Weekly Breaking Research Updates

Weekly Breaking Research Updates

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 (below).

If you’d like to make an appointment with Dr. Hanna to discuss your treatment options, please contact us.

Ketamine 

 

Wastewater analysis to monitor spatial and temporal patterns of use of two synthetic recreational drugs, ketamine and mephedrone, in Italy

S Castiglioni, A Borsotti, I Senta, E Zuccato – Environmental Science & Technology, 2015

Wastewater analysis was applied in a four-year monitoring study to assess temporal and

spatial patterns of ketamine and mephedrone use in the general population in Italy.

Composite raw wastewater samples were collected from sewage treatment plants (STPs)

 

The use of ketamine as an antidepressant: a systematic review and meta‐analysis

CM Coyle, KR Laws – Human Psychopharmacology: Clinical and …, 2015

Objective The current meta-analysis examines the effects of ketamine infusion on

depressive symptoms over time in major depressive disorder (MDD) and bipolar disorder

(BD). Methods Following a systematic review of the literature, data were extracted from 21

 

Intravenous Ketamine to Facilitate Non-Invasive Ventilation in a Patient with a Severe Asthma Exacerbation

E Kiureghian, JM Kowalski – The American Journal of Emergency Medicine, 2015

Background Despite advances in outpatient treatment and an improved understanding of

the pathophysiology, asthma continues to be a significant source of morbidity and mortality

in the United States. While there is certainly a component of chronic inflammation, the

 

Perioperative low-dose ketamine improves postoperative analgesia following Cesarean delivery with general anesthesia

M Haliloglu, M Ozdemir, N Uzture, PO Cenksoy… – The Journal of Maternal- …, 2015

Abstract Objective: In this study, the effect of perioperative uses of low dose ketamine on

post-operative wound pain and analgesic consumption in patients undergoing elective

Cesarean section was evaluated. Methods: In randomized, double blind clinical trial, 52

 

The Clinical Effect of Fentanyl in Comparison with Ketamine in Analgesic Effect for Oncology Procedures in Children: A Randomized, Double-Blinded, Crossover Trial

C Monsereenusorn, P Rujkijyanont, C Traivaree – JOURNAL OF THE MEDICAL …, 2015

Material and Method: A randomized, double-blinded, crossover trial was conducted with 55 children

undergoing painful procedures (intrathecal chemotherapy and/or bone marrow

aspiration/biopsy). Patients were randomly assigned in a double-blinded fashion to

 

Dexmedetomidine, Ketamine, and Midazolam for Oral Rehabilitation: A Case Report

BWS Kim, RM Peskin – Anesthesia Progress, 2015

Abstract Intravenous sedation is frequently provided by anesthesiologists for phobic patients

undergoing elective dental treatment in outpatient settings. Propofol is one of the most

commonly used anesthetic agents that can result in apnea and respiratory depression,

 

Ketamine May Be Related to Minor Troponin Elevations in Children Undergoing Minor Procedures in Emergency Department

M Serinken, C Eken – The American Journal of Emergency Medicine, 2015

Objective Ketamine is a dissociative anesthetic agent that has an increased frequency of

usage in the last years particularly in emergency departments. In the present study, we

aimed to determine whether ketamine is related to myocardial injury in children

 

Anesthesia and neuromonitoring

EN Menga, GJ Spessot, JA Bendo – Seminars in Spine Surgery, 2015

Commonly used intravenous anesthetics include propofol, dexmedetomidine, etomidate,

barbiturates, ketamine, and benzodiazepines. Using a canine model, Glassman et al. 13 reported

consistent and reproducible TcMEPs with ketamine and etomidate.

 

Inflammatory Biomarkers as Differential Predictors of Antidepressant Response

K Hashimoto – International Journal of Molecular Sciences, 2015

situation. This article discusses inflammatory molecules as predictive biomarkers

for antidepressant responses to several classes of antidepressants, including the

N-methyl-d-aspartate (NMDA) receptor antagonist ketamine.

 

Spinal cord neuron inputs to the cuneate nucleus that partially survive dorsal column lesions: A pathway that could contribute to recovery after spinal cord injury

CC Liao, GE DiCarlo, OA Gharbawie, HX Qi, JH Kaas – Journal of Comparative …, 2015

tranquilized with an intramuscular injection (IM) of ketamine hydrochloride (10-25 mg/ kg, IM)

and Page 4 of 55 John Wiley & Sons Journal of Comparative Neurology In preparation for the

injection, each monkey was tranquilized with ketamine hydrochloride (10mg/kg,

 

Radiofrequency Ablation (RFA)

 

[PDF] Comparison of amiodarone and propafenone for maintenance of stable sinus rhythm after bipolar radiofrequency ablation combined with a mitral valve procedure in …

Y Beşir, O Gökalp, U Yetkin, E Çelik, H İner, B Lafçı… – Türk Göğüs Kalp Damar …, 2015

ABSTRACT Background: This study aims to examine the effects of amiodarone versus

propafenone for maintenance of stable sinus rhythm after left atrial bipolar radiofrequency

ablation combined with a mitral valve procedure in patients with mitral valve disease and

 

New Technologies and Approaches to Endoscopic Control of Gastrointestinal Bleeding

LL Fujii-Lau, LMWK Song, MJ Levy – Gastrointestinal Endoscopy Clinics of North …, 2015

Radiofrequency Ablation. Technique. Focal radiofrequency ablation (RFA) catheters

(Barrx; Covidien, Mansfield, MA) have been used to treat GI bleeding in the setting of

gastric antral vascular ectasia (GAVE) (Fig. 3) and radiation proctitis.

 

Dichorionic triplet pregnancies: risk of miscarriage and severe preterm delivery with fetal reduction versus expectant management. Outcomes of a cohort study and …

M Morlando, L Ferrara, F D’Antonio, A Lawin‐O’Brien… – BJOG: An International …, 2015

Ultrasound-guided laser ablation or radiofrequency ablation of the pelvic vessels of one

of the monochorionic fetuses was used in all cases of reduction from three to two fetuses

for selective reduction of one of the two monochorionic fetuses.

 

Interventional MR elastography for MRI‐guided percutaneous procedures

N Corbin, J Vappou, E Breton, Q Boehler, L Barbé… – Magnetic Resonance in …, 2015

[27] showed that the Young’s modulus of the treated liver tumor in swine increases from 6 to 40

kPa approximately during a 5 min-long radiofrequency ablation by providing elastographic

information every 30 s. The monitoring of thermal ablations with MRE is limited by the

 

[HTML] Editorials & Opinions

JP Tasto – Am J Orthop, 2015

Published December 2014. Accessed March 6, 2015. « Back To: Editorials & Opinions. Did

you miss this content? Cutaneous Burn Caused by Radiofrequency Ablation Probe During

Shoulder Arthroscopy. More From The American Journal of Orthopedics

 

Hysteroscopy and heavy menstrual bleeding (to cover TCRE and second generation endometrial ablation)

M Bongers – Best Practice & Research Clinical Obstetrics & …, 2015

cryo-ablation (HerOption™, Cooper Surgical, Trumbull, CT) [14], and bipolar radiofrequency

(Novasure™, Hologic The difference between the first and the second-generation endometrial

ablation are several. Under direct vision the total endometrium can be resected or ablated.

 

Atrioesophageal fistula and pneumocephalus after pulmonary vein isolation

BD Wilson, JH Morshedzadeh – European Heart Journal-Cardiovascular Imaging, 2015

Catheter radiofrequency ablation of atrial fibrillation is an increasingly common procedure,

and atrioesophageal fistula is a rare and often fatal complication. High clinical suspicion,

rapid diagnosis, and surgical therapy may prevent death.

 

Gastroparesis as a Complication of Atrial Fibrillation Ablation

T Aksu, S Golcuk, TE Guler, K Yalin, I Erden – The American Journal of Cardiology, 2015

ventricular ejection fraction, M=male; N=normal; PIN=patient identification number; R=

radiofrequency. more reasonable avoiding cryo-energy at lower temperatures while ablating

inferior PVs The most possible mechanism of gastroparesis related with AF ablation is collateral

 

The impact of left atrial surface area and the second generation cryoballoon on clinical outcome of atrial fibrillation cryoablation

H Greiss, A Berkowitsch, M Wojcik, S Zaltsberg… – Pacing and Clinical …, 2015

16 Impact of LA area on outcome In our previous studies performed on patients ablated with CB,

we found NLA area to be predictive for outcome, but absolute LA area was not predictive. Raviele

A, Themistoclakis S, Rossillo A, Bonso A, Natale A. Radiofrequency ablation

 

Persistence of Phrenic Nerve Palsy Following 28 mm Cryoballoon Ablation: A Four Year Single Center Experience

Y Saitoh, G Irfan, G Ciconte, G Mugnai, J Sieira… – Pacing and Clinical …, 2015

Great attention must be paid when ablating with the large 28 mm CB2 due to the large cryoballoon

for treatment of paroxysmal and persistent atrial fibrillation: medium-term outcomes and

non-randomised comparison with pulmonary venous isolation by radiofrequency ablation.

 

Complex Regional Pain Syndrome (CRPS/RSD)

 

Hydromorphone for neuropathic pain in adults

D Aldington, P Cole, R Knaggs, C Stannard, S Derry… – The Cochrane Library, 2015

Types of participants Studies will include adults aged 18 years and above with one or more chronic

neuropathic pain condition including (but not lim- ited to): 1. cancer-related neuropathy; 2. central

neuropathic pain; 3. complex regional pain syndrome (CRPS) Type II; 4. human

 

Fentanyl for neuropathic pain in adults

S Derry, R Knaggs, PJ Wiffen, C Stannard, D Aldington… – The Cochrane Library, 2015

Types of participants Studies will include adults aged 18 years and above with one or more chronic

neuropathic pain condition including (but not lim- ited to): 1. cancer-related neuropathy; 2. central

neuropathic pain; 3. complex regional pain syndrome (CRPS) Type II; 4. human

 

The role of glia in the spinal cord in neuropathic and inflammatory pain

EA Old, AK Clark, M Malcangio – Pain Control, 2015

microglia pool. Nat Neurosci 14: pp. 1142-1149; Alexander, GM, Rijn, MA, Hilten,

JJ, Perreault, MJ, Schwartzman, RJ (2005) Changes in cerebrospinal fluid levels

of pro-inflammatory cytokines in CRPS. Pain 116: pp. 213-219;

 

[HTML] To study the incidence and risk factors of early onset neonatal sepsis in an out born neonatal intensive care unit of India

M Jajoo, K Kapoor, LK Garg, V Manchanda, SK Mittal – Journal of Clinical …, 2015

[6] Screening tests such as total and differential leukocyte counts, band cells, absolute neutrophil

counts (ANCs), and rapid immunological techniques like C-reactive proteins (CRPs) assays may

help in the diagnosis of septicemia; however, they lack the capacity to detect

 

[PDF] Psychological Aspects of Reflex Sympathetic Dystrophy (RSD) Complex Regional Pain Syndrome (CRPS)

H Hooshmand, EM Phillips, FL Vero Beach

Abstract. Reflex sympathetic dystrophy (RSD) or complex regional pain syndrome (CRPS) is

a complex form of neuropathic pain associated with hyperpathia; neurovascular instability;

neuroinflammation; and limbic system dysfunction. As the condition becomes chronic, the

 

[PDF] COMPLEX REGIONAL PAIN SYNDROME (CRPS) REFLEX SYMPATHETIC DYSTROPHY (RSD) DIAGNOSIS AND MANAGEMENT PROTOCOL

H Hooshmand, EM Phillips, FL Vero Beach

Complex Regional Pain Syndrome (CRPS)/Reflex Sympathetic Dystrophy (RSD) is a

disease that usually starts after a relatively minor trauma. In the early stages there is a

sympathetic component in the development of the disease, but with passage of time, quite

 

[PDF] Complex Regional Pain Syndrome (CRPS) and Sympathectomy

H Hooshmand, EM Phillips

Abstract. Sympathectomy may provide temporary pain relief, but after a few weeks to months

it loses its effect. Sympathectomy and the application of Chemical Sympathectomy

(neurolytic agents eg, phenol, alcohol, etc.) should be limited to patients with life

 

[PDF] REPETITIVE STRAIN INJURY (RSI) DIAGNOSIS AND TREATMENT

H Hooshmand, EM Phillips, FL Vero Beach

Careful history taking, neurological evaluation, along with such tests as quantitative

sensory testing (QST) and infrared thermal imaging (ITI) is helpful to differentiate RSI

from other causes of complex regional pain syndrome (CRPS).

 

Polysomnographic Characteristics in Nonmalignant Chronic Pain Populations: A Review of Controlled Studies

MF Bjurstrom, MR Irwin – Sleep Medicine Reviews, 2015

Glossary of terms. AHI apnea/hypopnea index. ArI arousal index. BDNF brain-derived neurotrophic

factor. CNS central nervous system. CRPS complex regional pain syndrome,. CWP chronic

widespread pain. EEG electroencephalography. FM fibromyalgia. HC healthy controls.

 

Fibromyalgia

 

Validation and cross-cultural adaptation of the ‘Fibromyalgia Participation Questionnaire’to the Spanish population: study protocol

M Gomez-Calvente, I Medina-Porqueres… – Rheumatology International, 2015

Abstract There are few high-quality instruments to evaluate the participation and social

functioning of fibromyalgia patients. The Fibromyalgia Participation Questionnaire (FPQ) is a

questionnaire that evaluates these aspects with high reliability and validity in its German

 

What Constitutes Appropriate Treatment of Post-Lyme Disease Symptoms and Other Pain and Fatigue Syndromes?

AC Steere, SL Arvikar – Clinical Infectious Diseases, 2015

This chronic syndrome, which sometimes meets criteria for fibromyalgia or chronic fatigue

syndrome, is not specific for Lyme disease [8]. Such symptoms may follow other infections or

physical or emotional trauma, or the inciting cause may not be apparent.

 

Central sensitization in humans: assessment and pharmacology

L Arendt-Nielsen – Pain Control, 2015

J Pain 4: pp. 372-380; Balasubramaniam, R, Leeuw, R, Zhu, H, Nickerson, RB, Okeson, JP,

Carlson, CR (2007) Prevalence of temporomandibular disorders in fibromyalgia and failed

back syndrome patients: a blinded prospective comparison study.

 

Chronic pain and the adaptive significance of positive emotions.

AD Ong, AJ Zautra, MC Reid – 2015

Indeed, such in- terventions may prove to be particularly important for patients with specific chronic

pain conditions, such as fibromyalgia, who show a core affective disturbance that is characterized

by an overall deficit in posi- tive emotion (Finan, Zautra, & Davis, 2009).

 

Chronic widespread pain: clinical comorbidities and psychological correlates Running title: Genetics of CWP

A Burri, S Ogata, J Vehof, FMK Williams, B Box – 2015

3 1. Introduction Chronic widespread pain (CWP) is the cardinal symptom of fibromyalgia. four

items pertaining to the “pain subscale” were drawn from the London Fibromyalgia Epidemiology

Symptom Screening questionnaire (LFESSQ).[34] The four items ask about pain

 

Hydromorphone for neuropathic pain in adults

D Aldington, P Cole, R Knaggs, C Stannard, S Derry… – The Cochrane Library, 2015

Pharmacological treatment of fibromyalgia. Journal of Pain 2008;9(2): 105–21. [DOI:

10.1016/j.jpain.2007.09.005] Gaskell 2014 Gaskell H, Moore RA, Derry, S, Stannard

C. Oxycodone for neuropathic pain and fibromyalgia in adults.

 

Tarasoff’s catch-22.

SR Huey – 2015

REFERENCES Davis, MC, & Zautra, AJ (2013). An online mindfulness intervention targeting

socioemo- tional regulation in fibromyalgia: Results of a randomized controlled trial. Daily affect

relations in fibromyalgia patients reveal positive affective disturbance.

 

Fentanyl for neuropathic pain in adults

S Derry, R Knaggs, PJ Wiffen, C Stannard, D Aldington… – The Cochrane Library, 2015

Pharmacological treatment of fibromyalgia. Durogesic® DTrans. www.medicines.org.uk/EMC/

medicine/17088/ (accessed 16 December 2014). Gaskell 2014 Gaskell H, Moore RA, Derry, S,

Stannard C. Oxycodone for neuropathic pain and fibromyalgia in adults.

 

Polysomnographic Characteristics in Nonmalignant Chronic Pain Populations: A Review of Controlled Studies

MF Bjurstrom, MR Irwin – Sleep Medicine Reviews, 2015

CNS central nervous system. CRPS complex regional pain syndrome,. CWP chronic widespread

pain. EEG electroencephalography. FM fibromyalgia. HC healthy controls. IL interleukin. MFP

myofascial pain. NREM non-rapid-eye-movement. NSM non-sleep migraine. OA

 

Methods to Measure Peripheral and Central Pain Sensitization Using Quantitative Sensory Testing: A Focus on Individuals with Low Back Pain

AR Starkweather, A Heineman, S Storey, G Rubia… – Applied Nursing Research, 2015

In order to evaluate and compare centralized mechanisms, the QST protocol of the German

Research Network on Neuropathic Pain was used in a group of 21 patient with fibromyalgia

(mean duration 13.4 years), 23 individuals with chronic back pain (mean duration 15.9 years

Clinical study shows safety and efficacy of ketamine in pediatric patients with chronic pain

Clinical study shows safety and efficacy of ketamine in pediatric patients with chronic pain

Ketamine has long been used as an anesthetic in both adults and children for more than 50 years.  Although it is still used for anesthesia and also off-label for the treatment of many pain and psychiatric disorders, concerns of possibly deleterious neurocognitive effects have lingered.  This is due to sparse reports of children that have experienced neurocognitive delays following multiple surgeries using a ketamine and other anesthetics.  Since these occurrences were not associated with any primary endpoints in a clinical study setting, the cognitive delays could not be attributed to ketamine but it did raise the question.

A recent clinical study was conducted by researchers at the University of Rochester (Rochester, New York) and published in the Journal of Palliative Care & Medicine.  These investigators designed a clinical trial to monitor neurocognitive function and pain levels in pediatric patients with chronic pain.  Patients enrolled in the trial completed 2 weeks of daily oral ketamine exposure.  Neurocognitive assessments were conducted at baseline and at weeks 2 and 14.  Further, pain levels were assessed using the Numerical Rating Scale.

The researchers found no deleterious effects on neurocognitive function in the children at any time point during the study or for 3 months following completion of the study.  In fact, they found that executive function scores improved in children following oral administration of ketamine.  These findings support the safe use of ketamine in pediatric patients with chronic pain that is refractory to more conventional medications, such as opioid medicines.

Dr. Hanna’s clinical team at the Florida Spine Institute has used intravenous ketamine therapy to treat pediatric cases of chronic regional pain syndrome with great success.  To learn more about intravenous ketamine infusions, click here.  To find out if ketamine therapy is right for you, please make an appointment by contacting Dr. Hanna.

For full article, visit the Journal of Palliative Care & Medicine.

Citation: Bredlau AL, Harel BT, McDermott MP, Dworkin RH, Korones DN, et al. (2015) Neurocognitive Changes after Sustained Ketamine Administration in Children with Chronic Pain. J Palliat Care Med 5: 215. doi:10.4172/2165-7386.1000215

Three Things You Need to Know About CRPS

Three Things You Need to Know About CRPS

symptoms of chronic painOne of Americans’ most common medical complaints is chronic pain. According to Institute of Medicine of The National Academies, over 100 million Americans suffer from chronic pain. Furthermore, it is one of the most common causes of disability in America — for example back pain is one of the leading causes of disability in Americans who are younger than the age of 45, and more than 26 million Americans have frequent back pain.

According to data gathered by the National Center for Health Statistics, about 76.2 million Americans have had pain that lasts longer than a day, and millions more live with acute pain — one of the common culprits responsible for chronic pain. Here’s what you need to know.

1. What is CRPS?
Complex regional pain syndrome is a medical condition that causes chronic pain. It usually affects a limb after the area suffers an injury or a trauma. The condition is believed to be an issue with the nervous system, which transmits pain information through the body. The nervous system is comprised of the brain, spinal cord, and nerves, and in some cases nerves fire pain signals more frequently than they need to. This is the cause of the chronic pain.

2. What are the symptoms of complex regional pain syndrome?
Symptoms of chronic pain are not limited to experiencing pain itself. Common symptoms of chronic pain include things like skin texture changing near the pain, abnormal hair or nail growth, stiff joints, changes in sweating patterns, and abnormal movements and reflexes in the affected area. Studies have shown that migraine pain could be connected to CRPS, and in the United States, every 10 seconds someone goes to the emergency room because of a migraine or a headache.

3. What are the treatments?
There are a few different types of treatment for CRPS. Rehabilitation and physical therapy exercises are sometimes used, which help improve blood flow. In some cases, chronic pain patients are prescribed medications to help them manage their pain. In others, relief of pain can come from minimally invasive procedures like nerve block injections which can help stop the nerve from firing pain signals.

Do you have any other questions about CRPS? Feel free to ask us in the comments section below.

9 Pain Pill Mistakes – Pain Medication Mistakes: Overdoses, Side Effects, and More

9 Pain Pill Mistakes – Pain Medication Mistakes: Overdoses, Side Effects, and More

Pain Pills

It’s been a hard day, and Joe’s back is killing him.

His wife has some Percocet left over from a trip to the dentist, and there’s that big bottle of Tylenol under the sink, so Joe grabs a couple of each and washes them down with a slug of beer.

Luckily for Joe, he’s a fictional character invented for this article. But there are a lot of real-life Joes out there making big mistakes with over-the-counter and prescription pain pills.

Can you spot Joe’s mistakes? Joe didn’t make every mistake in the book. But he made quite a few.

Here’s WebMD’s list of common pain pill mistakes, compiled with the help of pharmacist Kristen A. Binaso, RPh, spokeswoman for the American Pharmacists Association; and pain specialist Eric R. Haynes, MD, founder of Comprehensive Pain Management Partners in Trinity, Fla.

Pain Medications Mistake No.1: 
If 1 Is Good, 2 Must Be Better

Doctors prescribe pain pills at the doses they believe will offer the greatest benefit at the least risk. Doubling or tripling that dose won’t speed relief. But it can easily speed the onset of harmful side effects.

“The first dose of a pain medication may not work in five minutes the way you want. But this does not mean you should take five more,” Binaso says. “With some pain drugs, if you take additional doses, it makes the first dose not work as well. And with others, you end up in the emergency room.”

If you’ve given your pain medication time to work, and it still does not control your pain, don’t double down. See your doctor about why you’re still hurting.

“This ‘one is good so two must be better’ thing is a common problem,” Haynes says. “Patients should follow the instructions their doctor gives. Ask before leaving the office: Can I take an extra pill if I still hurt? What is the upper limit for this medication?”

Another bad idea is trying to boost the effect of one kind of pain pill by taking another.

“There may be ibuprofen, acetaminophen, and naproxen in the house, and a person may take them all,” Binaso says.

This can escalate into a very bad situation, Haynes says.

Pain Medications Mistake No. 2: 
Duplication Overdose

People often take over-the-counter pain drugs — and even prescription pain drugs — without reading the label. That means they often don’t know which drugs they’re taking. That’s never a good idea.

And if they take another over-the-counter drug — either for extra pain relief or for other reasons — they may be getting an overdose. That’s because many OTC drugs are combination pills that carry a full dose of pain pill ingredients.

In Joe’s case, he’s taken a prescription pain pill that contains acetaminophen along with a second full dose of acetaminophen from Tylenol, putting him at risk of injury.

Pain Medications Mistake No. 3: 
Drinking While Taking Pain Drugs

Pain medications and alcohol generally enhance each other’s effect. That’s why many of these prescription medications carry a “no alcohol” sticker.

That sticker shows a martini glass covered by the international “No” sign of a circle with a slash. But it applies to wine and beer just as much as it does to spirits.

“A common misperception is people see that sticker and think, ‘I’m OK as long as I don’t drink liquor — I can have a beer.’ But no alcohol means no alcohol,” Binaso says.

“The patient should heed that alcohol warning, because it can be a major problem if they do not,” Haynes says. “Alcohol can make you inebriated, and some pain medications can make you have that feeling as well. You can easily get yourself into trouble.”

Drinking alcohol can be a problem even with over-the-counter pain drugs.

Pain Medications Mistake No. 4: 
Drug Interactions

Before taking any pain pill, think about what other medicines, herbal remedies, and supplements you are taking. Some of these drugs and supplements may interact with pain medications or increase the risk of side effects.

For example, aspirin can affect the action of some non-insulin diabetes drugs; codeine and oxycodone can interfere with antidepressants.

You should give your doctor a complete list of all the drugs, herbs, and supplements you take — before getting any prescription.

If buying over-the-counter medications, Binaso recommends showing a list of everything else you’re taking to the pharmacist.

Pain Medications Mistake No. 5: 
Drugged Driving

Pain medications can make you drowsy. Different people react differently to different drugs.

“How I react to a pain medication is different from how you react,” Binaso says. “It may not make me drowsy, but may make you drowsy. So I recommend trying it at home first, and see how you feel. Don’t take two pills and go out driving.”

Pain Medications Mistake No. 6: 
Sharing Prescription Medicines

Unfortunately, it’s very common for people to share prescription medications with friends, relatives, and co-workers. Not smart, Haynes and Binaso say — particularly when it comes to pain medications.

“If a fairly healthy person is taking a medicine because she is in pain, and wants to give some pills to Uncle Joe because he is hurting — well, this is a potential problem,” Haynes says. “Uncle Joe may have a problem that keeps his body from eliminating the drug, or he may have an allergic reaction, or the drug may interact with a medication he is taking, with life-threatening results.”

Pain Medications Mistake No. 7: 
Not Talking to the Pharmacist

It’s not easy to read drug labels, even if you can make out the small print. If you have a question about either a prescription or OTC drug, ask the pharmacist.

“That’s why I’m in the store,” Binaso says. “You may have to wait a couple of minutes for me to finish what I’m doing. But you’ll get the information you need to take the right medicine the right way. Just say, ‘Tell me about this medicine; what should I be on the lookout for?'”

Pain Medications Mistake No. 8: 
Hoarding Dead Drugs

Joe’s wife is actually to blame for one of his mistakes. She should have disposed of those extra pain pills once she was over her dental pain.

Why? One reason is that pills stored at home start breaking down soon after their expiration date. That’s especially true of drugs kept in the moist environment of the bathroom medicine cabinet.

“People say, “That drug is only a year past its expiration date; isn’t it good?” But if you take a pill that’s broken down, it may not work — or you may end up in the emergency room because of reaction to a breakdown product. That is really common,” Binaso says.

Another reason that it’s dangerous to hoard is that the drugs may tempt someone else into making a very bad choice.

“Teen drug abuse is really up, especially with pain medications,” Binaso says. “It is not uncommon for kids to go to their parents’ or grandparents’ medicine cabinet and then go to a party and put the drugs in a bowl.”

Pain Medications Mistake No. 9: 
Breaking Unbreakable Pills

Pills are actually little drug-delivery machines. They don’t work the way they’re supposed to when taken apart the wrong way.

Scored pills should be cut only across the line, Binaso says. Those without scoring should not be cut at all, unless you’re specifically instructed to do so.

“When you start chopping up pills like that, the pill may not work,” she says. “We find more and more people are doing this. And then they say, “Oh, that pill had a really bad taste. That is because they cut away the coating.”

Source: Web MD
By Daniel J. DeNoon

Reviewed By David T. Derrer, MD

 

Intravenous infusion therapy for the management of pain conditions

Intravenous infusion therapy for the management of pain conditions

Intravenous Infusion Therapy

Intravenous (IV) infusion therapy is an exciting treatment option for numerous pain syndromes ranging from fibromyalgia and small fiber neuropathy to Complex Regional Pain Syndrome (CRPS) and Reflex Sympathetic Dystrophy (RSD). IV infusion therapy is very simple: an IV line is placed in the patient’s arm and the medication flows in.

There are several medications that are commonly delivered IV for pain management:

• Lidocaine
• Ketamine
• Immunoglobulin (IG)
• Clonidine
• Dexmedetomidine
• Bisphosphonates
• Magnesium

These medications are typically mixed with saline in an IV bag and slowly infused accordingly based on the medication and/or protocol being utilized.

Procedure Overview

Patient Looking At Nurse While Receiving Intravenous Treatment I

Dr. Hanna will first select the appropriate medication to be used in the infusion depending on the type of pain that you are experiencing. Next, the office staff will weigh you to determine the proper amount of medication needed and mix it with saline in an IV bag. Next, Dr. Hanna will place an IV line in your arm or hand per standard IV protocols. The medication is infused through the IV over variable times depending on the medication. It’s that simple. During the infusion process, you will be placed on a monitor and your vitals will be closely observed for the duration of the infusion.

Medication Overview

Lidocaine – Blocks sodium channels in the neuronal cell membrane that may potentially play a role in the pathogenesis and maintenance of both neuropathic and inflammatory pain

Ketamine – N-methyl-D-aspartate (NMDA) Receptor antagonist – therefore decreases sustained neuronal depolarization and excitatory transmission along afferent pain pathways in the dorsal horn of the spinal cord

Immunoglobulin (IG) – Counteracts neuroinflammation by inhibiting complement deposition, neutralizing cytokines and growth factors, speeds up clearance of potentially pain-inducing auto-antibodies, and activation of macrophages and T cells through FcγRIIb receptor

Clonidine – α2-adrenergic receptor agonist believed to reduce of norepinephrine release from the α2-adrenergic in the periphery

Dexmedetomidine – Selective α2-adrenergic agonist that may have a role in treating painful conditions that are manipulated and/or attenuated by the sympathetic nervous system

Bisphosphonates – Decreases neuropathic bone pain by suppressing bone resorption via osteoclast inhibition, shortens osteoclast life span and decreasing the acidity of the local microenvironment

Magnesium – Competitive NMDA receptor antagonist that decreases acute and chronic pain by stabilizing abnormal nerve excitation

How Many Treatments are Required?

The response to treatment varies patient by patient. Most require several treatments; the amount required depends on the medication and the protocol being used. Some people respond at first infusion, but most will not feel the full benefit until several treatments have been administered.

Is Infusion Therapy Right for me?

If you suffer from chronic pain that has not responded to medication or other traditional treatment options, then infusion therapy may be an option for you.

To make an appointment today with Dr. Hanna, call 727-797-7463. 

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