bodies and remove them, if present. The goals of treatment include pain control, prevention of infection, and healing. Pain relief may be achieved with topical nonsteroidal anti-inflammatory drugs or oral analgesics. Evidence does not support the use of topical cycloplegics for uncomplicated corneal abrasions. Patching is not recommended because it does not improve pain and has the potential to delay healing. Although evidence is lacking, topical antibiotics are commonly prescribed to prevent bacterial superinfection. Contact lens–related abrasions should be treated with antipseudomonal topical antibiotics. Follow-up may not be necessary for patients with small (4 mm or less), uncomplicated abrasions; normal vision; and resolving symptoms. All other patients should be reevaluated in 24 hours. Referral is indicated for any patient with symptoms that do not improve or that worsen, a corneal infiltrate or ulcer, significant vision loss, or a penetrating eye injury.


Caffeine as an Analgesic Adjuvant for Acute Pain in Adults - Cochrane for Clinicians


Pharmacologic Therapy for Acute Pain - Article

ABSTRACT: The approach to patients with acute pain begins by identifying the underlying cause and a disease-specific treatment. The first-line pharmacologic agent for the symptomatic treatment of mild to moderate pain is acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). The choice between these two medications depends on the type of pain and patient risk factors for NSAID-related adverse effects (e.g., gastrointestinal, renovascular, or cardiovascular effects). Different NSAIDs have similar analgesic effects. However, cyclooxygenase-2 selective NSAIDs (e.g., celecoxib) must be used with caution in patients with cardiovascular risk factors and are more expensive than nonselective NSAIDs. If these first-line agents are not sufficient for mild to moderate pain, medications that target separate pathways simultaneously, such as an acetaminophen/opioid combination, are reasonable choices. Severe acute pain is typically treated with potent opioids. At each step, adjuvant medications directed at the underlying condition can be used. Newer medications with dual actions (e.g., tapentadol) are also an option. There is little evidence that one opioid is superior for pain control, but there are some pharmacologic differences among opioids. Because of the growing misuse and diversion of controlled substances, caution should be used when prescribing opioids, even for short-term treatment. Patients should be advised to properly dispose of unused medications.


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