by admin | Jun 9, 2015 | Uncategorized
Ketamine: Reinventing Chronic Pain Management
Author: Jeannette Y. Wick, RPh, MBA, FASCP
For patients who respond poorly or incompletely to opioids, ketamine may be the answer. In the middle of the past century, phencyclidine hydrochloride—called PCP or angel dust on the street—was developed to be a safe, effective anesthetic that did not cause cardiovascular and respiratory depression. However, its propensity to cause convulsions at high doses and long-lasting psychoactive side effects during emergence from anesthesia destroyed its potential.
Ketamine—a PCP derivative—was synthesized in 1963 and was tested on 20 prison volunteers in 1965. One-tenth as potent as PCP, ketamine was intended to induce anesthesia like PCP, but with greater specificity and fewer side effects.
.1 The FDA approved it in 1970, and its widespread use in the Vietnam conflict theater catapulted its popularity
.2 Today, ketamine is used less and less in the operating suite
.3 Although ketamine’s psychomimetic side effects are milder than those of PCP, they can be problematic (Table 12-10).
Recreational abuse has dogged ketamine since its approval. Abusers have injected, inhaled, and smoked ketamine, revealing characteristics of the drug that would otherwise remain unknown. Researchers hypothesize that abusers may develop tolerance because ketamine induces liver enzymes.11 Abusers rarely experience withdrawal, instead reporting a sensation called the K-hole—a constellation of visual hallucinations, dissociation, and out-of-body, and sometimes, near-death experiences. Heavy, prolonged ketamine use can cause cognitive and psychological impairment.4,12-15
Up to one-third of chronic ketamine abusers develop dose-dependent urinary tract symptoms within weeks to years: lower urinary tract irritation (vesicopathy), hydroureter, and hemorrhagic or ulcerative cystitis.13,16,17
The symptom etiology remains unclear, but may be direct toxic damage, immune system activation, or the effect of unknown bacteria.16,18
Long-term complications include hepatotoxicity (jaundice, itching, or elevated liver enzyme levels, especially in alcoholic patients) and/or cholangiopathy.19,20
Some long-term abusers develop corneal edema.21
These complications reverse after cessation of ketamine use.17,20,21
Clinically, the most common side effects of ketamine are inebriation, mental alteration, headache, hypertension, and altered liver enzymes.22
Newer, cleaner drugs or biologics are replacing ketamine in the operative suite. Yet ketamine is finding a new place in clinical therapy. Ketamine, an N-methyl-D-aspartate (NMDA)–receptor antagonist, is becoming an option for perioperative pain management among patients with opioid tolerance, acute hyperalgesia, and chronic neuropathic pain.1
NMDA Receptors
NMDA receptors are 1 of 3 glutamategated ion receptors. Gated by a magnesium ion, they normally open only briefly to allow calcium ions and other cations to enter the cell. Calcium activates second- messenger systems, causing neuronal hyperactivity.1,22-24 NMDA receptors may be involved in neuronal survival and maturation, synaptic plasticity, and memory. Abnormal NMDA function may cause neurologic disorders including Alzheimer’s disease, amyotrophic lateral sclerosis, depression, epilepsy, multiple sclerosis, Parkinson’s disease, and schizophrenia.25 Unrelenting NMDA receptor excitation allows continuous calcium influx into the cell and creates hyperexcitability. This presents clinically as opioid tolerance, hyperalgesia, and allodynia.22,26,27
Ketamine is the most potent clinically available, uncompetitive, open-channel NMDA-receptor blocker (it only works if the receptor is activated and the channel is open). Ketamine depresses the thalamus and limbic systems, preventing central nervous system centers from receiving or processing sensory input. This creates anesthesia, analgesia, and amnesia, and sometimes unpleasant psychomimetic effects or emergence phenomena.23,28,29
Sympathetic cardiovascular stimulation caused by ketamine is unique among intravenous anesthetics: it inhibits neuronal catecholamine reuptake, thereby increasing heart rate, cardiac output, and systemic and pulmonary blood pressure.30,31 Theoretically, ketamine use should be avoided in patients with prolonged QT syndrome.32 Ketamine inhibits neuronal serotonin reuptake, causing an emesis that is reversed by 5-HT–receptor blockers.33,34
What Route?
To minimize adverse events associated with ketamine use, researchers are examining the use of administration routes other than intravenous. Oral ketamine, as an injectable liquid or a compounded product, is subject to hepatic first-pass metabolism and is less effective than parenteral doses. It also lacks a clear dose-response relationship.22,35 Some study results suggest that the oral route leads to few side effects.36 Topical formulations of ketamine or ketamine with other potential analgesics has been used for managing several painful conditions (eg, pelvic pain, pruritus) with mixed results.22,37-39
Managing Pain
Ketamine use in pain management evolved from its perioperative use. Perioperative pain is expected, but may have physical or psychological consequences that delay rehabilitation and prolong hospitalization.1 Most surgeons use opioids to treat postoperative pain and supplement with regional anesthesia, other analgesics, and adjuvant agents as needed.1,23,40 Some patients respond poorly or incompletely to opioids; ketamine may help these patients.26,27,41
In low doses, NMDA-receptor antagonists can provide analgesia and circumvent opioid-related tolerance, hyperalgesia, and allodynia.10,23,40 Randomized, placebo-controlled, double-blind clinical trials (RCTs) have found that perioperative subanesthetic doses of ketamine added to opioid analgesia improved pain scores and reduced opioid consumption by approximately 30% to 50%. Ketamine was given as an intermittent low-dose intravenous bolus or a continuous infusion. It reduced opioid-related nausea and vomiting and added no additional significant adverse effects.42,43
Ketamine can also be given with morphine patient-controlled analgesia, contributing a morphine-sparing effect. Patients with chronic neuropathic pain, opioid dependence or tolerance, and acute hyperalgesia seem to benefit more.42,43 Low-dose ketamine administered before the surgical incision can lead to better analgesia for 24 hours after surgery.1 Most studies report no significant increase in psychomimetic adverse effects when ketamine is added to morphine.42,43
Sickle Cell Crisis and Chronic Noncancer Pain
Acute sickle cell disease creates severe pain with a neuropathic element. Several published guidelines recommend using opioids as first-line treatment, but some patients are unresponsive to even high opioid doses. Rapidly escalating opioid doses may induce acute tolerance and opioid-induced hyperalgesia.29,44 Case studies (but no RCTs) indicate that adding a low-dose ketamine infusion to opioids can improve pain in sickle cell disease.44 Usually, NMDA receptors activate continually only after a severe, sustained painful stimulus allows sufficient glutamate release. This is why ketamine may be useful as an adjuvant in several types of chronic central and peripheral neuropathic pain (Table 223,45,46).
Several of ketamine’s properties may prevent chronic pain from developing:
Dampening of nociception
Prevention or attenuation of hyperalgesia, allodynia, and tolerance
Attenuating central sensitization and windup phenomenon from repeated noxious stimuli when previously nonpainful stimuli become exaggerated and painful23,40
Clinicians have used short-term subanesthetic doses of ketamine to treat neuropathic pain.45 Scheduled infusions over several days can improve pain scores in patients with chronic pain; a few studies report pain relief persisting for weeks following treatment, indicating that ketamine may be disease modifying.46
Cancer Pain
Limited but increasing data support ketamine use in refractory cancer pain. Adding a small dose of ketamine to opioid therapy in a patient with opioid tolerance, called burst therapy, can improve pain management.12,47 Patients on highdose opioids whose cancer pain has a neuropathic component may respond to oral ketamine.48 Adding a small dose of ketamine to patient-controlled morphine seems to improve pain management, and some researchers are testing a ketamine mouthwash for mucositis.49,50
Endnote
Large, well-designed RCTs are needed to confirm the analgesic role of ketamine. Most studies suggest, and experts believe, that ketamine use should be reserved for patients in whom opioids, anticonvulsants, or antidepressants have failed.3,36 Because pain management is an off-label use for ketamine, clinicians should consult with field experts for dosing recommendations.
Ms. Wick is a visiting professor at the University of Connecticut.
References
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by admin | May 22, 2015 | Uncategorized
Weekly Breaking Research Updates, May 22, 2015
Scientific breakthroughs happen every day! In an effort to help our patients stay up to speed on the most cutting edge treatment options available for them, our scientists monitor current research and publish weekly research updates. The title of each article below is a link to the full study report. If you’d like to make an appointment with Dr. Hanna to discuss your treatment options, please contact us.
Ketamine
[HTML] Exaggerated Acute Lung Injury and Impaired Antibacterial Defenses During Staphylococcus aureus Infection in Rats with the Metabolic Syndrome
X Feng, M Maze, LG Koch, SL Britton, J Hellman – 2015
… All procedures were performed under ketamine and xylazine anesthesia, and all efforts
were made to minimize suffering. Animals. The … edema. At 48 h, the rats were sacrificed
under deep anesthesia provided by ketamine/xylazine. …
Drugs that Target the Glutamate Synapse: Implications for the Glutamate Hypothesis of Schizophrenia
CA MIELNIK, A RAMSEY – Drug Discovery for Schizophrenia, 2015
… In addition to the ligand bind- ing domains, NMDA receptors have modulatory sites for
zinc and spermine, and a modulatory site within the channel that binds the
non-competitive inhibitors phencyclidine (PCP), dizocilpine, and ketamine. …
EVALUATION OF ANTHELMINTIC FISHMEAL POLYMER BAITS FOR THE CONTROL OF BAYLISASCARIS PROCYONIS IN FREE-RANGING RACCOONS ( …
TJ Smyser, SR Johnson, MD Stallard, AK McGrew… – Journal of Wildlife Diseases, 2015
… lactating were released at the capture location. We anesthe- tized captured raccoons
with ketamine/xyla- zine (10 mg/kg ketamine and 2 mg/kg xylazine, intramuscularly
[Fowler 2009]). Upon induc- tion, animals were weighed …
[PDF] Intra-ventral tegmental HIV-1 Tat1-86 attenuates nicotine-mediated locomotor sensitization and alters mesocorticolimbic ERK and CREB signaling in rats
J Zhu, NM Midde, AM Gomez, W Sun, SB Harrod – Name: Frontiers in Microbiology, 2015
… session 29 (Fig 1A). 30 Briefly, rats were anesthetized using a mixture of ketamine
hydrochloride and xylazine 31 by intraperitoneal (IP) injection (7.5 mg ketamine/100
g b.wt. and 30 mg xylazine/100 g b.wt.). 32 Rats were then …
Autonomic remodeling: How atrial fibrillation begets atrial
L Zhang, SS Po, HW PhD&, BJ Scherlag, HL PhD&… – 2015
… 13 Fifty-two male adult New Zealand white rabbits, weighing 2.0–2.5 kg, were 14 premedicated
with ketamine/xylazine ( 35mg/5mg/kg ),and restrained in the 15 supine position. Anesthesia
was also maintained by intra-peritoneal injection of 16 20% urethane 5 ml as needed. …
Protein Interactions with Dopamine Receptors as Potential New Drug Targets for Treating Schizophrenia
P SUa, AHC WONG, F LIU – Drug Discovery for Schizophrenia, 2015
… Page 222. Chapter 9 208 antagonist, ketamine, or PCP-induced cognitive deficits with an
inverted U-shaped dose response curve. … 52 Conversely, there is less ketamine-induced
behavioral activation in D1R knockout mice than in wild-type mice. …
Plasma arginine metabolites reflect airway dysfunction
H Grasemann, JA Scott, ML North, M Rafii, H Huang… – J Appl Physiol, 2015
… On day 21, 24 h after the final aerosol challenge, mice were anesthetized (ketamine/xylazine)
for tracheal and jugular venous cannulations for ventilator-based measurement of respiratory
function and infusion of the stable L-arginine isotopomer cocktail, respectively. …
[PDF] Histological and Histomorphometric Evaluation of Pharmacological Action of the Essential Oil of Melaleuca Alternifolia on Healing of Infected Alveolitis in Experimental …
WS Abdel-fattah, MM Dahaba, AA Ahmed… – J Interdiscipl Med Dent Sci, 2015
… Materials and Methods Chemicals Tea tree oil was purchased from (SIGMA-ALDRICH
Chemie GmbH RiedstrasseUSA), vancomycin hydrochloride and ketamine were
obtained from the local pharmaceutical market. Bacterial infection …
[PDF] Clinical Evaluation of Caudal Clonidine as an Adjuvant to Bupivacaine in Pediatric Patients Undergoing Sub Umbilical Surgeries
S Dalal – 2015
… Prolongation of caudal analgesia using a single-shot technique has been achieved by addition
of various adjuvants, such as epinephrine, opioid, ketamine, and alpha 2 agonists [9]. Clonidine,
an alpha 2 agonist has extensively been used in neuraxial blocks [10- 13] and …
The effects of pentoxifylline and caffeic acid phenethyl ester in the treatment of d-galactosamine-induced acute hepatitis in rats
E Taslidere, N Vardi, M Esrefoglu, B Ates, C Taskapan… – Human & Experimental …, 2015
… kg body weight for 20 days. At the end of the experiment, rats were killed by ketamine
anesthesia. After blood samples were collected from tail vein, livers were removed
and divided into two portions. One sample was used for …
[PDF] Assessment of the effect of ketamine on cytochrome P450 isoforms activity in rats by cocktail method
F Lin, Y He, L Zhang, M Zhang, Y Zhang, C Wen – Int J Clin Exp Med, 2015
Abstract: Cocktail method was used to evaluate the influence of ketamine on the activities of
CYP450 isoforms CYP1A2, CYP2D6, CYP3A4, CYP2C19, CYP2C9 and CYP2B6, which
were reflected by the changes of pharmacokinetic parameters of six specific probe drugs …
Ketamine and suicidal ideation in depression: Jumping the gun?
R Rajkumar, J Fam, EYM Yeo, GS Dawe – Pharmacological Research, 2015
Abstract Depression and suicide are known to be intricately entwined but the
neurobiological basis underlying this association is yet to be understood. Ketamine is an N-
methyl D-aspartate (NMDA) receptor antagonist used for induction and maintenance of …
Ketamine-mediated alleviation of electroconvulsive shock-induced memory impairment is associated with the regulation of neuroinflammation and soluble amyloid- …
X Zhu, P Li, X Hao, K Wei, S Min, J Luo, F Xie, J Jin – Neuroscience Letters, 2015
Abstract Electroconvulsive therapy (ECT) is an effective treatment for depression, but can
result in memory deficits. This study aimed to determine whether ketamine could alleviate
electroconvulsive shock (ECS, an analogue of ECT in animals)-induced memory …
D-AMPHETAMINE withdrawal-induced decreases in brain-derived neurotrophic factor in sprague-dawley rats are reversed by treament with ketamine
JJL Fuller, RC Murray, KA Horner – Neuropharmacology, 2015
Abstract Withdrawal from chronic D-amphetamine (D-AMPH) can induce negative emotional
states, which may contribute to relapse and the maintenance of addiction. Diminished levels
of brain-derived neurotrophic factor (BDNF), particularly in the hippocampus has been …
Management of acute pain in patients on treatment with opioids
J De Andres, G Fabregat-Cid, JM Asensio-Samper… – Pain Management, 2015
… In fact, the use of NMDA receptor antagonists such as ketamine inhibits the development of
tolerance in test animals [15]. … Inhibition of tolerance has been demonstrated in test animals with
the use of noncompetitive antagonists of NMDA receptors such as ketamine [48]. …
DrugScan
T Ha, L Abbott, J Booth, M Morrow, M Rawlins… – 2015
… Emerg Med J 2014; 31: 706–13. Ketamine and Intraocular Pressure in Children This prospective
observational study sought to examine the potential increase in the intraocular pressure following
ketamine administration for paediatric procedural seda- tion. …
Multimodal Analgesic Protocol and Postanesthesia Respiratory Depression During Phase I Recovery After Total Joint Arthroplasty.
TN Weingarten, AK Jacob, CW Njathi, GA Wilson… – Regional Anesthesia and …, 2015
… Procedural sedation during block placement was with incremental dosing of intravenous midazo-
lam, fentanyl, and ketamine. … Use of ketamine as a sedative for nerve blockade or analgesia was
at the discretion of the attending anesthesiologist and not part of the protocol. …
Stem cell-based therapies for intracerebral hemorrhage in animal model: a meta-analysis
X Ma, J Qin, B Song, C Shi, R Zhang, X Liu, Y Ji, W Ji… – Neurological Sciences, 2015
… CAMARADES) [10]: peer- reviewed publication; statement of control of tem- perature; random
allocation to treatment or control; blinded induction; blinded assessment of outcome; use of
anesthetic without significant intrinsic neuroprotec- tive activity (such as ketamine); use of …
Anatomical organization of the visual dorsal ventricular ridge in the chick (Gallus Gallus): Layers and columns in the avian pallium
P Ahumada‐Galleguillos, M Fernandez, GJ Marin… – Journal of Comparative …, 2015
… Deposits of biocytin in vital slices. Forty chicks (P1-P5) were deeply anesthetized with a mixture
(3:1) of 1% Ketamine and 2% Xylazine, and then decapitated. … Deposits of DiI in fixed slices. Ten
chicks were deeply anesthetized using the Ketamine/Xilazine mixture and perfused …
[PDF] Alterations in molecular pathways in the retina of early experimental glaucoma eyes
L Cao, L Wang, G Cull, A Zhou – Int J Physiol Pathophysiol Pharmacol, 2015
… in one eye of each animal under ketamine and xyla- zine anesthesia. One hundred … follow-
up. During each test, IOP was measured by a rebound tonometer (Tonopen XL, Reichert
Inc) under ketamine and xylazine anesthesia. The peripapillary …
Radiofrequency Ablation (RFA)
… K Antagonist Oral Anticoagulants versus Vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Radiofrequency Catheter Ablation of Atrial Fibrillation: A …
G Santarpia, S De Rosa, A Polimeni, S Giampà… – PloS one, 2015
BACKGROUND: Use of the non-vitamin K antagonist oral anticoagulants (NOACs) is
endorsed by current guidelines for stroke prevention in patients with atrial fibrillation (AF).
However efficacy and safety of NOACs in patients undergoing catheter ablation (RFCA) of …
Treatment of Renal Cell Carcinomas
SN Kurukkal, SS Al-Busaidy – Urological Cancer Management, 2015
… cavitational ultrasound (PCU). However, only two ablation therapies are recommended
by expert panels for the treatment of renal tumours: cryoablation and radiofrequency
ablation. … hilum. 16.3.1 Radiofrequency Ablation (RFA). It is …
[PDF] Metastatic Colorectal Cancer: Review of Diagnosis and Treatment Options
M Palaghia, CC Prelipcean, E Cotea, N Vlad… – Journal of Surgery [Jurnalul …, 2015
… Liver Metastases: Addition of new, multidisciplinary techniques and therapies like systemic or
local chemotherapy, radiofrequency ablation (RFA), cryotherapy and radiotherapy improves the
rate of liver metastases resectability but currently there is no gold standard concerning …
ть е рыв ж ть
H Takeuchi – 2015
… transplantation and as a radiofrequency ablation for AF [3]. Sixty-four-slice multidetector CT
(64-MDCT) becomes an option to evaluate coronary artery stenosis. … pulmonary venous stenosis
following radiofrequency ablation. Respiratory Care 2004; 49:1525-7. …
[PDF] The natural product sulforaphane inhibits breast cancer stem cell targets in triple negative and trastuzumab-resistant breast cancers
J Burnett – 2015
… metastasis (1). Substantial progress has been made with respect to the treatment of primary
tumors using surgery, chemotherapy, radiation therapy, and radiofrequency ablation. However,
the advancement of cancer to an invasive or metastatic stage is …
[HTML] Multidisciplinary management of advanced lung neuroendocrine tumors
PL Filosso, P Ferolla, F Guerrera, E Ruffini, WD Travis… – Journal of Thoracic Disease, 2015
… In the absence of hormonal control, many patients may benefit of SSA or Interferon,
associated with loco-regional therapies (liver palliative surgery, radiofrequency metastasis
ablation or trans arterial chemoembolization). Low-grade NETs. …
[PDF] Minimally-invasive Therapy in Thyroid Practice
L Hegedüs
… Ethanol ablation (PEI) • Laser ablation (ILP) • Radiofrequency ablation (RFA • Laszlo Hegedüs •
Enrico Papini (Rome, Italy) • Jung Hwan Baek (Seoul) Ford T Maserati Quatroporte Proto Spirra …
Radiofrequency Ablation (RFA) Page 21. 5/13/2015 21 P < 0,0001 RFA Obs. …
[PDF] 0915-0940 TBD 0940-1000 Coffee break/Poster viewing
M Kudo, G Abou-Alfa, O Baatarkhuu, RN Chien… – Surgery
… Prof Ho Yeong Lim (Korea) 1535-1555 Novel techniques: ablation Dr Shuichiro
Shiina (Japan) Circulating biomarkers Dr Wei Tang (Japan) 1555-1615 Surgery
vs. ablation: a new balance in the era of new technologies? …
Urological Cancer Management
SA Al-Mamari, SS Al-Busaidy
… time PSM Positive surgical margins PTH-rP Parathormone-related peptide pTNM Pathological
TNM QoL Quality of life RALP Robotic assisted laparoscopic radical prostatectomy RC Radical
cystectomy RCC Renal cell carcinoma RFA Radiofrequency ablation RN Radical …
[DOC] Deliverable 11
B Plan
… Introduction. Ablatech Inc. is a novel company developing a direct current (DC) Ablation device
for the treatment of fibroadenomas and lipomas. … Note: The DC Ablation generator is indicated
for use with Ablatech’s A2500 series of delivery needles, which are sold separately. …
Radiofrequency ablation for treatment of hereditary hemorrhagic telangiectasia lesions:“How I do it”
B Rotenberg, S Noyek, CJ Chin – American Journal of Rhinology & Allergy, 2015
Introduction: Hereditary hemorrhagic telangiectasia (HHT) can cause significant epistaxis for
those that suffer from it. Traditaional surgical treatments are ablative and can cause thermal
damage. Radiofrequency (RF) energy can potentially be used to ablate HHT plaques at a …
Angiotensin receptor blockers improve survival outcomes after radiofrequency ablation in hepatocarcinoma patients
A Facciorusso, V Del Prete, N Crucinio, N Muscatiello… – Journal of Gastroenterology …, 2015
Methods Data on 153 patients were reviewed. The study population was classified into three
groups: 73 (47.8%) patients who received neither angiotensin converting enzyme inhibitors
nor sartans (Group 1), 49 (32%) patients treated with angiotensin converting enzyme …
Ablative therapies: Advantages and disadvantages of radiofrequency, cryotherapy, microwave and electroporation methods, or how to choose the right method for an …
O Seror – Diagnostic and Interventional Imaging, 2015
… It is important, however, to understand that each of the ablated regions created remains … as possible
the functional liver parenchyma which implies to not ablate too large … No touch multibipolar
radiofrequency ablation for single liver metastases: a: axial computed tomography at …
Pulmonary Vein Stenosis After Minimally Invasive Stand‐alone Surgical Ablation of Atrial Fibrillation
E Abo‐salem, J Munjal, S Kapur – Journal of Cardiac Surgery, 2015
… vein. In our case, several rounds of cryoablation alternating with radiofrequency ablation
were also applied to confirm a transmural block. An extensive ablation strategy may
have contributed to the development of stenosis. Aggressive …
[PDF] Comparative study between conventional chemo-embolization and chemo-embolization using drug eluting beads as alternative methods for treatment of …
RS Elshahat, HA Ahmed, OI Saleh, EEA Ibrahim… – Life Science Journal, 2015
… Although preliminary screening and diagnosis have allowed HCC patients to benefit from radical
resection, transplantation, or radiofrequency ablation, tumors in some patients still progress rapidly
because of local spreading or metastases, particularly in those with background …
Treatment of hepatocellular carcinomas by thermal ablation and hepatic transarterial chemoembolization
P Chevallier, G Baudin, R Anty, A Guibal, M Chassang… – … and Interventional Imaging, 2015
… It has now been shown for monopolar radiofrequency ablation that this therapy
alone is sufficient to effectively treat single HCCs < 3 cm in diameter provided that
liver micrometastases are not present. If the HCC is >3 cm in …
The “Duality” of Idiopathic Ventricular Arrhythmias from the Left Ventricular Ostium
DJ Callans, P Santangeli – Pacing and Clinical Electrophysiology, 2015
… LBBB, the other RBBB which were ablated from a single region. These patients were identified
from a series of 247 patients with idiopathic outflow tract PVCs. The methods included
electroanatomic mapping, irrigated radiofrequency ablation and site verification …
nonsystemic treAtment of Liver metAstAses from neuroendocrine tumor
D Putzer, G Widmann, D Waitz, W Jaschke, IJ Virgolini – … Analogues: From Research …, 2015
… 274 NONsYsTEMIC TREATMENT Of LIVER METAsTAsEs RfA radiofrequency ablation RILD
radiation‐induced liver disease sIRT selective internal radiation therapy sPECT single photon
emission computed tomography TACE transarterial chemoembolization Us ultrasound …
Interventional oncology for liver and lung metastases from colorectal cancer: The current state of the art
T de Baere, L Tselikas, E Pearson, S Yevitch, V Boige… – … and Interventional Imaging, 2015
… tissue causes cooling through convention, which is responsible for the “heat sink effect”, and
causes difficulties in ablating tissue close to … The hepatic recurrence rate in 6025 patients
undergoing surgery with or without radiofrequency ablation for malignant liver metastases from …
One Year Incidence of Atrial Septal Defect After PV Isolation: A Comparison Between Conventional Radiofrequency and Cryoballoon Ablation
G Mugnai, J Sieira, G Ciconte, MS Hervas, G Irfan… – Pacing and Clinical …, 2015
Background: Transseptal (TS) catheterization is needed to access the left heart during
pulmonary vein isolation (PVI) procedures. In the radiofrequency (RF) ablation procedure,
left atrial access is commonly achieved with a double TS puncture; cryoballoon (CB) …
Complex Regional Pain Syndrome (CRPS/RSD)
[PDF] Topics on estimation, prediction and bounding risk for multivariate extremes
RA Yuen – 2015
… 17 2.3 CRPS M-estimation for max-stable models . . . . . 20 2.4 Simulation . . . . . … 141
A.1 Code for fitting max-linear models via CRPS . . . . . 142 A.2 Code for fitting a
Tawn-Molchanov max-stable model . . . . 144 BIBLIOGRAPHY . . . . . …
[PDF] A NOVEL APPROACH TO THE MANAGEMENT OF PARSONAGE-TURNER SYNDROME
DK Garas, MD Rano Faltas, ER Viscusi
… refractory CRPS, and has been found to be particularly efficacious6. • In a study
of 25 patients with refractory CRPS who underwent surgery, IV ketamine …
exacerbations or spread of their CRPS at their 3 month evaluation6, 13.
[PDF] Preliminary Port Recovery Plan Schedule 2: Regional Coastal Environment Plan for the Canterbury Region (RCEP) Provisions-Specific Changes Sought (or wording …
L Port, P Page – policy
… for by policies, rules and other methods set out in the RCEP. These changes sought are consistent
with the CRPS as set in Schedule 1. … These changes sought are consistent with the CRPS as set
out in Schedule 1. Amendments sought to Action 7 are Insert a new policy: …
Organisational Complaint Management
S Garding, A Bruns – Complaint Management and Channel Choice, 2015
… 2013). Garnefeld et al. (2013) even recommend companies to consider “building CRPs
into social media campaigns to take advantage 6 1 Organisational Complaint
Management Page 7. of the increasing social commerce opportunities”. …
[PDF] Reverse total shoulder arthroplasty for complex proximal humeral fractures in the elderly: How to improve outcomes and avoid complications
RPDM UCT, F Ortho, UCT MMed Orth, BVM Zim, F Orth… – pain
… 139 (90–180) – 27 (0–45) 1 (VAS) 10% 1 patient with CRPS, DVT, and GT resorption, 1 patient
with GT malunion, 1 patient with Grade 1 notching ASES 78 T a b le I: R esu lts o … RTSA 9
133(±20) 41 (±19) 1 (±1) 1/9 CRPS (recovered) ASES 80 (±11) T a b le II: R esu lts fo r stu …
[PDF] Syringomyelia & Spinal Cord Stimulation
RB Pitkanen, DL James
… found to be successfully used in the treatment of several neuropathic pain syndromes
such as radiculopathy, failed back surgery syndrome, CRPS, post-herpetic neuralgia,
as well as to a lesser extent for chronic migraine, refractory …
[PDF] Neuropsychology of Chronic Pain
EM Desensitization
… For example, com- plex regional pain syndrome (CRPS) is caused by a disturbance of the
sympathetic nervous system— the network of nerves located along the spinal cord that controls
bodily functions such as the opening and closing of blood vessels and sweat glands. …
Stefan Garding Andrea Bruns
SBIN BUSINESS
… 2013). Garnefeld et al. (2013) even recommend companies to consider “building CRPs
into social media campaigns to take advantage 6 1 Organisational Complaint Management
Page 19. of the increasing social commerce opportunities”. …
” What I really needed was the truth”. Exploring the information needs of people with Complex Regional Pain Syndrome
S Grieve, C McCabe, J Adams – Musculoskeletal Care, 2015
… Download (52Kb) | Request a copy: Description/Abstract. Background United Kingdom
guidelines indicate individuals with Complex Regional Pain Syndrome (CRPS) require
information and education to support self management. …
Reprogramming of in situ spinal cord stimulator for covering newly developed postthoracotomy pain
NN Knezevic, MV Rana, P Czarnocki… – Journal of Clinical …, 2015
… Postthoracotomy pain; Spinal cord stimulation. 1. Introduction. Spinal cord stimulation has become
increasingly successful in the treatment of pain syndromes, especially neuropathic pain, ranging
from failed back surgery syndrome to complex regional pain syndrome (CRPS). …
Late Amputation May Not Reduce Complications or Improve Mental Health in Combat-Related, Lower Extremity Limb Salvage Patients
CA Krueger, JC Rivera, DJ Tennent, AJ Sheean… – Injury, 2015
… Table 2. Documented reasons of why the limb salvage patients wanted a late amputation. CRPS:
Chronic Regional Pain Syndrome. Reasons for Desired Late Amputation, (n, %), … Lack of joint
motion, 6, 13%. Lack of strength, 4, 9%. Skin coverage or flap failure, 2, 5%. CRPS, 1, 2% …
Community-Based Review of Research Across Diverse Community Contexts: Key Characteristics, Critical Issues, and Future Directions
N Shore, A Ford, E Wat, M Brayboy, ML Isaacs, A Park… – American Journal of Public …, 2015
… These community-based research review processes (CRPs) can provide individual and
community-level ethics protections, enhance the cul- tural relevance of study de- signs and
competence of re- searchers, build community and academic research capac- ity, and shape …
Bayesian Model Averaging with Stratified Sampling for Probabilistic Quantitative Precipitation Forecasting in Northern China during Summer 2010
J Zhu, F Kong, L Ran, H Lei – Monthly Weather Review, 2015
Page 1. Monthly Weather Review EARLY ONLINE RELEASE This is a preliminary PDF of
the author-produced manuscript that has been peer-reviewed and accepted for publication.
Since it is being posted so soon after acceptance, it has not yet been …
COMPOSITIONS AND METHODS OF USING THREOHYDROXYBUPROPION FOR THERAPEUTIC PURPOSES
H Tabuteau – US Patent 20,150,133,485, 2015
… In some embodiments, a combination of dextromethorphan and an antidepressant, such as
bupropion, may be administered to relieve complex regional pain syndrome, such as complex
regional pain syndrome type I (CRPS-I), complex regional pain syndrome type II (CRPS-II …
BUPROPION AS A MODULATOR OF DRUG ACTIVITY
H Tabuteau – US Patent 20,150,133,486, 2015
… In some embodiments, a combination of dextromethorphan and an antidepressant, such as
bupropion, may be administered to relieve complex regional pain syndrome, such as complex
regional pain syndrome type I (CRPS-I), complex regional pain syndrome type II (CRPS-II …
Osteoclast Inhibitors for Knee Conditions
H Tabuteau, G Jones – US Patent 20,150,133,403, 2015
… embodiments, an osteoclast inhibitor, such as a nitrogen-containing bisphosphonate, eg
zoledronic acid, ibandronic acid or minodronic acid, may be administered to relieve complex
regional pain syndrome, such as complex regional pain syndrome type I (CRPS-I), complex …
Neuroimaging-based biomarker discovery and validation.
CW Woo, TD Wager, CW Woo – PAIN, 2015
… Neuroimage 2008;40(2):788-795. [11] Geha PY, Baliki MN, Harden RN, Bauer WR, Parrish
TB, Apkarian AV. The brain in chronic CRPS pain: abnormal gray-white matter interactions
in emotional and autonomic regions. Neuron 2008;60(4):570-581. …
[PDF] IASP Interprofessional Pain Curriculum Outline
N Kariuki, J Miró, L Niemi-Murola, G Ochoa…
… Primary Lesion Peripheral • degenerative disc disease with radiculopathy in neck and low back •
peripheral neuropathies (diabetes, cancer, alcohol, HIV) • post herpetic neuralgia • acute disc
herniation with radiculopathy • complex regional pain syndrome II (CRPS II) (causalgia …
Fibromyalgia
Inflammatory Allied Conditions
MA Oliveira, A Ciechomska – Musculoskeletal Ultrasonography in Rheumatic …, 2015
… biopsies. Whereas in fibromyalgia, there are conflicting data about the utility of US,
and if used, it is mainly to exclude other causes of pain. … XXXIX. Sonographic assessment
of hip in fibromyalgia patients. Clin Exp Rheumatol 30: pp. …
Childhood adversity and illness progression in bipolar disorder
J Bücker, M Kauer-Sant’Anna, LN Yatham – Neuroprogression and Staging in Bipolar …, 2015
… BD patients with a history of childhood adversity also seem to report comorbidity with numerous
medical conditions, including allergies, arthritis, asthma, chronic fatigue syndrome, chronic
menstrual irregularities, fibromyalgia, head injury, hypotension, irrit- able bowel syndrome …
The Use of Motivational Interviewing in Physical Therapy Education and Practice: Empowering Patients Through Effective Self-Management
RM Pignataro, PT James Huddleston – Journal of Physical Therapy Education, 2015
… been successfully employed in promoting adherence to a walking program in patients receiving
chemotherapy for breast cancer,42 in improving health promotion behaviors among people with
coronary risk factors,42 and in promoting exercise in patients with fibromyalgia.39 In …
[PDF] Temporomandibular Joint Dysfunction
J Poduval – JMR, 2015
… J Craniomandib Disord 1992, 6:301-355. 4. Truta MP, Santucci ET, Donlon WC. Head
and Neck fibromyalgia and temporomandibular arthralgia. In: Jacobson AL, Donlon WC,
(Eds). Headache and Facial Pain. New York: Raven, 1990:141. …
From the Desk of Dr. Karl ROS Johnson, DC…..
ROS Karl
… Intentional musings of a unique Shelby Township Michigan Chiropractic Physician dedicated
to helping people find solutions to improving their health by rooting out causes to chronic
conditions such as fibromyalgia, thyroid disorder symptoms, balance disorders, migraines …
Ankylosing Spondylitis
M Backhaus, Y El Miedany – Musculoskeletal Ultrasonography in Rheumatic …, 2015
… Beside spondyloarthritis patients, enthesitis have been reported among athletes
as a consequence of traumatic injuries. Distinguishing fibromyalgia tender points
from enthesitis is another important challenge to be considered. …
[HTML] Development of a Learning-Oriented Computer Assisted Instruction Designed to Improve Skills in the Clinical Assessment of the Nutritional Status: A Pilot Evaluation
LG de Diego, M Cuervo, JA Martínez – 2015
Advertisement. …
[PDF] P1. Community-Clinical Linkages in the WISEWOMAN Program
K Ahmed, I Vaid, D May, D Manheim – JOURNAL OF WOMEN’S HEALTH, 2015
… this study. Of the women patients, 361 reported a history of hysterectomy. A
comparison group consisted of 361 patients with a primary diagnosis of headache
or fibromyalgia without history of hysterectomy. Patients completed …
[HTML] The Hot Sauce: Peppers and Fat Loss
VR Prisk
… Aside from deterrence of muggers and bets between friends, there are many therapeutic
applications of capsaicin. Capsaicin creams, which desensitize nerves over time, are used
to treat neuropathy, shingles, psoriasis, arthritis pain and fibromyalgia. …
[PDF] TEMPORALITY AND INFORMATION WORK IN BONE MARROW TRANSPLANT
AG Büyüktür – 2015
… al., 2010; Hubbard et al., 2010), motor neuron disease (eg Locock et al., 2009), chronic fatigue
syndrome and fibromyalgia (eg Asbring, 2001), HIV infection (eg Anderson et al., 2010; Wilson,
2007), and multiple sclerosis (eg Green et al., 2007), among others. …
34 Fibromyalgia, Chronic Fatigue, Functional Disorders, and Vaccination: Where Do We Stand?
JN Ablin, D Buskila – Vaccines and Autoimmunity, 2015
Gender and psychosocial context as determinants of fibromyalgia symptoms (fibromyalgia research criteria) in young adults from the general population
S Lourenço, L Costa, AM Rodrigues, F Carnide… – Rheumatology, 2015
Objective. To quantify the prevalence of FM (FM research criteria), to describe its
components—symptom severity score (SSS) and widespread pain index (WPI)—and to
identify biopsychosocial predictors of the severity of SSS as well as WPI using a …
Fibromyalgia and the Risk of a Subsequent Motor Vehicle Crash
DA Redelmeier, JD Zung, D Thiruchelvam… – The Journal of …, 2015
Objective Motor vehicle crashes are a widespread contributor to mortality and morbidity,
sometimes related to medically unfit motorists. We tested whether patients diagnosed with
fibromyalgia (FM) have an increased risk of a subsequent serious motor vehicle crash. …
Association of antithyroid peroxidase antibody with fibromyalgia in rheumatoid arthritis
J Ahmad, H Blumen, CE Tagoe – Rheumatology International, 2015
Abstract To investigate how autoimmune thyroiditis (ATD) affects the clinical presentation of
established rheumatoid arthritis (RA) with particular reference to fibromyalgia and chronic
widespread pain (CWP). A cohort of 204 patients with RA for whom the presence or …
Association between fibromyalgia and thyroid autoimmunity
N Shirzad, S Movassaghi, H Karmostaji, F Esfahanian… – 2015
Fibromyalgia is a disorder characterised by fatigue, generalised body pain and cognitive
symptoms, and the aetiology has not been clearly described. Because similar symptoms are
frequently found in Hashimoto’s thyroiditis and there is not an optimal response to the …
COMPOSITIONS AND METHODS FOR THE TREATMENT OF RESTLESS LEG SYNDROME AND FIBROMYALGIA
M Kandula – US Patent 20,150,133,408, 2015
Abstract: The invention relates to the compounds of formula I or its pharmaceutical
acceptable salts, as well as polymorphs, solvates, enantiomers, stereoisomers and hydrates
thereof. The pharmaceutical compositions comprising an effective amount of compounds …
[PDF] REVISTA BRASILEIRA DE REUMATOLOGIA
SB de Lorena, MCC de Lima, A Ranzolin, ÂLBP Duarte – rev bras reumatol, 2015
… Review article Effects of muscle stretching exercises in the treatment of fibromyalgia: a systematic
review … articleinfo Article history: Received 16 March 2014 Accepted 17 August 2014 Available
online 6 January 2015 Keywords: Fibromyalgia Stretching Physiotherapy abstract …
36 Infections, Vaccinations, and Chronic Fatigue Syndrome
H Mahagna, N Mahroum, H Amital – Vaccines and Autoimmunity, 2015
COMPOSITIONS AND METHODS FOR INDUCING MYOBLAST DIFFERENTIATION AND MYOTUBE FORMATION
MP Czech, M Wang – US Patent 20,150,133,520, 2015
… 12. The method of claim 11, wherein the muscle disorder is selected from the group consisting
of: muscle atrophy, muscle weakness, myopathy, chronic fatigue syndrome, fibromyalgia, muscular
dystrophy, fatigue fibromyalgia, spinal muscle atrophy, distal muscular dystrophy …
27 Aluminum Particle Biopersistence, Systemic Transport, and Long-Term Safety: Macrophagic Myofasciitis and Beyond
RK Gherardi, J Cadusseau, FJ Authier – Vaccines and Autoimmunity, 2015
You only need to know one thing about your back —