The document summarizes a symposium on revolutionary concepts in pain management presented by Prof. G.S. Patnaik. It discusses various types and sources of pain, as well as common treatment options. It then presents Prof. Patnaik's concept of using sublingual piroxicam tablets as a safer and faster-acting alternative to traditional NSAIDs for pain relief. Studies are cited showing sublingual piroxicam has equivalent bioavailability to intramuscular injections and superior efficacy and safety profile to traditional oral NSAIDs. A range of painful conditions are identified as suitable indications for treatment with sublingual piroxicam.

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WELCOME
Symposium on
Revolutionary ConceptRevolutionary Concept
in the Management of
Pain

2. PAIN MANAGEMENT-PAIN MANAGEMENT-
NewNew
Concept..Concept..
Prof
.G.S.Patnaik

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Pain ….Quotes
• Pain is such an uncomfortable
feeling that even a tiny amount
of it is enough to ruin every
enjoyment. Will Rogers
• We cannot learn without
pain. Aristotle

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PAIN……

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Pain in poetry……
pain surrounds you day to day
nothing helps it go away
pain in muscles pain in joints
pain so bad in trigger points.
pain that comes and pain that goes
pain that keeps you on your toes.
pain that people think is in your head.
pain that it took
To just be me
pain i go through.
but people can't see.

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pAIN
• Pain (from Ancient Greek ποινή - poine)
is defined by the
International Association for the Study of Pain
(IASP) as “an unpleasant sensory and
emotional experience associated with
actual or potential tissue damage, or
described in terms of such damage”.

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Pain in…. portrait

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Pain as perceived

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Sources of pain
• Cutaneous pain
• Somatic pain
• Visceral pain
• Phantom limb pain
• Neuropathic pain

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Pain……………

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Pain………….

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Pain as a malady…….

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Treatment options for Pain
Opioid
analgesics
NSAID’s
Massage
Traction
Acupunture
Steroids
Heat/Cold

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Mind can’t think what
eyes dont see

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Why prescribe the Unsafe??
•Vioxx (Rofecoxib) withdrawn…
•Bextra (Valdecoxib) banned…
•Celebrex (Celecoxib) withdrawn…
Shadows over COX 2 inhibitors
3

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Need of the Hour
•Highest Safety
•Rapid Action.
•Effective Analgesia

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Need of hour ….
NSAID with injection like
action without the G.I. Side
effects of NSAID’s.

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• Piroxicam in new incarnation.
• Piroxicam sublingual tablets.
• The faster and safest form of NSAID.
Piroxicam fits the bill….

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Faster onset of action
Revolutionary
SUB-LINGUAL ROUTE
Safety with Rapid Action

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Piroxicam– High Safety
22
By-passes the 1st
Pass Metabolism
By-passes the G.I. Tract for Safety & Efficacy & Speedy Action.

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Advantages
Revolutionary PiroxicamRevolutionary Piroxicam
sublingual routesublingual route.
 Needs larger dose 40 mg.  Smaller dose – 20mg.
 G.I damage.  Bypasses G.I tract.
 Slow onset of action.  Rapid onset of action.
 Low efficacy.  Higher efficacy.
 Low bioavailibility  Higher bioavailibility.
 Proven hepatotoxicity
 Traditional oral routeTraditional oral route
 Less chances of
hepatotoxicity

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Establishing the superiority by facts…
BRITISH JOURNAL OF UROLOGY
THE
TRIAL
REPORT
Efficacy and Safety
The revolution
in Analgesia

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40mg sublingual piroxicam
compared with
intramuscular 75mg diclofenac
IN ACUTE RENAL COLIC
in a randomized, double blind
controlled clinical trial.
BRITISH JOURNAL OF UROLOGY TRIAL REPORT

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The overall efficacy of the treatment was 81%.
Contd…
The Pain Relief was significant at 30 minutes
in both the groups.
Piroxicam sublingual is as effective as
parentral diclofenac in emergency renal colic treatment.
Furthermore, its ease of self-administration increases
patient compliance and potential use in general practice.
(Sublingual v/s Injection)
12

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Various studies…
• Double-Blind, Placebo-
Controlled, Randomized Clinical
Trial of Sublingual or
Intramuscular Piroxicam in the
Treatment of Renal Colic---A
Comparative Study
B. Altaya, K. etall..
Department of Urology,
Etfal Training and Research Hospital, Istanbul, Turkey

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An Indian study
confirms …

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Objective:
Bioavailibility study of Piroxicam 40mg (20mg x 2)
tablets administered sublingually in comparison with
Piroxicam 40mg / 2ml injections {Dolonex}
administered intramuscularly.
Conclusion:
Bioavailibility of Sublingual Piroxicam is equivalent
to that of intramuscular Piroxicam
Piroxicambioavailibility study at
the Leading College of Pharmacy, Mumbai.``

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 Rheumatoid arthritis.1
 Osteoarthritis. 2.
 Ankylosing spondylitis. 3.
 Acute musculoskeletal disorders. 4
 Dysmenorrhea. 5.
 Postoperative pain. 6.
 Migraine. 7
 Dental pain 8
 Renal colic pain. 9.
 Acute gout. 10
Indications for Piroxicam
1.(Minerva Med. 1994 Dec;85(12):633-8.)
2.(Clin Ter. 1993 Dec;143(6):519-29)
3.(Eur J Rheumatol Inflamm. 1981;4(3):364-7.)
4.(Am J Gastroenterol. 1990 Jul;85(7):898-9. )
5.Minerva Ginecol. 1993 Jul-Aug;45(7-8):365-75. )
6.(Spine. 2002 Mar 1;27(5):447-51.)
7.(Headache. 1993 Jun;33(6):296-300.)
8.(Int J Clin Pharmacol Res 1998;18(3):151)
9.(Br J Urol. 1998 Jan;81(1):27-30)
10.(Eur J Rheumatol Inflamm. 1983;6(1):126-33.)

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• Piroxicam,
which is a
time, trusted
analgesic has
been
REVOLUTIONIZE
D into more
safer and
faster acting
analgesics

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Therefore……
• The secret of success
is learning how to use
pain and pleasure
instead of having pain
and pleasure use you.
If you do that, you're in
control of your life. If
you don't, life controls
you. Anthony Robbins
• Pain is never
permanent. --Teresa
of Avila

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