Podcasts about Analgesic

In this episode of the PFC Podcast, Dennis and John discuss the ongoing updates and changes within the Tactical Combat Casualty Care (TCCC) guidelines. They delve into the role of the TTC Committee, the importance of literature reviews in developing algorithms for trauma care, and the proposed changes to the March algorithm, emphasizing the need for resuscitation before decompression. The conversation also covers the overhaul of the analgesic section, the recommendations for antibiotics, and the role of TXA in treating hemorrhagic shock. Additionally, they touch on the significance of triage in mass casualty situations and the future directions of the committee's work. Takeaways TCCC is continuously updated to reflect new research. Resuscitation should be prioritized over decompression in trauma care. The March algorithm may undergo significant changes to improve outcomes. Analgesic options are being re-evaluated due to supply issues. Rocephin is being recommended as a primary antibiotic. TXA is crucial for managing hemorrhagic shock in trauma patients. Triage protocols are essential for effective mass casualty management. The committee is open to innovative ideas and solutions. Training and education are vital for implementing new guidelines. Future meetings will focus on finalizing and voting on proposed changes. Chapters 00:00 Introduction to the PFC Podcast 02:46 Understanding the TTC Committee and Its Role 06:06 Literature Review and Algorithm Development 09:00 Resuscitation vs. Decompression in Trauma Care 12:07 Proposed Changes to the March Algorithm 15:06 Analgesic Section Overhaul and Alternatives 18:09 Antibiotic Recommendations and Changes 20:54 TXA and Its Role in Hemorrhagic Shock 23:51 Triage in Mass Casualty Situations 26:45 Future Directions and Upcoming Votes 30:06 Conclusion and Final Thoughts Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

On this episode of Rehab and Performance Lab, we sit down with Johnny Owens, MPT, a trailblazer in blood flow restriction (BFR) therapy and the founder of Owens Recovery Science. Together with host Phil Plisky, we explore how BFR has reshaped rehabilitation by allowing rehab practitioners to build muscle strength and improve recovery in patients unable to tolerate heavy loads. Phil and Johnny discuss how BFR works physiologically, the science and robust research behind it, and clinical applications for a variety of conditions, including postoperative limb injuries, tendinopathy, Parkinson's disease, and much more. Listen in for practical insights on implementing this game-changing tool and where the research is taking us next in rehab and performance. Examine the application of blood flow restriction training Interpret the mechanisms behind BFR and how they could impact muscle Solve patient case scenarios involving injury/surgery and pain Timestamps: (00:00:00) Welcome (00:01:01) Introduction to blood flow restriction (BFR) in rehab (00:06:15) The origin and development of BFR (00:11:33) Understanding the mechanisms of BFR (00:15:32) Research and evidence supporting BFR (00:19:29) Clinical applications and considerations for BFR (00:27:16) Early intervention in rehabilitation (00:32:02) Understanding contraindications for BFR (00:36:05) Analgesic benefits of BFR (00:38:45) Tendon adaptations and BFR (00:44:07) Case studies: practical applications of BFR (00:50:18) The broader impact of BFR on health Resources Mentioned in Episode Owens Recovery Science A Comprehensive Approach to the Use of Blood Flow Restriction in ACL Rehab (Recorded Webinar) Rehab and Performance Lab is brought to you by Medbridge. If you'd like to earn continuing education credit for listening to this episode and access bonus takeaway handouts, log in to your Medbridge account and navigate to the course where you'll find accreditation details. If applicable, complete the post-course assessment and survey to be eligible for credit. The takeaway handout on Medbridge gives you the key points mentioned in this episode, along with additional resources you can implement into your practice right away. To hear more episodes of Rehab and Performance Lab, visit https://www.medbridge.com/rehab-and-performance-lab If you'd like to subscribe to Medbridge, visit https://www.medbridge.com/pricing/

Research Evaluates CBD as an Alternative Analgesic for Acute Dental Pain By Today's RDH Research Original article published on Today's RDH: https://www.todaysrdh.com/research-evaluates-cbd-as-an-alternative-analgesic-for-acute-dental-pain/ Need CE? Start earning CE credits today at ⁠⁠⁠https://rdh.tv/ce⁠⁠⁠  Get daily dental hygiene articles at ⁠⁠⁠https://www.todaysrdh.com⁠⁠⁠ Follow Today's RDH on Facebook: ⁠⁠⁠https://www.facebook.com/TodaysRDH/⁠⁠⁠ Follow Kara RDH on Facebook: ⁠⁠⁠https://www.facebook.com/DentalHygieneKaraRDH/⁠⁠⁠ Follow Kara RDH on Instagram: ⁠⁠⁠https://www.instagram.com/kara_rdh/

Jesse Eisenberg is the writer, director, and star of A Real Pain. We discuss his plays, where you can find early versions of the characters played by Kieran Culkin and Jesse himself, the dynamics of cousin relationships, and when crying can be useful for both the artist and the individual. Plus, another exciting edition of Palter Talk! Oh, and we might just have a government shutdown. Sorry.    SUBSCRIBE  We offer premium subscriptions, including an AD-FREE version of the show and options for bonus content.    The Gist is produced by Joel Patterson and Corey Wara    Email us at thegist@mikepesca.com  Subscribe to The Gist's YouTube Page  Follow Mike's Substack > Pesca Profundities  To advertise on the show, click here  Learn more about your ad choices. Visit podcastchoices.com/adchoices

PainExam Podcast Episode: An In-Depth Look at Hydrogen-Rich Water for Chronic Inflammatory Pain In a recent episode of the PainExam podcast, Dr. David Rosenblum delves into an intriguing study published in the journal Antioxidants, exploring the therapeutic potential of hydrogen-rich water (HRW) in alleviating chronic inflammatory pain and associated mood disorders in mice. The study, conducted by Santiago Coral-Pérez and colleagues from the Institut d'Investigació Biomèdica Sant Pau and Universitat Autònoma de Barcelona, presents compelling evidence supporting the analgesic, antidepressant, and anxiolytic effects of HRW. Study Overview The study investigates the efficacy of HRW in treating nociceptive responses and affective disorders associated with chronic inflammatory pain. Using a mouse model induced by the subplantar injection of complete Freund's adjuvant (CFA), the researchers evaluated the impact of HRW on several parameters: Nociceptive Responses: Mechanical allodynia and thermal hyperalgesia. Affective Disorders: Depressive-like behaviors (measured by Tail Suspension Test and Forced Swimming Test) and anxiety-like behaviors (assessed using Elevated Plus Maze and Open Field tests). Biomarker Analysis: Levels of oxidative stress, inflammatory, and apoptotic markers in the paws and amygdala. Key Findings 1. Analgesic Effects: Mechanical Allodynia and Thermal Hyperalgesia: The study found that both intraperitoneal and subplantar administration of HRW significantly reduced mechanical allodynia and thermal hyperalgesia in CFA-injected mice. Remarkably, the local (subplantar) administration showed greater effectiveness, achieving complete inhibition of nociceptive responses with just one day of treatment. 2. Antidepressant and Anxiolytic Effects: Depressive-like Behaviors: HRW treatment normalized the increased immobility times in both the Tail Suspension Test and Forced Swimming Test, indicating potent antidepressant properties. Anxiety-like Behaviors: HRW also reversed the anxiety-like behaviors in the Elevated Plus Maze and Open Field tests, showcasing its anxiolytic effects without impairing motor function. 3. Biochemical Pathways: The study highlighted the significant role of the Nrf2/HO-1-NQO1 pathway in mediating the analgesic effects of HRW. Inhibitors targeting this pathway reversed the pain-relieving actions of HRW, underscoring its pivotal role. Oxidative Stress and Inflammation: HRW treatment reduced the expression of oxidative (4-HNE), inflammatory (p-IKBα), and apoptotic (BAX) markers in both the paw and amygdala tissues, demonstrating its broad-spectrum protective effects. Implications for Clinical Practice Dr. Rosenblum emphasizes the potential of HRW as a novel therapeutic strategy for chronic inflammatory pain and its associated comorbidities. The study's findings suggest that HRW could offer a multifaceted approach, addressing both pain and mood disorders through its antioxidant, anti-inflammatory, and anti-apoptotic properties. Conclusion The episode concludes with a discussion on the broader implications of these findings for pain management, particularly in conditions where chronic inflammatory pain is prevalent. Dr. Rosenblum highlights the need for further clinical trials to validate these promising preclinical results and explore the potential of HRW in human subjects. For more detailed insights into this study, including potential applications and future research directions, tune into the PainExam podcast with Dr. David Rosenblum. For more information go to: https://molecularhydrogeninstitute.org/links-mhi/ Other Announcements from NRAP Academy: PainExam App is ready for iphone    Pain Management Board Prep migrated to NRAPpain.org AnesthesiaExam Board Prep migrated to NRAPpain.org PMRExam Board Prep migrated to NRAPpain.org   Live Workshop Calendar       Ultrasound Interventional Pain Course Registration    For Anesthesia Board Prep Click Here! References Coral-Pérez, S., Martínez-Martel, I., Martínez-Serrat, M., Batallé, G., Bai, X., Leite-Panissi, C. R., & Pol, O. (2022). Treatment with hydrogen-rich water improves the nociceptive and anxio-depressive-like behaviors associated with chronic inflammatory pain in mice. Antioxidants, 11(11), 2153.

Welcome to Episode 37 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 37 of “The 2 View” – Pitfalls in Managing Pain in the ED with Sergey M. Motov, MD, FAAEM. Segment 1 Bachhuber MA, Hennessy S, Cunningham CO, Starrels JL. Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996-2013. Am J Public Health. 2016;106(4):686-688. doi:10.2105/AJPH.2016.303061. https://pubmed.ncbi.nlm.nih.gov/26890165/ Bijur PE, Kenny MK, Gallagher EJ. Intravenous morphine at 0.1 mg/kg is not effective for controlling severe acute pain in the majority of patients. Ann Emerg Med. 2005;46(4):362-367. doi:10.1016/j.annemergmed.2005.03.010. https://pubmed.ncbi.nlm.nih.gov/16187470/ Evoy KE, Covvey JR, Peckham AM, Ochs L, Hultgren KE. Reports of gabapentin and pregabalin abuse, misuse, dependence, or overdose: An analysis of the Food And Drug Administration Adverse Events Reporting System (FAERS). Res Social Adm Pharm. 2019;15(8):953-958. doi:10.1016/j.sapharm.2018.06.018. https://pubmed.ncbi.nlm.nih.gov/31303196/ Kim HS, McCarthy DM, Hoppe JA, Mark Courtney D, Lambert BL. Emergency Department Provider Perspectives on Benzodiazepine-Opioid Coprescribing: A Qualitative Study. Acad Emerg Med. 2018;25(1):15-24. doi:10.1111/acem.13273. https://pubmed.ncbi.nlm.nih.gov/28791786/ Li Y, Delcher C, Wei YJ, et al. Risk of Opioid Overdose Associated With Concomitant Use of Opioids and Skeletal Muscle Relaxants: A Population-Based Cohort Study. Clin Pharmacol Ther. 2020;108(1):81-89. doi:10.1002/cpt.1807. https://pubmed.ncbi.nlm.nih.gov/32022906/ Peckham AM, Evoy KE, Covvey JR, Ochs L, Fairman KA, Sclar DA. Predictors of Gabapentin Overuse With or Without Concomitant Opioids in a Commercially Insured U.S. Population. Pharmacotherapy. 2018;38(4):436-443. doi:10.1002/phar.2096. https://pubmed.ncbi.nlm.nih.gov/29484686/ Smith RV, Havens JR, Walsh SL. Gabapentin misuse, abuse and diversion: a systematic review. Addiction. 2016;111(7):1160-1174. doi:10.1111/add.13324. https://pubmed.ncbi.nlm.nih.gov/27265421/ Suvada K, Zimmer A, Soodalter J, Malik JS, Kavalieratos D, Ali MK. Coprescribing of opioids and high-risk medications in the USA: a cross-sectional study with data from national ambulatory and emergency department settings. BMJ Open. 2022;12(6):e057588. Published 2022 Jun 16. doi:10.1136/bmjopen-2021-057588. https://pubmed.ncbi.nlm.nih.gov/35710252/ Segment 2 Caplan M, Friedman BW, Siebert J, et al. Use of clinical phenotypes to characterize emergency department patients administered intravenous opioids for acute pain. Clin Exp Emerg Med. 2023;10(3):327-332. doi:10.15441/ceem.23.018. https://pubmed.ncbi.nlm.nih.gov/37092185/ Connors NJ, Mazer-Amirshahi M, Motov S, Kim HK. Relative addictive potential of opioid analgesic agents. Pain Manag. 2021;11(2):201-215. doi:10.2217/pmt-2020-0048. https://pubmed.ncbi.nlm.nih.gov/33300384/ Fassassi C, Dove D, Davis A, et al. Analgesic efficacy of morphine sulfate immediate release vs. oxycodone/acetaminophen for acute pain in the emergency department. Am J Emerg Med. 2021;46:579-584. doi:10.1016/j.ajem.2020.11.034. https://pubmed.ncbi.nlm.nih.gov/33341323/ Irizarry E, Cho R, Williams A, et al. Frequency of Persistent Opioid Use 6 Months After Exposure to IV Opioids in the Emergency Department: A Prospective Cohort Study. J Emerg Med. Published online March 14, 2024. doi:10.1016/j.jemermed.2024.03.018. https://pubmed.ncbi.nlm.nih.gov/38821847/ Sapkota A, Takematsu M, Adewunmi V, Gupta C, Williams AR, Friedman BW. Oxycodone induced euphoria in ED patients with acute musculoskeletal pain. A secondary analysis of data from a randomized trial. Am J Emerg Med. 2022;53:240-244. doi:10.1016/j.ajem.2022.01.016. https://pubmed.ncbi.nlm.nih.gov/35085877/ Wightman R, Perrone J, Portelli I, Nelson L. Likeability and abuse liability of commonly prescribed opioids. J Med Toxicol. 2012;8(4):335-340. doi:10.1007/s13181-012-0263-x. https://pubmed.ncbi.nlm.nih.gov/22992943/ Segment 3 Anshus AJ, Oswald J. Erector spinae plane block: a new option for managing acute axial low back pain in the emergency department. Pain Manag. 2021;11(6):631-637. doi:10.2217/pmt-2021-0004. https://pubmed.ncbi.nlm.nih.gov/34102865/ Chauhan G, Burke H, Srinivasan SK, Upadhyay A. Ultrasound-Guided Erector Spinae Block for Refractory Abdominal Pain Due to Acute on Chronic Pancreatitis. Cureus. 2022;14(11):e31817. Published 2022 Nov 23. doi:10.7759/cureus.31817. https://pubmed.ncbi.nlm.nih.gov/36579238/ Dove D, Fassassi C, Davis A, et al. Comparison of Nebulized Ketamine at Three Different Dosing Regimens for Treating Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind Clinical Trial. Ann Emerg Med. 2021;78(6):779-787. doi:10.1016/j.annemergmed.2021.04.031. https://pubmed.ncbi.nlm.nih.gov/34226073/ Elkoundi A, Eloukkal Z, Bensghir M, Belyamani L, Lalaoui SJ. Erector Spinae Plane Block for Hyperalgesic Acute Pancreatitis. Pain Med. 2019;20(5):1055-1056. doi:10.1093/pm/pny232. https://pubmed.ncbi.nlm.nih.gov/30476275/ Finneran Iv JJ, Gabriel RA, Swisher MW, Berndtson AE, Godat LN, Costantini TW, Ilfeld BM. Ultrasound-guided percutaneous intercostal nerve cryoneurolysis for analgesia following traumatic rib fracture -a case series. Korean J Anesthesiol. 2020 Oct;73(5):455-459. doi: 10.4097/kja.19395. Epub 2019 Nov 5. PMID: 31684715; PMCID: PMC7533180. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533180/ Finneran JJ, Swisher MW, Gabriel RA, et al. Ultrasound-Guided Lateral Femoral Cutaneous Nerve Cryoneurolysis for Analgesia in Patients With Burns. J Burn Care Res. 2020;41(1):224-227. doi:10.1093/jbcr/irz192. https://pubmed.ncbi.nlm.nih.gov/31714578/ Gabriel RA, Finneran JJ, Asokan D, Trescot AM, Sandhu NS, Ilfeld BM. Ultrasound-Guided Percutaneous Cryoneurolysis for Acute Pain Management: A Case Report. A A Case Rep. 2017;9(5):129-132. doi:10.1213/XAA.0000000000000546. https://pubmed.ncbi.nlm.nih.gov/28509777/ Herring AA, Stone MB, Nagdev AD. Ultrasound-guided abdominal wall nerve blocks in the ED. Am J Emerg Med. 2012;30(5):759-764. doi:10.1016/j.ajem.2011.03.008. https://pubmed.ncbi.nlm.nih.gov/21570238/ Kampan S, Thong-On K, Sri-On J. A non-inferiority randomized controlled trial comparing nebulized ketamine to intravenous morphine for older adults in the emergency department with acute musculoskeletal pain. Age Ageing. 2024;53(1):afad255. doi:10.1093/ageing/afad255. https://pubmed.ncbi.nlm.nih.gov/38251742/ Mahmoud S, Miraflor E, Martin D, Mantuani D, Luftig J, Nagdev AD. Ultrasound-guided transverse abdominis plane block for ED appendicitis pain control. Am J Emerg Med. 2019;37(4):740-743. doi:10.1016/j.ajem.2019.01.024. https://pubmed.ncbi.nlm.nih.gov/30718116/ McCahill RJ, Nagle C, Clarke P. Use of Virtual Reality for minor procedures in the Emergency Department: A scoping review. Australas Emerg Care. 2021;24(3):174-178. doi:10.1016/j.auec.2020.06.006. https://pubmed.ncbi.nlm.nih.gov/32718907/ Nguyen T, Mai M, Choudhary A, et al. Comparison of Nebulized Ketamine to Intravenous Subdissociative Dose Ketamine for Treating Acute Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind, Double-Dummy Controlled Trial. Ann Emerg Med. Published online May 2, 2024. doi:10.1016/j.annemergmed.2024.03.024. https://pubmed.ncbi.nlm.nih.gov/38703175/ Sikka N, Shu L, Ritchie B, Amdur RL, Pourmand A. Virtual Reality-Assisted Pain, Anxiety, and Anger Management in the Emergency Department. Telemed J E Health. 2019;25(12):1207-1215. doi:10.1089/tmj.2018.0273. https://pubmed.ncbi.nlm.nih.gov/30785860/ Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. 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In this episode, we review the high-yield topic of⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Opiates & Analgesic Medications⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Basic Science section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Orthobullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on Social Media: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Twitter⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠LinkedIn⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠YouTube

Get ahead with VETAHEAD and join Dr. Proença on 15 minutes of ZooMed (exotic animal medicine) content. Today, let's dive into the world of rabbit care post-surgery as we explore the use of maropitant for pain management. Does it work? Discover groundbreaking research findings, evaluates Maropitant's effectiveness, and hints at future studies poised to further illuminate this topic. A must-listen for veterinary professionals seeking to enhance their knowledge in ZooMed (exotic animal medicine).  Do you want to access more ZooMed (exotics) knowledge directly from specialists? Come with us and #jointhemovement #nospeciesleftbehind ⁠⁠⁠⁠⁠⁠Head to VETAHEAD Website⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠Join our VETAHEAD Community⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow @the_vetahead on Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠Subscribe to @vetahead channel on YouTube⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow @vetahead on Facebook⁠⁠⁠⁠⁠⁠⁠

If you have ever experienced chronic pain you know firsthand how difficult it can be to get a good night's sleep. Sleep and pain appear to have a bidirectional relationship. For instance, many people say that their painful symptoms tend to be alleviated after a better night's sleep. Therefore, if you are living with chronic pain, prioritizing sleep may significantly help in recovery. What is Pain? Pain is an unpleasant sensation that we experience when nerve receptors send a signal to the brain telling us something is wrong. Pain can be acute or chronic. Acute pain refers to pain that lasts for a short time, such as a broken bone that eventually heals. Chronic pain refers to recurring pain or pain that lasts for longer than a few months, such as lower back pain, arthritis, recurrent headaches, cancer pain, or fibromyalgia. Effects of Poor Sleep on Body Pain There is an unquestionable link between sleep and pain, with research evidence showing that the effect of sleep on pain may be even stronger than the effect of pain on sleep. Researchers found that poor sleep causes low levels of a neurotransmitter called N-arachidonoyl dopamine (NADA) within an area of the brain called the thalamic reticular nucleus (TRN), resulting in heightened pain sensitivity, medically known as hyperalgesia. The researchers explained that short sleep times, poor sleep quality, and fragmented sleep often cause increased sensitivity to pain in chronic conditions like rheumatoid arthritis. People with sleep problems also appear to be at a higher risk of eventually developing conditions like migraines and fibromyalgia. Sleep and pain appear to share similar pathways and neurotransmitters. Therefore, sleep deprivation affects the release of essential neurotransmitters and hormones involved in pain regulation, such as serotonin and cortisol, contributing to increased pain sensitivity. Lack of sleep can also cause inflammation in the body, which will often result in muscle aches and pains and can exacerbate inflammatory conditions like arthritis. Discover how improving your sleep can reduce body pain Sleep quality and pain sensitivity have a significant correlation. Good sleep quality can help decrease pain sensitivity. Adequate sleep is essential for maintaining healthy pain processing in the brain reducing the risk of chronic pain conditions. Sleeping better also helps the brain with its painkilling capabilities. Sleep is considered a natural analgesic that can help manage and lower pain. During sleep, the brain undergoes important restorative processes necessary for pain modulation, reducing the risk of chronic pain conditions. Therefore, addressing sleep quality can lead to better patient outcomes with reduced pain levels, improved physical function, and better mental health outcomes. Contact Us for a Chiropractic Appointment If muscle and joint pains are making it difficult for you to enjoy adequate sleep, chiropractic may help. Your chiropractor will use a range of techniques, including massage, heat application, joint mobilization, exercises, and advice to improve circulation and healing in the affected areas and relieve muscle and joint pains. Contact 252-335-2225 to schedule a visit with Dr. Jason B. Jones - 706 W. Ehringhaus Street - Elizabeth City, NC 27909.

Moderator: James P. Rathmell, M.D. Participants: Faraj Abdallah, M.D. and Michael R. Fettiplace, M.D., Ph.D. and Ashraf S. Habib, M.D., M.B.B.Ch., M.Sc., M.H.Sc. and Jonathan Slonin, M.D., M.B.A. Articles Discussed: Analgesic Effectiveness of Liposomal Bupivacaine versus Plain Local Anesthetics for Abdominal Fascial Plane Blocks: A Systematic Review and Meta-analysis of Randomized Trials Meta-analyses of Randomized Clinical Trials in Postsurgical Pain: Verify before Trusting Liposomal Bupivacaine for Abdominal Fascial Plane Blocks: No Evidence or Lack of Relevant Evidence? Liposomal Bupivacaine, Scientific Evidence, and the Clinician's Conundrum Liposomal Bupivacaine's Plausibility Fails to Translate

Preexposure prophylaxis approved for COVID-19; Nexletol and Nexlizet gain expanded approval; Novel Duchenne muscular dystrophy treatment; First blood test to screen for malaria in donors; Warning letter for OTC topical analgesic products.  

RespireRx Pharmaceuticals Inc CEO Arnold Lippa joined Steve Darling from Proactive to unveil exciting developments within the company. Lippa shared the groundbreaking news that RespireRx's lead GABAA receptor potentiator, KRM-II-81, has ascended to the next phase of evaluation within the esteemed NIH HEAL Initiative® Preclinical Screening Platform for Pain program. The NIH HEAL Initiative, an integral component in combatting the national opioid public health crisis, stands as a collaborative and resolute effort aimed at accelerating scientific solutions. Launched in April 2018, this initiative is dedicated to advancing prevention and treatment strategies for opioid misuse and addiction, while concurrently enhancing pain management protocols. Lippa elaborated on the significant progress made with KRM-II-81, citing emerging data that showcased its efficacy in mitigating pain-like behaviors in rats. Remarkably, these effects were observed at doses demonstrating minimal or no detectable side effects, underscoring the compound's potential for therapeutic success. These promising results were witnessed across both male and female rats, across two distinct measures, including models of post-incision pain and spinal nerve ligation-induced persistent neuropathic pain. This latest research builds upon prior observations made by RespireRx Pharmaceuticals Inc and other laboratories, affirming KRM-II-81's effectiveness in alleviating acute, chronic, and neuropathic pain across various experimental models. Importantly, these benefits were achieved without the development of tolerance or sedation, highlighting the compound's favorable safety profile and therapeutic potential. As a result of these compelling findings, KRM-II-81 has progressed within the NIH PSPP program, where it will undergo further evaluation across additional disease-specific pain models. With promising clinical validation on the horizon, RespireRx Pharmaceuticals Inc firmly believes that KRM-II-81 holds the potential to emerge as a groundbreaking medication not only for pain management but also for the treatment of epilepsy and other neuropsychiatric disorders. This remarkable advancement underscores the company's commitment to pioneering innovative solutions that address critical medical needs and improve patient outcomes. #proactiveinvestors #respirerxpharmaceuticalsinc #otc #rspi #CAREM281, #Analgesic, #NonAddictive, #OpioidAlternative, #PainReliefInnovation, #GABAAgonist, #PharmaNews, #DrugDevelopment, #HEALInitiative, #NeurologicalDisorders, #MedicalBreakthrough, #AddictionFree, #ChronicPainSolution, #NeuropathicPain, #AcutePain, #OpioidEpidemicSolution, #HealthcareInnovation, #Pharmaceuticals, #ClinicalResearch, #PainManagement, #ScienceNews, #Biotech, #MedicalResearch, #PharmaTech #invest #investing #investment #investor #stockmarket #stocks #stock #stockmarketnews

Show notes at pharmacyjoe.com/episode902. In this episode, I’ll discuss the analgesic ceiling dose of ibuprofen in ED patients. The post 902: The analgesic ceiling dose of ibuprofen applies to ED patients too appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode902. In this episode, I’ll discuss the analgesic ceiling dose of ibuprofen in ED patients. The post 902: The analgesic ceiling dose of ibuprofen applies to ED patients too appeared first on Pharmacy Joe.

In today's episode, I chat with Paul Timko of Stopain Clinical. We dive into how topical analgesics work, why formulation matters, and how Stopain is more than just a product company; it is an extension of your practice.Episode Notes: Get exclusive access to a special Stopain starter pack only for EBC Listeners here: https://stopa.in/ebc Interested in ShockWave technology? I built a practice using StemWave and can't recommend it enough. Learn more at- https://gostemwave.com/theevidencebasedchiropractor Patient Pilot by The Smart Chiropractor is the fastest, easiest to generate weekly patient reactivations on autopilot…without spending any money on advertising. Click here to schedule a call with our team.Our members use research to GROW their practice. Are you interested in increasing your referrals? Discover the best chiropractic marketing you aren't currently using right here!

Max Willis and Nikita Austen are back with Jared on this episode of Vitality Radio to talk about more medicinal uses of nature's amazing herbs! This time they tackle five herbs  with wide ranging benefits from lung health to antimicrobial uses, pain, and nervous system support. You'll learn the benefits of these herbs and which ones you might want to keep on hand in your medicine cabinet.Nikita Austen is the Director of Education and Innovation Specialist for Solaray and Max Willis is Chief Innovation Science Officer for Solaray. Both always bring us such great education on herbs and their many uses!Products:Solaray Mullein LeafSolaray Oil of OreganoCat's ClawSolaray SkullcapSolaray Devil's ClawAdditional Information:Episode #355: Herbs of Calm: Passion Flower, Valerian, Holy Basil, Lemon Balm and MoreEpisode #351: Exciting New Discoveries in the Herbal Kingdom For Stress, Mood, Hormone Balance, Varicose Veins, and Much MoreEpisode #321: Four Amazing Herbs You May Not Know About: Fenugreek, Tongkat Ali, Activated Broccoli, and Black Seed Oil with Nikita AustenEpisode #320: A Sharp, Focused Mind using Bacopa and Lion's Mane with Nikita Austen

Pharmac is about to run out of a crucial pain relief drug. The drug-buying agency was warned two years ago the Pfizer factory producing one-milligram liquid morphine is closing. But it hasn't found a replacement before New Zealand's supplies run out next month. Analgesic Advisory Committee member Catherine D'Souza says Pfizer promised to help find alternatives, but didn't. "Which is really disappointing. So then Pharmac looks at opening a competitive process asking for companies to apply to provide New Zealand with this product, but there were no bids at all." A Pfizer spokesperson issued the following statement: "The transfer of sponsorship of RA-Morph was Friday 22 September and supply was available from Bridgewest on Monday 9 October. Pfizer and Bridgewest worked cooperatively to ensure continuity of supply to customers in New Zealand was maintained in the interim.  Pfizer has been in regular communication with Pharmac on medicines supplied from the Perth site. Following the decision to exit the Perth site (the site was divested in April 2023 and purchased by Bridgewest Group - the sale having closed on 4 April 2023), it was also decided to discontinue the manufacturing of RA-Morph and its supply in New Zealand.      In the interest of patients, and to ensure that the market had lead-time to seek alternative means of supply, a discontinuation notice was given to Pharmac with two years' notice in September 2021."  LISTEN ABOVESee omnystudio.com/listener for privacy information.

Listen to the Q&A between Esther Pogatzki-Zahn and Eric Albrecht as they discuss the article “The postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve and field blocks: A systematic review and meta-analysis, with trial sequential analysis”, found in the September 2023 issue of the EJA.

Listen as  Samantha Catanzano, PharmD, BCPP; Andrew Friedman, MD; and Mark Queralt, MD, answer the most pressing questions from 2 live webinars covering nonpharmacologic, nonopioid, and opioid pharmacologic options for pain management. These webinars are part of the 2022-2023 Opioid REMS Education Initiative and are titled, “Managing Pain: A Focus on Nonpharmacologic and Nonopioid Approaches” and “Managing Pain: A Focus on Opioid Analgesic Approaches.”Presenters:Samantha Catanzano, PharmD, BCPPClinical Assistant ProfessorDivision of Pharmacy PracticeThe University of Texas at Austin  College of PharmacyBoard-Certified Psychiatric PharmacistIntegrated Behavioral Health DepartmentAustin, TexasAndrew Friedman, MDSection Head, Physical Medicine and RehabilitationVirginia Mason Medical CenterClinical Assistant ProfessorUniversity of WashingtonSeattle, WashingtonMark Queralt, MDAssistant ProfessorDirector of the Musculoskeletal InstituteBack and Neck Pain Clinical DirectorUniversity of Texas Health AustinAustin, TexasThis activity is supported by an independent educational grant from the Opioid Analgesic REMS Program Companies. Please see https://bit.ly/3mgrfb9 for a listing of REMS Program Companies. This activity is intended to be fully compliant with the Opioid Analgesic REMS education requirements issued by the FDA.Provided by Clinical Care Options, LLC and in partnership with the American Academy of Physical Medicine and Rehabilitation, Alliance to Advance Comprehensive Integrative Pain Management, Practicing Clinicians Exchange, and ProCE.Link to full program:https://bit.ly/3mcDHsi   

Evidence suggests that Tylenol isn't an effective pain reliever in many cases, so why do doctors rely on it post-surgery? When it comes to treating and discussing COVID-19, do doctors have the right to speak freely, even when they dissent from accepted medical wisdom?

Other episodes on Patreon/Fansly/Gumroad! ______________________ You're laying in bed, ready to release some stress when you pop open your favorite tube and a hangry slime girl emerges! She's making a scene about being fed after being freed when she lets slip she's in heat. A slime girl in heat wants nothing more than to engorge herself so she can split and consuming you will give her all the energy she needs. Her hunger comes in all forms now that humans are on the menu.  No longer hangry, only horngry, the slime girl envelops you, pulling you inside her where she does the unspeakable to every part of you as you are engulfed by her warm, analgesic, oxygenated slime. The hungrier she gets, the more she seems at war with her inner self on whether or not to devour you – a sign the slime might split. Part of her seems hungry, angry, and condescending, reminding you that you are being claimed by the lowest of the low while she relishes in your panic. The other part begs you to help her fight her nature through the mind link you share. As the slime's effect takes ahold of you, a dim lightbulb flickers in your final thoughts. With what little energy you have left, you pull, thrust, and drag yourself and the growing slime girl toward the kitchen – but will you make it in time? Support the show

You're laying in bed, ready to release some stress when you pop open your favorite tube and a hangry slime girl emerges! She's making a scene about being fed after being freed when she lets slip she's in heat. A slime girl in heat wants nothing more than to engorge herself so she can split and consuming you will give her all the energy she needs. Her hunger comes in all forms now that humans are on the menu.  No longer hangry, only horngry, the slime girl envelops you, pulling you inside her where she does the unspeakable to every part of you as you are engulfed by her warm, analgesic, oxygenated slime. The hungrier she gets, the more she seems at war with her inner self on whether or not to devour you – a sign the slime might split. Part of her seems hungry, angry, and condescending, reminding you that you are being claimed by the lowest of the low while she relishes in your panic. The other part begs you to help her fight her nature through the mind link you share. As the slime's effect takes ahold of you, a dim lightbulb flickers in your final thoughts. With what little energy you have left, you pull, thrust, and drag yourself and the growing slime girl toward the kitchen – but will you make it in time? Support the show

Visit: https://nursing.com/140meds to request your free copy of "140 Must Know Meds" Generic Name hydrocodone/acetaminophen Trade Name Vicodin, Lortab, Norco Indication management of moderate to severe pain Action alters the perception and reaction to pain by binding to opiate receptors in the CNS, also suppresses the cough reflex Therapeutic Class opioid Analgesic, allergy, cold and cough remedies, antitussive Pharmacologic Class opioid agonists, nonopioid analgesic combinations Nursing Considerations • use caution with concurrent use of MAOI – avoid use within 14 days of each other • hypotension – monitor hemodynamics and respirations after administering • may increase ICP use caution with head trauma • Narcan (nalaxone) is the antidote for overdose • DO NOT exceed 4g of acetaminophen per day

In this episode, we review the high-yield topic of ⁠Opiates & Analgesic Medications ⁠⁠⁠⁠from the Basic Science section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Orthobullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on Social Media: Facebook: www.facebook.com/orthobullets Instagram: www.instagram.com/orthobulletsofficial Twitter: www.twitter.com/orthobullets LinkedIn: www.linkedin.com/company/27125689 YouTube: www.youtube.com/channel/UCMZSlD9OhkFG2t25oM14FvQ --- Send in a voice message: https://podcasters.spotify.com/pod/show/orthobullets/message

Sedation and pain control are not the same thing! In this episode we discuss what experienced nurses, medical teams AND new graduate nurses alike often get wrong in relation to management of sedation & pain control for ventilated patients in the ICU or the ER. ➡LINKS MENTIONED: Articles on Pain and Sedation in the ICU: ⭒ https://pubs.asahq.org/anesthesiology/article/111/6/1187/9928/Pain-⭒ Assessment-Sedation-and-Analgesic ⭒ https://pubs.asahq.org/anesthesiology/article/111/6/1308/9845/Pain-Assessment-Is-Associated-with-Decreased --------------------------- CRAVING MORE IN DEPTH NEW GRAD ICU EDUCATION? JOIN THE CONFIDENT CARE MEMBERSHIP! https://www.confidentcareacademy.com/p/confidentcare MORE CONFIDENT CARE ACADEMY: Website: https://www.confidentcareacademy.com/ Podcast: https://open.spotify.com/show/7bElMXUFr5R3Eyz7FnrTXC Anna's Youtube: https://www.youtube.com/@annaSRNA Anna's Instagram: https://www.instagram.com/annasrna_/ Chrissy's Instagram: https://www.instagram.com/chrissycrna/ PRODUCTS WE LIKE (AMAZON STOREFRONT): https://www.amazon.com/shop/chrissycrna --------------------------- ✉ CONTACT: For potential business inquiries and partnerships: hello@confidentcareacademy.com --------------------------- DISCLAIMER: Some of the links in this description might be affiliate links, which brings me a small commission at no additional cost to you. Thank you for your support!

How can you settle symptoms and make progress with patients, when pain is a significant barrier to performing the rehab that will help them get back to the things they want to do? Discover the five step process in this podcast with Tom Goom (Running Physio) to settle patients symptoms, overcome this barrier of pain, and help patients make progress with their rehab.   Improve running injury assessment & treatment now with the Running Repairs Online course with Tom Goom at clinicaledge.co/runningrepairs Tricky tendons - Your free video guide to tendinopathy treatment with Tom Goom. Discover a new, effective approach to treatment of tricky tendinopathy presentations, and lesser known tendinopathies with this free video series presented by Tom Goom (Running Physio) and hosted by Clinical Edge. Tom will reveal the secrets to successfully treat tendon pain, and get your patients back to running and sport quickly and easily, without stirring up their pain. Get your free access to this video series now. CLICK HERE for your access to three free videos with Tom Goom CLICK HERE for your access to three free videos with Tom Goom Improve your running injury assessment & treatment now with the Running Repairs Online course with Tom Goom Links associated with this episode: Discover the simple secrets to successfully treat tendon pain in this free three part video series with Tom Goom Improve your confidence and clinical reasoning with a free trial Clinical Edge membership Join Tom live on Facebook & ask your shoulder related questions every Friday Download and subscribe to the podcast on iTunes Download the podcast now using the best podcast app currently in existence - Overcast Listen to the podcast on Spotify Tom Goom on Twitter Tom Goom's website David Pope - Twitter David Pope & why I started Clinical Edge Review the podcast on iTunes Infographics by Clinical Edge     Chapters 03:05 -  Screen for serious pathology 04:13 - Analgesic review  05:13 - Discuss the pain 06:09 - Identify and modify aggravating factors 07:58 - Reduce irritation 15:48 - Key takeaways  

Have you ever wondered why some cancer patients unexpectedly recover?  In this episode, Drs. Lemanne and Gordon discuss the cases of four persons who survived a range of cancer diagnoses considered universally terminal. But instead of dying promptly, two left hospice to return to active, athletic lives for several years. Two others defied all odds to achieve apparent cures.  These four patients used radically different approaches.The four diagnoses include chronic lymphocytic leukemia (CLL), advanced ovarian cancer, metastatic prostate cancer, and metastatic melanoma.Several surprising ideas that come up in this episode include why having chemotherapy before surgery is often better than rushing to surgery, and how the principles of evolution (as in Darwin) are pointing to lighter, more infrequent cancer treatments as a way to prolong both healthspan and lifespan. Links, Episode 1: 1. MIT research demonstrating the detrimental effect of surgery on cancer metastasis.2. How Anesthetic, Analgesic and Other Non-Surgical Techniques During Cancer Surgery Might Affect Postoperative Oncologic Outcomes: A Summary of Current State of Evidence. 3. N of 1,  by Glenn Sabin and Dawn Lemanne, MD, MPH.  The popular book about Mr. Sabin's successful search for a cure for his "incurable" chronic lymphocytic leukemia. 4. Case report of durable CLL remission without standard systemic therapy: Lemanne D, Block KI, Kressel BR, Sukhatme VP, White JD. A Case of Complete and Durable Molecular Remission of Chronic Lymphocytic Leukemia Following Treatment with Epigallocatechin-3-gallate, an Extract of Green Tea. 5. Research demonstrating that maximal PSA suppression may be detrimental in advanced prostate cancer. Dawn Lemanne, MD Oregon Integrative OncologyLeave no stone unturned.Deborah Gordon, MDNorthwest Wellness and Memory CenterBuilding Healthy Brains

Dr Gallardo discusses best practice for drip titration.

In this episode, we review the high-yield topic of Opiates & Analgesic Medications from the Basic Science section. Follow Orthobullets on Social Media: Facebook: www.facebook.com/orthobullets Instagram: www.instagram.com/orthobulletsofficial Twitter: www.twitter.com/orthobullets LinkedIn: www.linkedin.com/company/27125689 YouTube: www.youtube.com/channel/UCMZSlD9OhkFG2t25oM14FvQ --- Send in a voice message: https://anchor.fm/orthobullets/message

Moderator: James Rathmell, M.D. Participants: Naheed Kabirudeen Jivraj, M.B.B.S., M.Sc. Articles Discussed: Nonopioid Analgesic Prescriptions Filled after Surgery among Older Adults in Ontario, Canada: A Population-based Cohort Study Transcript

It's our first solo episode! We review the evidence around perioperative use of gabapentinoids (gabapentin and pregabalin) and discuss interesting concepts including trial sequential analysis and minimally important difference. If you enjoy our content, leave a 5-star review on Apple Podcasts and share our content with your colleagues.  — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References Dirks J, Fredensborg BB, Christensen D, Fomsgaard JS, Flyger H, Dahl JB. A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy. Anesthesiology. 2002 Sep;97(3):560-4. doi: 10.1097/00000542-200209000-00007. PMID: 12218520. Ian Gilron; Is Gabapentin a “Broad-spectrum” Analgesic?. Anesthesiology 2002; 97:537–539 doi: https://doi.org/10.1097/00000542-200209000-00004 Mishriky BM, Waldron NH, Habib AS. Impact of pregabalin on acute and persistent postoperative pain: a systematic review and meta-analysis. Br J Anaesth. 2015 Jan;114(1):10-31. doi: 10.1093/bja/aeu293. Epub 2014 Sep 10. PMID: 25209095.Fabritius ML, Geisler A, Petersen PL, Nikolajsen L, Hansen MS, Kontinen V, Hamunen K, Dahl JB, Wetterslev J, Mathiesen O. Gabapentin for post-operative pain management - a systematic review with meta-analyses and trial sequential analyses. Acta Anaesthesiol Scand. 2016 Oct;60(9):1188-208. doi: 10.1111/aas.12766. Epub 2016 Jul 18. Erratum in: Acta Anaesthesiol Scand. 2017 Mar;61(3):357-359. PMID: 27426431. Chan JSK, Harky A. Trial sequential analysis in meta-analyses: A clinically oriented approach with real-world example. J Thorac Cardiovasc Surg. 2021 Jul;162(1):167-173. doi: 10.1016/j.jtcvs.2020.06.063. Epub 2020 Jun 27. PMID: 32868066. Clephas PRD, Kranke P, Heesen M. How to perform and write a trial sequential analysis. Anaesthesia. 2022 Jul 13. doi: 10.1111/anae.15811. Epub ahead of print. PMID: 35831946. Michael Verret, François Lauzier, Ryan Zarychanski, Caroline Perron, Xavier Savard, Anne-Marie Pinard, Guillaume Leblanc, Marie-Joëlle Cossi, Xavier Neveu, Alexis F. Turgeon, the Canadian Perioperative Anesthesia Clinical Trials (PACT) Group; Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain: A Systematic Review and Meta-analysis. Anesthesiology 2020; 133:265–279 doi: https://doi.org/10.1097/ALN.0000000000003428 Deljou A, Hedrick SJ, Portner ER, Schroeder DR, Hooten WM, Sprung J, Weingarten TN. Pattern of perioperative gabapentinoid use and risk for postoperative naloxone administration. Br J Anaesth. 2018 Apr;120(4):798-806. doi: 10.1016/j.bja.2017.11.113. Epub 2018 Feb 10. PMID: 29576120. Kharasch ED, Clark JD, Kheterpal S. Perioperative Gabapentinoids: Deflating the Bubble. Anesthesiology. 2020 Aug;133(2):251-254. doi: 10.1097/ALN.0000000000003394. PMID: 32667153; PMCID: PMC7367437.

Editor's note: The North American Pain School (NAPS) took place 19-24 June 2022, in Montebello, Québec City, Canada. NAPS – an educational initiative of the International Association for the Study of Pain (IASP) and Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), and presented by the Quebec Pain Research Network (QPRN) – brings together leading experts in pain research and management to provide trainees with scientific education, professional development, and networking experiences. This year's theme was, “Controversies in Pain Research.” Five of the trainees were also selected to serve as PRF-NAPS Correspondents, who provided firsthand reporting from the event, including interviews with NAPS' Visiting Faculty members and Patient Partners, summaries of scientific sessions, and coverage on social media.  In the podcast below, PRF-NAPS Correspondent Joseph Lesnak, a PhD candidate at the University of Iowa, US, spoke with NAPS Visiting Faculty member Rajesh Khanna. Rajesh is a Professor of Molecular Pathobiology and the Director of New York University's Pain Research Center in the US. His research focuses on the functions of voltage-gated ion channels and the discovery of novel biologics and small molecules targeting pain and neurodegenerative diseases (see related PRF news article). Joseph and Rajesh discussed targeting Nav1.7 for pain relief, the challenge of moving a pharmacologic through the regulatory process, and a serendipitous finding that arose during the COVID-19 pandemic. This podcast is also available on Apple Podcasts here and Spotify here.

Kristin is joined by Thuy Bui, Lead Pharmacist - Analgesic Stewardship (AGS) & Perioperative Services at Alfred Health in Victoria to discuss the role of analgesic stewardship. In their discussion they address the importance of appropriate acute pain management, some of the clinical considerations for analgesic choice and the role of the perioperative pharmacist. Note: this episode discusses the use of real-time prescription monitoring. The monitoring system and requirements for monitoring vary from state to state. Please refer to information from the jurisdiction where you practice for guidance on when you are required to use real-time prescription monitoring.

I love my ITO ES 130's but I need my electric stim device to do more than a continuous one frequency stimulation.   Here are a couple things I mention in this episode: https://pantheonresearch.com/p12pens/   https://journals.lww.com/anesthesia-analgesia/Fulltext/1999/04000/The_Effect_of_Stimulus_Frequency_on_the_Analgesic.30.aspx    

References Cell Tissue Res. 2019 Jan; 375(1): 143–172. Int. J. Mol. Sci. 2021, 22(21), 11465 --- Send in a voice message: https://anchor.fm/dr-daniel-j-guerra/message

Elizabeth Maxwell, DVM discusses the limitations and side effects associated with current canine oral analgesic medications and how this shows the need to investigate novel pharmacologic options for the management of canine pain.

Marina Kittaka is co-founder at Analgesic Productions, developers of Sephonie (2022). Sephonie is a 3D platformer with exploration, puzzles, and a strong narrative emphasis. It's a very fun and beatiful game with a unique control scheme. In this episode we will discuss blending genres, key art creation, gamedev partnerships, Steam Greenlight, why make a sequel?, video game art, open world game design, and much more. Sephonie on Steam Sephonie on itch Marina on Twitter: @even_kei Marina's website: https://marinakittaka.com/ Analgesic productions on the web: https://analgesic.productions IGI on Twitter: @IndieGameINTL Consider becoming an IGI Patron: https://www.patreon.com/indiegameINTL IGI is a production of Su Madre Podcasts: https://sumadrepodcasts.com/

In this episode of “Ask the Experts,” Rita Agrawal, MD, joins the show to discuss the efforts in California to pass legislation to change anesthesia delivery in pediatric dental anesthesia cases. Agrawal has played an important role in advising and promoting the need for improved practices in the state, especially when it comes to the sole-operator model of anesthesia delivery.Agrawal is a clinical professor of anesthesiology at Stanford University School of Medicine, in California. She is also the past president of the Society for Pediatric Pain Medicine. She has been working on the efforts to pass legislation on dental anesthesia delivery since 2015.“Ask the Experts” is a conversation podcast series from the “Anesthesiology News Presents” channel. It features up close and personal Q&A interviews with leading experts in the field of anesthesiology on topics such as difficult airways and women in medicine.Links Mentioned:Caleb's LawDisagreements Persist Over Safety of Dental Anesthesia - Anesthesiology NewsLink to Interview with Peggy Seidman, MD, a SmileMD anesthesiologistTake Our Listener Survey!Follow Us:Our WebsiteApple PodcastsSpotifyGoogle PodcastFind Us on Social:TwitterFacebookLinkedInInstagram

Opioids are a group of morphine-like drugs which are used to control pain. In Australia we haven't experienced an opioid disaster similar to the United States, but Australia has had problems.

In this episode of “Ask the Experts,” we talk with Navin Goyal, MD, a co-founder of OFFOR Health, and Saket Agrawal, the CEO of OFFOR Health, about their company's success in building a mobile anesthesia service aimed at providing office-based anesthesia for dental procedures.Goyal is an anesthesiologist from Columbus, Ohio. He started OFFOR Health to address the problems with patient access to anesthesia care in his community. Agrawal, who is also a Columbus native, spent 10 years working in Silicon Valley gaining experience in building startup-style companies. Goyal and Agrawal now run OFFOR Health and SmileMD, which provide office-based anesthesia care in Ohio, Illinois, Kentucky and Tennessee.“Ask the Experts” is a conversation podcast series from the “Anesthesiology News Presents” channel. It features up close and personal Q&A interviews with leading experts in the field of anesthesiology on topics such as difficult airways and women in medicine.Links Mentioned:Link to OFFOR HealthLink to Interview with Peggy Seidman, MD, a SmileMD anesthesiologistLink to the ASA's Difficult Airway GuidelinesTake Our Listener Survey!Follow Us:Our WebsiteApple PodcastsSpotifyGoogle PodcastFind Us on Social:TwitterFacebookLinkedInInstagram

We have an instinctive understanding of the importance of the spine, especially the weight-bearing structures of the low back. But given that the majority of us will have some experience of low back pain during our lives, perhaps we need a little help figuring out how to best support it during yoga practice and in daily activities. In this episode, hosts Tiffany and Rachel explore the low back with Yoga Medicine teacher Jenni Tarma. Jenni co-teaches the Yoga Medicine Spine Anatomy, Disfunction, and Application Yoga Teacher Training. As an RRCA endurance coach, CrossFit Level 1 Trainer, and lifelong athlete, she specializes in mobility, movement, and injury prevention. She is also the Founder and Head Coach at Kaari Prehab, a company that provides customized mobility, recovery and injury prevention, and rehab services for athletes and other active people. Listen in as we unpack the role and resilience of the low back and discuss the prevalence of (and possible contributors to) low back pain. We talk about the impact of posture, the need for both strength and mobility, and offer a wide range of yoga practices that yoga students and teachers can call on to support the low back. Throughout, you'll hear the crucial impact our individual differences and circumstances play in determining which practices are helpful, and which are not. Show Notes: The role of the low back and the importance of caring for it [3:25] The staggering prevalence of low back pain and its potential causes [6:28] Isolated versus full-body movement practices for low back pain [9:45] Analgesic effects of isometric strength work, even for skilled athletes [13:57] The role of fear in low back pain or dysfunction and a TCM perspective [17:18] The impact of posture on the health of the spine [20:55] Disk loading in different body positions [23:30] “Bad posture” versus “good posture” and acknowledging individual variation [27:27] The importance of thoracic mobility [35:35] Tapping into deep, subtle core support for the low back [36:37] Yoga poses and transitions that require more thought or care [44:55] Opinions on yoga backbends [51:54] Finding the right amount of challenge [57:20] Recruiting the power of the feet and legs to support the low back [1:01:51] More supportive practices: gentle off-loaded movement, myofascial release, slowing down, and more [1:04:14] Links Mentioned: Watch this episode on YouTube Spine: Anatomy, Dysfunction, and Application Yoga Teacher Training Yoga Medicine Online Connect with Jenni Tarma: Facebook | Instagram | LinkedIn | Jenni Tarma You can learn more about this episode, and see the full show notes at www.YogaMedicine.com/podcast-26. And you can find out more about insider tips, online classes or information on our teacher trainings at www.YogaMedicine.com. To support our work, please leave us a 5 star review with your feedback on iTunes/Apple Podcasts.

In this episode of “On the Case,” James Prudden interviews Elizabeth A.M. Frost, MD, about some of this most unique and memorable cases of her career.Frost was the original clinical editor of The Frost Series, which bears her name in honor of her contributions to the art of the case study. And she will be the guest editor of the series again in the May and June issues. In preparation for her return to editing the series, Prudden, our editorial director, caught up with Frost to discuss some of the highlights of her career in treating and writing about unusual cases.“On the Case” is an interview-driven podcast series, in which we take a behind-the-scenes look at the popular case reports that are published in Anesthesiology News. We interrogate the authors of those case reports about what it was like to experience those clinical situations and why they decided to write about them afterward.Links Mentioned:Link to The Frost SeriesLink to Submit Your Own Case ReportLink to listener surveyFollow Us:Our WebsiteApple PodcastsSpotifyGoogle PodcastFind Us on Social:TwitterFacebookLinkedInInstagram

In this episode of “Ask the Experts,” William Rosenblatt, MD, comes back on the show to discuss his work on the American Society of Anesthesiologists (ASA) Difficult Airway Guidelines. He also explains how it took years to build the Airway on Demand video library and why he does it.Rosenblatt is a professor of anesthesiology and otolaryngology at Yale School of Medicine, in New Haven, Conn. He developed the Airway on Demand program to provide educational resources on airway management. He was also a co-author of the ASA's guidelines.“Ask the Experts” is a conversation podcast series from the “Anesthesiology News Presents” channel. It features up close and personal Q&A interviews with leading experts in the field of anesthesiology on topics such as difficult airways and women in medicine.Links Mentioned:Sign up for Going ROAG seminarRevised Difficult Airway Guidelines Broaden Scope – Anesthesiology NewsASA Updates Difficult Airway Guidelines - Anesthesiology NewsLink to the ASA's Difficult Airway GuidelinesLink to presentation by Tim Cook on “no trace, wrong place”Send us an email submit a case for The Frost SeriesTake Our Listener Survey!Follow Us:Our WebsiteApple PodcastsSpotifyGoogle PodcastFind Us on Social:TwitterFacebookLinkedInInstagram

Don't miss this thought-provoking episode with Dr. Patrick Tighe! Dr. Tighe discusses how his work led him to the burgeoning field of artificial intelligence in medicine and what he hopes this new technology can do for the future of healthcare.Dr. Tighe's many titles include: Associate Professor Of Anesthesiology; Donn M. Dennis MD Professorship In Anesthetic Innovation; Co-Director, Perioperative Cognitive Anesthesia Network; Associate Professor Of Orthopaedics And Information Systems And Operations Management.Learn more about his work here. (https://anest.ufl.edu/profile/tighe-patrick/#research-profile)Dr. Tighe's Bio:Dr. Tighe serves in the Division of Acute Pain Medicine and provides care in the blockroom, acute pain service, and operating room. Additionally, he is the director of the Perioperative Analytic Group and Co-Director of the Perioperative Cognitive Anesthesia Network (PeCAN).Dr. Tighe's research examines how machine and deep learning algorithms, decision and process modeling, and social network analyses can improve processes related to acute postoperative pain, cognition, and perioperative patient safety. His work is currently supported by an R01 from the National Institute of General Medical Sciences at the National Institutes of Health to examine the temporal dynamics of postoperative pain. Additionally, he is a Co-PI for PRECEDE, examining the role of perioperative factors associated with postoperative cognition. He collaborates with a diverse array of researchers from the Colleges of Medicine, Engineering, Business, Dentistry, and Pharmacy.Dr. Tighe serves as section co-editor for the Acute and Perioperative Section of the journal Pain Medicine, and is on the Board of Directors for the American Academy of Pain Medicine. He serves on the committee on Electronic and Media Information Technology (EMIT) at the American Society of Anesthesiologists. In addition, Dr. Tighe has worked with the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) group to develop a new multidimensional taxonomy for acute pain. He recently served as a consultant to the Institute for Healthcare Improvement on behalf of the Anesthesia Patient Safety Foundation for the IHI “Advancing the Safety of Acute Pain Management” initiative.

“On the Case” is back for another season of in-depth interviews with the authors of the best case reports published in Anesthesiology News. The first episode of the year features L. Jane Stewart, MD, JD, MPH, who co-wrote the review titled “Comatose in the PACU? Remove the Scopolamine Patch” (Anesthesiology News Special Edition 2021;17:81-85).Stewart comes on the podcast to discuss the details behind the case as well as how she and her team were able to determine the right diagnosis despite the uniqueness of the case.Stewart is a senior instructor of anesthesiology at the Denver Health Medical Center, and the director of Diversity, Equity and Inclusion in the Department of Anesthesiology at the University of Colorado, Denver.“On the Case” is an interview-driven podcast series, in which we take a behind-the-scenes look at the popular case reports that are published in Anesthesiology News. We interrogate the authors of those case reports about what it was like to experience those clinical situations and why they decided to write about them afterward.Link to listener survey!Other Links Mentioned:Link to Case ReportLink to Submit Your Own Case ReportFollow Us:Our WebsiteApple PodcastsSpotifyGoogle PodcastFind Us on Social:TwitterFacebookLinkedInInstagram

Anesthesiology News will be publishing a new season of our popular podcast series, “On the Case” and “Ask the Experts.”“On the Case” is a review series that features the authors of our popular case report series. We hear the behind-the-scenes story on the most unique clinical case studies published in the magazine directly from the professionals who managed them. The first episode of this new season features an interview with L. Jane Stewart, MD, JD, MPH, who co-wrote a case report about a patient who experienced a unique complication from a scopolamine patch.“Ask the Experts” is an interview series that features leading anesthesia experts on topics ranging from airway management to medical mission work and the future of anesthesia practice models. The first episode of this new season will feature an interview with William Rosenblatt, MD, who was a co-author of the new American Society of Anesthesiologists difficult airway guidelines.These episodes will be published later this month. And new episodes from both of these new series will appear every month. Follow Us:Our WebsiteApple PodcastsSpotifyGoogle PodcastFind Us on Social:TwitterFacebookLinkedInInstagram

Show notes at pharmacyjoe.com/episode645. In this episode, I’ll discuss the analgesic ceiling dose of ibuprofen in ED patients. The post 645: The analgesic ceiling dose of ibuprofen applies to ED patients too appeared first on Pharmacy Joe.

When properly and safely administered regional anesthesia can augment your limited supply of narcotics and ketamine in resource poor environments. It can also preserve your patient's mental status while providing targeted pain relief. This can be accomplished using a nerve stimulator and the techniques found in the Military Advanced Regional Anesthesia and Analgesia Handbook as taught in the Special Forces Medical Sergeant course. If you have a portable ultrasound machine and a little practice you can also use the safe techniques found in the videos made available in by the New York School of Regional Anesthesia at NYSORA.com. For more content, visit www.prolongedfieldcare.org

Intubation Essentials-- Part 1 Preparation and ChecklistsAbout our guests:Dr. Alyssa Stoner is an Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine and practicing pediatric intensivist at Children's Mercy Kansas City.Dr. Gina Patel is a fellow in pediatric critical care at Children's Mercy Kansas City.How to support PedsCrit?Please share, like, rate and review on Apple Podcasts or Spotify!Donations appreciated @PedsCrit on Venmo --100% of all funds will go to supporting the show to keep this project going.ObjectivesThe participant will be able to compile a complete list of equipment necessary to perform a pediatric intubation, with acknowledgment of mnemonic.The participant will be able to determine the appropriate size and depth of insertion of endotracheal tube based on patient's age utilizing a common estimation formulas.The participant will be able to describe the appropriate patient set up; including positioning for a successful intubation. When a checklist is elusive a simple mnemonic can be helpful to recall the necessary equipment:Mnemonic: SOAP MESuction Device: Ensure suction is turned on and at appropriate levelYaunker or large bore suction tube 14 FrenchConsider second suction set up especially if concerned about pulmonary hemorrhage or pulmonary edemaOxygen Delivery system: ensure oxygen sources is connected and functioning appropriatelyNasal Cannula vs. High Flow/ Non-RebreatherConsider non-Invasive if poor oxygenationConsider need for apneic oxygenation depending on clinical situation Self-inflating anesthesia bag with appropriately sized mask Airway Equipment:Direct Laryngoscope: Blade type and size considerations Video Laryngoscope: CMAC or Glidescope dependent upon access and comfort Endotracheal tube: Correct size + size downBack up airway IE: Laryngeal Mask Airway (LMA)Patient Position: Most of procedural success is based upon the appropriate patient positioningConsider age of patient and position accordingly to achieve appropriate sniffing position, consider utilizing small shoulder roll (in patients

View the show notes in Google Docs here: http://bit.ly/3bFS43j Gonorrhea Updates Gonorrhea Treatment and Care. Centers for Disease Control and Prevention Website. https://www.cdc.gov/std/gonorrhea/treatment.htm. Published December 14, 2020. Accessed January 11, 2021. CDC No Longer Recommends Oral Drug for Gonorrhea Treatment. Centers for Disease Control and Prevention. https://www.cdc.gov/nchhstp/newsroom/2012/gctx-guidelines-pressrelease.html. Published August 9, 2012. Accessed January 11, 2021. Recurrent UTI Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2019). American Urological Association. https://www.auanet.org/guidelines/recurrent-uti?fbclid=IwAR1TwSTQNHv8PDWLfW7WjsDan46D_9b6Qs1ptJxaXr6YFnDpBeptpW3BY. Published 2019. Accessed January 11, 2021. Combo Ibuprofen and Acetaminophen / Pain Advil® Dual Action. GSK Expert Portal. https://www.gskhealthpartner.com/en-us/pain-relief/brands/advil/products/dual-action/?utmsource=google&utmmedium=cpc&utmterm=ibuprofen+acetaminophen&utmcampaign=GS+-+Unbranded+Advil+DA+-+Alone+-+PH. Accessed January 11, 2021. FDA approves GSK's Advil Dual Action with Acetaminophen for over-the-counter use in the United States. GSK. https://www.gsk.com/en-gb/media/press-releases/fda-approves-gsk-s-advil-dual-action-with-acetaminophen-for-over-the-counter-use-in-the-united-states/. Published March 2, 2020. Accessed January 11, 2021. Tanner T, Aspley S, Munn A, Thomas T. The pharmacokinetic profile of a novel fixed-dose combination tablet of ibuprofen and paracetamol. BMC clinical pharmacology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906415/. Published July 5, 2010. Accessed January 11, 2021. Searle S, Muse D, Paluch E, et al. Efficacy and Safety of Single and Multiple Doses of a Fixed-dose Combination of Ibuprofen and Acetaminophen in the Treatment of Postsurgical Dental Pain: Results From 2 Phase 3, Randomized, Parallel-group, Double-blind, Placebo-controlled Studies. The Clinical journal of pain. https://pubmed.ncbi.nlm.nih.gov/32271183/. Published July 2020. Accessed January 11, 2021. 1000 mg versus 600/650 mg Acetaminophen for Pain or Fever: A Review of the Clinical Efficacy. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK373467/. Published June 17, 2016. Accessed January 11, 2021. Motov S. Is There a Limit to the Analgesic Effect of Pain Medications? Medscape. https://www.medscape.com/viewarticle/574279. Published June 17, 2008. Accessed January 11, 2021. Motov, Sergey. Faculty Forum: A Practical Approach to Pain Management. YouTube. https://www.youtube.com/watch?v=lJSioPsGw3A. The Center for Medical Education. Published December 2, 2020. Accessed January 1, 2021. Wuhrman E, Cooney MF. Acute Pain: Assessment and Treatment. Medscape. https://www.medscape.com/viewarticle/735034_4. Published January 3, 2011. Accessed January 11, 2021. Social Pain Dewall CN, Macdonald G, Webster GD, et al. Acetaminophen reduces social pain: behavioral and neural evidence. Psychological science. https://pubmed.ncbi.nlm.nih.gov/20548058/. Published June 14, 2010. Accessed January 11, 2021. Mischkowski D, Crocker J, Way BM. From painkiller to empathy killer: acetaminophen (paracetamol) reduces empathy for pain. Social cognitive and affective neuroscience. https://pubmed.ncbi.nlm.nih.gov/27217114/. Published May 5, 2016. Accessed January 11, 2021. Other / Recurrent liner notes Center for Medical Education. https://courses.ccme.org/. Accessed January 11, 2021. Roberts M, Roberts JR. The Proceduralist. https://www.theproceduralist.org/. Accessed January 11, 2021. The Procedural Pause by James R. Roberts, MD, & Martha Roberts, ACNP, PNP. Emergency Medicine News. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx. Accessed January 11, 2021. The Skeptics' Guide to Emergency Medicine. sgem.ccme.org. https://sgem.ccme.org/. Accessed January 11, 2021. Trivia Question: Send answers to 2viewcast@gmail.com Please note that you must answer the 2 part question to win a copy of the EMRA Pain Guide. “What controversial drug was given a black box warning for prolonged QT and torsades in 2012 and now has been declared by WHICH organization to be an effective and safe treatment use for nausea, vomiting, headache and agitation?” Practical Pain Management in Acute Care Setting Handout Sergey Motov, MD @painfreeED • Pain is one of the most common reasons for patients to visit the emergency department and other acute care settings. Due to the extensive number of visits related to pain, clinicians and midlevel providers should be aware of the various options, both pharmacological and nonpharmacological, available to treat patients with acute pain. • As the death toll from the opioid epidemic continues to grow, the use of opioids in the acute care setting as a first-line treatment for analgesia is becoming increasingly controversial and challenging. • There is a growing body of literature that is advocating for more judicious use of opioids and well as their prescribing and for broader use of non-pharmacological and non-opioid pain management strategies. • The channels/enzymes/receptors targeted analgesia (CERTA) concept is based on our improved understanding of the neurobiological aspect of pain with a shift from a symptom-based approach to pain to a mechanistic approach. This targeted analgesic approach allows for a broader utilization of synergistic combinations of nonopioid analgesia and more refined and judicious (rescue) use of opioids. These synergistic combinations result in greater analgesia, fewer side effects, lesser sedation, and shorter LOS. (Motov et al 2016) General Principles: Management of acute pain in the acute care setting should be patient-centered and pain syndrome-specific by using multimodal approach that include non-pharmacological modalities and pharmacological ones that include non-opioid and opioid analgesics. Assessment of acute pain should be based on a need for analgesics to improve functionality, rather than patients-reported pain scores. Brief pain inventory short form BPI-SF is better than NRS/VAS as it assesses quantitative and qualitative impact of pain (Im et al 2020). ED clinicians should engage patients in shared decision-making about overall treatment goals and expectations, the natural trajectory of the specific painful condition, and analgesic options including short-term and long-term benefits and risks of adverse effects. If acute pain lasting beyond the expected duration, complications of acute pain should be ruled out and transition to non-opioid therapy and non-pharmacological therapy should be attempted. Non-Pharmacologic Therapies • Acute care providers should consider applications of heat or cold as well as specific recommendations regarding activity and exercise. • Music therapy is a useful non-pharmacologic therapy for pain reduction in acute care setting (music-assisted relaxation, therapeutic listening/musical requests, musical diversion, song writing, and therapeutic singing (Mandel 2019). • The use of alternative and complementary therapies, such as acupuncture, guided imagery, cognitive-behavioral therapy, and hypnosis have not been systemically evaluated for use in the Acute care setting including ED. (Dillan 2005, Hoffman 2007) • In general, their application may be limited for a single visit, but continued investigation in their safety and efficacy is strongly encouraged. • Practitioners may also consider utilization of osteopathic manipulation techniques, such as high velocity, low amplitude techniques, muscle energy techniques, and soft tissue techniques for patients presenting to the acute care setting with pain syndromes of skeletal, arthroidal, or myofascial origins. (Eisenhart 2003) Opioids • Acute Care providers are uniquely positioned to combat the opioid epidemic by thoughtful prescribing of parenteral and oral opioids in inpatient setting and upon discharge, and through their engagement with opioid addicted patients in acute care setting. • Acute Care providers should make every effort to utilize non-pharmacological modalities and non-opioid analgesics to alleviate pain, and to use opioid analgesics only when the benefits of opioids are felt to outweigh the risks. (not routinely) • When opioids are used for acute pain, clinicians should combine them with non-pharmacologic and non-opioid pharmacologic therapy: Yoga, exercise, cognitive behavioral therapy, complementary/alternative medical therapies (acupuncture); NSAID's, Acetaminophen, Topical Analgesics, Nerve blocks, etc. • When considering opioids for acute pain, Acute Care providers should involve patients in shared decision-making about analgesic options and opioid alternatives, risks and benefits of opioid therapies, and rational expectations about the pain trajectory and management approach. • When considering opioids for acute pain, acute care providers should counsel patients regarding serious adverse effects such as sedation and respiratory depression, pruritus and constipation, and rapid development of tolerance and hyperalgesia. • When considering administration of opioids for acute pain, acute care providers should make every effort to accesses respective state's Prescription Drug Monitoring Program (PDMP). The data obtained from PDMP's to be used to identify excessive dosages and dangerous combinations, identify and counsel patients with opioid use disorder, offer referral for addiction treatment. • PDMPs can provide clinicians with comprehensive prescribing information to improve clinical decisions around opioids. However, PDMPs vary tremendously in their accessibility and usability in the ED, which limits their effectiveness at the point of care. Problems are complicated by varying state-to-state requirements for data availability and accessibility. Several potential solutions to improving the utility of PDMPs in EDs include integrating PDMPs with electronic health records, implementing unsolicited reporting and prescription context, improving PDMP accessibility, data analytics, and expanding the scope of PDMPs. (Eldert et al, 2018) • Parenteral opioids when used in titratable fashion are effective, safe, and easily reversible analgesics that quickly relieve pain. • Acute care clinicians should consider administering these analgesics for patients in acute pain where the likelihood of analgesic benefit is judged to exceed the likelihood of harm. • Parenteral opioids must be titrated regardless of their initial dosing regimens (weight-based or fixed) until pain is optimized to acceptable level (functionality status) or side effects become intolerable. • When parenteral opioids are used, patients should be engaged in shared-decision making regarding the route of administration, as repetitive attempts of IV cannulation and intramuscular injections are associated with pain. In addition, intramuscular injections are associated with unpredictable absorption rates, and complications such as muscle necrosis, soft tissue infection and the need for dose escalation. (Von Kemp 1989, Yamanaka 1985, Johnson 1976) • Morphine sulfate provides better balance of analgesic efficacy and safety among all parenteral opioids. a. Dosing regimens and routes: b. IV: 0.05-0.1mg/kg to start, titrate q 10-20 min c. IV: 4-6 mg fixed, titrate q 10-20 min d. SQ: 4-6 mg fixed, titrate q 20 min e. Nebulized: 0.2 mg/kg or 10-20 mg fixed, repeat q 15-20 min f. PCA: prone to dosing errors g. IM: should be avoided (pain, muscle fibrosis, necrosis, increase in dosing requirements) • Hydromorphone should be avoided as a first-line opioid due to significant euphoria and severe respiratory depression requiring naloxone reversal. Due to higher lipophilicity, Hydromorphone use is associated with higher rates of euphoria and subsequent development of addiction. Should hydromorphone be administered in higher than equi-analgesic morphine milligram equivalents, close cardiopulmonary monitoring is strongly recommended. Dosing h. IV: 0.2-0.5 mg initial, titrate q10-15 min i. IM: to be avoided (pain, muscle fibrosis, necrosis, increase in dosing requirements) j. PCA: prone to dosing errors (severe CNS and respiratory depression) k. Significantly worse AE profile in comparison to Morphine l. Equianalgesic IV conversion (1 mg HM=8mg of MS) m. Overprescribed in >50% of patients n. Inappropriately large dosing in EM literature: 2 mg IVP o. Abuse potential (severely euphoric due to lipophilicity) • Fentanyl is the most potent opioid, short-acting, requires frequent titration. Dosing: p. IV: 0.25-0.5 μg/kg (WB), titrate q10 min q. IV: 25-50 μg (fixed), titrate q10 min r. Nebulization: 2-4 μg/kg, titrate q20-30 min s. IN: 1-2 μg/kg, titrate q5-10min t. Transbuccal: 100-200μg disolvable tablets u. Transmucosal: 15-20 mcg/kg Lollypops • Opioids in Renal Insufficiency/Renal Failure Patients-requires balance of ORAE with pain control by starting with lower-than-recommended doses and slowly titrate up the dose while extending the dosing interval. (Dean 2004, Wright 2011) • Opioid-induced pruritus is centrally mediated process via μ-opioid receptors as naloxone, nalbuphine reverse it, and can be caused by opioids w/o histamine release (Fentanyl). Use ultra-low-dose naloxone of 0.25 -1 mcg/kg/hr with NNT of 3.5. (Kjellberg 2001) • When intravascular access is unobtainable, acute care clinicians should consider utilization of intranasal (fentanyl), nebulized (fentanyl and morphine), or transmucosal (rapidly dissolvable fentanyl tablets) routes of analgesic administration for patients with acute painful conditions. • Breath actuated nebulizer (BAN): enclosed canister, dual mode: continuous and on-demand, less occupational exposures. a. Fentanyl: 2-4 mcg//kg for children, 4 mcg/kg for adults: titration q 10 min up to three doses via breath-actuated nebulizer (BAN): systemic bioavailability of 50-60% of IV route. (Miner 2007, Furyk 2009, Farahmand 2014) b. Morphine: 10-20 mg g10 min up to 3 doses via breath-actuated nebulizer (BAN)-Systemic bioavailability (concentration) of 30-35% of IV Route. (Fulda 2005, Bounes 2009, Grissa 2015) c. Intranasal Fentanyl: IN via MAD at 1-2 mcg/kg titration q 5 min (use highly concentrated solution of 100mcg/ml for adults and 50 mcg/ml for children)- systemic bioavailability of 90% of IV dosing. (Karisen 2013, Borland 2007, Saunders 2010, Holdgate 2010) d. IN route: shorter time to analgesia, titratable, comparable pain relief to IV route, minimal amount of side effects, similar rates of rescue analgesia, great patients and staff satisfaction. Disadvantages: requires highly concentrated solutions that not readily available in the ED, contraindicated in facial/nasal trauma. Oral Opioids • Oral opioid administration is effective for most patients in the acute care setting, however, there is no appreciable analgesic difference between commonly used opioids (oxycodone, hydrocodone and morphine sulfate immediate release (MSIR). • When oral opioids are used for acute pain, the lowest effective dose and fewest number of tablets needed should be prescribed. In most cases, less than 3 days' worth are necessary, and rarely more than 5 days' worth are needed. • If painful condition outlasts three-day supply, re-evaluation in health-care facility is beneficial. Consider expediting follow-up care if the patient's condition is expected to require more than a three-day supply of opioid analgesics. • Only Immediate release (short-acting) formulary are to be prescribed in the acute care setting and at discharge. • Clinicians should not administer or prescribe long-acting, extended-release, or sustained-release opioid formulations, which include both oral and transdermal (fentanyl) medications in the acute care setting. These formulations are not indicated for acute pain and carry a high risk of overdose, particularly in opioid-naïve patients. • Acute care providers should counsel patients about safe medication storage and disposal, as well as the consequences of failure to do this; potential for abuse and misuse by others (teens and young adults), and potential for overdose and death (children and teens). • Oxycodone is no more effective than other opioids (hydrocodone, MSIR). Oxycodone has highest potential for abuse, misuse and diversion as well as increased risks of overdose, addiction and death. Oxycodone should be avoided as a first-line oral opioid for acute pain. ( Strayer 2016) • If still prescribed, lowest dose (5mg) in combination with acetaminophen (lowest dose of 325 mg) should be considered as it associated with less abuse and diversion (in theory). Potential for acetaminophen overdose exist though with combination. • Hydrocodone is three times more prescribed than oxycodone, but three times less used for non-medical purpose. Combo with APAP (Vicodin)-Use lowest effective dose for hydrocodone and APAP (5/325). (Quinn 1997, Adams 2006) • Immediate release morphine sulfate (MSIR) administration is associated with lesser degree of euphoria and consequently, less abuse potential (Wightman 2012). ED providers should consider prescribing Morphine Sulfate Immediate Release Tablets (MSIR) (Wong 2012, Campos 2014) for acute pain due to: o Similar analgesic efficacy to Oxycodone and Hydrocodone o Less euphoria (less abuse potential) o Less street value (less diversion) o More dysphoria in large doses o Less abuse liability and likeability • Tramadol should not be used in acute care setting and at discharge due to severe risks of adverse effects, drug-drug interactions, and overdose. There is very limited data supporting better analgesic efficacy of tramadol in comparison to placebo, or better analgesia than APAP or Ibuprofen. Tramadol dose not match analgesic efficacy of traditional opioids. (Juurlink 2018, Jasinski 1993, Babalonis 2013) • Side effects are: o Seizures o Hypoglycemia o Hyponatremia o Serotonin syndrome o Abuse and addiction • Codeine and Codeine/APAP is a weak analgesic that provides no better pain relief than placebo. Codeine must not be administered to children due to: o dangers of the polymorphisms of the cytochrome P450 iso-enzyme: o ultra-rapid metabolizers: respiratory depression and death o poor metabolizers: absent or insufficient pain relief • Transmucosal fentanyl (15 and 20 mcg/kg lollypops) has an onset of analgesia in 5 to 15 minutes with a peak effect seen in 15 to 30 minutes (Arthur 2012). • Transbuccal route can be used right at the triage to provide rapid analgesia and as a bridge to intravenous analgesia in acute care setting. (Ashburn 2011). A rapidly dissolving trans-buccal fentanyl (100mcg dose) provides fast pain relief onset (median 10 min), great analgesics efficacy, minimal need for rescue medication and lack of side effects in comparison to oxycodone/acetaminophen tablet (Shear 2010) • Morphine Milligram Equivalent (MME) is a numerical standard against which most opioids can be compared, yielding a comparison of each medication's potency. MME does not give any information of medications efficacy or how well medication works, but it is used to assess comparative potency of other analgesics. • By converting the dose of an opioid to a morphine equivalent dose, a clinician can determine whether a cumulative daily dose of opioids approaches an amount associated with increased risk of overdose and to identify patients who may benefit from closer monitoring, reduction or tapering of opioids, prescribing of naloxone, and other measures to reduce risk of overdose. • Opioid-induced hyperalgesia: o opioid-induced hyperalgesia (OIH) is a rare syndrome of increasing pain, often accompanied by neuroexcitatory effects, in the setting of increasing opioid therapy. o Morphine is by far the most common opiate implicated in OIH. Hydromorphone and oxycodone, members of the same class of opiate as morphine (phenanthrenes), can also cause OIH. Fentanyl, a synthetic opioid in the class of phenylpiperidine, is less likely to precipitate OIH. Existing data suggests that OIH is caused by multiple opioid-induced changes to the central nervous system including: -Activation of N-methyl-D-aspartate (NMDA) receptors -Inhibition of the glutamate transporter system -Increased levels of the pro-nociceptive peptides within the dorsal root ganglia -Activation of descending pain facilitation from the rostral ventromedial medulla -Neuroexcitatory effects provoked by metabolites of morphine and hydromorphone • OIH can be confused with tolerance as in both cases patients report increased pain on opioids. The two conditions can be differentiated based on the patient's response to opioids. In tolerance, the patient's pain will improve with dose escalation. In OIH, pain will worsen with opioid administration. This paradoxical effect is one of the hallmarks of the syndrome. Non-opioid analgesics • Acetaminophen is indicated for management of mild to moderate pain and as a single analgesic and has modest efficacy at most. Addition of Acetaminophen to Ibuprofen does not provide better analgesia for patients with acute low back pain. The greatest limitation to the use of intravenous (IV) versus oral acetaminophen is the nearly 100-fold cost differential, which is likely not justified by any marginal improvement in pain relief. Furthermore, IV APAP provide faster onset of analgesia only after an initial dose. (Yeh 2012, Serinken 2012) • NSAIDs should be administered at their lowest effective analgesic doses both in the ED and upon discharge and should be given for the shortest appropriate treatment course. Caution is strongly advised when NSAIDs are used in patients at risk for renal insufficiency, heart failure, and gastrointestinal hemorrhage, as well as in the elderly. Strong consideration should be given to topical NSAID's in managing as variety of acute and chronic painful Musculo-skeletal syndromes. The analgesic ceiling refers to the dose of a drug beyond which any further dose increase will not result in additional analgesic efficacy. Thus, the analgesics ceiling for ibuprofen is 400 mg per dose (1200 mg/24 h) and for ketorolac is 10 mg per dose (10 mg/24 h). These doses are less than those often prescribed for control of inflammation and fever. When it comes to equipotent doses of different NSAIDs, there is no difference in analgesic efficacy. • Ketamine, at sub-dissociative doses (also known as low-dose ketamine or analgesic dose ketamine) of 0.1 to 0.4 mg/kg, provided effective analgesia as a single agent or as an adjunct to opioids (reducing the need for opioids) in the treatment of acute traumatic and nontraumatic pain in the ED. This effective analgesia, however, must be balanced against high rates of minor adverse side effects (14%–80%), though typically short-lived and not requiring intervention. In addition to IV rout, ketamine can be administered via IN,SQ, and Nebulized route. • Local anesthetics are widely used in the ED for topical, local, regional, intra-articular, and systemic anesthesia and analgesia. Local anesthetics (esters and amides) possess analgesic and anti-hyperalgesic properties by non-competitively blocking neuronal sodium channels. o Topical analgesics containing lidocaine come in patches, ointments, and creams have been used to treat pain from acute sprains, strains, and contusions as well as variety of acute inflammatory and chronic neuropathic conditions, including postherpetic neuralgia (PHN), complex regional pain syndromes (CRPS) and painful diabetic neuropathy (PDN). o UGRA used for patients with lower extremity fractures or dislocations (eg, femoral nerve block, fascia iliaca compartment block) demonstrated significant pain control, decreased need for rescue analgesia, and first-attempt procedural success. In addition, UGRA demonstrated few procedural complications, minimal need for rescue analgesia, and great patient satisfaction. o Analgesic efficacy and safety of IV lidocaine has been evaluated in patients with renal colic and acute lower back pain. Although promising, this therapy will need to be studied in larger populations with underlying cardiac disease before it can be broadly used. o knvlsd • Antidopaminergic and Neuroleptics are frequently used in acute care settings for treatment of migraine headache, chronic abdominal pain, cannabis-induced hyperemesis. • Anti-convulsant (gabapentin and pregabalin) are not recommended for management of acute pain unless pain is of neuropathic origin. Side effects, particularly when combined with opioids (potentiation of euphoria and respiratory depression), titration to effect, and poor patients' compliance are limiting factors to their use. (Peckham 2018) References: Chang HY, Daubresse M, Kruszewski SP, et al. 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