The CDC recently released guidelines regarding the use of opioid medications in the treatment of chronic pain. The CDC recommends that clinicians should consider nonpharmacologic therapies like medical foods as a first line therapy to safely and effectively treat chronic pain.
This document discusses diabetic neuropathy and its management. It provides definitions of diabetic neuropathy and outlines its causes, types, risk factors, features, burden, and management approaches. Pregabalin is established as an effective first-line treatment based on evidence from multiple clinical trials. Trials showed that pregabalin across dosage ranges of 150-600 mg/day significantly reduced neuropathic pain in patients with diabetic peripheral neuropathy.
Gout is a metabolic disorder manifesting in primary or secondary forms characterized by hyperuricemia & joint lesions .
A metabolic disease characterized by recurrent attack of acute inflammatory arthritis caused by elevated levels of uric acid in the blood (hyperuricemia).
Gout: Very painful form of arthritis characterized by the formation of uric acid crystals and severe inflammation.
Gout is a metabolic disorder of purine metabolism, characterized by intermittent attacks of acute pain, swelling and inflammation. • It always preceded by hyperuricemia
During exercise in the heat, the body undergoes several cardiovascular adjustments to maintain blood flow to active muscles and dissipate excess heat through the skin. Sweating increases greatly to cool the body, but prolonged sweating can lead to dehydration and electrolyte imbalances. The body attempts to compensate through increased antidiuretic hormone and aldosterone to retain water and sodium. Failure of thermoregulation can result in heat cramps, heat exhaustion, and the life-threatening heatstroke if core body temperature rises above 104°F. Measuring wet bulb globe temperature accounts for multiple environmental factors to assess heat stress risk. Proper precautions and acclimatization can help prevent dangerous hyperthermia during exercise in
Clinical presentation in musculoskeletal physiotherapyThenukaAvinash
1. The patient is a 32-year-old software engineer complaining of pain in the medial side of the right elbow that worsens with weight lifting, computer use, and poor posture at work.
2. On examination, the physician found swelling and tenderness over the medial epicondyle, reduced strength and range of motion in the right elbow and wrist, and a positive result for the golfer's elbow test.
3. The physician diagnosed medial epicondylitis and prescribed a treatment plan including rest, ice, ultrasound, stretching, strengthening exercises, and posture advice to reduce pain and swelling and improve strength and function over several weeks.
Neuropathic pain strategies to improve clinical outcomewebzforu
This document discusses strategies for improving outcomes for patients with neuropathic pain. It begins by describing common conditions associated with neuropathic pain such as diabetes and shingles. It then discusses diagnostic approaches and distinguishing characteristics of neuropathic pain. Key points covered include the pathogenesis of neuropathic pain and new treatment options that modulate underlying mechanisms. Major forms of neuropathic pain like post-herpetic neuralgia and diabetic neuropathy are examined in depth. The document concludes by outlining a stepwise approach to managing neuropathic pain.
Diabetic neuropathy- a Precise Insight , by RxVichuZ!! ;) ;)RxVichuZ
Hello members....this is my 40th powerpoint...published in GOOGLE SLIDESHARE!! :) :)
I wish to thank each and everyone who have supported me all the way...!!!
This presentation deals with DIABETIC NEUROPATHY ...the causes, epidemiological statistics, pathogenesis.
A deeper insight into manifestations, complications, management & natural remedies have been provided....!!
Do go through this...and let me know you reviews!!!
When you THINK DIFFERENTLY, it becomes an INNOVATION,
When u infuse DEDICATION into that INNOVATION, it becomes an INVENTION..!!
HAPPY READING!!
#RxVichuZ-alwz4uh!! :)
This document discusses the functional model approach to treating musculoskeletal pain and dysfunction. It views the body as an integrated system where trauma can cause fascial tension and tender points. Treatment involves identifying tender points, positioning the body in comfort to reduce irritability, and holding that position to allow neuromuscular and fascial release. The goal is to normalize tissue balance, reduce pain and spasm, and restore proper movement and function through a phased approach.
This document provides information about hypertension, including:
- Definitions of hypertension from various health organizations.
- Prevalence rates of hypertension globally and in Malaysia, which is higher in urban vs. rural areas.
- Risk factors, symptoms, complications and classifications of hypertension.
- Recommended tests for diagnosing hypertension including ambulatory blood pressure monitoring and stress tests.
- Lifestyle modifications to manage hypertension including the DASH diet, physical activity, and aerobic and resistance exercise programs.
The goal is to lower blood pressure through a combination of diet, exercise and medications in order to reduce risks of complications like heart attack and stroke. Regular physical activity and following the DASH diet are important
This document discusses diabetic neuropathy and its management. It provides definitions of diabetic neuropathy and outlines its causes, types, risk factors, features, burden, and management approaches. Pregabalin is established as an effective first-line treatment based on evidence from multiple clinical trials. Trials showed that pregabalin across dosage ranges of 150-600 mg/day significantly reduced neuropathic pain in patients with diabetic peripheral neuropathy.
Gout is a metabolic disorder manifesting in primary or secondary forms characterized by hyperuricemia & joint lesions .
A metabolic disease characterized by recurrent attack of acute inflammatory arthritis caused by elevated levels of uric acid in the blood (hyperuricemia).
Gout: Very painful form of arthritis characterized by the formation of uric acid crystals and severe inflammation.
Gout is a metabolic disorder of purine metabolism, characterized by intermittent attacks of acute pain, swelling and inflammation. • It always preceded by hyperuricemia
During exercise in the heat, the body undergoes several cardiovascular adjustments to maintain blood flow to active muscles and dissipate excess heat through the skin. Sweating increases greatly to cool the body, but prolonged sweating can lead to dehydration and electrolyte imbalances. The body attempts to compensate through increased antidiuretic hormone and aldosterone to retain water and sodium. Failure of thermoregulation can result in heat cramps, heat exhaustion, and the life-threatening heatstroke if core body temperature rises above 104°F. Measuring wet bulb globe temperature accounts for multiple environmental factors to assess heat stress risk. Proper precautions and acclimatization can help prevent dangerous hyperthermia during exercise in
Clinical presentation in musculoskeletal physiotherapyThenukaAvinash
1. The patient is a 32-year-old software engineer complaining of pain in the medial side of the right elbow that worsens with weight lifting, computer use, and poor posture at work.
2. On examination, the physician found swelling and tenderness over the medial epicondyle, reduced strength and range of motion in the right elbow and wrist, and a positive result for the golfer's elbow test.
3. The physician diagnosed medial epicondylitis and prescribed a treatment plan including rest, ice, ultrasound, stretching, strengthening exercises, and posture advice to reduce pain and swelling and improve strength and function over several weeks.
Neuropathic pain strategies to improve clinical outcomewebzforu
This document discusses strategies for improving outcomes for patients with neuropathic pain. It begins by describing common conditions associated with neuropathic pain such as diabetes and shingles. It then discusses diagnostic approaches and distinguishing characteristics of neuropathic pain. Key points covered include the pathogenesis of neuropathic pain and new treatment options that modulate underlying mechanisms. Major forms of neuropathic pain like post-herpetic neuralgia and diabetic neuropathy are examined in depth. The document concludes by outlining a stepwise approach to managing neuropathic pain.
Diabetic neuropathy- a Precise Insight , by RxVichuZ!! ;) ;)RxVichuZ
Hello members....this is my 40th powerpoint...published in GOOGLE SLIDESHARE!! :) :)
I wish to thank each and everyone who have supported me all the way...!!!
This presentation deals with DIABETIC NEUROPATHY ...the causes, epidemiological statistics, pathogenesis.
A deeper insight into manifestations, complications, management & natural remedies have been provided....!!
Do go through this...and let me know you reviews!!!
When you THINK DIFFERENTLY, it becomes an INNOVATION,
When u infuse DEDICATION into that INNOVATION, it becomes an INVENTION..!!
HAPPY READING!!
#RxVichuZ-alwz4uh!! :)
This document discusses the functional model approach to treating musculoskeletal pain and dysfunction. It views the body as an integrated system where trauma can cause fascial tension and tender points. Treatment involves identifying tender points, positioning the body in comfort to reduce irritability, and holding that position to allow neuromuscular and fascial release. The goal is to normalize tissue balance, reduce pain and spasm, and restore proper movement and function through a phased approach.
This document provides information about hypertension, including:
- Definitions of hypertension from various health organizations.
- Prevalence rates of hypertension globally and in Malaysia, which is higher in urban vs. rural areas.
- Risk factors, symptoms, complications and classifications of hypertension.
- Recommended tests for diagnosing hypertension including ambulatory blood pressure monitoring and stress tests.
- Lifestyle modifications to manage hypertension including the DASH diet, physical activity, and aerobic and resistance exercise programs.
The goal is to lower blood pressure through a combination of diet, exercise and medications in order to reduce risks of complications like heart attack and stroke. Regular physical activity and following the DASH diet are important
This document discusses the relationship between depression and diet. It begins by defining depression and listing common symptoms. It then explains that when people are depressed, they often eat unhealthy foods high in saturated fat, sugar, and caffeine to cope, which can worsen their mood. The document recommends avoiding caffeine, sugar, alcohol, and drugs, and instead eating lean proteins, whole grains, fruits and vegetables to stabilize blood sugar. Omega-3 fatty acids, vitamin D, and selenium from foods like fish, nuts, and leafy greens may also help manage depression symptoms. In conclusion, maintaining a balanced diet can elevate mood and energy when feeling depressed.
Muscular dystrophy is a group of genetic diseases that causes progressive muscle weakness and loss of muscle mass due to defects in proteins needed for healthy muscle. The most common and severe type is Duchenne Muscular Dystrophy (DMD), which affects boys in early childhood and is often fatal in the 20s due to heart and respiratory failure. Treatment focuses on managing symptoms, maintaining function and quality of life through physical and occupational therapy, bracing, wheelchairs, and respiratory support as needed.
This document provides guidance on rehabilitation for various ankle injuries including gastrocnemius strains, soleus muscle strains, Achilles tendon ruptures, and lateral collateral ligament (LCL) ankle sprains. For gastrocnemius strains, the rehabilitation plan focuses on reducing pain and swelling followed by gentle stretching and progressive strengthening exercises. For Achilles tendon ruptures, the plan involves initial immobilization followed by range of motion and strengthening exercises over several weeks before returning to full weight bearing and functional activities. For LCL ankle sprains, the rehabilitation follows the RICE method initially and focuses on restoring range of motion, strengthening, proprioception training, and functional exercises before returning to sport. Protective taping or bra
Use side hand grip for head control, the therapist assist lip close & jaw closer. Use straw when drinking liquid. Place food to unimpaired side. Use cold food / liquid.
This document discusses spina bifida, including:
- Defining spina bifida as an incomplete closure of the neural tube, usually in the lumbar or sacral region.
- Describing the different types from spina bifida occulta to myelomeningocele.
- Detailing the various clinical presentations depending on the location and severity, including neurological deficits, hydrocephalus, orthopedic issues.
- Explaining that treatment involves surgery to cover or untether the spinal cord, along with medications, physical/occupational therapy, and follow-up to address complications.
- Emphasizing prevention through adequate folate intake before and during pregnancy to reduce the risk of spina bifida
Bell's palsy is a condition that causes temporary weakness or paralysis of the muscles on one side of the face. It is the most common cause of facial paralysis. Occupational therapy plays an important role in the treatment of Bell's palsy by providing facial exercises and techniques to improve muscle strength, facial expressions, and issues like drooling. Therapists also recommend eye protection methods like eye drops or patches to keep the affected eye moist. With treatment, most patients experience a full recovery within 6 months.
Peripheral neuropathy is a condition that results from damage to the peripheral nerves outside of the brain and spinal cord. It can cause numbness, tingling, pain or weakness in the hands, feet or other areas. There are several types including peripheral, autonomic and focal neuropathies. The most common cause is diabetes, through mechanisms such as increased aldose reductase activity and oxidative stress damaging nerves over time. Diagnosis involves physical exams, nerve conduction tests and ruling out other potential causes. Treatment focuses on managing pain, slowing progression, and preventing complications through good glucose control, medications, physical therapy and foot care.
Psychogenic Pain : Psychosomatic Point of ViewAndri Andri
This presentation was presented in "Medical Approach in Holistic Management to Relieve Pain" 13 Des 2015 at The Sunan Hotel, SOLO.
Since Pain is always subjective, Psychogenic pain is very related to psychiatric problems and very often it does not recognized by physicians in their practice.
The document discusses chiropractic care and its benefits. It notes that chiropractic care can benefit those without chronic pain conditions by helping restore and maintain balance in the body. Regular chiropractic adjustments can help injuries heal faster and reduce the likelihood of serious injuries. Vertebral subluxations, if left unaddressed, can cause pain and nervous system imbalances. Pursuing chiropractic care can improve overall health and reduce common ailments.
This document provides an overview of interventions to improve balance in children with cerebral palsy. It defines cerebral palsy and discusses its causes, classifications, common impairments, diagnosis and prognosis. It then summarizes several studies on interventions for improving balance, gait, upper extremity function, muscle strength, and postural control in children with cerebral palsy, including stretching, electrical stimulation, virtual reality, treadmill training, mirror therapy, and balance training. The studies examined the effects of these interventions on outcomes like gross motor function, muscle strength, and balance.
Cholinergic agents stimulate the parasympathetic nervous system by mimicking the effects of acetylcholine. They are used to treat glaucoma, bladder issues, and Alzheimer's disease. Side effects include increased salivation, sweating, and gastrointestinal activity. Cholinergic blockers work by blocking acetylcholine in the parasympathetic nervous system. They are used to treat Parkinson's disease, asthma, ulcers, and urinary retention. Side effects include blurred vision, dry mouth, constipation, and urinary retention. Nurses monitor for both therapeutic effects and side effects of these drugs.
This document provides an overview of upper extremity orthoses, including their objectives, nomenclature, designs, and specific examples. The main objectives of upper limb orthoses are protection, correction, and assistance. They are named based on the joints they cover, their function, condition treated, appearance, or designer. Designs include non-articular, static, serial static, dynamic, and more. Examples provided include wrist splints, elbow braces, shoulder slings, and finger orthoses. The document aims to classify and describe the various types of upper extremity splints and braces used in orthotic treatment.
Occupational therapy in rheumatoid arthritisShikha Mamgain
Occupational therapy plays an important role in managing rheumatoid arthritis by assessing functional abilities, providing splinting and joint protection education, and implementing a treatment protocol focused on reducing pain and inflammation while maintaining range of motion and strength. Standardized assessments of hand function are used to evaluate dexterity and grip strength over time. Splinting and joint protection principles can help relieve pain and support joints, while therapeutic exercises and activities aim to improve motor skills and endurance to enhance daily living.
Modern Principles of Osteopathy
The International Academy of Osteopathy provides osteopathic education in Europe and beyond.
Contact us for more information: info@osteopathy.eu
http://www.osteopathie.eu/en/publications
http://www.osteopathie.eu/en
This document discusses the importance of assessment in occupational therapy and physical therapy. It notes that assessment expertise will be critical for the future of these professions as the healthcare environment rapidly changes and demands for efficiency, accountability, and effectiveness increase. Recent publications by the Joint Commission on Accreditation of Healthcare Organizations emphasize the growing need for performance measurement and outcome assessment in clinical settings. Mastering assessment techniques will allow rehabilitation practitioners to keep pace with developments in healthcare and move their professions to a leadership position.
This document provides information on developing a moderate exercise program for managing diabetes, including 7 major components of an exercise routine: warm up, cardiovascular fitness, muscular strength, flexibility, balance, cool down, and body composition. It outlines the benefits of exercise for diabetes, defines moderate intensity, and provides guidance for each component, exercise prescription and safety considerations.
Regular exercise has an important role in diabetes management by helping to control blood sugar levels, improve heart health, aid with weight control, and increase overall well-being. The document recommends aerobic exercise, strength training, and flexibility exercises at a low to moderate intensity for 20-60 minutes, 3-7 times per week depending on the type of diabetes. Guidelines include checking blood sugar levels before exercise, eating a snack beforehand for prolonged sessions, and exercising at the same time each day with consistent intensity levels.
Clearwayz supports healthy sinus, respiratory and immune function. The ingredients in Clearwayz have been carefully selected based on their history of safety and efficacy for supporting immune function, respiratory and sinus health.
Each capsule of Clearwayz uses Targeted Cellular Technology, a patented five phase process that maximizes the cellular absorption of milligram amounts of amino acids and antioxidants which help support healthy sinus and immune system activity by eliminating the free radicals that contribute to inflammation.
This document discusses the relationship between depression and diet. It begins by defining depression and listing common symptoms. It then explains that when people are depressed, they often eat unhealthy foods high in saturated fat, sugar, and caffeine to cope, which can worsen their mood. The document recommends avoiding caffeine, sugar, alcohol, and drugs, and instead eating lean proteins, whole grains, fruits and vegetables to stabilize blood sugar. Omega-3 fatty acids, vitamin D, and selenium from foods like fish, nuts, and leafy greens may also help manage depression symptoms. In conclusion, maintaining a balanced diet can elevate mood and energy when feeling depressed.
Muscular dystrophy is a group of genetic diseases that causes progressive muscle weakness and loss of muscle mass due to defects in proteins needed for healthy muscle. The most common and severe type is Duchenne Muscular Dystrophy (DMD), which affects boys in early childhood and is often fatal in the 20s due to heart and respiratory failure. Treatment focuses on managing symptoms, maintaining function and quality of life through physical and occupational therapy, bracing, wheelchairs, and respiratory support as needed.
This document provides guidance on rehabilitation for various ankle injuries including gastrocnemius strains, soleus muscle strains, Achilles tendon ruptures, and lateral collateral ligament (LCL) ankle sprains. For gastrocnemius strains, the rehabilitation plan focuses on reducing pain and swelling followed by gentle stretching and progressive strengthening exercises. For Achilles tendon ruptures, the plan involves initial immobilization followed by range of motion and strengthening exercises over several weeks before returning to full weight bearing and functional activities. For LCL ankle sprains, the rehabilitation follows the RICE method initially and focuses on restoring range of motion, strengthening, proprioception training, and functional exercises before returning to sport. Protective taping or bra
Use side hand grip for head control, the therapist assist lip close & jaw closer. Use straw when drinking liquid. Place food to unimpaired side. Use cold food / liquid.
This document discusses spina bifida, including:
- Defining spina bifida as an incomplete closure of the neural tube, usually in the lumbar or sacral region.
- Describing the different types from spina bifida occulta to myelomeningocele.
- Detailing the various clinical presentations depending on the location and severity, including neurological deficits, hydrocephalus, orthopedic issues.
- Explaining that treatment involves surgery to cover or untether the spinal cord, along with medications, physical/occupational therapy, and follow-up to address complications.
- Emphasizing prevention through adequate folate intake before and during pregnancy to reduce the risk of spina bifida
Bell's palsy is a condition that causes temporary weakness or paralysis of the muscles on one side of the face. It is the most common cause of facial paralysis. Occupational therapy plays an important role in the treatment of Bell's palsy by providing facial exercises and techniques to improve muscle strength, facial expressions, and issues like drooling. Therapists also recommend eye protection methods like eye drops or patches to keep the affected eye moist. With treatment, most patients experience a full recovery within 6 months.
Peripheral neuropathy is a condition that results from damage to the peripheral nerves outside of the brain and spinal cord. It can cause numbness, tingling, pain or weakness in the hands, feet or other areas. There are several types including peripheral, autonomic and focal neuropathies. The most common cause is diabetes, through mechanisms such as increased aldose reductase activity and oxidative stress damaging nerves over time. Diagnosis involves physical exams, nerve conduction tests and ruling out other potential causes. Treatment focuses on managing pain, slowing progression, and preventing complications through good glucose control, medications, physical therapy and foot care.
Psychogenic Pain : Psychosomatic Point of ViewAndri Andri
This presentation was presented in "Medical Approach in Holistic Management to Relieve Pain" 13 Des 2015 at The Sunan Hotel, SOLO.
Since Pain is always subjective, Psychogenic pain is very related to psychiatric problems and very often it does not recognized by physicians in their practice.
The document discusses chiropractic care and its benefits. It notes that chiropractic care can benefit those without chronic pain conditions by helping restore and maintain balance in the body. Regular chiropractic adjustments can help injuries heal faster and reduce the likelihood of serious injuries. Vertebral subluxations, if left unaddressed, can cause pain and nervous system imbalances. Pursuing chiropractic care can improve overall health and reduce common ailments.
This document provides an overview of interventions to improve balance in children with cerebral palsy. It defines cerebral palsy and discusses its causes, classifications, common impairments, diagnosis and prognosis. It then summarizes several studies on interventions for improving balance, gait, upper extremity function, muscle strength, and postural control in children with cerebral palsy, including stretching, electrical stimulation, virtual reality, treadmill training, mirror therapy, and balance training. The studies examined the effects of these interventions on outcomes like gross motor function, muscle strength, and balance.
Cholinergic agents stimulate the parasympathetic nervous system by mimicking the effects of acetylcholine. They are used to treat glaucoma, bladder issues, and Alzheimer's disease. Side effects include increased salivation, sweating, and gastrointestinal activity. Cholinergic blockers work by blocking acetylcholine in the parasympathetic nervous system. They are used to treat Parkinson's disease, asthma, ulcers, and urinary retention. Side effects include blurred vision, dry mouth, constipation, and urinary retention. Nurses monitor for both therapeutic effects and side effects of these drugs.
This document provides an overview of upper extremity orthoses, including their objectives, nomenclature, designs, and specific examples. The main objectives of upper limb orthoses are protection, correction, and assistance. They are named based on the joints they cover, their function, condition treated, appearance, or designer. Designs include non-articular, static, serial static, dynamic, and more. Examples provided include wrist splints, elbow braces, shoulder slings, and finger orthoses. The document aims to classify and describe the various types of upper extremity splints and braces used in orthotic treatment.
Occupational therapy in rheumatoid arthritisShikha Mamgain
Occupational therapy plays an important role in managing rheumatoid arthritis by assessing functional abilities, providing splinting and joint protection education, and implementing a treatment protocol focused on reducing pain and inflammation while maintaining range of motion and strength. Standardized assessments of hand function are used to evaluate dexterity and grip strength over time. Splinting and joint protection principles can help relieve pain and support joints, while therapeutic exercises and activities aim to improve motor skills and endurance to enhance daily living.
Modern Principles of Osteopathy
The International Academy of Osteopathy provides osteopathic education in Europe and beyond.
Contact us for more information: info@osteopathy.eu
http://www.osteopathie.eu/en/publications
http://www.osteopathie.eu/en
This document discusses the importance of assessment in occupational therapy and physical therapy. It notes that assessment expertise will be critical for the future of these professions as the healthcare environment rapidly changes and demands for efficiency, accountability, and effectiveness increase. Recent publications by the Joint Commission on Accreditation of Healthcare Organizations emphasize the growing need for performance measurement and outcome assessment in clinical settings. Mastering assessment techniques will allow rehabilitation practitioners to keep pace with developments in healthcare and move their professions to a leadership position.
This document provides information on developing a moderate exercise program for managing diabetes, including 7 major components of an exercise routine: warm up, cardiovascular fitness, muscular strength, flexibility, balance, cool down, and body composition. It outlines the benefits of exercise for diabetes, defines moderate intensity, and provides guidance for each component, exercise prescription and safety considerations.
Regular exercise has an important role in diabetes management by helping to control blood sugar levels, improve heart health, aid with weight control, and increase overall well-being. The document recommends aerobic exercise, strength training, and flexibility exercises at a low to moderate intensity for 20-60 minutes, 3-7 times per week depending on the type of diabetes. Guidelines include checking blood sugar levels before exercise, eating a snack beforehand for prolonged sessions, and exercising at the same time each day with consistent intensity levels.
Clearwayz supports healthy sinus, respiratory and immune function. The ingredients in Clearwayz have been carefully selected based on their history of safety and efficacy for supporting immune function, respiratory and sinus health.
Each capsule of Clearwayz uses Targeted Cellular Technology, a patented five phase process that maximizes the cellular absorption of milligram amounts of amino acids and antioxidants which help support healthy sinus and immune system activity by eliminating the free radicals that contribute to inflammation.
The Clearwayz formula provides the respiratory system, nasal and sinus cavities with a balance of nutrients, amino acids and polyphenols required to support anti-inflammatory processes and support autonomic nervous system function.
The use of Clearwayz for acute sinus and respiratory support can result in balanced mucous production, improved immune function, and improved nasal breathing during times of congestion.
As a daily supplement the patented Clearwayz formula provides the body with the natural tools it needs to safely manage inflammation in the respiratory system, nasal and sinus cavities.
The fundamental principle of Clearwayz is to support healthy airflow in the nasal and sinus cavities through anti-inflammatory mediators and nervous system support.
There are two types of pain experienced after surgery: cutaneous and visceral pain. Cutaneous pain is fast, sharp pain caused by chemicals released after incision that activate nerve endings in the skin. This pain travels along A-delta fibers to the spinal cord. Visceral pain is slow, aching pain detected by nerves in internal organs that activates C fibers, carrying referred pain signals. Both types of pain signals travel up the spinal cord and midbrain to be processed and perceived as the pain sensation. The type of post-operative pain determines the appropriate analgesic treatment.
Paracetamol iv as a single analgesic is very safe analgesic, but only for mild and moderate pain.
It can be combined with many analgesic or adjuvan drugs to provide strong analgesic for postoperative pain.
So, it can be the basic regiment for Multimodal Analgesia.
Because of its safety it can be the choice for high risk surgical patient
This document discusses acute perioperative pain management. It defines pain and its classification, and explains why treating pain is important for patient outcomes and recovery. It covers pain assessment methods, non-pharmacological and pharmacological treatment options including the WHO analgesic ladder and multimodal analgesia. Specific pain medications like acetaminophen, NSAIDs, opioids, gabapentin and regional anesthesia techniques are described. Management of side effects and opioid overdose is also summarized.
Management of acute postoperative pain rcacareyesmd
The document discusses pain assessment and management. It defines pain and describes different types of acute pain. Pain is the fifth vital sign and should be properly assessed. Several self-report scales are presented to assess pain intensity. Preemptive analgesia aims to prevent pain sensitization by providing analgesia before a painful stimulus occurs. Multimodal analgesia using opioids, NSAIDs, and acetaminophen can provide effective pain relief while reducing opioid requirements and side effects. Patient-controlled analgesia safely allows patients to self-administer opioids. Special populations like neonates and the elderly require modified dosing approaches.
Dr. Kumar presented on acute pain management. He discussed how acute pain is initiated by nociceptors and transmitted through three neurons to the brain. Poorly managed acute pain can lead to central sensitization and chronic pain. He described the anatomy and pathways of acute pain transmission, including modulation by descending pathways. Drugs like opioids, NSAIDs, ketamine, alpha-2 agonists, and gabapentinoids were discussed as treatment options, as well as patient-controlled analgesia and regional anesthesia techniques.
Pain management after joint replacement surgeryPranav Bansal
The document discusses key concepts in pain management following hip and knee arthroplasty. It defines pain and discusses what patients want after surgery like mobility and pain management. It outlines the benefits of a multimodal approach using techniques like neuraxial blocks, peripheral nerve blocks, and local infiltration to provide good pain relief with fewer side effects than opioids alone. This multimodal, balanced approach can lead to early mobilization, recovery and discharge from the hospital.
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.
THERAMINE is a safe and effective option for the dietary management of pain without the adverse side effects associates with opioids, NSAIDs or acetaminophen. The efficacy and safety of THERAMINE is supported by two double blind clinical trials and over a decade of clinical use. To learn more about THERAMINE please call (844) 474-3111 or visit www.medicalfoods.com.
The document discusses different concepts and types of pain. It defines pain and discusses theories of pain transmission including the specificity theory, pattern theory, and gate control theory. It describes the neurophysiology of pain and distinguishes between acute pain, which serves as a warning and lasts less than 6 months, and chronic pain, which persists beyond healing and has complex causes. Common types of chronic pain include neuropathic pain, reflex sympathetic dystrophy, hyperesthesia, myofascial pain, cancer pain, and postoperative pain. Central pain arises from brain lesions, while phantom pain occurs after amputation.
Post operative pain management has no specific criteria. Lots of methods and procedures are suggested with various types of drugs. It is just a guideline for management of pain after surgery.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise boosts blood flow, releases endorphins, and promotes changes in the brain which help enhance one's emotional well-being and mental clarity.
Este documento proporciona recomendaciones sobre el manejo del paciente que requiere tomar antiinflamatorios no esteroideos (AINEs). Se evalúa el riesgo gastrointestinal y cardiovascular del paciente para determinar el AINE más seguro y si se requiere una estrategia de protección gastrointestinal. Para pacientes con alto riesgo cardiovascular, la mejor opción es naproxeno con o sin protección gastrointestinal dependiendo del riesgo gastrointestinal. El documento también discute factores de riesgo gastrointestinal, diferencias entre AINEs convencionales e inhibidores de COX-2, y
El documento presenta las recomendaciones de un consenso sobre el uso de antiinflamatorios no esteroideos (AINEs). Se discute la evaluación del riesgo gastrointestinal y cardiovascular, la elección y dosis del AINE según el perfil de riesgo del paciente, y las estrategias de prevención de complicaciones. Se analizan factores como la indicación, tiempo de uso, calidad de vida, riesgos específicos y complicaciones asociadas a cada AINE. El objetivo es prescribir el AINE más seguro y a la dosis mínima efectiva para cada
Spinal cord injuries can cause partial or complete loss of motor and sensory function below the site of injury. There are several types of spinal cord injuries including complete and incomplete injuries. Risk factors include men, young adults, seniors, and those active in sports. Causes include trauma, bullet wounds, and falls. Symptoms depend on the injury level but may include paralysis, numbness, loss of bowel/bladder control. Diagnostic tests include imaging like CT, MRI to determine injury level and severity. Complications can include autonomic dysreflexia, pressure sores, loss of sexual function. Treatment involves stabilizing the spine, managing complications, and long-term rehabilitation.
Este documento resume la historia, usos, mecanismos de acción, clasificaciones, interacciones y toxicidad de los AINES (antiinflamatorios no esteroideos). Los AINES inhiben la enzima ciclooxigenasa que convierte el ácido araquidónico en prostaglandinas inflamatorias. Pueden causar daño gastrointestinal, renal y hemorragias cuando se usan a altas dosis o de forma crónica. Requieren precaución en personas con trastornos de la coagulación o hepáticos.
Patients and healthcare providers interested in non-addictive, pain management options that do not cause ulcers, GI bleeds or cardiovascular issues are encouraged to learn more about the medical food Theramine. Theramine is a viable pain management option for patients over the age of 65 or who have a history of liver, kidney or cardiovascular disease. Theramine is a also a treatment option for providers interested in shifting their patients away from narcotic or anti-epileptic pain medications.
The document discusses management strategies for acute and subacute pain. It compares analgesic options and outlines the World Health Organization's three-step "pain ladder" approach. The pain ladder involves scheduled administration of medications ranging from non-steroidal anti-inflammatories to weak opioids like tramadol and strong opioids if needed. Proper use of analgesics requires considering factors like compliance, side effects, and risk of dependence.
The document discusses issues around balancing the risks and benefits of opioid use for pain management. It notes that while opioids carry risks like addiction and side effects, untreated pain also has physiological, psychological and immunological impacts that can impair quality of life. The document reviews guidelines from organizations that advocate for the safe and effective use of opioids to treat acute, cancer and chronic pain when non-opioid options are insufficient.
Savella Vs. Cymbalta Consideration For FormularyMmorshed217
The document compares Savella and Cymbalta for the treatment of fibromyalgia. Both drugs were shown to be effective in randomized controlled trials. Savella demonstrated significant improvements in pain and response rates compared to placebo in two large multicenter trials. Cymbalta also demonstrated efficacy in treating fibromyalgia. Overall, both drugs provide benefit for fibromyalgia patients but Savella may have a slightly lower cost and less severe side effects. The pharmacy and therapeutics committee will need to decide whether additional benefits of one drug outweighs the other for their formulary needs.
This document summarizes medications used to treat pain and inflammation. It discusses non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, tramadol, anti-epileptic drugs, tricyclic antidepressants, muscle relaxants, and opiates. NSAIDs are first-line treatments that reduce inflammation and pain by inhibiting cyclooxygenase enzymes. Acetaminophen also reduces pain but lacks anti-inflammatory effects. Tramadol, anti-epileptics, tricyclics, and muscle relaxants may be used as adjuvants. Opiates are reserved for moderate to severe short-term pain. Careful patient screening and protocols are recommended when prescribing op
The document discusses pharmacogenomic considerations for chronic pain management. It reviews CYP2D6, OPRM1, and COMT polymorphisms and their impact on medications like codeine, tramadol, and hydrocodone. Several studies are summarized, including ones finding that prescribing guided by genetic testing improved pain relief and reduced adverse events compared to usual care, and identifying SNPs correlated with response to morphine and oxycodone. Future recommendations include more widespread clinical implementation of pharmacogenomic testing to improve personalized pain management.
Percura, Improve Pain and Numbness Associated with Peripheral NeuropathyTargeted Medical Pharma
Percura capsules by oral administration. A specially formulated Medical Food product, consisting of a proprietary blend of amino acids in specific proportions, for the dietary management of the metabolic processes associated with pain, inflammation and loss of sensation due to peripheral neuropathy. Must be administered under physician supervision.
Percura is a proprietary formulation of amino acids and other dietary factors to support induction, maintenance, and enhancement of the specific neurotransmitter activity involved in the physiology of neuropathic pain. The formulation consists of nonessential and essential amino acids L-Arginine HCL, L-Histidine HCL, L-Glutamine, L-Serine, L-Lysine, L-Ornithine, Acetyl L-Carnitine, L-Tyrosine, the nonstandard amino acid Gamma Aminobutyric Acid, Choline Bitartrate, Glucose, Inositol, Griffonia Extract griffonia simplicifolia (95% 5-HTP) , and Creatine. These ingredients fall into the classification of Generally Recognized as Safe (GRAS) as defined by the Food and Drug Administration (FDA) (Sections 201(s) and 409 of the Federal Food, Drug, and Cosmetic Act). A GRAS substance is distinguished from a food additive on the basis of the common knowledge about the safety of the substance for its intended use. The standard for an ingredient to achieve GRAS status requires not only technical demonstration of non-toxicity and safety, but also general recognition of safety through widespread usage and agreement of that safety by experts in the field. Many ingredients have been determined by the FDA to be GRAS, and are listed as such by regulation, in Volume 21 Code of Federal Regulations (CFR) Sections 182, 184, and 186.
The document provides information on clinical analgesia including objectives, quiz questions, and details on pain mechanisms and treatment. It discusses non-opioid analgesics like acetaminophen and NSAIDs as well as adjuvant analgesics including antidepressants, anticonvulsants, corticosteroids, and muscle relaxants. The document also provides dosing information for various analgesics.
The document discusses multimodal analgesia, which is the use of different analgesic medications and interventions with various mechanisms of action to provide additive or synergistic pain relief while minimizing side effects. It notes that opioids alone may not be optimal for many acute pain patients due to risks of abuse, side effects, and inadequate efficacy for some conditions. Instead, it recommends multimodal approaches combining opioids, acetaminophen, NSAIDs, local anesthetics, corticosteroids, and other classes of drugs to maximize pain relief while lowering medication requirements and side effects from individual drugs.
Three published clinical studies found that Anodyne Therapy using MIRE improved symptoms in patients with peripheral neuropathy:
1. A study of 49 diabetic patients found significant improvement in sensation after 12 treatments over 4 weeks.
2. A randomized controlled study of 27 diabetic patients found 106% improved sensation, 45% reduced pain, and 70% reported improved balance after 6 treatments over 2 weeks.
3. A study of 1047 peripheral neuropathy patients found 366% improved sensation to touch as measured by monofilaments after a mean of 18 treatments.
This document discusses pain and its treatment. It begins by defining pain and classifying common types of pain conditions. It then discusses the body's reflex responses to pain and the endorphin system that modulates pain. It describes the differences between acute and chronic pain and methods of pain measurement. Various treatment options are provided for different types of pain, including NSAIDs, opioids, tramadol, tapentadol, muscle relaxants, and sodium channel blockers. Newer treatments discussed include epirisone and the comparative properties of different NSAIDs, muscle relaxants, tramadol, and tapentadol. Key questions are also provided about comparing treatment effectiveness and safety across patient subgroups.
The document discusses several major concerns regarding the long-term use of opioids to treat chronic pain, including addiction, tolerance, and neuropsychological and endocrine effects. It notes that while some retrospective studies have suggested addiction is rare, no published studies have prospectively evaluated addiction rates using standardized definitions. It also summarizes several studies that have investigated tolerance, side effects, and endocrine impacts but have not systematically addressed these issues. The document concludes that while opioids may be generally safe, more research is still needed to fully understand long-term risks and benefits.
Pharmaceutical Care of People with Chronic PainNES
This document provides an overview of chronic pain management from a pharmaceutical care perspective. It discusses the causes and types of chronic pain, assessments, pharmacological and non-pharmacological treatment options, and key issues for patients including effectiveness, safety, adherence, and self-management. It also describes a chronic pain management project where the pharmacist identified opportunities to optimize patients' medication regimens and refer those with risks like gastrointestinal issues or neuropathic pain elements.
Palmitoylethanolamide in the Treatment of Neuropathic Pain Sudhir Kumar
Neuropathic pain is quite common. It is associated with severe disability and adversely affects the quality of life of sufferers. Current treatment options for neuropathic are not very effective. Moreover, they are associated with significant adverse effects. A new naturally occurring substance- PALMITOYLETHANOLAMIDE (PEA)- has been found to be effective and safe in treating neuropathic pain. The current presentation looks at the efficacy of PEA in neuropathic pain.
Nutrition Packs a Punch in Regenerative MedicineDr. E. Magaziner
Regenerative treatments are gaining popularity because they repair an injury rather than just control pain with steroids or anti-inflammatory drugs. But why repair an injury without addressing the cellular level issues?
an important ppt for medical students and prescribing clinicians of medicine..... which deals with the methodology of right prescribing...... enjoy reading.... <3.... satya
The document discusses adult cancer pain, including:
1. It defines cancer pain, describes types like somatic and visceral pain, and ways to measure pain intensity.
2. Cancer pain can be caused by direct tumor involvement or cancer treatments, and can be acute or chronic. It outlines common pain syndromes.
3. Management follows the WHO ladder, starting with non-opioid analgesics and progressing to opioids. It discusses converting between opioids, managing toxicities, and using adjuvant therapies.
Pharmacological Pain Control in Emergency Department.pdfReza Aminnejad
Pain occurs in more than half of ED patient. Analgesia is often sub-optimally addressed or reassessed in a significant number of patients. A combination of non-pharmacologic and pharmacologic (opioid and non-opioid) analgesics modalities can enhance the quality of pain management.
Topical pain medications another approach to pain, wound and scar management...Valuecare pharmacy
Struggling through chronic pain or the side effects of pain medication does not have to be a daily activity. Pharmacy compounding offers patients customized options for pain medication. Compounding is the art and science of preparing customized medications for patients. It provides valuable benefits to those for whom pain management has become a way of life.
Every individual is unique, and the types of pain experienced can be equally diverse. By working with a compounding pharmacist, your healthcare provider can prescribe treatments tailored specifically for your pain management needs.
Brief overview of the categories of pain
Review opioid pharmacology
Review the available treatment modalities and alternative options for pain management
Discuss alternative options for wound treatment
Discuss alternative options for scaring
Many patients experience stomach irritation or other unpleasant side effects from taking pain medication. Some have difficulty taking the medication in its commercially available form. Pharmacy compounding can provide alternate methods of delivery to make the process easier. Instead of a capsule or tablet, pain medications often can be compounded as dosage forms such as:
A topical gel, cream or spray form that can be applied directly to the site of the pain and absorbed through the skin.
A custom-flavored troche that dissolves under the tongue, a nasal spray, or a suppository.
Such dosage forms may bypass the gastrointestinal tract, providing optimal results with less GI irritation, and help patients who have difficulty swallowing pills, removing yet another source of aggravation.
Similar to The Dietary Management of Chronic Pain with Medical Foods (20)
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.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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.
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
2. 2www.tmedpharma.com
• 100 Million Americans Affected
• Almost 35% of the US Population
• $635 Billion a Year in Costs
• By 2029, 20% of the US
Population will be 65 Years or
Older
The Epidemic of
Chronic Pain in America
3. Persistent Pain Lasting Longer than 12 weeks
www.tmedpharma.com 3
Defining Chronic Pain
A Disease of the Nervous System
A Maladaptive Physiologic Response
8. 8www.tmedpharma.com
Chronic Back Pain Altering Amino
Acid Metabolism
0
5
10
15
20
25
30
35
Arginine Serine Histidine Tryptophan
mg%ofProtein
CBP Change in Blood Concentration of Amino Acids2
Day 1
Day 28
Normal
N=25
Patients with chronic pain syndromes have documented deficiencies of certain
amino acids.1 Patients with chronic low back pain commonly present with lower
levels of the amino acids required for producing pain modulating neurotransmitters
compared to healthy subjects.
2
1. Russell IJ, Michalek JE, Vipraio GA, Fletcher EM, Wall K. Serum amino acids in fibrositis/fibromyalgia syndrome. J Rheumatol Suppl 1989;19:158-163
2. Shell, et al., “A Double-Blind Controlled Trial of a Single Dose Ibuprofen and an Amino Acid Medical Food Theramine for the Treatment of Low Back Pain; Publication pending, 2010.
9. 9www.tmedpharma.com
Expanding and Augmenting
Chronic Pain Treatments with
Medical Foods
Medical Foods work through a
different pathway from drugs,
addressing the distinct
physiologic and metabolic
needs of chronic pain.
Manipulation vs. Creation
10. 10www.tmedpharma.com
Nutritional Requirements
of Pain Syndromes
The altered metabolic processes
associated with pain syndromes require
additional amounts of 1-2 :
• Arginine Nitric Oxide
• Choline Acetylcholine
• GABA GABA
• Glutamine Glutamate, GABA, Glutathione
• Histidine Histamine
• Tryptophan Serotonin
• Serine d-Serine
1. Wurtman RJ. Nutrients affecting brain composition and behavior. Integr
Psychiatry 1987;5:226-238.
2. Russell IJ, Michalek JE, Vipraio GA, Fletcher EM, Wall K. Serum amino acids in
fibrositis/fibromyalgia syndrome. J Rheumatol Suppl 1989;19:158-163.
11. 11www.tmedpharma.com
Amino Acid Concentrations Affect the
Ability of the Nervous System to Regulate Pain
Choline Acetylcholine Potentiates NO and
Serotonin
Inhibits NMDA
receptor activity
Tryptophan 5-HTP Serotonin
Inhibits Substance
P and NMDA
receptor activity
Decreases Pain
Signals in CNS
Serine d-Serine Regulates NMDA
receptor activity
Sensitizes opioid
receptors
Arginine Nitric Oxide
Inhibits afferent
pain signals in
CNS
Vasodilator and
opioid activator
Histidine Histamine
Stimulates
production of
glucocorticoids
Modulates
inflammation
GABA GABA
Inhibits NMDA
receptor activity
Dampens Pain
Signals
12. 12www.tmedpharma.com
Medical Foods for the Dietary
Management of Pain and Osteoarthritis
Product NAME Manufacturer Indication
Theramine® Targeted Medical Pharma Clinical Dietary Management of
Pain Disorders and Inflammatory
Conditions
Limbrel® Primus Pharmaceuticals Clinical Dietary Management of
the Metabolic Processes of
Osteoarthritis
Trepadone® Targeted Medical Pharma Clinical Dietary management of the
altered metabolic processes
associated with pain and
inflammation related to joint
disorders. (JD)
Percura™ Targeted Medical Pharma Clinical dietary management of the
altered metabolic processes
associated with pain, inflammation
and loss of sensation due to
peripheral neuropathy.
13. 13www.tmedpharma.com
Theramine®
for the dietary management of pain disorders and inflammatory conditions
“Naproxen and an Amino Acid Medical Food
Theramine for the Treatment of Low Back
Pain” American Journal of Therapeutics 2010.
Double-blind,
multicenter,
randomized 3 arm
trial conducted at
independent facilities
in the USA with 129
subjects over 28
days.
44% reduction in back
pain over 28 days.
65% reduction in back
pain when combined
with low dose naproxen
17% reduction in CRP
“Reduction in Pain and Inflammation
Associated with Chronic Low Back Pain with
the use of the Medical Food Theramine”
American Journal of Therapeutics 2014.
Double-blind,
multicenter,
randomized 3 arm
trial conducted at
independent facilities
in the USA with 122
subjects over 28
days.
41% reduction in back
pain over 28 days.
62% reduction in back
pain when combined
with low dose
ibuprofen
24% reduction in IL-6
14. 14www.tmedpharma.com
Limbrel®
for the clinical dietary management of the metabolic processes of osteoarthritis
“Safety, efficacy and acceptability of flavocoxid
(Limbrel®) compared with naproxen in subjects with
osteoarthritis of the knee: A Pilot Study”
Osteoarthritis and Cartilage Vol. 15.
Double-blind
randomized trial
conducted at facilities
in Russia with 103
subjects for 30 days.
Significant reduction in
the signs and symptoms
of knee OA.
Equivalent efficacy to
500mg naproxen in
controlling the signs and
symptoms of OA
“ Efficacy and safety of flavocoxid, a novel
therapeutic, compared with naproxen: a
randomized multicenter controlled trial in subjects
with osteoarthritis of the knee.” Advances in
Therapy, 2010.
Double-blind,
multicenter
randomized trial
conducted at
independent facilities
in the USA with 220
subjects for 12
weeks.
90% of subjects
responded
positively
Equivalent efficacy
to 500mg naproxen,
with far fewer UGI
and renal AEs
15. 15www.tmedpharma.com
Comprehensive Pain
Management with Medical Foods
Reduce: Adjunct Therapy
Poly-pharmacy, drug dose, and
treatment duration
Replace: Standalone Therapy
Ineffective or dangerous drugs
Restore:
Amino acid, nutrient and
neurotransmitter levels, minimizing
co-morbidities of chronic pain
16. 16www.tmedpharma.com
Medical Foods as an Adjunct to
Low Dose Analgesics
2.95
-44
-65
-80
-60
-40
-20
0
20
Percent(%)
Reduction of Pain – Roland Morris Index
Naproxen Theramine Both
p<0.05
n=126
0.73
-50.3
-63.1-70
-60
-50
-40
-30
-20
-10
0
10
Percent(%)
Reduction of Pain - Roland-Morris Index
Ibuprofen n = 43 Theramine n = 41 Combination n = 38
p<0.01
Optimize Drug Dosages
Minimize Attenuation
Reduce Harmful Side
Effects
Improve Clinical
Outcomes
17. 17www.tmedpharma.com
Benefits to Providers and
Pharmacists
•Generally Recognized as Safe Ingredients
•Most Side Effects Comparable to Placebo
•FDA Regulation and Oversight
•Non-Addictive
Safety Profile
•Supported by Multiple Double Blind Efficacy Studies
•Individual Ingredient Efficacy
•Fills the Treatment Gap that Drugs Cannot
•Replacement/Adjuct Therapy for High Risk Narcotics & NSAIDs
Efficacy Profile
•Encapsulated for Easy Use
•Improved Tolerability
•No Serious Side Effects
Adherence and
Compliance
18. 18www.tmedpharma.com
Benefits to Patients and
Caregivers
•Comparable to and More Effective than NSAIDs
•Compliment to or Replacement for Narcotic Analgesics, SSRI, SNRI
•Reduces Pain and Inflammation
Alternative
Therapy
•Non-Addictive
•Non-Sedative
•Addresses Underlying Metabolic Demands of Pain Disorders
Natural
Therapy
•Physician Oversight
•No Serious Side Effects
•Over 15 years of Professional Clinical Use
Safe &
Effective
19. 19www.tmedpharma.com
Understanding the
Market Potential
30 billion OTC tablets
sold annually in the
USA
70 million annual
NSAID prescriptions
in the USA
127 Million annual
narcotic prescriptions
in the USA
100 million
Americans with from
chronic pain
27 Million people
with OA in USA
76 Million Baby
Boomers in the USA
16,500 NSAID
Related Deaths
Annually
16,651 Deaths Due
to Rx Narcotics in
2010
Patients 65
and older
should not
take NSAIDs
20. 20www.tmedpharma.com
The Future of Pain
Management
• Pain
• Inflammation
• Co-morbidities
• Poly-pharmacy
• NSAIDs
Reduce
• Amino Acids and
Neurotransmitters
depleted by disease
• Dangerous and
Addictive Drugs
• Ineffective Therapies
Replace
• Nervous System
Function
• Pain Control
• Daily Function
• Homeostasis
Restore
Lynette Add Notes Here
Common drugs do not address many of these issues and can exacerbate them.
Affect of Chronic Back Pain Pain on Brain Morphology.
Given that normal whole-brain gray matter atrophy is 0.5% per year of aging and that atrophy caused by CBP is 5–11%, the magnitude of brain gray matter atrophy caused by CBP is equivalent to 10 –20 years of aging. However, this analogy only holds for the overall magnitude, because the regional specificity of atrophy in CBP is distinct from that seen with aging
Patients with CBP showed 5-11% less neocortical gray matter volume than control subjects. The magnitude of this decrease is equivalent to the gray matter volume lost in 10-20 years of normal aging. The decreased volume was related to pain duration, indicating a 1.3 cm3 loss of gray matter for every year of chronic pain. CBP is accompanied by brain atrophy and suggests that the pathophysiology of chronic pain includes thalamocortical processes.
Data from a double blind , multicenter study published in the American Journal of Therapeutics indicates the relationship between CBP and amino acid deficiency.
Drugs treat the symptoms of pain and do not address the underlying physiologic, metabolic and cellular changes that result from chronic pain. In many cases drugs can exacerbate the symptoms of a disease by depleting neurotransmitters and their receptors. Ex. Benzodiazapines
Ex. SSRI depleting serotonin without replacing tryptophan
Medical Foods provide the nervous system with the cellular tools/fuel it needs to mitigate pain and inflammatory signals
Example Continued:
Decrease in Choline means decreased parasympathetic autonomic nervous system activity due to pain disorder. Decrease in choline causes increased creatine phosphokinase and alanine transaminase, and must be addressed.
Administration of choline increases production of acetylcholine which reduces transmission of pain signals and inhibits proinflammatory cytokines and substance P release without noxious side effects related to harmful drugs
Nociception or pain signaling are propagated and mitigated by a series of chemical and electrical processes involving amino acids, nutrients and neurotransmitters. Amino acid deficiencies in Chronic pain patients can lead to complex pain conditions such as hyperalgisia and allodynia. Because the nervous system is using the same amino acids and neurotransmitters to operate multiple systems, patients with chronic pain often suffer from other co-morbiditiess such as sleep disorders and depression.
In addition to a variety of open label and post market studies Theramine has been the subject of 2 double blind studies.
In addition to a variety of open label and post market studies Theramine has been the subject of 2 double blind studies.
The risk of adverse events increases with the number of medications prescribed, and the number of medications prescribed increases with age.
In multiple clinical trials the co-administration of a low dose drug and a medical food have proven to be effective at treating symptoms and improving clinical outcomes without dangerous side effects.
Providers and pharmacists have a natural, clinically effective tool that they can educate patients about. A medication that works as a standalone and as an adjunct therapy. A complimentary therapy that helps manage a disease without harmful side effects. Since many side effects are dose dependent, MF can help a provider have flexibility in his/her dosing of a drug.
Addressing the distinct nutritional requirements of a patient suffering from chronic pain is a vital part of COMPREHENSIVE pain mgmt. Offering patients a non-sedative, non-addictive pain management option that can be an adjunct to current pain regimes or used as a standalone medication is often well received.
Offer pateints better or comparable efficacy without the dangerous side effects.
70 million prescriptions and more than 30 billion over-the counter tablets sold annually in the United States alone
107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures of all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated.”