This document discusses targeted topical analgesics for acute pain. It begins by introducing Ms. D'Arcy and her background in pain management. It then discusses the increasing use of targeted topical analgesics as an alternative or addition to opioids for acute pain. Topical NSAIDs are popular options that have fewer side effects than oral NSAIDs. The document provides details on the pathophysiology of pain relief from topicals and the differences between topical and transdermal absorption. It lists several acute pain conditions that may be suitable for treatment with targeted topical analgesics, including low back pain, neck pain, soft tissue injuries, and postherpetic neuralgia.
The document discusses pain management standards established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2001. These standards require facilities to properly assess, treat, and manage patient pain. It also discusses the differences between PRN ("as-needed") medication, where patients receive pain medication as requested, versus around-the-clock (ATC) scheduled dosing. Previous studies have found that ATC dosing results in better pain relief and fewer barriers to patients receiving adequate pain treatment compared to PRN dosing. This quality improvement study similarly found that ATC dosing was associated with lower reported pain levels without increasing adverse events.
The document provides an overview of pain management, defining pain, classifying different types of pain, discussing pain physiology and assessment tools, and outlining approaches for managing both acute and chronic pain, including non-pharmacological and pharmacological options following the WHO analgesic ladder. It emphasizes the importance of regular pain assessment and treatment according to the R-A-T framework of recognizing pain, assessing its cause and severity, and then treating it appropriately.
This document discusses the management of chronic (neurogenic) pain. It provides information on understanding pain, its pathophysiology, assessment, and treatment options. Chronic pain is a complex condition with physical and psychological components. Proper management requires a multidisciplinary approach including pharmacological, rehabilitative, and psychologic interventions to help improve patient function and quality of life.
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
This document provides an overview of pain management. It begins with an introduction defining pain and its prevalence in society. It then covers the pathophysiology and classification of different types of pain such as nociceptive, neuropathic, and chronic pain. The clinical presentation of acute and chronic pain is discussed. Treatment options including pharmacological therapies like opioids and non-opioid drugs as well as non-pharmacological approaches are summarized. Specific drugs like morphine are also described in terms of their use, effects, and side effects.
The document discusses the use of anti-inflammatory drugs for postoperative pain management. It provides conclusions from several studies on nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors. The studies found that NSAIDs and COX-2 inhibitors provided effective postoperative pain relief when used as part of a multimodal analgesic regimen. Specifically, dexamethasone, ketorolac, parecoxib, celecoxib, and rofecoxib reduced postoperative pain and opioid consumption with few side effects when administered before or after surgery. The document concludes that anti-inflammatory drugs are a valuable adjuvant for multimodal postoperative pain management.
INFLUENCE OF DEMOGRAPHIC FACTORS ON PAIN KILLER USAGE AND ADDICTION SYMPTOMSJing Zang
Pain killers have been a necessity for humans since their skin has been laden with pain receptors to signal them against any invasion or unusual going on in the body.This pain when exceeds the limits of tolerance has to be alleviated to reduce suffering. Since ancient times numerous natural substances like herbs and oils have been used to relieve pain, but in modern era more refined ways to relieve pain have been discovered that exactly target the precise pain. This research identifies the factors that govern painkiller usage and addiction and the people who, in majority fall prey to pleasures of pain killers. The research was carried out through a questionnaire and results were statistically analyzed by fishers exact test. Males, employed people, non medics and graduates are most attracted to pain killers and are susceptible to long term addiction. The reasons for these people falling prey to pain killers are work load, mental stress and physiological responses to the drug. These factors can be managed through proper intervention by health professionals. The role of friends and family too here cannot be ignored.
The document discusses pain management standards established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2001. These standards require facilities to properly assess, treat, and manage patient pain. It also discusses the differences between PRN ("as-needed") medication, where patients receive pain medication as requested, versus around-the-clock (ATC) scheduled dosing. Previous studies have found that ATC dosing results in better pain relief and fewer barriers to patients receiving adequate pain treatment compared to PRN dosing. This quality improvement study similarly found that ATC dosing was associated with lower reported pain levels without increasing adverse events.
The document provides an overview of pain management, defining pain, classifying different types of pain, discussing pain physiology and assessment tools, and outlining approaches for managing both acute and chronic pain, including non-pharmacological and pharmacological options following the WHO analgesic ladder. It emphasizes the importance of regular pain assessment and treatment according to the R-A-T framework of recognizing pain, assessing its cause and severity, and then treating it appropriately.
This document discusses the management of chronic (neurogenic) pain. It provides information on understanding pain, its pathophysiology, assessment, and treatment options. Chronic pain is a complex condition with physical and psychological components. Proper management requires a multidisciplinary approach including pharmacological, rehabilitative, and psychologic interventions to help improve patient function and quality of life.
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
This document provides an overview of pain management. It begins with an introduction defining pain and its prevalence in society. It then covers the pathophysiology and classification of different types of pain such as nociceptive, neuropathic, and chronic pain. The clinical presentation of acute and chronic pain is discussed. Treatment options including pharmacological therapies like opioids and non-opioid drugs as well as non-pharmacological approaches are summarized. Specific drugs like morphine are also described in terms of their use, effects, and side effects.
The document discusses the use of anti-inflammatory drugs for postoperative pain management. It provides conclusions from several studies on nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors. The studies found that NSAIDs and COX-2 inhibitors provided effective postoperative pain relief when used as part of a multimodal analgesic regimen. Specifically, dexamethasone, ketorolac, parecoxib, celecoxib, and rofecoxib reduced postoperative pain and opioid consumption with few side effects when administered before or after surgery. The document concludes that anti-inflammatory drugs are a valuable adjuvant for multimodal postoperative pain management.
INFLUENCE OF DEMOGRAPHIC FACTORS ON PAIN KILLER USAGE AND ADDICTION SYMPTOMSJing Zang
Pain killers have been a necessity for humans since their skin has been laden with pain receptors to signal them against any invasion or unusual going on in the body.This pain when exceeds the limits of tolerance has to be alleviated to reduce suffering. Since ancient times numerous natural substances like herbs and oils have been used to relieve pain, but in modern era more refined ways to relieve pain have been discovered that exactly target the precise pain. This research identifies the factors that govern painkiller usage and addiction and the people who, in majority fall prey to pleasures of pain killers. The research was carried out through a questionnaire and results were statistically analyzed by fishers exact test. Males, employed people, non medics and graduates are most attracted to pain killers and are susceptible to long term addiction. The reasons for these people falling prey to pain killers are work load, mental stress and physiological responses to the drug. These factors can be managed through proper intervention by health professionals. The role of friends and family too here cannot be ignored.
This document presents the 2018 consensus statement of the Section of Regional Anaesthesia and Pain Therapy of the Polish Society of Anaesthesiology and Intensive Therapy on postoperative pain management. It provides guidelines and recommendations based on a review of the latest scientific evidence published since 2014. The guidelines cover appropriate use of opioids and other drugs for postoperative pain relief, and emphasize the importance of multimodal analgesia and the need to individualize treatment to the patient and surgery. Pethidine is not recommended due to concerns about its efficacy and safety profile compared to other opioids.
CHRONIC PAIN AND DEPRESSION: Cause or Effect or Linked?Sudhir Kumar
Chronic pain and depression are both common conditions, and in many patients, they co-exist. This presentation looks at the link between chronic pain and depression. Various drugs that can be used to treat chronic pain/depression have been discussed, with a special emphasis on tricyclic antidepressants.
The document discusses pain assessment and management in elderly patients. It outlines common misconceptions about pain in elderly patients held by patients and nurses. It also summarizes the pathophysiology of pain and different pain management approaches including pharmacological interventions following the WHO analgesic ladder and alternative therapies that can help close the gate control system and reduce pain. Effective pain assessment and regular reassessment using a pain scale is important to properly treat pain.
No poison can kill a positive thinker and no medicine can cure a negative thinker. Pain is a complex perceptual experience. Pain is a major public health problem. Beat back pain without surgery and conquer pain without painkillers. Delays have dangerous ends. Knee braces invite injury. Chronic pain affects one in three people in the United States. There are more Americans suffering from chronic pain than with diabetes, heart disease, and cancer combined. Chronic pain is caused by degeneration, illnesses, injuries, surgeries, and treatment side effects. Pain is a major public health problem and is the most common reason why Americans use complementary and integrative health practices. Recent imaging evidence suggests a possible hypothalamic origin for a headache attack, but further research is needed. A migraine is associated with a modest increase in the risk of ischemic stroke.
This document provides guidance on palliating pain for patients near the end of life through pharmacological and non-pharmacological means. It outlines the WHO analgesic ladder for treating mild, moderate, and severe pain with non-opioids, opioids, and adjuvants. Specific opioid and adjuvant medication options are discussed along with guidelines for effective pain management including administering analgesics regularly, anticipating and treating side effects, and using multimodal treatment approaches. Non-pharmacological strategies like physical therapy, behavioral modifications, and psychosocial support are also reviewed. The goal is to effectively manage a patient's pain using all available tools based on the underlying causes of pain.
This document provides guidance on palliating pain for patients near the end of life through pharmacological and non-pharmacological means. It outlines the WHO analgesic ladder for treating mild, moderate, and severe pain with non-opioids, opioids, and adjuvants. Specific opioid and adjuvant medication options are discussed along with guidelines for effective pain management including titration, administration routes, managing side effects, and combining treatments. Non-pharmacological approaches like physical therapy, behavioral modifications, and psychosocial support are also summarized. The goal is to effectively manage a patient's pain using all available tools based on the underlying causes of pain.
postoperative pain assessment and managementpropofol2012
This document provides an overview of acute postoperative pain assessment and management. It defines pain and discusses pain assessment tools and the pathophysiology of pain. It outlines the objectives of treating pain, barriers to effective pain management, and complications of unrelieved pain. Different analgesic drugs are described including opioids, paracetamol, NSAIDs, and NMDA receptor antagonists. Methods of drug administration and non-pharmacological pain management methods are also summarized. Assessment of pain in critical care settings is discussed.
The dark side_of_opioids_in_pain_management__.3Paul Coelho, MD
This document summarizes basic science research that helps explain clinical observations about the effects of opioids on pain. Studies show that long-term or high dose opioid use can paradoxically increase pain through central sensitization and the activation of pronociceptive systems. Mechanisms like NMDA receptor activation, MAP kinase signaling, and glial cell activity contribute to opioid-induced hyperalgesia and tolerance. These biological adaptations may undermine the long-term effectiveness of opioids for chronic pain and even increase pain vulnerability after opioid treatment ends. The findings suggest clinicians should reexamine practices like indefinite opioid escalation that have increased opioid doses without clear evidence of improved analgesia.
This document summarizes basic science research that helps explain clinical observations about opioids increasing pain in some patients. It discusses how high and prolonged opioid doses can cause central sensitization and hyperalgesia through mechanisms like NMDA receptor potentiation and MAP kinase signaling. This suggests that newer opioid prescribing practices involving higher and around-the-clock dosing may need reexamination, as they could paradoxically increase pain through these neuroadaptive processes.
This document discusses pain therapy and postoperative pain management. It defines pain and describes different types of pain like acute, chronic, and neuropathic pain. The goals of postoperative pain management are to reduce pain, improve quality of life, reduce morbidity, facilitate rapid recovery, and allow for early hospital discharge. Effective pain management can decrease complications, chronic pain, hospital stay, and costs while increasing patient satisfaction. Pain should be assessed using scales like VAS, VNR, and categorical scales. Both pharmacological treatments like acetaminophen, NSAIDs, opioids, and alpha-2 agonists as well as procedural approaches like regional anesthesia and local infiltration are discussed. Factors that influence analgesic requirements and safety information are also summarized.
Nociceptors are found in somatic structures like skin, muscle, connective tissue, bones and joints as well as visceral structures like organs and blood vessels. They detect and respond to potentially damaging stimuli to signal the presence of actual or threatened tissue damage.
This document provides information on multimodal regiments for acute pain management. It discusses the goals of multimodal analgesia including reducing opioid use through additive or synergistic effects. Key points:
- Multimodal analgesia involves using two or more analgesics with different mechanisms to better treat multiple pain sources and reduce side effects.
- Postoperative pain involves peripheral and central sensitization, so multimodal regiments target both levels.
- Common regiments discussed include paracetamol, NSAIDs, COXIBs, ketamine, gabapentinoids, clonidine and opioids. Low dose ketamine and gabapentinoids are highlighted for their anti-hyperalgesic effects.
- Combining
Mick Serpell discusses drug developments for treating post-operative pain and neuropathic pain, including optimal drug strategies, combinations, and prophylaxis. Some key areas covered include gabapentin reducing post-mastectomy pain and opioid requirements; combinations of gabapentin and opioids providing better pain relief than either alone; and amitriptyline potentially preventing post-herpetic neuralgia. New drugs mentioned include cannabinoids and a lidocaine plaster for treating neuropathic pain.
This document discusses postoperative pain management. It begins by stating that pain is commonly experienced after surgery and has historically been under treated. It then discusses pain assessment and various methods for treating pain, including acetaminophen, NSAIDs, opioids, local anesthetics, and patient-controlled analgesia. The document emphasizes the importance of treating pain for patient wellbeing and recovery, and the need for a multimodal approach using different drug classes to provide effective pain relief with fewer side effects.
This document discusses acute pain management in the emergency department. It begins with an introduction noting that pain is the most common presenting symptom in emergency departments, with over 60% of patients experiencing pain. It then focuses on defining acute pain and providing an overview of the pathophysiology of acute pain. The document also discusses common barriers to pain management in emergency settings, dos and don'ts of pain treatment, and strategies to improve pain management in the emergency department. It provides recommendations from international health organizations on patients' right to pain relief.
Presentation was originally done at Group Health Cooperative’s National Summit on Opioid Safety: http://www.ghinnovates.org/?p=3502
Presentation by: Roger Chou, MD, Associate Professor of Medicine for Oregon Health & Science University
and Director of Pacific Northwest Evidence-based Practice Center.
Topical analgesics are recommended in guidelines for treating the pain of both osteoarthritis and neuropathy. Topical analgesics are defined as therapies applied to body surfaces to treat pain, and are either rubbed onto the skin or made into patches or plasters that are adhered onto the skin. Under the header of topical analgesics, we find both transdermal as well as intradermal formulations. This differentiation in terminology is recommendable, as transdermal topicals act via adequate drug concentrations in the blood, while intradermal formulations act via mechanisms in the skin and do not need to penetrate into the blood. This will be demonstrated based on examples of amitriptyline and phenytoin gels and creams
Intensity of chronic pain — the wrong metric Paul Coelho, MD
The document discusses how pain intensity is an imperfect metric for evaluating chronic pain treatment outcomes. While pain intensity was widely used as the goal of acute and end-of-life pain treatment, it fails as a measure for chronic pain, which has different causes and meanings. For chronic pain patients, factors like suffering, distress, disability, and quality of life may be better indicators of treatment success than pain intensity alone. The document advocates for moving beyond a focus solely on pain intensity and adopting multimodal treatments and a biopsychosocial approach that considers the complex nature of chronic pain.
Austin Pain & Relief is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Pain & Relief.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Pain & Relief. Austin Pain & Relief accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of pain and relief.
Austin Pain & Relief strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
This document presents the 2018 consensus statement of the Section of Regional Anaesthesia and Pain Therapy of the Polish Society of Anaesthesiology and Intensive Therapy on postoperative pain management. It provides guidelines and recommendations based on a review of the latest scientific evidence published since 2014. The guidelines cover appropriate use of opioids and other drugs for postoperative pain relief, and emphasize the importance of multimodal analgesia and the need to individualize treatment to the patient and surgery. Pethidine is not recommended due to concerns about its efficacy and safety profile compared to other opioids.
CHRONIC PAIN AND DEPRESSION: Cause or Effect or Linked?Sudhir Kumar
Chronic pain and depression are both common conditions, and in many patients, they co-exist. This presentation looks at the link between chronic pain and depression. Various drugs that can be used to treat chronic pain/depression have been discussed, with a special emphasis on tricyclic antidepressants.
The document discusses pain assessment and management in elderly patients. It outlines common misconceptions about pain in elderly patients held by patients and nurses. It also summarizes the pathophysiology of pain and different pain management approaches including pharmacological interventions following the WHO analgesic ladder and alternative therapies that can help close the gate control system and reduce pain. Effective pain assessment and regular reassessment using a pain scale is important to properly treat pain.
No poison can kill a positive thinker and no medicine can cure a negative thinker. Pain is a complex perceptual experience. Pain is a major public health problem. Beat back pain without surgery and conquer pain without painkillers. Delays have dangerous ends. Knee braces invite injury. Chronic pain affects one in three people in the United States. There are more Americans suffering from chronic pain than with diabetes, heart disease, and cancer combined. Chronic pain is caused by degeneration, illnesses, injuries, surgeries, and treatment side effects. Pain is a major public health problem and is the most common reason why Americans use complementary and integrative health practices. Recent imaging evidence suggests a possible hypothalamic origin for a headache attack, but further research is needed. A migraine is associated with a modest increase in the risk of ischemic stroke.
This document provides guidance on palliating pain for patients near the end of life through pharmacological and non-pharmacological means. It outlines the WHO analgesic ladder for treating mild, moderate, and severe pain with non-opioids, opioids, and adjuvants. Specific opioid and adjuvant medication options are discussed along with guidelines for effective pain management including administering analgesics regularly, anticipating and treating side effects, and using multimodal treatment approaches. Non-pharmacological strategies like physical therapy, behavioral modifications, and psychosocial support are also reviewed. The goal is to effectively manage a patient's pain using all available tools based on the underlying causes of pain.
This document provides guidance on palliating pain for patients near the end of life through pharmacological and non-pharmacological means. It outlines the WHO analgesic ladder for treating mild, moderate, and severe pain with non-opioids, opioids, and adjuvants. Specific opioid and adjuvant medication options are discussed along with guidelines for effective pain management including titration, administration routes, managing side effects, and combining treatments. Non-pharmacological approaches like physical therapy, behavioral modifications, and psychosocial support are also summarized. The goal is to effectively manage a patient's pain using all available tools based on the underlying causes of pain.
postoperative pain assessment and managementpropofol2012
This document provides an overview of acute postoperative pain assessment and management. It defines pain and discusses pain assessment tools and the pathophysiology of pain. It outlines the objectives of treating pain, barriers to effective pain management, and complications of unrelieved pain. Different analgesic drugs are described including opioids, paracetamol, NSAIDs, and NMDA receptor antagonists. Methods of drug administration and non-pharmacological pain management methods are also summarized. Assessment of pain in critical care settings is discussed.
The dark side_of_opioids_in_pain_management__.3Paul Coelho, MD
This document summarizes basic science research that helps explain clinical observations about the effects of opioids on pain. Studies show that long-term or high dose opioid use can paradoxically increase pain through central sensitization and the activation of pronociceptive systems. Mechanisms like NMDA receptor activation, MAP kinase signaling, and glial cell activity contribute to opioid-induced hyperalgesia and tolerance. These biological adaptations may undermine the long-term effectiveness of opioids for chronic pain and even increase pain vulnerability after opioid treatment ends. The findings suggest clinicians should reexamine practices like indefinite opioid escalation that have increased opioid doses without clear evidence of improved analgesia.
This document summarizes basic science research that helps explain clinical observations about opioids increasing pain in some patients. It discusses how high and prolonged opioid doses can cause central sensitization and hyperalgesia through mechanisms like NMDA receptor potentiation and MAP kinase signaling. This suggests that newer opioid prescribing practices involving higher and around-the-clock dosing may need reexamination, as they could paradoxically increase pain through these neuroadaptive processes.
This document discusses pain therapy and postoperative pain management. It defines pain and describes different types of pain like acute, chronic, and neuropathic pain. The goals of postoperative pain management are to reduce pain, improve quality of life, reduce morbidity, facilitate rapid recovery, and allow for early hospital discharge. Effective pain management can decrease complications, chronic pain, hospital stay, and costs while increasing patient satisfaction. Pain should be assessed using scales like VAS, VNR, and categorical scales. Both pharmacological treatments like acetaminophen, NSAIDs, opioids, and alpha-2 agonists as well as procedural approaches like regional anesthesia and local infiltration are discussed. Factors that influence analgesic requirements and safety information are also summarized.
Nociceptors are found in somatic structures like skin, muscle, connective tissue, bones and joints as well as visceral structures like organs and blood vessels. They detect and respond to potentially damaging stimuli to signal the presence of actual or threatened tissue damage.
This document provides information on multimodal regiments for acute pain management. It discusses the goals of multimodal analgesia including reducing opioid use through additive or synergistic effects. Key points:
- Multimodal analgesia involves using two or more analgesics with different mechanisms to better treat multiple pain sources and reduce side effects.
- Postoperative pain involves peripheral and central sensitization, so multimodal regiments target both levels.
- Common regiments discussed include paracetamol, NSAIDs, COXIBs, ketamine, gabapentinoids, clonidine and opioids. Low dose ketamine and gabapentinoids are highlighted for their anti-hyperalgesic effects.
- Combining
Mick Serpell discusses drug developments for treating post-operative pain and neuropathic pain, including optimal drug strategies, combinations, and prophylaxis. Some key areas covered include gabapentin reducing post-mastectomy pain and opioid requirements; combinations of gabapentin and opioids providing better pain relief than either alone; and amitriptyline potentially preventing post-herpetic neuralgia. New drugs mentioned include cannabinoids and a lidocaine plaster for treating neuropathic pain.
This document discusses postoperative pain management. It begins by stating that pain is commonly experienced after surgery and has historically been under treated. It then discusses pain assessment and various methods for treating pain, including acetaminophen, NSAIDs, opioids, local anesthetics, and patient-controlled analgesia. The document emphasizes the importance of treating pain for patient wellbeing and recovery, and the need for a multimodal approach using different drug classes to provide effective pain relief with fewer side effects.
This document discusses acute pain management in the emergency department. It begins with an introduction noting that pain is the most common presenting symptom in emergency departments, with over 60% of patients experiencing pain. It then focuses on defining acute pain and providing an overview of the pathophysiology of acute pain. The document also discusses common barriers to pain management in emergency settings, dos and don'ts of pain treatment, and strategies to improve pain management in the emergency department. It provides recommendations from international health organizations on patients' right to pain relief.
Presentation was originally done at Group Health Cooperative’s National Summit on Opioid Safety: http://www.ghinnovates.org/?p=3502
Presentation by: Roger Chou, MD, Associate Professor of Medicine for Oregon Health & Science University
and Director of Pacific Northwest Evidence-based Practice Center.
Topical analgesics are recommended in guidelines for treating the pain of both osteoarthritis and neuropathy. Topical analgesics are defined as therapies applied to body surfaces to treat pain, and are either rubbed onto the skin or made into patches or plasters that are adhered onto the skin. Under the header of topical analgesics, we find both transdermal as well as intradermal formulations. This differentiation in terminology is recommendable, as transdermal topicals act via adequate drug concentrations in the blood, while intradermal formulations act via mechanisms in the skin and do not need to penetrate into the blood. This will be demonstrated based on examples of amitriptyline and phenytoin gels and creams
Intensity of chronic pain — the wrong metric Paul Coelho, MD
The document discusses how pain intensity is an imperfect metric for evaluating chronic pain treatment outcomes. While pain intensity was widely used as the goal of acute and end-of-life pain treatment, it fails as a measure for chronic pain, which has different causes and meanings. For chronic pain patients, factors like suffering, distress, disability, and quality of life may be better indicators of treatment success than pain intensity alone. The document advocates for moving beyond a focus solely on pain intensity and adopting multimodal treatments and a biopsychosocial approach that considers the complex nature of chronic pain.
Austin Pain & Relief is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Pain & Relief.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Pain & Relief. Austin Pain & Relief accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of pain and relief.
Austin Pain & Relief strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Topical Specialist & Compound Pharmacy Study in Jacksonville FL Dr Manish Bansal MD explains the quality of life effects of various transdermal pain therapies. A multicenter prospective cohort study.
This editorial discusses the author's changing views on long-term opioid treatment for non-cancer pain. While the author previously believed opioids were appropriate to treat all types of pain, the author now questions their effectiveness and safety for long-term treatment of non-cancer pain. The author describes commonly encountering patients on dangerously high opioid doses for musculoskeletal pain. The author argues guidelines setting a maximum recommended opioid dose could help address this problem.
This document discusses optimizing pain management in cancer treatment. It provides an overview of concepts like total pain, the WHO analgesic ladder for treating pain with opioids, and the importance of proper pain assessment and documentation. The key points are:
1) Total pain includes physical, psychosocial, emotional, and spiritual suffering experienced by cancer patients.
2) The WHO analgesic ladder recommends treating mild pain with non-opioids like paracetamol, moderate pain with weak opioids like codeine, and severe pain with strong opioids like morphine.
3) Proper pain assessment involves documenting pain scores, characteristics, causes, and impact on function to effectively guide pain treatment decisions.
This document discusses optimizing pain management in cancer treatment. It provides an overview of concepts like total pain, the WHO analgesic ladder for treating pain with opioids, and the importance of proper pain assessment and documentation. The key points are:
1) Total pain includes physical, psychosocial, emotional, and spiritual suffering experienced by cancer patients.
2) The WHO analgesic ladder recommends treating mild pain with non-opioids like paracetamol, moderate pain with weak opioids like codeine, and severe pain with strong opioids like morphine.
3) Proper pain assessment involves documenting pain scores, characteristics, causes, and impact on function to effectively guide pain treatment decisions.
Study of Analgesic usage In a Tertiary Care.pptxHariHaran726642
This document outlines a study to assess analgesic usage patterns at the outpatient departments of a tertiary hospital in India. The study will involve collecting data on analgesics prescribed to patients aged 18-60 across several outpatient departments. The objectives are to document conditions analgesics are prescribed for, determine any cases requiring caution, and assess prescribing practices to promote rational analgesic use. Data on analgesic class, dosage, frequency, number prescribed, and generic name will be gathered from prescriptions and analyzed statistically. The goal is to identify commonly prescribed analgesics and provide information to optimize pain management and treatment.
The document discusses pain management, including defining pain, different pain theories like the gate control theory, differentiating between acute and chronic pain, non-pharmacological and pharmacological interventions. It covers non-opioid analgesics, opioid analgesics according to pain level, opioid side effects, equianalgesic dosing, adjuvants, the WHO pain ladder, routes of opioid delivery, patient-controlled analgesia, and nursing guidelines for patient-centered pain management.
iCAAD London 2019 - Mel Pohl - CHRONIC PAIN AND ADDICTION: HOW WE MISSED THE...iCAADEvents
The document discusses chronic pain and addiction. It notes that while all pain is real, emotions drive the experience of chronic pain. Opioids are often ineffective in treating chronic pain and can actually make pain worse. The goals of pain management should be to maintain or improve function rather than just reducing pain. Non-medication treatments like exercise, massage, and mindfulness can be effective alternatives or supplements to medication for chronic pain.
The conundrum of opioid tapering in long term opioid therapy for chronic pain...Paul Coelho, MD
The document discusses the challenges clinicians face when tapering patients off long-term opioid therapy for chronic pain. It explains that opioid dependence can cause worsening pain, psychiatric symptoms, and functioning during tapering due to neuroplastic changes. While tapering seems logical to address risks of high-dose opioids, it may paradoxically make a patient's issues worse due to protracted abstinence syndrome. The document provides guidance for managing these complex patients focused on both pain and opioid dependence.
C. Give the patient Tylenol 650mg P.O as ordered and assist the patient with guided imagery.
This patient's pain level is relatively low at a 2/10 and is being well managed with scheduled Tylenol. Guided imagery could help further reduce the patient's perception of pain without unnecessary opioid exposure. Options A, B, and D would likely provide more pain relief than is needed and increase risks of opioid dependence, misuse or overdose.
This document discusses the distinction between opioid dependence and addiction. It notes that while tolerance and dependence are physiological adaptations to long-term opioid use, addiction is defined by aberrant drug-seeking behaviors. For patients receiving opioids long-term for pain, dependence may develop but not necessarily addiction if they do not exhibit drug-seeking behaviors. However, abruptly stopping opioids can cause withdrawal and craving, emerging addiction behaviors. The experience in Washington state shows that for some patients, tapering established long-term opioid treatment can destabilize them and complex, persistent dependence may require ongoing treatment similar to addiction maintenance therapy.
The paper lists the correct method of diagnosing chronic pain, and matching the proper medication to tissue damage without the use of narcotics or opioids.
5069 -Module 4 The Value of Information and CostsHomework .docxalinainglis
5069 -Module 4 The Value of Information and Costs
Homework 4
Class,
Do a search on the internet and find a company that does this well reliability measures, and write up a page telling me what this company does and why it does well with this area.
Running head: PAIN MANAGEMENT AND ADDICTION 1
PAIN MANAGEMENT AND ADDICTION 7
Pain Management and Addiction
Name
Institution
Pain Management for Patients with Addiction Problems
Thesis Statement
The ability of clinicians to keep patients in check has proven to be a challenge, especially with concerns regarding the legitimacy and physical functions affecting overall pain management in patients with an addiction problem.
Background
The treatment modalities for chronic pain using COT in active drug users or those who are in remission presents a significant challenge for clinicians who oversee the effectiveness of the intervention. Moreover, such notions are correlated to the concerns of patients experiencing a relapse to substance abuse during the duration of therapy since analgesics may obscure drug seeking behaviors that are characteristic of addictive diseases. This results in poor treatment outcomes where patients are likely to be discharged prematurely from pain care treatment. Additionally, there is the widespread misconception that chronic pain patients with an addiction problem often encounter health professionals who possess inadequate training in clinical guidelines that are related to comorbidities of chronic pain and related addiction issues. Moreover, there exists a dilemma for the treatment of abstinent and former heroin addicts as they are at a high risk of relapsing to addiction if they are exposed to opioid drugs. They also face the risk of relapsing if they are not accorded sufficient care. For people who are already on opioid medication such as methadone often experience challenges responding to pain relievers when they are hospitalized. In such as case, the fundamental principle of management denotes the prevention of withdrawals by initiating methadone for heroin users while providing additional analgesia as recommended while confirming whether the pain relief is satisfactory. Additionally, most physicians have developed a phobia of overprescription of narcotics as pain relievers. Perhaps this may be attributed to the fear of the legal repercussions that may ensue including the divergences in federal guidelines on matters about use of narcotics as a pain reliever. Thus, it is the responsibility of the individual practitioner to offer pain management using opioids for legitimate standard and by the regulation of medical practice.
Objective
The purpose of this research is to evaluate the challenges that are faced by clinicians in pain treatment for patients with addiction problems. On the other hand, the study focuses on offering a counter argument to the thesis by providing ideal solutions for pain management for patients with SUDs. Additionally, the rese.
A woman in her 50s presented for medically managed withdrawal from an ultra-high-dose opioid regimen of 1620 mg MEDD for chronic back pain stemming from a 1983 injury. Over multiple decades, her opioid doses escalated despite providing limited functional benefit and resulting in several hospitalizations. She agreed to an acute inpatient withdrawal managed with buprenorphine, allowing her to discontinue full agonists without functional impairment. The case illustrates the risks of long-term high-dose opioid therapy and the need to regularly re-evaluate risks versus benefits.
Challenges in Managing Cancer Pain: The Role of the Oncology Pharmacistflasco_org
The correct answer is E. All of the strategies listed can be used by oncology or supportive care pharmacists to better manage pain in patients in the hospital setting.
Wsam Presentation For Opiate GuidelinesJKRotchford
CME presentation at WSMA annual meeting. Problematic opioid use, questioning the concept of "pseudo-addiction", seeing chemical dependency as somewhere well along the continuum of problematic opioid use.
FIRST DRAFT1FIRST DRAFT9First DraftErica K.docxAKHIL969626
FIRST DRAFT 1
FIRST DRAFT 9
First Draft
Erica K. Fernandez
Argosy University
Pain Management for Patients with Addiction Problems
Thesis Statement
The ability of clinicians to keep patients in check has proven to be a challenge, especially with concerns regarding the legitimacy and physical functions affecting overall pain management in patients with an addiction problem.
Background
The treatment modalities for chronic pain using COT in active drug users or those who are in remission present a significant challenge for clinicians who oversee the effectiveness of the intervention. Moreover, such notions are correlated to the concerns of patients experiencing a relapse to substance abuse during the duration of therapy since analgesics may obscure drug-seeking behaviours that are characteristic of addictive diseases. This results in poor treatment outcomes where patients are likely to be discharged prematurely from pain care treatment (Ballantyne & Mao, 2003). Additionally, there is the widespread misconception that chronic pain patients with an addiction problem often encounter health professionals who possess inadequate training in clinical guidelines that are related to comorbidities of chronic pain and related addiction issues. Moreover, there exists a dilemma for the treatment of abstinent and former heroin addicts as they are at a high risk of relapsing to addiction if they are exposed to opioid drugs. They also face the risk of relapsing if they are not accorded sufficient care. For people who are already on opioid medication such as methadone often experience challenges responding to pain relievers when they are hospitalized. In such as case, the fundamental principle of management denotes the prevention of withdrawals by initiating methadone for heroin users while providing additional analgesia as recommended while confirming whether the pain relief is satisfactory (Chou et al., 2009). Additionally, most physicians have developed a phobia of over prescribing narcotics as pain relievers. Perhaps this may be attributed to the fear of the legal repercussions that may ensue including the divergences in federal guidelines on matters about the use of narcotics as a pain reliever. Thus, it is the responsibility of the individual practitioner to offer pain management using opioids for legitimate standard and by the regulation of medical practice.
Objective
The purpose of this research is to evaluate the challenges that are faced by clinicians in pain treatment for patients with addiction problems. On the other hand, the study focuses on offering a counter-argument to the thesis by providing ideal solutions for pain management for patients with SUDs. Additionally, the research intends to highlight the complex interconnection that exists between pain management and addiction to opioids.
Supporting Points
For clinicians, the hardest challenge is perhaps knowing the right way to handle patients who require pain medication, ...
- 49% of chronic pain patients taking opioids reported severe pain (≥7/10).
- Patients reporting higher pain were more likely to have characteristics associated with centralized pain processing, including higher fibromyalgia survey scores, more neuropathic pain symptoms, and higher depression levels.
- While only 3.2% were diagnosed with fibromyalgia by their doctor, 40.8% met criteria for fibromyalgia based on a validated survey questionnaire. This suggests centralized pain characteristics are underrecognized.
This document provides information on pain assessment and management. It discusses:
- Common types of pain including acute, chronic, cancer, and breakthrough pain.
- Tools for assessing pain such as visual scales, verbal scales, and numeric rating scales from 0-10.
- Pharmacological approaches to pain management including the WHO analgesic ladder with steps from non-opioids to mild then strong opioids.
- Non-pharmacological approaches like relaxation, distraction, TENS, and hypnosis.
- Side effects of pain medications like constipation and risks of opioids like respiratory depression.
Similar to Estudio sobre opiáceos vs Biofreeze (20)
El documento describe la composición de CELLFOOD, un suplemento nutricional. Contiene una amplia variedad de minerales, aminoácidos, enzimas y electrolitos que proporcionan nutrientes esenciales para el cuerpo. Al tomar CELLFOOD, algunas personas pueden experimentar una "crisis de curación" en la que el cuerpo elimina toxinas acumuladas, lo que puede causar síntomas temporales de desintoxicación. Esto es un signo positivo de que el cuerpo se está limpiando a profundidad. Siguiendo las
I. Un estudio prospectivo evaluó el efecto de Rowatinex® en 50 pacientes tratados con litotripsia para cálculos renales o ureterales.
II. A los 14 días, el 60% de pacientes estaban libres de cálculos y el 82% a los 28 días.
III. Los resultados para el alivio de dolor también fueron excelentes, con un 82% libres de dolor a los 14 días y un 94% a los 28 días.
La dispepsia o indigestión se define como un síntoma que incluye náuseas, ardor de estómago y dolor abdominal superior. Rowachol contiene seis terpenos purificados que mejoran la bilis, son coleréticos, antiespasmódicos, estimulan la secreción pancreática y tienen efectos carminativos, lo que alivia los síntomas de la dispepsia. Varios estudios con animales y humanos han demostrado que Rowachol mejora la función del sistema digestivo y la composición de la bilis.
This document is a medication guide for non-steroidal anti-inflammatory drugs (NSAIDs) that outlines important safety information. It states that NSAIDs can increase the risk of heart attack, stroke, ulcers and bleeding in the stomach and intestines. It lists common side effects like stomach pain and serious side effects like kidney problems. The guide provides information on who should not take NSAIDs and cautions to stop use and seek medical help if concerning symptoms arise. It also lists examples of prescription NSAID medicines.
Este documento describe un estudio clínico sobre el tratamiento de la celulitis mediante mesoterapia homeopática y fitoterapia. El estudio incluyó 1,564 pacientes tratados entre 1991 y 1994 con una mezcla homeopática llamada Lipodistrofin inyectada mediante mesoterapia, complementada con tratamientos dietéticos, de ejercicio y aplicaciones tópicas. Los resultados mostraron mejoras en la pérdida de peso, disminución del diámetro de la cintura y síntomas relacionados con la celulitis, sin efectos
This study evaluated the effectiveness of Osteobios and Guna-Fem supplements for treating early postmenopausal osteoporosis compared to calcium and vitamin D supplements. 70 postmenopausal women with osteoporosis were divided into two groups. The group treated with Osteobios and Guna-Fem showed greater reductions in pain levels, improvements in quality of life, and decreases in bone resorption markers compared to the calcium/vitamin D group. The results suggest Osteobios and Guna-Fem may be effective treatments for reducing symptoms of early postmenopausal osteoporosis.
This document discusses using cytokines and homeopathic dilutions therapeutically. It argues that cytokines, which are protein molecules that regulate the immune system, can be used in homeopathic form to help defend the body against illness. The document states that homeopathy uses extremely diluted stimuli that are able to precisely target ultrafine body structures. It asserts that this approach can help restore balance to the complex fractal dynamics of various biological systems interacting in the body. Overall, the document proposes that cytokines can be applied homeopathically to provide a balanced, non-toxic stimulation that supports the body's natural healing responses.
The document summarizes a study on the use of Osteobios to treat calcium metabolism disorders in patients with chronic kidney disease stages II-III. 20 patients received Osteobios drops daily for a month in addition to other treatments, while a control group of 20 similar patients received no such treatment. Testing showed improvements in calcium, phosphorus, parathyroid hormone, and pain levels in the treatment group compared to baseline and the control group. The study concluded that Osteobios safely improves calcium metabolism in patients with chronic kidney disease without the need for additional medications.
Physiological Regulating Medicine (PRM) is the latest integration between Conventional Medicine and Homeopathic Medicine. PRM integrates classic Homeopathy with a new therapeutic concept - the restoration of physiological conditions through molecules such as hormones, neuropeptides, interleukins and growth factors in homeopathic dilutions corresponding to physiological concentrations. The method includes current knowledge on Homeopathy, Homotoxicology, the Psycho-Neuro-Endocrine-Immune axis, and nutrition. PRM offers injectable formulations for the control of nociceptive, neuropathic and mixed pain that can be injected into acupuncture points with excellent therapeutic results and no side effects.
Este documento presenta los resultados de un estudio multicéntrico sobre el uso de la mesoterapia homeopática con Condrotrofín R para tratar la patología articular. El estudio evaluó 200 pacientes durante 5 semanas y encontró una mejoría significativa de los síntomas en el 40% de los pacientes después de la primera semana de tratamiento. El tratamiento con Condrotrofín R redujo la necesidad de medicamentos convencionales y fue bien aceptado por los pacientes.
1. The extracellular matrix (ECM) represents the basic system of living organisms, where nourishment, control, and management of cells takes place through mutual information exchange.
2. The ECM is composed of proteoglycans and glycosaminoglycans which help maintain homeostasis. It also contains collagen, elastin, and other glycoproteins.
3. Over a lifetime, catabolites can accumulate in the ECM, making energy exchange between cells more difficult and contributing to the aging process. Physiological Regulating Medicine aims to cleanse and restore the ECM, such as through the product GUNA-MATRIX.
This study aimed to determine the safety and efficacy of three popular mesotherapy cocktails in treating localized fat deposits in Filipino women. Sixty subjects received injections of one of three cocktails - phosphatidylcholine and organic silicium (PC-OS), phaphatidylcholine, tiratricol and L-carnitine (PC+L), or the homeopathic formula Omeoformula 1. Measurements and blood tests showed PC-OS and Omeoformula 1 were comparable in reducing arm circumference and had fewer adverse effects than PC+L. Overall, mesotherapy was deemed safe and effective for reducing localized fat deposits with some benefit to HDL and LDL cholesterol levels.
Este estudio experimental evaluó los efectos de un preparado homeopático llamado Musclebig en parámetros antropométricos y dinamométricos de 32 culturistas masculinos. Los participantes fueron asignados aleatoriamente a un grupo tratado con inyecciones de Musclebig o a un grupo control. Tras 12 semanas, el grupo tratado mostró aumentos estadísticamente significativos en su índice de masa corporal, masa magra y fuerza de resistencia, así como una disminución en la grasa corporal, en comparación con el
The document describes a clinical study on 681 patients that evaluated the efficacy of the homeopathic remedy MADE® in treating wrinkles and skin slackening. The study found MADE® to be an effective alternative to conventional pharmacological treatments, showing good results in preventing and treating wrinkles and skin slackening, especially in patients aged 30-40 and 40-50.
1. The study investigated the effectiveness of antihomotoxic preparations Traumeel S and Osteobios in combination treatment of degenerative spinal diseases. Patients receiving these preparations in addition to traditional therapy saw greater improvements in pain, mobility, and bone healing markers than the control group receiving only traditional therapy.
2. Specifically, those receiving Traumeel S injections and ointment experienced greater reductions in pain levels and muscle spasms after 4 days compared to the control group. They also had faster wound healing after surgery.
3. The group also receiving Osteobios showed higher blood alkaline phosphatase levels upon discharge, indicating increased bone formation compared to the control group. This supported Osteobios' role
This document discusses inflammation and cytokines. It notes that cytokines are proteins secreted by immune cells in response to antigens that induce inflammation. Cytokines influence each other in cascades and have pleiotropic, redundant, synergistic and antagonistic effects. Their secretion is brief and self-limiting, requiring multiple cytokines in relay to achieve a targeted biological response. Physiological regulating medicine uses homeopathic cytokines and other remedies to reset and coordinate the immune system.
The document discusses the transition from homeopathy to physiological regulating medicine (PRM). While homeopathy is based on the principle of treating "like with like" using highly diluted substances, PRM was developed by an Italian research group inspired by homeopathy but aiming to have a more scientifically valid treatment approach based on the latest immunology and neuroendocrinology discoveries. Key aspects of homeopathy discussed include the principle of similarity in symptom matching, and the use of potentized dilutions, which some research has found can induce physical changes in water and potentially have physiological effects.
The document discusses the transition from homeopathy to physiological regulating medicine (PRM). While homeopathy is based on the principle of treating "like with like" using highly diluted substances, PRM was developed by an Italian research group inspired by homeopathy but aiming to have a more scientifically valid treatment approach based on the latest immunology and neuroendocrinology discoveries. Key aspects of homeopathy discussed include the principle of similarity in symptom matching, and the use of potentized dilutions, which some research has found can induce physical changes in water and potentially have physiological effects.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia