This document discusses neuropathic pain, its causes, symptoms, and treatment options. It begins by defining neuropathic pain as pain resulting from damage or disease affecting the somatosensory nervous system, such as diabetic neuropathy or postherpetic neuralgia. Symptoms include abnormal sensations like tingling, burning, and pain from stimuli that are normally non-painful. Treatment options discussed include tricyclic antidepressants, gabapentin, pregabalin, serotonin-norepinephrine reuptake inhibitors, topical lidocaine, opioids, and emerging treatments like botulinum toxin, cannabinoids, spinal cord stimulation, and intrathecal drug delivery.
this presentation discusses pain pathways, definition and glossary of pain symptoms, classification of pain, pathogenesis, causes, diagnosis , types and treatment of neuropathic pain
illustrated with figures
this presentation discusses pain pathways, definition and glossary of pain symptoms, classification of pain, pathogenesis, causes, diagnosis , types and treatment of neuropathic pain
illustrated with figures
The presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes is called diabetic peripheral neuropathy.
The diagnosis is principally a clinical one. Patients with type 1 diabetes for 5 or more years and all patients with type 2 diabetes should be assessed annually.Treatment goals include
good glycemic control,symptomatic treatment and halt progressive nerve damage.
Peripheral neuropathy is a common condition, encountered by physicians as well as neurologists. However, a large number of challenges remain. These include difficulty in diagnosing, delay in diagnosis, investigations and lack of effective treatments. This presentation discusses these unmet needs and provides suggestions to overcome them.
Phantom pain is pain caused by elimination or interruption of sensory nerve impulses by destroying or injuring the sensory nerve fibers after amputation or deafferentation
Back pain
Etiology
Anatomical & pathophysiological concepts
Diagnostic approach
Clinical approach
Red flags & yellow flags
Investigations
Back pain in children & elderly
Medical management of neuropathic painSudhir Kumar
This presentation looks at medical therapies for the treatment of neuropathic pain. Neuropathic pain is commonly caused by diabetes, herpes zoster, trigeminal neuralgia, cancer, vitamin B12 deficiency, vasculitis, etc.
The presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes is called diabetic peripheral neuropathy.
The diagnosis is principally a clinical one. Patients with type 1 diabetes for 5 or more years and all patients with type 2 diabetes should be assessed annually.Treatment goals include
good glycemic control,symptomatic treatment and halt progressive nerve damage.
Peripheral neuropathy is a common condition, encountered by physicians as well as neurologists. However, a large number of challenges remain. These include difficulty in diagnosing, delay in diagnosis, investigations and lack of effective treatments. This presentation discusses these unmet needs and provides suggestions to overcome them.
Phantom pain is pain caused by elimination or interruption of sensory nerve impulses by destroying or injuring the sensory nerve fibers after amputation or deafferentation
Back pain
Etiology
Anatomical & pathophysiological concepts
Diagnostic approach
Clinical approach
Red flags & yellow flags
Investigations
Back pain in children & elderly
Medical management of neuropathic painSudhir Kumar
This presentation looks at medical therapies for the treatment of neuropathic pain. Neuropathic pain is commonly caused by diabetes, herpes zoster, trigeminal neuralgia, cancer, vitamin B12 deficiency, vasculitis, etc.
Neuropathic pain poses a challenge to effective rehabilitation. Best practice, considerations & the use of Action Potential Simulation therapy to effectively treat neuropathic pain, sharing our results from a 2 year research project in people with MS.
Overview of the anatomical pathways of acute and chronic pain, detailed explaination of the synapse, and summary of various types of pharmacological agents for chronic pain
pain management after craniotomy and spine surgery. as a neuroanesthesiologist it our duty to manage post operative pain. pain in these patient are under treated.
A comprehensive presentation on dependence on and abuse of pregablin and gabapentin and the context of the drugs in the pharmaceutical market - by a substance use nurse
Training Courses in Clinical Embryology.
Embryology Academy for Research & Training is a one stop training center for all aspects of Embryology and Andrology laboratory techniques.
Assisted Reproductive Technologies, be they Intrauterine Insemination, In Vitro Fertilization or Intra cytoplasm sperm injection - all need skill and precision which could be acquired from in depth knowledge and experience. To young aspirants and embryologists alike, we at EART with our judicious mixture of various teaching modules, lectures, actual hands-on-training and demonstrations ensure quality training much to your satisfaction. Knowledge from the basics in embryology to the ultimate in cryosciences and laser devices all will be imparted by our dedicated team to ensure continuity of care.
Embryology Academy for Research & Training
Address: 26 A, Raju Industrial Estate, Near Dashisar Check Naka,
Mira 401 104.
Telephone:+91 22 2845 7140 / 2845 7059
Fax: +91 22 2845 6766
ivftraining@gmail.com
a detailed description of pain and therpaeutic options available and clinical assessment of pain, approach to the patient with pain, assessment of intensity of pain, nsaids and opioids, tca. WHO pain ladder, chronic opioid therapy
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Neuropathic pain resulting directly from a
lesion or disease affecting the
somatosensory system.
diabetic polyneuropathies, postherpetic
neuralgia, trigeminal neuralgia, and central
poststroke or spinal cord injury pain.
Traumatic or postsurgical neuropathies and
painful radiculopathies are also common
conditions in the general population.
3. Paresthesia are abnormal spontaneous or stimulus-
independent sensations, often described as tingling or
compared to a limb that has fallen "asleep.
Dysesthesia refers to an unpleasant abnormal sensation
that can be spontaneous or evoked.
allodynia to pain following contact by a normally non-
noxious stimulus.
hyperalgesia to exaggerated pain from a noxious
stimulus
Hyperpathia is a complex sensory experience
characterized by an abnormally painful reaction to a
stimulus, especially a repetitive stimulus, in a patient who
initially perceives the stimulus as less intense.
4. MAJOR MECHANISMS INVOLVED IN
NEUROPATHIC PAIN
Peripheral Mechanisms:
Abnormal (ectopic) neuronal activity has been reported in primary
afferents and in the dorsal root ganglion and appears to be mainly
related to dysregulation of the synthesis or the functioning of
sodium channels (notably the tetrodotoxin resistant channels),
although potassium channels may also be involved.
Nerve injury also induces upregulation of several receptor
proteins, including transient receptor potential vanilloid 1
(TRPV1).
TRPV1 is located on subtypes of peripheral nociceptive
endings and is physiologically activated by noxious heat, among
other stimuli.
After a nerve lesion, TRPV1 is upregulated in uninjured C
fibers and downregulated in injured nerve fibers.
5. CENTRAL MECHANISMS
Several major types of modifications can induce pathologic
activation of central nociceptive neurons:
1)modification of the modulatory controls of the transmission of
nociceptive messages;2) anatomic reorganization
(neuroplasticity) of the central nociceptive neurons and thus their
pathologic activation; 3)microglial activation; and 4) central
sensitization (hyperexcitability) of nociceptive neurons.
Central sensitization probably depends critically on intracellular
changes induced by the activation of NMDA receptors or other
receptors (ie, glutamate metabotropic receptors) by excitatory
amino acids released by primary afferents.
Because of the multiplicity of mechanisms, it is unlikely that NP is
related to only one mechanism.
6. CURRENT DRUG TREATMENT FOR NEUROPATHIC
PAIN .
Tricyclic antidepressants
Nortriptyline ,Desipramine ,Amitriptyline
Inhibition of reuptake of monoamines, block of
sodium channels, anticholinergic.
Somnolence, anticholinergic effects, weight gain.
Cardiac disease (ECG), glaucoma,prostatic
adenoma, seizure, use Desipramine of tramadol.
A: Diabetic neuropathy, postherpetic neuralgia
(PHN)
B: Spinal cord injury/central side effects poststroke
pain, traumatic nerve lesions, cancer neuropathic
pain
8. CALCIUM CHANNEL ALPHA-2-DELTA
LIGANDS
Gabapentin,Pregabalin
Acts on alpha-2-delta subunit of voltage-gated calcium
channels, which decreases central sensitization.
Sedation, dizziness, peripheral edema,weight gain.
Reduce dosages in renal insufficiency.
Gabapentin:A: Diabetic neuropathy, PHN,cancer
neuropathic pain
B: Spinal cord injury pain No clinically significant drug
interactions, improvement of generalized anxiety and
sleep
Pregabalin:A: Diabetic neuropathy, PHN, spinal cord
injury pain
9. TOPICAL LIDOCAINE
Lidocaine 5% plasters:
Block of sodium channels
Local erythema, itch, rash.
No systemic side effects,potential effect on
allodynia.
A: PHN 1 to 3 patches/3 patches.
10. Capsaicin patches 8%
Transient receptor potential vanilloid 1
agonist
Pain, erythema, elevated blood pressure due
to initial increase in pain.
No systemic side effects, potential effects on
burning pain, itching, and allodynia.
A: HIV neuropathy and PHN 1 to 4 patches
to cover the painful area, repeat every 3
months.
11. OPIOID AGONISTS
Tramadol
Mu receptor agonist and inhibition of monoamine
reuptake
Nausea and vomiting, constipation, dizziness,
somnolence.
History of substance abuse, suicide risk, use of
antidepressants in elderly patients.
Rapid onset of analgesic effect, effect on
inflammatory pain
A: Diabetic neuropathy, phantom pain
B: Spinal cord injury pain
12. Morphine, oxycodone,methadone,
levorphanol
Mu receptor agonists (oxycodone may also
cause k-receptor antagonism)
Nausea and vomiting, constipation,
dizziness,somnolence.
Rapid onset of analgesic effect,effect on
inflammatory pain
A: Diabetic neuropathy, PHN, phantom pain
13. OTHER NEUROPATHIC PAIN
INDICATIONS
pregabalin is now the drug of choice for SCI
pain.
A Class I trial showed no superiority of
duloxetine over placebo on the primary outcome
of central pain due to stroke or SCI, but several
secondary outcomes, including allodynia to
brush and cold, favored duloxetine.
Studies of gabapentin have found positive
results in Guillain-Barre´ syndrome and cancer
NP and discrepant results in phantom limb pain.
14. Opioids and tramadol have been found to be
efficacious for phantom limb pain.
amitriptyline has been found to be
efficacious for cancer neuropathic pain.
A recent large-scale study using an
enrichment phase demonstrated no benefit
of pregabalin for lumbosacral radiculopathy.
15. EMERGING TREATMENTS FOR
NEUROPATHIC PAIN
Botulinum Toxin Type A:
Several lines of investigation have suggested that botulinum toxin
type A (BTX-A), a potent neurotoxin commonly used for the
treatment of focal muscle hyperactivity, may have analgesic
effects independent of its action on muscle tone, possibly by
acting on neurogenic inflammation.Such mechanisms may be
involved in some cases of peripheral NP.
Three single-center RCTs reported the long-term efficacy of a
series of subcutaneous injections of BTX-A (from 100 to 200 U)
injected into the painful area among patients with
mononeuropathies (traumatic or related to herpes zoster) and
patients with diabetic PPNs.
Interestingly, in these two studies, the onset of efficacy (about 1
week) and duration of effects (3 months) was remarkably similar.
The drug had an excellent safety profile; patients reported only
pain during injection and no systemic side effects.
16. CANNABINOIDS
The therapeutic potential of cannabinoids has been extensively
investigated in chronic pain following the discovery of
cannabinoid
receptors and their endogenous ligands.
Oromucosal cannabinoids (2.7 mg delta- 9-
tetrahydrocannabinol/2.5 mg cannabidiol) are effective for
multiple sclerosis associated pain and for refractory peripheral NP
associated with allodynia.
Adverse events include dizziness, dry mouth, sedation, fatigue,
gastrointestinal effects, and oral discomfort.
cannabinoids are not recommended for patients with psychiatric
disorders.
There is controversy with regard to tolerance and dependence
after long-term treatment.
17. STIMULATION TECHNIQUES AND
INTRATHECAL THERAPY
Transcutaneous electrical nerve stimulation
(TENS) is commonly used for the treatment of
pain associated with peripheral neuropathies,
although the evidence level is moderate (Level
B).
TENS can be proposed as a first-line treatment
for painful focal neuropathies.
Interest in noninvasive brain stimulation
(notably transcranial magnetic stimulation) for
the treatment of NP is increasing.
18. Spinal cord stimulation has been reported to
be efficacious in patients with failed back
surgery syndrome , and motor cortex
stimulation has been increasingly used for
the treatment of peripheral or central painful
neuropathic conditions.
19. For refractory NP, opioids and local
anesthetics can be delivered intrathecally
and have shown some benefit, although no
Class I studies regarding their efficacy
specifically in NP have been reported.