The document discusses pain and modern medicine. It defines pain and chronic pain. It notes that chronic pain is common, affecting 20% of Australians and costing $34 billion per year. While scans cannot detect pain, medications only help reduce pain in 30-40% of cases. The document discusses how views of pain have changed from being tissue-based to involving brain and spinal cord patterns. It advocates addressing all pain inputs using a biopsychosocial approach.
Understanding fatigue and an introduction to the FACETS programmeMS Trust
This presentation by Alison Nook and Vicky Slingsby, Occupational Therapists at the Dorset MS Service, explores fatigue in multiple sclerosis, the most common MS symptom. It looks at how fatigue can be managed with energy effectiveness techniques and introduces FACETS (Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle),
Understanding fatigue and an introduction to the FACETS programmeMS Trust
This presentation by Alison Nook and Vicky Slingsby, Occupational Therapists at the Dorset MS Service, explores fatigue in multiple sclerosis, the most common MS symptom. It looks at how fatigue can be managed with energy effectiveness techniques and introduces FACETS (Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle),
Abnormal mental states and behaviours in MSMS Trust
Learning outcomes:
Recognition and treatment of depression and anxiety in MS
Recognise sudden changes in emotional state (laughter, crying, anger)
Recognition of mania and psychosis in MS
Cognitive impairment
Abnormal mental states and behaviours in MSMS Trust
Learning outcomes:
Recognition and treatment of depression and anxiety in MS
Recognise sudden changes in emotional state (laughter, crying, anger)
Recognition of mania and psychosis in MS
Cognitive impairment
An abridged version of a presentation I delivered to a group of interns in Perth, Western Australia, introducing them to palliative care in the hospital setting
Acute neuropathic pain - Stephan Schug - SSAI2017scanFOAM
A talk by Stephan Schug at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
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.
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.
Pain Physicians should consider nerve blocks when systemic analgesics are failing. (Adjuvant therapy)
Careful selection of patients
Benefits should outweigh the risks
Thorough knowledge of the limitations and side effects
Need for randomized controlled clinical trials.
The evaluation of back pain can be a pain in the neck or a back-breaking exercise, so to speak. However, the diagnosis hinges always on a focused History and Physical Exam and not really on labs or imaging. Knowing what to ask and where to look can make the evaluation of this all-too-common condition manageable for the internist.
This lecture focuses on the evaluation of low back pain and will guide the reader on the key points in the Hx and PE and prevent unnecessary testing/imaging. It also presents 3 "unusual" cases of low back pain which may be disabling if not recognized immediately.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
Pain and Modern Medicine, Stephanie Davies, Head of Service, Pain Medicine Unit, Fremantle Hospital, Perth, WA
1. Pain and Modern Medicine Dr Stephanie Davies MBBS, FANZCA, FFPMANZCA Head of Service, Fremantle Hospital Pain Medicine Unit Adj. A/Prof Curtin University, School of Physiotherapy Senior Lecturer UWA, School of Medicine
2. Pain “ Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” IASP (1979) “ Chronic pain is a complex biopsychosocial phenomenon that can have a profound impact on people’s lives. The condition persists beyond the normal time of healing and is conservatively defined as pain experienced every day for three months or more in the previous six months.” Chronic Pain Prevalence in Australia: Access Economics 2007
3. Persistent Pain is Common 1.. The High Price of Pain: The economic impact of persistent pain in Australia, Blyth et al, Access Economics Report 2007
4.
5. Acute But .. Chronic? Rene Descartes (1644), L’Homme “Telestra” Old Thinking (1644-1965)
6. We “See” Structure … Not Pain MRI: Magnetic Resonance Imaging CT: Computer Tomography XR
7. The Gate Control Theory (1965) Nervous system Patrick Wall Ronald Melzack PAIN Disease, Injury
8. The gate control theory of pain S S = small fibres E E = excitatory inter-neuron L L = large fibres I = inhibitory inter-neuron I T Off On Brain CENTRAL CONTROL CENTRAL CONTROL
9. Implication of Gate Control The nervous system is NOT hard-wired = NEUROPLASTIC THE BRAIN CHANGES ITS OWN STRUCTURE!
10. Pain and Music fMRI: functional Magnetic Resonance Imaging [Blood Flow (not pain)]
13. Acute versus Chronic .. Or.. “Simple” versus Complex Nociceptive Anxiety Fear Unknown ..Or … Pain versus Threat ARTIFICIAL GAP (time, definitions) !! INPUTS OUTPUTS Central Sensitisation, Activity Avoidance, Worry Nociception
14. Trick 1: Address all the inputs Nociceptive Anxiety Fear Unknown Reduce “threat” value of Pain INPUTS OUTPUTS Less: Central Sensitisation, Activity Avoidance, Worry Less: Nociception Non-catastrophic explanation, mindfulness, Patient control = active pain management skills Rx, Needles Pacing, Relax n TARGETS
15. Low Back Pain LBP is the most common MSK condition managed by GPs and is 26% of those people with persistent pain
16. Henschke BMJ (2008) ; Prof Christopher Maher APS 2009 N=973 (<3% drop out) Low Back Pain and ‘Load’ Sydney primary care Yellow flags (adverse prognostic factors): Courtesy of gPEP: GP Pain Education Program: SHRAC 2008-09
26. DRUGS (or PROCEDURES) ALONE NOT THE ANSWER ! Doctors pour drugs, of which they know little, for diseases of which they know less, into patients - of whom they know nothing. [Voltaire] STILL TRUE TODAY !! Deyo et al, Over-treating chronic back pain: time to back Off? J Am Board Fam Med 2009; 22:62-68
27. Tramadol - An Atypical Centrally Acting Analgesic 40% 40% 20% µ-agonist NA uptake inhibition 5HT uptake inhibition
37. Address all the inputs !! Nociceptive Anxiety Fear Unknown Reduce “threat” value of Pain INPUTS OUTPUTS Less: Central Sensitisation, Activity Avoidance, Worry Less: Nociception Non-catastrophic explanation, mindfulness, Patient control = active pain management skills Rx, Needles Pacing, Relax n TARGETS
47. Cognitive-Behavioural Model of Fear of Movement or (Re)Injury 1 Haythornthwaite JA. Assessment of pain beliefs, coping and function. Textbook of Pain. 5 th ed. 2006. p. 317. Painful experiences Catastrophising Fear of movement reinjury Avoidance Disability Disuse Depression Injury Non-catastrophising Confrontation Recovery
48. Low Back Pain LBP is the most common MSK condition managed by GPs and is 26% of those people with persistent pain
49. Henschke BMJ (2008) ; Prof Christopher Maher APS 2009 N=973 (<3% drop out) Low Back Pain and ‘Load’ Sydney primary care Yellow flags (adverse prognostic factors): Courtesy of gPEP: GP Pain Education Program: SHRAC 2008-09
54. Pain, pathology & radiology poorly correlated No help in ~ > 90% cases NSLBP 3 Red flags + High Index of Clinician Suspicion to be worth Radiation Dose !! www.DiagnosticImagingPathways.health.wa.gov.au
60. [Price, 2000] Location & intensity Affective responses etc. Early levels of pain localization processing Negative emotional valence to experience of pain Working memory, affect & attention Emotion Fear Anxiety Motor Planning Relay station 26 AREAS OF BRAIN INVOLVED IN PAIN (at the last count)
61.
Editor's Notes
WHO HAS HEARD OF THE GATE THEORY OF PAIN? TWO BRILLIANT PIONEERS - RONALD MELZACK, A CANADIAN PSYCHLOGIST, AND PATRICK WALL, A BRITISH NEUROSCIENTIST, USED THE OBSERVATION THAT MECHANICALLY STIMULATING THE SKIN IN REGION OF PAIN COULD RESULT IN PAIN REDUCTION. SUCH STIMULATION COULD BE RUBBING THE SKIN OR APPLYING AN ELECTRICAL CURRENT THROUGH A TENS MACHINE MELZACK AND WALL WERE AMONG THE FIRST PEOPLE TO TACKLE THE MYSTERIOUS BLACK BOX - THE NERVOUS SYSTEM THEIR THEORY HAS REVOLUTIONISED THE WAY WE THINK ABOUT PAIN.
FINALLY, MESSAGES FROM THE BRAIN CAN TRIGGER EITHER THE ON OR THE OFF SWITCH - DEPENDING UPON THE CIRCUMSTANCES. THIS IS WHY FOOTBALLERS CAN KEEP ON PLAYING DESPITE INJURIES TO THEIR MUSCLES, KNEES OR ANKLES. AND WHY SOLDIERS CAN CONTINUE TO FIGHT EVEN WHEN WOUNDED OR MINUS A LIMB. AFTER THE GAME (OR THE BATTLE) THE “ON” SWITCH IS ACTIVATED AND MESSAGES OF TISSUE DAMAGE QUICKLY REACH THE BRAIN!
THE IMPORTANT IMPLICATIONS OF GATE CONTROL THEORY ARE: FIRST - THE BRAIN CAN ENHANCE OR INHIBIT “PAIN” TRANSMISSION DEPENDING UPON THE CIRCUMSTANCES IN WHICH THE PERSON FINDS HIMSELF SECOND - THE NERVOUS SYSTEM IS PLASTIC - WHICH MEANS IT IS ADAPTABLE. NEW CONNECTIONS ARE FORMING ALL THE TIME! NERVE CELLS CAN ALSO TAKE ON NEW FUNCTIONS - SOME CAN REGENERATE. WHEN YOU THINK ABOUT IT, NEUROPLASTICITY IS A DOMINANT PRINCIPLE OF THE NERVOUS SYSTEM. WITHOUT IT, WE COULD NOT LEARN TO ADAPT TO OUR ENVIRONMENT!!! DNIC: classical counterirritation phenomenon (i.e. pain inhibits paineffect) might depend on diffuse noxious inhibitory controls (DNIC), which modulate the spinal transmission of nociceptive signals. With rare exception nerve impulses from the body all must come into the spinal cord. Here the nerves synapse with spinal nerves that form tracts that run to the brain. Where pain is concerned, these tracts run through the spine to the part of the brain known as the Thalamus. The Dorsal Horn is the part of the spinal cord that receives painful nerve impulses. Here nerve axon terminals synapse with nerve cell bodies. It is here where the battle against chronic pain begins. If this part of the nervous system fails, pain can be greatly increased and difficult to bring under control. Failure can occur with NMDA receptor based wind-up, neuropathic pain and/or brain based modulating.
YOU SAW THIS SLIDE EARLIER. IT CONFIRMS THE OBSERVATION THAT BY LISTENING TO MUSIC, PAIN CAN BE REDUCED. PEOPLE IN PAIN TELL ME THAT THE SAME EFFECT IS PRODUCED WHEN THEY DO OTHER CREATIVE THINGS, SUCH AS PHOTOGRAPHY, PAINTING, READING, OR MEDITATING. THEY ARE USING IT (THE BRAIN) TO LOSE IT (THEIR PAIN). WHAT TECHNIQUES DO YOU USE TO MANAGE YOUR PAIN?
Whenever tissues are damaged, many substances are released from the damaged cells and also from many other cells that congregate to mop up the damage. This is the process of inflammation. These substances excite nearby nerve endings which, in turn, release products that hasten the process of repair. Usually this is a finely tuned process. As you can see, when activated, the immune system talks to the nervous system and vice versa.
[1] Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med 1996;335:1721-1726 [2] Vad VB, Bhat AL, Lutz GE, Cammisa F. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine 2002;27:11-15. [3] van Kleef M, Barendse GA, Kessels A, Voets HM, Weber WE, de Lange S. Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine 1999;24:1937-1942. [4] Carette S, Marcoux S, Truchon R, Grondin C, Gagnon J, Allard Y, Latulippe M. A controlled trial of corticosteroid injections into facet joints for chronic low back pain. N Engl J Med 1991;325:1002-1007. [5] Boswell MV, Colson JD, Sehgal N, Dunbar EE, Epter R. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain physician 2007;10:229-253. [6] Price C, Arden N, Coglan L, Rogers P. Cost-effectivenss and safety of epidural steroids in the management of sciatica. Health Technol Asess 2005;9:1-58.
[1] Eisenberg E, McNicol E, Carr DB. Opioids for neuropathic pain. Cochrane Database Syst Rev 2006;3:CD006146 [2] Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, Donovan MI, Fishbain DA, Foley KM, Fudin J, Gilson AM, Kelter A, Mauskop A, O'Connor PG, Passik SD, Pasternak GW, Portenoy RK, Rich BA, Roberts [3] Mattia C, Coluzzi F, Tramadol. Focus on musculoskeletal and neuropathic pain., Minerva Anestesiol, 2005, 71/10, 565-84, 16163147 [4] Moore R A, McQuay H J, Single-patient data meta-analysis of 3453 postoperative patients: oral tramadol versus placebo, codeine and combination analgesics., Pain, 1997, 69/3, 287-94, 9085303 In postsurgical pain tramadol 50, 100 and 150 mg had NNTs for > 50%maxTOTPAR of 7.1 (95% confidence intervals 4.6-18), 4.8 (3.4-8.2) and 2.4 (2.0-3.1), comparable with aspirin 650 mg plus codeine 60 mg (NNT 3.6 (2.5-6.3)) and acetaminophen 650 mg plus propoxyphene 100 mg (NNT 4.0 (3.0-5.7)). [5] Saarto T, Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Database Syst Rev 2007;4:CD005454. [6] Wiffen PJ, McQuay HJ, Edwards JE, Moore R., Gabapentin for acute and chronic pain. Cochrane Database Syst Rev 2005;3:CD005452. [7] Finnerup NB, Otto M, McQuay HJ, Jensen TS, Sindrup SH. Algorithm for neuropathic pain treatment: An evidence based proposal. Pain 2005;118:289-305. [8] Moore R Andrew, Straube Sebastian, Wiffen Philip J, Derry Sheena, McQuay Henry J, Pregabalin for acute and chronic pain in adults., Cochrane Database Syst Rev, 2009, /3, CD007076, 20008756 [9] Straube Sebastian, Derry Sheena, Moore R Andrew, Paine Jocelyn, McQuay Henry J, Pregabalin in fibromyalgia--responder analysis from individual patient data., BMC Musculoskelet Disord, 2010, 11/, 150, 20602781 [1o] Lunn Michael Pt, Hughes Richard Ac, Wiffen Philip J, Duloxetine for treating painful neuropathy or chronic pain., Cochrane Database Syst Rev, 2009, /4, CD007115, 19821395 [11] Towhead T, Maxwell L, Judd M, Catton M, Hochberg MC, Wells GA. Acetaminophen for osteoarthritis. Cochrane Database of Syst Rev 2006;1:CD004257.
THE ROMAN SAYING “TO RELIEVE PAIN IS DIVINE” IS AS APT TODAY AS IT WAS 2,000 YEARS AGO. ALTHOUGH WE DO A LOT BETTER THAN THE ANCIENT ROMAN DOCTORS, NONE OF US ON THE PAIN TEAM ARE GODS OR GODDESSES!!! WE STILL HAVE A LONG WAY TO GO!!! NEVERTHELESS, AS YOU HAVE SEEN (AND WILL SEE AGAIN TODAY) THE PATH TO PAIN RELIEF IS A LONG AND WINDING ROAD. TO SUM UP OUR SELF-MANAGEMENT APPROACH IN A FEW SIMPLE WORDS - USE IT TO LOSE IT!!
[1] Eisenberg E, McNicol E, Carr DB. Opioids for neuropathic pain. Cochrane Database Syst Rev 2006;3:CD006146 [2] Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, Donovan MI, Fishbain DA, Foley KM, Fudin J, Gilson AM, Kelter A, Mauskop A, O'Connor PG, Passik SD, Pasternak GW, Portenoy RK, Rich BA, Roberts [3] Mattia C, Coluzzi F, Tramadol. Focus on musculoskeletal and neuropathic pain., Minerva Anestesiol, 2005, 71/10, 565-84, 16163147 [4] Moore R A, McQuay H J, Single-patient data meta-analysis of 3453 postoperative patients: oral tramadol versus placebo, codeine and combination analgesics., Pain, 1997, 69/3, 287-94, 9085303 In postsurgical pain tramadol 50, 100 and 150 mg had NNTs for > 50%maxTOTPAR of 7.1 (95% confidence intervals 4.6-18), 4.8 (3.4-8.2) and 2.4 (2.0-3.1), comparable with aspirin 650 mg plus codeine 60 mg (NNT 3.6 (2.5-6.3)) and acetaminophen 650 mg plus propoxyphene 100 mg (NNT 4.0 (3.0-5.7)). [5] Saarto T, Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Database Syst Rev 2007;4:CD005454. [6] Wiffen PJ, McQuay HJ, Edwards JE, Moore R., Gabapentin for acute and chronic pain. Cochrane Database Syst Rev 2005;3:CD005452. [7] Finnerup NB, Otto M, McQuay HJ, Jensen TS, Sindrup SH. Algorithm for neuropathic pain treatment: An evidence based proposal. Pain 2005;118:289-305. [8] Moore R Andrew, Straube Sebastian, Wiffen Philip J, Derry Sheena, McQuay Henry J, Pregabalin for acute and chronic pain in adults., Cochrane Database Syst Rev, 2009, /3, CD007076, 20008756 [9] Straube Sebastian, Derry Sheena, Moore R Andrew, Paine Jocelyn, McQuay Henry J, Pregabalin in fibromyalgia--responder analysis from individual patient data., BMC Musculoskelet Disord, 2010, 11/, 150, 20602781 [1o] Lunn Michael Pt, Hughes Richard Ac, Wiffen Philip J, Duloxetine for treating painful neuropathy or chronic pain., Cochrane Database Syst Rev, 2009, /4, CD007115, 19821395 [11] Towhead T, Maxwell L, Judd M, Catton M, Hochberg MC, Wells GA. Acetaminophen for osteoarthritis. Cochrane Database of Syst Rev 2006;1:CD004257.
Exercise interventions for cancer patients: systematic review of controlled trials; Stevinson Clare, Lawlor Debbie A, Fox Kenneth R, Cancer Causes Contro; 2004, 15/10, 1035-56 OBJECTIVE: To systematically review controlled trials investigating the effects of exercise interventions in cancer patients. METHODS: Studies were located through searching seven electronic databases (Medline, Embase, Cochrane Library, CancerLit, PsycInfo, Cinahl, SportDiscus), scanning reference lists of relevant articles, contacting experts (n = 20), and checking the contents lists of journals available through ZETOC (Electronic Table of Contents). To be included, trials had to be prospective, controlled, involve participants diagnosed with cancer and test an exercise intervention. Types of outcome were not restricted. Two reviewers independently applied the selection criteria. RESULTS: Thirty-three controlled trials (including 25 randomized trials) were included in the review. There was some evidence that physical function was increased among those who exercised. Furthermore, symptoms of fatigue did not appear to be increased and there were few adverse effects reported. There was insufficient evidence to determine effects on other outcomes, such as quality of life, with results hampered by the heterogeneity between studies as well as poor methodological quality. Data were also lacking on the long term effects of exercise relating to cancer recurrence or survival. CONCLUSIONS: There is preliminary evidence that exercise interventions for cancer patients can lead to moderate increases in physical function and are not associated with increased symptoms of fatigue. However, it is impossible from current evidence to determine whether exercise has long term beneficial effects on survival or quality of life
OUR PATIENTS EXPECT US TO HAVE ALL THE ANSWERS AND ABLE TO DELIVER TREATMENT TO THEM (A QUICK FIX) IN AS SHORT A SPACE OF TIME AS POSSIBLE.
Exercise interventions for cancer patients: systematic review of controlled trials; Stevinson Clare, Lawlor Debbie A, Fox Kenneth R, Cancer Causes Contro; 2004, 15/10, 1035-56 OBJECTIVE: To systematically review controlled trials investigating the effects of exercise interventions in cancer patients. METHODS: Studies were located through searching seven electronic databases (Medline, Embase, Cochrane Library, CancerLit, PsycInfo, Cinahl, SportDiscus), scanning reference lists of relevant articles, contacting experts (n = 20), and checking the contents lists of journals available through ZETOC (Electronic Table of Contents). To be included, trials had to be prospective, controlled, involve participants diagnosed with cancer and test an exercise intervention. Types of outcome were not restricted. Two reviewers independently applied the selection criteria. RESULTS: Thirty-three controlled trials (including 25 randomized trials) were included in the review. There was some evidence that physical function was increased among those who exercised. Furthermore, symptoms of fatigue did not appear to be increased and there were few adverse effects reported. There was insufficient evidence to determine effects on other outcomes, such as quality of life, with results hampered by the heterogeneity between studies as well as poor methodological quality. Data were also lacking on the long term effects of exercise relating to cancer recurrence or survival. CONCLUSIONS: There is preliminary evidence that exercise interventions for cancer patients can lead to moderate increases in physical function and are not associated with increased symptoms of fatigue. However, it is impossible from current evidence to determine whether exercise has long term beneficial effects on survival or quality of life
Pain not attributable to pathology or neurological encroachment in about 85% of people. ~ 4% of people seen with low back pain in primary care have compression fractures and < 0.1% has a neoplasm. Ankylosing spondylitis and spinal infections are rarer Prevalence of prolapsed intervertebral disc is about 1% to 3%. (Waddell & Burton 2001)
[1] Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med 1996;335:1721-1726 [2] Vad VB, Bhat AL, Lutz GE, Cammisa F. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine 2002;27:11-15. [3] van Kleef M, Barendse GA, Kessels A, Voets HM, Weber WE, de Lange S. Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine 1999;24:1937-1942. [4] Carette S, Marcoux S, Truchon R, Grondin C, Gagnon J, Allard Y, Latulippe M. A controlled trial of corticosteroid injections into facet joints for chronic low back pain. N Engl J Med 1991;325:1002-1007. [5] Boswell MV, Colson JD, Sehgal N, Dunbar EE, Epter R. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain physician 2007;10:229-253. [6] Price C, Arden N, Coglan L, Rogers P. Cost-effectivenss and safety of epidural steroids in the management of sciatica. Health Technol Asess 2005;9:1-58.
IMAGING STUDIES (fMRI) OVER THE LAST 10 YEARS HAVE SHOWN THAT MANY AREAS OF THE BRAIN CAN CONTRIBUTE TO THE PAIN EXPERIENCE. HERE WE CAN SEE THAT THE THALAMAUS ACTS AS A RELAY STATION FOR INCOMING MESSAGES, THE AMYGDALA HAS A ROLE IN FEELINGS OF FEAR OR DREAD, THE PREFRONTAL CORTEX IN HOW WE FEEL ABOUT THE MESSAGES AND WHETHER WE PAY MUCH ATTENTION TO THEM, THE ANTERIOR CINGULATE CORTEX IN WHETHER OR NOT WE LIKE THE EXPERIENCE, THE SENSORY CORTEX IN DECIDING WHERE THE MESSAGES MIGHT BE COMING FROM, AND THE CEREBELLUM IN PLANNING THE APPROPRIATE ACTION. SCIENTISTS AND PHILOSOPHERS STILL PONDER UPON THE “HARD PROBLEM” - HOW BRAIN ACTIVITY PRODUCES OUR LIFE EXPERIENCES, INCLUDING PAIN. AS YOU CAN SEE, THERE AINT NO BELL IN THE BRAIN!!!