Patient Care and Monitoring

1. Assess the patient's symptoms to determine if empirical care is appropriate or whether diagnostic evaluation is warranted. Determine the timing of injury (if applicable), duration of pain, type and degree of pain, and exacerbating factors. Determine if the musculoskeletal disorder interferes with usual activities or range of motion.

2. Assess exacerbating or alleviating factors. Ask if the patient has tried any nonpharmacologic or pharmacologic treatments.

3. Obtain a complete medication history, including history of prescription drug, non-prescription drug, and dietary supplement use. Determine if the patient has used any successful or unsuccessful treatments for this condition in the past.

4. Gather patient history. Assess factors involved in drug selection. Inquire about social history and alcohol use. Ask the patient about drug allergies and chronic health problems such as asthma.

5. Educate the patient on nonpharmacologic therapy, including each of the steps in RICE. If injury is the source of the pain and it occurred more than 48 hours ago, consider heat instead of ice.

6. Assess patient preference for systemic (oral) or local (topical) therapy. Would frequent application of topical medications be possible? Would the patient accept topical medications with a medicinal odor?

7. Recommend appropriate pharmacologic therapy and educate on proper use. If a counterirritant is recommended, counsel patients on the irritant effect of the product and recommend washing hands immediately after use and to avoid heating pads. For patients using a capsaicin product, emphasize that adherence to regular application is required for effectiveness.

8. Develop a plan to assess effectiveness of pharmacologic therapy. If pain is from an acute injury, assess effectiveness within 7 to 10 days. For chronic pain treated with capsaicin, begin to assess pain control in 2 weeks.

9. Evaluate for adverse effects and drug interactions. For patients on topical therapy, evaluate for local adverse effects. For patients on acetaminophen or NSAIDs, inquire about alcohol use.

10. Stress lifestyle modifications for rehabilitation and prevention. Recommend strength training, range-of-motion exercises, and a warm-up period before exercise. In repetitive-motion injury, recommend methods to correct biomechanical abnormalities and vary work tasks as applicable. Refer to a physical therapist or sports trainer as needed.

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