Non-steroidal anti-inflammatory drugs
NSAID is one of the primary building blocks of fracture pain management. It is used either alone, or often with added value when used in combination with other agents. Selection of which NSAID to use is largely based on personal preference and experience.
Opioid analgesics have much merit in the short-term management of fractures but are better at reducing the background pain that accompanies a fracture rather than the acute pain associated with movement. Given their propensity to induce constipation, prophylactic measures to prevent this eventuality are advisable. Those analgesics that contain codeine are not universally effective as a proportion of the population lack the cytochrome P450 enzyme necessary to convert codeine to morphine and hence to activate it. The same difficulty does not occur with dihydrocodeine or tramadol.
For more severe pain strong opioids may be necessary. For the most acute situations immediate release strong opioids should be selected while for less acute situations sustained release preparations supplemented by immediate release for breakthrough pain.
When used at appropriate doses, oral acetaminophen is an effective analgesic with a relatively benign side effect profile. Only in overdose does it become less safe. Regular dosing with acetaminophen, often with an NSAID is an effective treatment that should be instituted early and only supplemented with other agents or techniques if therapeutic failure occurs.
Skeletal muscle relaxants have no analgesic effect for pure bone fracture pain. However, muscle spasm is a frequent accompaniment of any fracture, can be painful by itself, but most importantly increases fracture pain by compounding the mal-alignment of fractured bone. Fracture reduction and stabilization may by themselves reduce or remove muscle spasm, but where it remains troublesome, a skeletal muscle relaxant drug may be indicated. Baclofen has a fairly rapid onset of action and a favorable side effect profile and can be used in adults at a dose of 15-60 mg daily in three divided doses. Where muscle spasm becomes chronic, then other agents such as dantrolene or tizanadine may be considered. Alternatively, if the spasm is confined to a well-defined muscle or muscle group, then botulinum toxin injection may become an option.
Was this article helpful?
Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.