Aches and Pains

Analgesic Ladder

Definition

Many people have aches and pains which are difficult to define. The pattern of these symptoms is all important.

When to refer

1. Unsure of diagnosis:
   The differential diagnosis includes
   1. palindromic rheumatism
   2. fibromyalgia
   3. myxoedema
   4. regional soft tissue syndromes e.g. SI joint strain, tennis elbow, trochanteric bursitis
   5. connective tissue disease especially SLE, RA, polymyositis
   6. referred pain especially spinal cervical or lumbar
   7. non-metastatic malignant disease
   8. part of hypermobility syndrome
2. When symptoms outweigh signs especially if sleep is disturbed.
3. When investigations are abnormal.

Investigations

• FBC
• ESR/PV Profile
• Auto antibodies including Rheumatoid factor
• Creatine kinase/aldolase
• TFT's
• CXR Rheumatology referral

First line management

This depends on diagnosis (see appropriate chapters).

Often reassurance is all that is necessary.

Exercise and fitness for life programmes may be appropriate

If these measures are not effective refer to Rheumatology

Document Information
Appraiser: Dr T Kennedy
Expiry Date: 11/04/04
Author: Dr Tom Kennedy
Organisation: Arrowe Park Hospital