RESPONDING TO SYMPTOMS PAIN AND

FEVER( updated)
BY MRS MUSONDA
 PAIN
• Pain can be caused by a variety of conditions and examples of
these commonly seen in the pharmacy are headache, toothache,
musculoskeletal pain and period pain.
• It may be described as acute or chronic.
• Acute pain is often transient and with treatment directed at the
cause and/or short-term pain relief, the pain will disappear.
Acute pain is a type of pain that typically lasts less than 3 to 6
months e.g pain that is related to soft tissue damage such as a
sprained ankle, dental work, surgery. Acute pain is distinct from
chronic pain and is relatively more sharp and severe.
• In chronic pain, it is often intractable(hard to control or deal
with) and will need regular analgesia to control it.chronic pain
is pain that is ongoing and usually lasts longer than six months.
This type of pain can continue even after the injury or illness
that caused it has healed or gone away. Chronic pain is linked
to conditions like;
• Arthritis
• Cancer
• Nerve pain
• Back pain
 referral
• Referral for further investigation is indicated for:
• patients who appear to be abusing analgesics (routine
appointment)
• young children who do not appear to have responded to doses of
analgesics (maximum for their age group) previously given
• patients suffering pain more severe than that experienced
previously or which is increasing in severity over several days
with no apparent reason
 Treatment options

• The three main OTC analgesic options are paracetamol,

ibuprofen and aspirin.
• Paracetamol is ineffective against inflammation but all three are
equally effective antipyretics.
• Restrictions on the use of paracetamol, aspirin and
ibuprofen
• Extreme care must be taken to ensure that intentional or
unintentional overdoses do not take place. Due to the risk of
overdose associated with paracetamol and aspirin, pack sizes are
restricted for OTC purchase.
• Patients should be reminded that many OTC preparations contain paracetamol,
for example, cold and flu preparations, and
• that the maximum daily dose must be adhered to.
• Paracetamol overdose leads to nausea, vomiting and eventually hepatic failure,
which is often not apparent for four to six days.
• The association of aspirin with Reye’s syndrome (a potentially fatal
neurological condition in children) has led to restriction in the use of aspirin, to
adults and children aged 16 years and over.
• Both aspirin and ibuprofen should be avoided during pregnancy, particularly
during the third trimester because of possible bleeding with aspirin and
prolongation of pregnancy with both drugs. Paracetamol is safe for use in
pregnancy and breastfeeding.
• Paracetamol is the only option for patients with a history of
hypersensitivity to aspirin or NSAIDs or active peptic ulceration.
Hemophiliacs(condition in which blood doesn’t clot normally)
should not be given aspirin. Aspirin interferes with the stickiness
of the blood platelets and adds to problems with bleeding.
• In overdose, ibuprofen is safer than aspirin. Both are associated
with adverse gastrointestinal (GI) effects but ibuprofen has a
lower incidence. GI effects are minimized by taking the drugs
after food. Paracetamol is less irritant to the stomach and so is
often preferred, particularly in the elderly.
• Aspirin side effects include-easy bruising or bleeding,
difficulty hearing, ringing in the ears, persistent or severe
nausea or vomiting etc.
• Side effects of ibuprofen include-upset stomach, mild
heartburn, nausea,
vomiting,constipation,bloating,dizziness etc.
• Codeine and dihydrocodeine( opiod analgesics) are available OTC
in combination with other analgesics,an example is co-codamol which
is a combination of paracetamol with codeine. The low dose of opioid
(8mg codeine) that is contained in the majority of OTC compound
preparations is not enough to provide significant pain relief.
• The therapeutic analgesic dose of codeine is 30mg.
• At subtherapeutic doses it will cause opioid side effects, in particular,
constipation, especially in the elderly. Higher doses of opioid
analgesics are associated with a risk of dependence and misuse, either
intentional or unintentional
• Caffeine is a weak stimulant which, when included in analgesic
preparations, is claimed to enhance the analgesic effect. Side
effects include nausea, headache and insomnia. There is also
the risk of a habit-forming effect. Caffeine is present in
common pain killers such as cafemol.
 Headache and migraine
• Tension headache is the most common type of headache. It is
bilateral(affecting both sides) and described as a dull ache with a
pressing or tightening sensation across the forehead.
• Migraine is a pulsating and throbbing headache. It may be present
with or without aura (visual disturbances, sensory, motor or language
alterations). It is typically unilateral, affecting one side of the head,
although it can be bilateral. Migraine can be accompanied by any or
all of nausea, vomiting, photophobia (sensitivity to light) or
phonophobia (sensitivity to sound). Pre-disposing factors include
depression, anxiety, head/neck trauma and hormonal changes, such as
menstruation or ovulation.
• trigger factors for migraine include :
• bright lights
• foods (eg alcohol, cheese, citrus fruits, chocolate, salami)
• extremes of weather (eg very hot or cold, strong winds)
• long-distance travel
• loud noise
• missing meals
• strenuous unaccustomed exercise
• altered sleep pattern
 DANGER SYMPTOMS
• Headaches may rarely be a symptom of more serious underlying disease,
for example, meningitis, cerebral haemorrhage, raised intra-cranial
pressure, tumours or temporal arteritis. This is an inflammatory condition
affecting the medium-sized blood vessels that supply the head, eyes, and
optic nerves which can result in loss of vision.
• Urgent referral is required if the headache is:
• of sudden onset
• different or more severe than any previous headache
• associated with recent head trauma, neck stiffness, vomiting, altered
level of consciousness, focal neurological symptoms, blackouts
• severe and associated with fever, or rash
• Routine referral is required if the headache is:
• suffered by children under 12
• suffered by a woman who is pregnant or breastfeeding
• a migraine lasting longer than 24 hours or unresponsive to
treatment
• new onset of migraine with women who are taking the oral
contraceptive pill, as this may be an early warning of
cerebrovascular changes
 Treatment options
• Simple analgesia, i.e. paracetamol, ibuprofen or aspirin is the first line
treatment, with the triptans(tryptamine based drugs e.g sumatriptan)
reserved for use if the migraine is unresponsive or for previous triptan
users. NSAIDs(diclofenac,ibuprofen) are more effective than
paracetamol for tension type headache.
• Codeine should be avoided in migraine as it is not proven to help
migraine pain. It reduces gastric motility further and has an
emetic( causing vomiting) action which can exacerbate existing
problems.
• Pharmacists have a duty to advise patients of the abuse potential for
codeine containing preparations.
 fever
• Fever is an abnormally high body temperature usually
accompanied by shivering, headache and in severe
instances delirium.
• Fever is when the persons body temperature goes above
the normal range of 36-37 degrees Celsius.
• As the body temperature goes up the person may feel
cold until it levels off and stops rising.
• A high body temperature or fever is one of the ways our
immune system attempts to combat an infection. Usually
the rise helps the individual to resolve an infection.
• The temperature may sometimes rise too high in which
case the fever can be serious and lead to complications.
• If the fever is mild theres no need to bring it down –if the
fever is not severe it is probably helping to neutralize the
bacterium or virus that is causing the infection.
• Medications that are used to bring down fever are called
antipyretics.
• If a person is complaining of discomfort due to fever then
they need to be given antipyretics.
 Symptoms of fever
• Feeling cold when nobody else does
• Shivering, shaking and chills
• Lack of appetite
• dehydration
• Depression
• Hyperalgesia or increased sensitivity to pain
• Lethargy
• Problems concentrating
• Sleepiness
• Sweating
• If the fever is high there may also be extreme irritability,
confusion delirium and seizure.
• Headache
• Feeling faint, dizzy or lightheaded
• weakness
 Causes of fever
• Fever can be caused by a number of factors such as:
• An infection such as flu, chicken pox or pneumonia
• Rheumatoid arthritis
• Overexposure of skin to sunlight or sunburn
• Heat stroke
• dehydration
 Types of fever
• A fever can be:
• Low grade from 38.1-39 degrees Celsius
• Moderate from 39.1-40 degrees Celsius
• High from 40.1-41.1 degrees Celsius
• Hyperpyrexia above 41.1 degrees Celsius
 Length of time
• A fever can be:
• acute if it lasts less than 7 days
• Sub- acute if it lasts up to 14 days
• Chronic or persistent if it persists for over 14 days
 Fever in children
• Children with a high temperature may develop febrile seizure also
known as a febrile fit or febrile convulsion.
• Most of these are not serious and can be as a result of an ear
infection, gastroenteritis, or a respiratory virus or a cold.
• Less commonly they can be as a result of something serious such
as meningitis, a kidney infection or pneumonia.
• Febrile seizures most commonly occur in children aged 6 months
to 6 years and affect boys more than girls.
• Seizures occur because the body temperature rises too fast, rather
than because it has been sustained for a long time.
 treatment
• Non steroidal anti inflammatory drugs(NSAIDS) such as aspirin or
ibuprofen can bring down the fever. These are available over the
counter.
• Don’t give aspirin to children because it may trigger a rare but
potentially fatal disorder known as Reyes syndrome. Children under 16
yrs can be given paracetamol and ibuprofen for the fever.
• Fluid intake- anyone with a fever should consume plenty of fluids to
prevent dehydration.
• You need rest to recover and activity can raise your body temperature.
• Stay cool by dressing in light clothing, keep the room temperature cool
and sleep in only a sheet or light blanket.
 Fever in babies
• Infants younger than 28 days need to be admitted to the
hospital for testing and treatment.
• In small babies fever could indicate a serious infection like
septicemia that requires intravenous medication and round the
clock monitoring.
• Therefore small babies need to be referred to the hospital and
not treated by a pharmacist.
THE END