Physical Modality for Acute Pain

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27 Aug 2016 - General

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Acute pain is one of the most common complaints in the medical field. NSAIDs , acetaminophen, and/or weak opiods are usually prescribed in combination to provide relief. There will be instances though that all three medications are contraindicated or will be risky for the patient due to co-morbidities such as uncontrolled hypertension or drug interaction with maintenance medications. In this case, we should consider giving physical modalities to provide relief. Compresses can be used to augment pain relief as adjunct to other pain relievers. Cold compress is the best option for pain within the 1st 48-72 hours. Cold pack application induces muscle relaxation by decreasing sensitivity of Golgi tendon organs and muscle spindles. It also reduces inflammation by vasoconstriction. Moreover, it alleviates pain by alterating pain transmission signals  at the level of the spinal cord. It is a powerful modality when advised correctly. Here are some steps that we must advise our patients when giving cold compress instructions:

  • Do not apply the compress directly over the skin. Wrap it in a towel to prevent skin burns and prolong the coldness of the compress.
  • Do not lie on top of the compress because it will cause focal heating to bony prominences.
  • Always gauge the compress with their sensation. If they feel it is too cold, then it is really frigid.
  • Interval between compresses should be at least an hour to prevent burns.
  • Discontinue if they feel a burning sensation.

For the MIMS community, what instructions do you give to ensure patient safety?


Maria Cristina Inserto One huge advantage of cold pack application is that it is generally safe to use. It would be unfortunate for pregnant women to have incision and drainage without anesthesia but application of anesthesia puts both the mother and child at risk. Lidocaine, which is commonly used, has a side effect of causing arrythmias even if it has anti-arrythmic properties. Paracetamol is rapidly metabolize...
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For my pregnant patients who cannot receive a root canal and/or tooth extraction, I usually just tell them to put cold compress to achieve some relief. Of course this is not going to resolve the issue, but when the OB does not give us clearance for anesthesia, we think of the baby. Paracetamol is hardly effective so I always feel sorry for the mothers. If there is abscess, I usually perform I&D without anesthesia, the tears make me sad, but they feel relieved after. I have never received a m...
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Wow! Thanks for sharing this doctor. Actually we have similar scenarios wherein we are practicing cold compress to alleviate patients pain. One example would when administering rapid potassium replacement. The doctor may order to have run 10 mess of KCl in a 90 cc nss to run for 1-2 hour per cycle, good for 5 cycles. Most of the patients but not all will complain about pain and can't tolerate it to be infused in 1 to 2 hours. As a remedy, we try to place ice pack or cold compress wrapped in ...
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