Pain & Fever: Back To Basics
41.6 °C - the temperature from which fevers are considered high-grade and dangerous!
In the management of pain and fever, it is important to remind patients from time to time of the side effects and dangers of using over the counter (OTC) medicines in combination with other drugs, or if they have underlying conditions. In the interests of holistic patient care, there is also room for taking patients back to basics and advising them of the place for nonmedicinal treatment, at least in certain stages of pain and fever.
Fevers over 38 °C are generally signs that the patient could benefit from some kind of medication to reduce the fever. However, patients often rush to self-medicate at the first sign of fever, without considering the important role that fever plays in fighting infection. Fever serves as one of the body’s natural defences against bacteria and viruses that cannot live at a higher temperature. For that reason, low fevers should normally go untreated, unless they are accompanied by further symptoms such as pain or swelling.
While values may vary according to different clinicians and the condition and age of the patient, generally, low-grade fevers range from about 37.7 °C – 38.3 °C while high-grade fevers range from about 39.4 °C – 40 °C and higher. Dangerous high-grade fevers range from over 41.6 °C or higher (also termed hyperpyrexia).
Pain can be classified as acute (short duration, identifiable pathology, a predictable prognosis and usually due to injuries) chronic nonmalignant (goes on for longer, associated with progressive, debilitating diseases such as arthritis) and chronic malignant (advanced, progressive diseases such as cancer).
Headaches are the most common cause of pain and can be considered a separate class of pain, and can generally be described under three categories: muscle contraction, migraine or vascular, and sinus headaches.
In all cases, OTC medications are a first line of relief. However, people with chronic pain should be warned against overuse, which can lead to side effects. Stronger prescription medications are usually necessary for chronic malignant pain.
Paracetamol is the analgesic of choice for mild to moderate pain and is also used to reduce fever. It is suitable for both adults and children and is safe for people who do not have stomach ulcers and who cannot take aspirin.
Aspirin, the common name for acetylsalicylic acid, is a nonsteroidal anti-inflammatory drug and one of the most common OTC analgesic drugs in use today, having been in use since the 1890s.
Both of these medicines work by inhibiting prostaglandin in the brain. When injured, the body produces prostaglandins, which are complex fatty acids that act as hormones within body tissues. Prostaglandins act by stimulating the dilation of blood vessels and muscle contraction, which are the beginning of pain.
Paracetamol products are suitable for most people including the elderly and young children. It does not interact negatively with other treatments and can generally be taken by people who are sensitive to aspirin. Paracetamol is also well tolerated by people with peptic ulcers and generally, by asthma sufferers. Because of its broad-spectrum usage, there is a danger that it can be overused, leading, in extreme cases, to liver damage.
While highly effective, aspirin should not be used by pregnant and breastfeeding women, as well as by people who suffer from asthma or other breathing-related disorders and who have a history of bleeding, gout or ulcers, as well as chronic alcohol usage.
Just about every household contains aspirin; however, children under age 17 are never given aspirin because of the concern about Reyes Syndrome, a potentially deadly disease affecting the brain and the liver. In particular, adults and children should not take aspirin before or during a viral illness. The probability of contracting Reyes syndrome is small, but there is no need to take the risk when other pain relievers are available.
In addition to reminding consumers about the possible side effects and dangers of combining medicines when self-medicating their pain and fever, it is also useful to inform patients about alternative methods of treating their symptoms.
For early treatment of fever, simple instructions such as the importance of maintaining body fluid by drinking as much water and as possible, rest, avoiding sudden changes in atmospheric temperatures and taking tepid baths constitute sound advice.
The management of pain, especially chronic pain, offers far more alternatives that do not include medication, including acupuncture, guided imagery, chiropractic treatment, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, massage and many others.
Article Courtesy of Medical Chronicle