Podcasts about Baclofen

In the patient populations treated by neurologists, central neuropathic pain develops most frequently following spinal cord injury, multiple sclerosis, or stroke. To optimize pain relief, neurologists should have a multimodal and individualized approach to manage central neuropathic pain. In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Charles E. Argoff, MD, author of the article “Central Neuropathic Pain,” in the Continuum October 2024 Pain Management in Neurology issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Argoff is a professor of neurology and vice chair of the department of neurology, director of the Comprehensive Pain Management Center, and director of the Pain Management Fellowship at Albany Medical College in Albany, New York. Additional Resources Read the article: Central Neuropathic Pain Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Full episode transcript available here Dr Jones: This is Doctor Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum Journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Jones: This is Doctor Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Charles Argoff, who recently authored an article on central neuropathic pain in the latest issue of Continuum covering pain management. Dr Argoff is a neurologist at Albany Medical College where he's a professor of Neurology, and he serves as vice chair of the Department of Neurology and program director of the Pain Medicine Fellowship Program there. Dr Argoff, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners?  Dr Argoff: I'm Charles Argoff. It's a pleasure to be here and thank you so much for that kind introduction. Dr Jones: I've read your article. Many of our listeners are going to read your article. Wonderful article, extremely helpful. Closes a lot of gaps, I think, that exist in our field about understanding central neuropathic pain, treating central neuropathic pain. You now, Doctor Argoff, you have the attention of a huge audience of mostly neurologists. What's the biggest point you would like to make to them, or the most important practice-changing advice that you would give to them? Dr Argoff: I think it's at least twofold. One is that central neuropathic pain is not as uncommon as you think it might be, and it occurs in a variety of settings that are near and dear to a neurologist's heart, so to speak. And secondly, although we live in an evidence-based world and we want to practice evidence-based medicine - and I'm proud to have formerly been a member of the Quality Standard subcommittee, which I think has changed its name over time. And so, I understand the importance of, you know, treatment based upon evidence - the true definition of evidence-based medicine is using the best available evidence in making decisions about individual patients. And so, I would urge those who are listening that, although there might not be as robust evidence currently as you'd like, please don't not take the time to try to treat the patient in front of you o r at least acknowledge the need for treatment and work with your colleagues to address the significant neuropathic pain associated with that central neurological disorder. Because it can be life-changing in a positive way to make even a dent and to really work with somebody, even though not clear-cut always what's going to work for an individual patient. Dr Jones: Well said. I'm glad you brought that up. So, to put it a different way, absence of evidence is not an excuse for absence of treatment. Right? Dr Argoff: Exactly. And I think that, I hope that we would agree that especially in neurology, what we do is about as far from, ‘Yep, you've got strep throat, here's that antibiotic that's going to work for you and all you have to do is take the medicine.' I mean, most of what we do is nowhere near that.  Dr Jones: It's complicated stuff. And this is a complicated topic. And I'll tell you, I learned a lot reading your article. I think most of us in neurology and medicine, when we hear the term neuropathic pain, it feels roughly synonymous with peripheral generators of that pain, such as diabetic neuropathy or posttraumatic neuralgia. But as you mentioned, there's central mechanisms for pain generation. How is it defined? What is central neuropathic pain? Dr Argoff: It's defined as pain caused by a lesion or disease of the central somatosensory system . Though neuropathic pain in general is pain associated with the lesion of the somatosensory system; and to your point, that can be peripheral, which of course is outside the spinal cord, or brain or central, which is within the spinal cord or brain. And central neuropathic pain is defined specifically as pain caused by a lesion or disease of the central somatosensory system. That's either brain or spinal cord. But there's an interesting follow-up, and I'm going to ask if you could remind me because I know we're talking about definitions now, but I'll just bring something up and we can come back to it. What's interesting about that is that my - whoever 's listening, that's not to say that they're not connected. And in fact, they are very much connected. And there's very new work, which I included in the article, down at Washington University in Saint Louis, that suggests you can actually affect central neuropathic pain by addressing peripheral input to the central nervous system. If you remember Ken Casey at the University of Michigan at the World Pain Congress in Vancouver, British Columbia many years ago, he ended his talk on pain with a limerick, of which the last line was, Remember, there ain't no such thing as pain without a brain. And so that kind of summarizes that. Dr Jones: Well, and it goes both ways too, right? We know that there's some central sensitization that can happen with peripheral generators, right? So we really have to think about the whole circuit. Dr Argoff: Yes. And that's been sometimes the bane of my existence as a colleague of others and a sometimes debater. Is the pain central? Is it peripheral? Well, it's everything. And it's important to know as many of the mechanisms and many of the targets that you could use for treatment so that you can affect the best outcome for your patients. Dr Jones: Yeah, so - and you mentioned in your article what some of the common causes of central neuropathic pain are. What are the big ones in your experience?  Dr Argoff: So, the biggest ones are spinal cord injury-related pain, MS-related pain - and I'd like to come back to a point and just if I do the third one - and central poststroke pain. And what struck me, I think Tim Vollmer published a survey about the incidence, the prevalence of ongoing pain in patients with multiple sclerosis. And it blew my mind several years ago because it was incredibly high. Like in this survey of MS patients who, you never hear about pain, you hear about these modifying treatments, all the wonderful expanses that have been made. I mean, like seventy something percent of people say they have moderate to severe pain. And when you think about how sensory processing occurs, it makes perfect sense that a demyelinating disorder is going to interrupt the flow of information for a person to feel normal.  Dr Jones: Yeah, I think it's a good example of, there are things that we tend to focus on as clinicians where we worry about deficit and function and capacity. But if we're patient-centered and we ask patients what they care about, pain usually moves up higher on the list. And so, I think that's why we, it's maybe underrecognized with some of those central disorders, right? Dr Argoff: I think so, and I and I think you hit the nail on the head that - and we're also trained that way. I tell this to my patients very often so that they are reassured when I examine them and I say, and I tell them that everything looked pretty OK. It's not a medical term, I understand that. Because what we do in a typical neurological exam, even if it's detailed, doesn't really address all the intricacies of the nervous system. So it's really a big picture and sensory processing and especially picking up sensory deficits; you know, we use quantitative sensory testing and research studies and things like that, but bedside testing may not reveal the subtle changes. And when we don't see overt changes, we often think - that can lead someone to think that everything is OK and it's not. Dr Jones: So, when you when you see a patient who you've diagnosed with a central mechanism, so central neuropathic pain, how do you approach the management of those patients, Dr Argoff? Dr Argoff: I always review what treatments and what approaches have been addressed already. And I see if - a handful of time, we actually just submitted a paper for publication regarding this in a group of patients with pelvic pain who had untreated, difficult-to-treat chronic pelvic pain, seen all the urological kinds, gynecological things. Look, we picked up two patients who had unknown MS. So, it's just interesting when it comes down to that level. And we also picked up some patients who had subacute combined degeneration. So that's another central kind of disorder as well. Again, the neurologist in us says to make sure that we have specific diagnosis that underlies the central neuropathic pain. And so interestingly, of course, for somebody with MS - or even though it's uncommon, it could be more than one. Somebody with MS might have a stroke, somebody with MS might have a cord injury due to cervical, you know, joint disc disease. Not to overcomplicate things. Know the lay of the land, know the conditions, know what you're battling and lay out so that you can treat the treatable; you want to treat whatever you can correct? So, for MS you simply want to have the best disease-modifying treatment on board, tolerable and appropriate for that person, and so on. And then you really want to take a history of past treatments - and your treatments can be everything and anything, including behavioral modification, physical rehabilitative approaches, as well as pharmacologic management. That's - as I think I put in my article, we concentrated in the article on pharmacologic management because honestly, that's what most patients are looking for, is ‘what can we, what can you do to help me now, in addition to what I can do myself.' And that's what we typically think of. There are also some more interventional approaches, invasive options, that have developed over time. And of course, those are the ones, some of them, especially in neuromodulation, that we have the least information about, but it appears somewhat promising.  Dr Jones: No, that's exactly what we need to hear. And you also mentioned something that I think is important. This is a common theme throughout the issue because I think it's true for the management of many different types of pain and interdisciplinary approach. In other words, not just honing in on pharmacotherapy or neuromodulation as a one-size-fits-all magic pill, right? So, that - tell us a little bit more about that interdisciplinary approach and how that's important for these patients. Dr Argoff: So, let me back up and give an example. Let's look at Botox for chronic migraine. So, the pre-M studies that led to the approval of Botox for chronic migraine: two treatment sessions versus two random, two placebo session in different patients. The mean headache frequency was, let's say, fifteen to twenty in each group. It was like seventeen, eighteen, something like that. But the mean pain headache day reduction was somewhere between four and five after two treatments compared to a lesser, a lower number in the placebo group. So, if you think about that, that means that you went from nineteen, let's say, to fourteen, thirteen, or twelve. Want to be generous, eleven or ten. But that means that person, everyone 's happy. We use treatment. We have better data than that because the longer you use it, the better it gets in general, but it means that people are still going to be symptomatic. So that drives home in a different painful disorder the importance of yes, treatment can be effective, but it's not the only treatment that a person is going to likely need. And so, I think that's what's so important about multidisciplinary approach. I- we may affect positive changes, reduction in pain intensity with a particular pharmacologic agent, but we don't anticipate it's like taking an antibiotic or a strep throat, not curative. And so, we want to, early on, to explain that logically, methodically, step by step. There are many options for you and we're going to, you know, systematically go through them. And I may need to call in some colleagues to help because I don't do everything. No one does everything, right? But don't feel as if there isn't any hope because there is. If we were to use intraspinal Baclofen for someone who has painful spasticity following a stroke or a spinal cord injury, combining that with physical therapy might give more effect, maybe synergistic. Some targeted muscles, some local muscles may not respond as well to the intraspinal Baclofen, so is that - what can we do? Well, we could use oral agents or we might be able to target that with botulinum toxin, and so on and so forth. So it's limitless, virtually, in what you can do. Dr Jones: There's kind of setting expectations and letting people know that you, you're going to need a lot of different approaches, right? To sort of get them the best possible outcome. Dr Argoff: Yeah, I think that's so important. And of course, no matter what we try to set out, there are going to be individuals - for those of you who are listening, we all know - who expect to be cured yesterday. That might be challenging for us not only to actually complete, but also, it's challenging for some individuals to appreciate that we're with them, we're going to work with them. It'll be a process, but we've got your back. Dr Jones: Great. And you know, this is a question that I get all the time from patients and from other clinicians is, you know, what about cannabinoids? What's the role of cannabinoids for the management of central neuropathic pain? Dr Argoff: First, I'll say that the short answer to that is we don't know. The second part of my response would be, there is new evidence that it might be helpful in the acute treatment of migraine. And I'm happy to say that the editor of this edition of Continuum is the person who developed that evidence, and it's been recently presented at the American Headache Society. But the challenge and the conundrum that we all face is, everywhere within our nervous system where there's pain being processed, there are endocannabinoid receptors. There also happen to be opioid receptors, but that's a separate issue. And the endocannabinoid system, the peripheral or central, you know, CB1, CB2, is very, very important, but we haven't figured out a way of harnessing that knowledge in developing an analgesic, an effective analgesic. And part of that is that there are so many chemical agents that have cannabinoid properties and there are different… the right balance has not yet been found. But even the legalization, the available of medical cannabis, hasn't led to a standardized approach to evaluating if a preparation does help. And that's part of the conundrum. It's like saying, ‘does medicine work?'Well, yeah, sometimes. But which medicine? Which receptor? How do you harness the right ratio between TBD, THC, other active agents, et cetera? And I think maybe as we go forward in the future, we'll be able to do that with - more precise. I mentioned Dr Schuster's study in which he had defined ratios of THC effect and CBD and was able to clearly show effect based upon that. But the average person going into a dispensary doesn't really get that. We don't get to study that. Each person's an NF1  and it's not very helpful to understand how to do that. I would say, as I'm sure you remember, there was a practice parameter that was published probably over a decade ago about using cannabis symptomatically in different neurological disorders. And I believe that it was what they studied or what they reviewed was helpful in MS-related urinary discomfort and spasticity, but not necessarily pain.  Dr Jones: And we're still in the early days of studying it, right? Dr Argoff: Yes.  Dr Jones: That's part of the point, as we got started late and we're still waiting for high-quality evidence. And I guess, if you look at the horizon, Dr Argoff, or the future of management of central neuropathic pain, what's going to be the next big thing?  Dr Argoff: One of the joys of being asked to get involved in a project like this is that inevitably we learn so many new things because, you know, that's when anyone says, oh, you must be an expert, I say, I don't know anything because I'm always learning something new. One of the reasons why I moved to Albany Medical College about seventeen years ago was to be able to further my interest in studying why people benefit from topical analgesics by working with a scientist at Albany Med who studied keratinocyte neurochemistry and its impact on pain transmission. And that's a separate issue, but it indicates my love for the peripheral nervous system. And one of my thoughts historically, that is, what the central nervous system processes is what it processes and it might get input, as you mentioned earlier, from the peripheral nervous system, so that topical agents could be dampening central mechanisms. And lo and behold, as I was doing research for this article, I learned that people doing peripheral nerve blocks - so blocking peripheral input at the into the spinal cord - at Washington University, Simon Guterian and colleagues, demonstrate that they could give prolonged benefit from central pain by blocking peripheral input. And that's wild because certainly the nervous system is a two-way street. It's an understatement. What I really found amazing was that, again, blocking input helped the injured central nervous system to behave better.  Dr Jones: That is kind of cool to think about. And I'll tell you, as editor of the journal, one of the funnest things is getting to learn all about neurology, including pain and including central neuropathic pain, when in the end you're doing all the work, I just get to sit here and enjoy it. And you're a program director of a pain fellowship. What's the pipeline look like? Are neurologists more interested in pain than they used to be?  Dr Argoff: I'm happy for this. We are seeing more and more applicants from neurology into our pain management programs. I would say… I was going to say tragically. If I say tragically, it's because what specialty better understands how to diagnose, figure out, assess, come to a conclusion? You can't have pain without your brain. It's always amazed me that more neurologists weren't interested, and I understand the background and such. Just like in migraine, it's only advances in understanding mechanisms of migraine that allow neuroscientific advances that are leading to great therapeutics - that's happening and increasing in ‘pain.' Today, as program director, we had our fellowship interviews earlier today and three of the nine applicants that we interviewed were neurologists. Last week, I think we interviewed two or three also. That would not have happened five years ago or six years ago. And if you think about it, we can not only diagnose, quote-unquote figure out what's happening, but we now, with pain management training, we can offer people a variety of both invasive and noninvasive options, all while understanding what we're doing with respect to the nervous system in a way that's different than the other specialties that typically go into pain med. And that's such - for me, it's a beautiful experience and something I really enjoy doing. There isn't a neurological condition in the most part that either doesn't have pain associated with it or doesn't have mechanisms that overlap. If you think about epilepsy, and please don't think I'm crazy, but epilepsy is associated with disinhibited hyper-excitatory behavior, just to put it loosely, among certain neurons. That's what pain and neuropathic pain is about too. And you, in fact, we know that several mechanisms since now what medicines are used for both. But what was interesting since, if I may just go back to another point, one of the advances since I brought up the migraine that's very exciting is the whole story about sodium channels. Dr Harouthounian at WashU and his group used lidocaine injection. Lidocaine's a more generalized sodium channel blocker, but some of the newest treatments for treating neuropathic pain. Our NAV specific sodium channel blocker's trying to match up mechanism to treatment. Not exactly the way that we do with migraine, but still a step forward to not just generally treat but really target different neuronal mechanisms. It's an exciting time.  Dr Jones: So, the pipeline is doing better because we're getting better understanding of disease, and hopefully that pulls in more interest because obviously there are big gaps in caring for patients with pain. And again, thank you, Dr Argoff, for an amazing article. Thank you for joining us and thank you for such a fascinating discussion. I enjoyed the article. I read the article, I learned from our conversation today. So, thank you for joining us to talk about central neuropathic pain. Dr Argoff: Thank you for having me. Dr Jones: Again, we've been speaking with Dr Charles Argoff, author of an article on central neuropathic pain in Continuum 's most recent issue on pain management. Please check it out, and thank you to our listeners for joining today. Dr Monteith: This is Doctor Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at Continpub.com/AudioCME. Thank you for listening to Continuum Audio.

Please Subscribe and Review: Apple Podcasts | RSS Submit your questions for the podcast here News Topic: Decouple Podcast: The Bottomless Well Show Notes: The Bottomless Well  - Book by Peter Huber and Mark Mills Rescue The Republic Covid Critical Care Alliance Questions:    Pain Relief for Rotator Cuff Injury Kat writes:  Hello from Canada. Love your podcast. I've just found out Iikely have an injury/tear as mentioned above and am pending diagnostic tests. In the meantime, I've been prescribed Baclofen (Muscle relaxant) and an NSAID. Both are making me very ill to the point where I've pretty much stopped taking the meds as Baclofen is causing me to be very unstable on my legs, horribly nauseated, physically ill and feeling very groggy/sedated/intoxicated. The NSAID...I noticed lastnight I had some blood drip during an Ileostomy appliance change. I'm aware of the bowel bleed risks to myself with Crohn's and an ostomy, but after a bleed, more. As a result of choosing not to take these meds anymore, I am in excruciating agony and nothing is providing relief...hot baths, cold packs, hot packs. I cannot sleep for the agony. Every single movement/action excruciating to the point of wanting to scream. Is there a safer, easy remedy for the pain that I can try without requiring much use of my arm? Any suggestions are appreciated.   Air Hunger and Keto Joe writes: Hello Robb and Nikki. I have a couple of questions: I have been chronically experiencing "air hunger" (feeling of inability to get a deep enough breath, rather than a shortness of breath) when following a ketogenic diet. Being insulin resistant, it is critical that I find a solution. My doctor pointed me to ph balance but offered no real solutions. I've since begun drinking alkaline water almost exclusively and it seems to have helped some, though not completely. I don't think this is just in my head, though my research yields a correlation with anxiety, which I do not have. Is this real thing or am I imagining things just because of my carb addiction? If it is real, any ideas how to combat it? Next question is about LMNT. Though I've been a user for quite a while, I tend have a rather explosive intestinal response soon after ingesting it. I've tried cutting back, which is fine when not following a ketogenic diet, but when on diet I really need it. Thoughts? Thanks!   Previous Myocarditis and MRNA shot Marc writes: Hi Robb and Nikki, Long time listener, and reader from the beginning here. Really appreciate all that you do as I have made vast improvements in my life which all started with the paleo solution over a decade ago. I am a healthy, active 37 year old male, living in Brooklyn NY. I cycle 4-5 days a week, lift weights 3-5 days, play ice hockey and get plenty of sun! I eat a carnivorish, paleo type diet, with a strict aversion to gluten. Sleep is pretty dialed in, though I do enjoy alcohol one or two nights a week, but am also very aware of how it effects me etc.  When I was 20 years old I ended up hospitalized for over a week with myocarditis. I had strep throat, which was all the norm for me, as I used to get it once or twice a season until my mid 20's. The infection had actually gone down into my heart and which had caused the issue. It was a terrifying experience as they thought at first I was having a heart attack. After things went back to normal and I was discharged, the cardiologist told me to take a baby asprin every day, prescribed me nitroglycerin incase I had chest pain, and told me to "maybe try meatless Mondays, as heart disease runs in the family." I was far from thrilled with the "solutions" I was given. Long story short, it was after this that I started my health journey which eventually led me to you and the Paleo Diet. Within a month I was down 20 lbs, feeling great, and fast forward over 15 years later I never had another strep infection! Cutting to the chase, when covid struck, I went and got the first 2 jabs of pfizer, back in early 2021 living here in NYC I wouldn't have been able to participate in life, and they dangled the carrot in front our noses, promising freedom once the shot was taken. I had not heard anything about the dangers of myocarditis being a side effect at that point, and Needless to say I was infuriated once the side effects were made known. Its been about 3.5 years since getting my second shot, but seeing all of these healthy young people drop dead has been pretty frightening. There is also no way to "google" this stuff and get answers, we all depend on brave people like RFK Jr, and Brett Weinstein to stand up and inform us. I was wondering if you had any advice on anything I can continue to do, and/or if you think I should even be concerned at this point. I know there's probably alot to unpack here, but any advice, or information that you have would be greatly appreciated. Thanks again for everything, and wish you all the best! -Marc     Sponsor: The Healthy Rebellion Radio is sponsored by our electrolyte company, LMNT. Proper hydration is more than just drinking water. You need electrolytes too! Check out The Healthy Rebellion Radio sponsor LMNT for grab-and-go electrolyte drink mix packets and the new LMNT Sparkling electrolyte performance beverage! Click here to get your LMNT electrolytes   Transcript: Coming soon! .

On this episode of the Real Life Pharmacology podcast, I cover medications 81 through 85 on the top 200 drug list. Famotidine is an H2 blocker. H2 blockers are less potent than PPIs but can be used to manage heartburn symptoms. Aspirin is technically an NSAID but is primarily used for cardioprophylaxis purposes. Senna is a stimulant laxative. I often see this medication used with opioids to help manage opioid-induced constipation. Novolog is a rapid acting insulin used to bring down post prandial blood sugars. I discuss sliding scale insulin and other concepts with this medication. Baclofen is a skeletal muscle relaxant. It has central nervous system depressant effects which can be especially problematic in elderly patients. Support the sponsor Meded101.com by going to meded101.com/store - Study materials, books, review courses for pharmacists, pharmacy students, pharmacy technicians, nurses, physicians, prescribers, dietitians, and all others who want to learn pharmacology!

The latest FDA approval of FluMist, a nasal spray influenza vaccine that can now be self-administered or given by caregivers for individuals aged 2 to 49 years. A systematic review found that while skeletal muscle relaxants (SMRs) like baclofen and cyclobenzaprine offer short-term relief for certain pain conditions, their long-term effectiveness remains questionable. Another study evaluated 24-hour versus 15-hour oxygen therapy for severe hypoxemia, finding no added benefit from the longer regimen in reducing hospitalizations or deaths.

Un nouvel épisode du Pharmascope est disponible… Et on s'attaque encore au trouble d'usage d'alcool! Dans cette deuxième partie, Nicolas, Isabelle et une invitée discutent des traitements de maintien du trouble d'usage d'alcool. Les objectifs pour cet épisode sont: Discuter des interventions comportementales dans le traitement de maintien du trouble d'usage d'alcool Discuter de la prise en charge pharmacologique du trouble d'usage d'alcool Comparer les avantages et les inconvénients de chaque classe médicamenteuse en trouble d'usage d'alcool Ressources pertinentes en lien avec l'épisode Wood E, Bright J, Hsu K, et coll. Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder. CMAJ. 2023 Oct 16;195(40):E1364-E1379. Repères canadiens sur l'alcool et la santé : rapport final. Centre canadien sur les dépendances et l'usage de substances. 2023 Répertoire des ressources en dépendances du MSSS INESSS. Sevrage d'alcool et prévention des rechutes. 2021. Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database Syst Rev. 2020 Mar 11;3(3):CD012880. McPheeters M, O'Connor EA, Riley S, et coll. Pharmacotherapy for Alcohol Use Disorder: A Systematic Review and Meta-Analysis. JAMA. 2023 Nov 7;330(17):1653-1665. Rösner S, Hackl-Herrwerth A, Leucht S, et coll. Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev. 2010 Dec 8;(12):CD001867 Rösner S, Hackl-Herrwerth A, Leucht S, et coll. Acamprosate for alcohol dependence. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD004332. Cheng YC, Huang YC, Huang WL. Gabapentinoids for treatment of alcohol use disorder: A systematic review and meta-analysis. Hum Psychopharmacol. 2020 Nov;35(6):1-11. Anton RF, Latham P, Voronin K, et coll. Efficacy of Gabapentin for the Treatment of Alcohol Use Disorder in Patients With Alcohol Withdrawal Symptoms: A Randomized Clinical Trial. JAMA Intern Med. 2020 May 1;180(5):728-736. Blodgett JC, Del Re AC, Maisel NC, Finney JW. A meta-analysis of topiramate's effects for individuals with alcohol use disorders. Alcohol Clin Exp Res. 2014 Jun;38(6):1481-8. Agabio R, Saulle R, Rösner S, Minozzi S. Baclofen for alcohol use disorder. Cochrane Database Syst Rev. 2023 Jan 13;1(1):CD012557.

Times where taking the muscle relaxer went completely wrong...

Alcohol Use Disorder (AUD) and cirrhosis are common medical conditions with significant morbidity and mortality. Join host, Geoff Wall, as he evaluates the new  American College of Gastroenterology guidelines.  The GameChangerThe MELD score is now preferred over the Madrey score for assessing mortality. Baclofen is the primary treatment for reducing consumption and craving in alcohol use disorder. HostGeoff Wall, PharmD, BCPS, FCCP, BCGPProfessor of Pharmacy Practice, Drake UniversityInternal Medicine/Critical Care, UnityPoint Health ReferenceJophlin LL, Singal AK, Bataller R, Wong RJ, Sauer BG, Terrault NA, Shah VH. ACG Clinical Guideline: Alcohol-Associated Liver Disease. Am J Gastroenterol. 2024 Jan 1;119(1):30-54. doi: 10.14309/ajg.0000000000002572. Epub 2023 Sep 1. PMID: 38174913.https://journals.lww.com/ajg/fulltext/2024/01000/acg_clinical_guideline__alcohol_associated_liver.13.aspx?context=featuredarticles&collectionid=5 Pharmacist Members, REDEEM YOUR CPE HERE! Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)CPE Information Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Discuss the initial treatment of a patient admitted with acute alcoholic hepatitis2. Describe a pharmacotherapeutic plan for adjunctive treatment of alcohol use disorder0.05 CEU/0.5 HrUAN: 0107-0000-24-042-H01-P Initial release date: 1/22/2024Expiration date: 1/22/2025Additional CPE details can be found here.Follow CEimpact on Social Media:LinkedInInstagram

Blane is reviewing a patient's electronic health record and notes that the patient has been prescribed baclofen. The therapist should understand that baclofen is primarily used for which of the following purposes? A. Relief of skeletal muscle spasms B. Increasing heart rate and blood pressure C. Managing symptoms of Parkinson's disease D. Lowering blood sugar levels LINKS MENTIONED: Did you get this question wrong?! If you were stuck between two answers and selected the wrong one, then you need to visit www.NPTEPASS.com, to learn about the #1 solution to STOP getting stuck. Are you looking for a bundle of Coach K's Top MSK Cheatsheets? Look no further: www.nptecheatsheets.com --- Support this podcast: https://podcasters.spotify.com/pod/show/thepthustle/support

Have you heard about using baclofen for alcohol use disorder? Does it work? How do you dose it? What are the contraindications? In this episode we do an evidence based review of the use of baclofen to treat alcohol use disorder

In deze podcast worden Marco Krukerink en Femke Veldman vergezeld door Chantal Emaus, huisarts en medisch directeur Eemland. Met zijn drieën bespreken zij 6 nieuws items. Dit keer op locatie in Brussel tijdens het Wonca congres. De volgende podcasts verschijnen weer in september. Een fijne zomer! De volgende items worden in deze podcast besproken: 1. Baclofen vermindert terugval in alcoholgebruik 2. Is een cultuursensitieve video over baarmoederhalsscreening nuttig? 3. Daling moedersterfte in Nederland 4. Nachtelijke bloeddrukstijging komt relatief vaak voor 5. Denk aan de SGLT2-remmer bij diabetes type 2 6. Ouderen met niet-specifieke klachten op de SEH zijn kwetsbaarder Veel luisterplezier!

Ms Lisa Beck, assistant professor of nursing and a clinical nurse specialist in the department of physical medicine and rehabilitation, shares her experiences over a career in caring for persons with intrathecal baclofen pumps for managing spinal cord injury related spasticity. Baclofen related complications such as withdrawal and overdose can both be fatal and pump specific complications as well require timely expertise from the emergency care team – but not often discussed in emergency medicine. Check out the episode to learn more! CONTACTS Twitter - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Singh NK, Agarwal A, Salazar L, Henkle JQ. Osborn waves in hypothermia induced by baclofen overdose. BMJ Case Rep 2009; 2009. Sullivan R, Hodgman MJ, Kao L, Tormoehlen LM. Baclofen overdose mimicking brain death. Clin Toxicol (Phila) 2012;50:141 Alden TD, Lytle RA, Park TS, et al. Intrathecal baclofen withdrawal: a case report and review of the literature. Childs Nerv Syst 2002;18:522

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.05.01.538987v1?rss=1 Authors: Gundersen, B. B., O'Brien, W. T., Schaffler, M. D., Schultz, M. N., Tsukahara, T., Lorenzo, S. M., Nalesso, V., Clayton, A. H. L., Abel, T., Crawley, J. N., Datta, S. R., Herault, Y. Abstract: Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

A client is an adult man with spastic cerebral palsy. He has a Baclofen pump and is preparing for Botox injections. He's also found a massage therapist who has the experience and expertise to help him—that's amazing! Understandably, the MT has questions about the Botox—what are the guidelines for manual therapy when this is used to treat spasticity? Well, that assumes that such guidelines exist, which is not a safe assumption. Listen to this episode of “I Have a Client Who . . .” for some thoughts about what to do next.   Sponsors:     Books of Discovery: www.booksofdiscovery.com       The Massage Mentor Institute: www.themassagementorinstitute.com     Host Bio:                    Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Werner is also ABMP's partner on Pocket Pathology, a web-based app and quick reference program that puts key information for nearly 200 common pathologies at your fingertips. Werner's books are available at www.booksofdiscovery.com. And more information about her is available at www.ruthwerner.com.                                      Recent Articles by Ruth:          “Working with Invisible Pain,” Massage & Bodywork magazine, November/December 2022, page 36, http://www.massageandbodyworkdigital.com/i/1481961-november-december-2022/38   “Unpacking the Long Haul,” Massage & Bodywork magazine, January/February 2022, page 35, www.massageandbodyworkdigital.com/i/1439667-january-february-2022/36.   “Chemotherapy-Induced Peripheral Neuropathy and Massage Therapy,” Massage & Bodywork magazine, September/October 2021, page 33, http://www.massageandbodyworkdigital.com/i/1402696-september-october-2021/34.           “Pharmacology Basics for Massage Therapists,” Massage & Bodywork magazine, July/August 2021, page 32, www.massageandbodyworkdigital.com/i/1384577-july-august-2021/34.           Resources:    Pocket Pathology: https://www.abmp.com/abmp-pocket-pathology-app   Adult Cerebral Palsy: Symptoms, New Challenges, Progression (2018) Healthline. Available at: https://www.healthline.com/health/adult-cerebral-palsy (Accessed: 22 February 2023).   Adults with Cerebral Palsy (no date). Available at: https://www.abmp.com/textonlymags/article.php?article=558 (Accessed: 22 February 2023).   Botox, Orthopedic Surgery, Posterior Rhizotomy and/or a Baclofen Pump? – KAREN PAPE, MD (no date). Available at: http://karenpapemd.com/Botox-orthopedic-surgery-posterior-rhizotomy-andor-a-baclofen-pump/?fbclid=IwAR0ymMxOR26gR2lg3ndskBbQgU5KQBKUU9d_cQHQqGmOox2-4II_9mS2TQg (Accessed: 21 February 2023).   Cerebral Palsy Massage Therapy (no date) Cerebral Palsy Guidance. Available at: https://www.cerebralpalsyguidance.com/cerebral-palsy/treatment/massage-therapy/ (Accessed: 21 February 2023).   Prevalence of Cerebral Palsy (no date) cerebralpalsy.org. Available at: https://www.cerebralpalsy.org/about-cerebral-palsy/prevalence-and-incidence (Accessed: 22 February 2023).   The Many Faces of Botox (no date). Available at: https://www.abmp.com/textonlymags/article.php?article=151 (Accessed: 22 February 2023).   ‘What is Cerebral Palsy?' (no date) Cerebral Palsy Research Network. Available at: https://cprn.org/what-is-cerebral-palsy-cp/ (Accessed: 22 February 2023).   About our Sponsor:   Massage Mentor Institute   In 2019, Diane Matkowski, aka the Massage Mentor, began a closed Facebook page for hosting discussions with industry leaders. These interviews gave her an idea for The Massage Mentor Institute and Jam Series workshops. The goal was to create various continuing education classes offered in one spot. The Institute is a space for massage therapists to learn different approaches and philosophies of bodywork and business classes. It's also home to the Shoulder, Hip, Neck, and Back Jam workshops. We believe that no one technique works for every human being. Our goal is to help you find your path. We have selected teachers we trust, admire, and believe will help you grow as a licensed massage therapist.   Website: themassagementorinstitute.com   Facebook Group: facebook.com/themassagementor   Instagram: @massagementorinstitute  

Stroke survivors with physical deficits have to fight to get the muscles moving again. They also have to fight to stop some muscles from moving. Tone and spasticity are why our elbows curl, our fists squeeze tight, and our toes can curl under our feet so we crush our own toes as we walk. Dr. Wayne Feng is an expert in tone and spasticity after stroke and he joins us this week to explain how we can address these challenges If you don't see the audio player below, visit Strokecast.com/MSN/ToneBasics to listen to the conversation. Click here for a machine-generated transcript Who is Dr. Wayne Feng? From Dr. Feng's Duke Profile: I am the division chief for Stroke and Vascular Neurology in the Department of Neurology at Duke Health. I see stroke patient in the emergency department, inpatient service as well as in the outpatient clinic. I also treated post-stroke limb spasticity, a disabling complication after stroke. In addition to the patient care, I also run a brain modulation and stroke recovery lab at the Duke University campus to study stroke patients in my lab to develop new stroke recovery therapy. On my days off, my boys and I are big on fishing. I enjoy drinking and collecting tea. As a stroke doctor, I do not drink coffee at all (there is a reason for it). If you come to see, I will tell you. Current Appointments and Affiliations: Professor of Neurology, Neurology, Stroke and Vascular Neurology 2019 Chief of Stroke & Vascular Neurology in the Department of Neurology, Neurology, Stroke and Vascular Neurology 2019 Professor of Biomedical Engineering, Biomedical Engineering 2022 [youtube https://www.youtube.com/watch?v=SGeOGI2bry4&w=560&h=315] Tone and Spasticity Overview Mos of our limbs move because of the interaction between two types of muscles -- extensors and flexors. The flexors contract to bend a limb. The extensors contract to extend the limb. For example, the biceps are flexors. They pull our forearm up or into an angle. When people want to show off their arm muscle, the flex their arm -- they activate their flexors. The triceps on the back of the upper arm are extensors. When they activate, they extend the arm -- they pull the arm straight.  When flexors contract extensors relax. When extensors contract, flexors relax. That's how we control our limbs. After stroke, the flexors can activate on their own. And they can be, well, overenthusiastic, in those actions. That happens because the default behavior of the flexors is to be active and curl up. When we talk about curling up into the fetal position, that's most of our flexors activating. The reason we can go through life upright and with our limbs straight is that the cortex of the waking brain is constantly suppressing the normal contracting of the flexors. After stroke impacting the motor cortex of the brain, the corticospinal tract is disconnected. With that disconnect, the brain can no longer suppress the flexors so they do what they do -- they contract and curl and cause all sorts of problems. Peripheral vs Cortical Problems Categorizing issues as cortical or peripheral is a fancy way of saying brain or limb. A stroke is a cortical issue. The problem exists in the brain. That's where the disconnect happens. A peripheral issue is when something goes wrong in the limb. Shoulder subluxation, for example, is peripheral issue. Most PT and OT works with the limbs to treat the cortical issues. Tone and spasticity are caused by cortical issues. The long-term problems caused by tone and spasticity are peripheral issues. One of those peripheral issues is contracture. When tone and spasticity is severe and long term, the muscles, tendons, ligaments, and other soft tissue can actually shrink in the contracted position. When that happens, getting the extensors back online and suppressing the flexors no longer  helps. The limb can become almost permanently bent. Repairing peripheral issues, like contracture, may require surgery to sever and extend tendons and other tissue. Preventing and Treating Tone and Spasticity The first line of defense is in the immediate short-term after stroke. Getting the limbs moving and keeping them moving to drive the neuroplastic change of recovery helps. Beyond that, and once tone and spasticity set in, regular stretching is critical. A survivor needs to keep stretching those limbs to prevent contracture. That's why in conference calls and interviews, I'm often stretching my fingers back and my wrist back to counteract the tone and spasticity in my left arm and hand. Medication can help, too. Baclofen is a popular choice. It's basically a muscle relaxer that helps counteract the excessive action in my flexors. Some people find it can cause drowsiness so it's not the best choice for everyone. I tend to take my Baclofen before going to bed. If it makes me drowsy then that's great. It also helps reduce the tone I might experience overnight. For folks with severe tone and spasticity, a surgically implanted Baclofen pump can help. The medicine directly target the key muscles which means the patient needs much less medicine for a much greater impact. Since it is a low dose, it is less likely to induce the fatigue, too. Other medications to treat tone and spasticity include: Tizanidine Flexeril Gabapentin Botox, Dysport, and Xeomin are also treatments that can help. These are neurotoxins that a doctor can inject every three to four months. By delivering the toxins to the flexors, it reduces their ability to flex. That gives the extensors a chance to recover and rebuild a normal relationship. Of course, this is a short-term solution. Combined with exercise, it can definitely help. I'm probably overdue for my next Dysport treatment. Contralateral C7 Nerve Transfer for Stroke Recovery: New Frontier for Peripheral Nerve Surgery A promising area for relieving tone and spasticity is C7 nerve transfer. Recent studies are showing promising results. Neurosurgeons split the a nerve from the unaffected side of the brain that runs through the spine and reconnect half of it to the equivalent nerve on the affected side. The do this in the neck. Results show a quick reduction in tone and spasticity even in patients 15+ years after stroke. After a year, patients are experiencing improved use of the limb, too. The number of people in the studies so far is pretty small (36) and more research is needed. It is a promising result, though, and builds on techniques that have been used to treat non-stroke injuries. It also highlights the tremendous ability of the brain to adapt since now the unaffected side starts to control the affected side of the body. You can read a review of the technique and studies at the Journal of Clinical Medicine. Vagus Nerve Stimulation In 2021, I spoke with Dr. Jesse Dawson, a Professor of Stroke Medicine and Consultant Physician in the Queen Elizabeth University Hospital in Scotland about his research in Vagus Nerve Stimulation. This research is now being commercialized and used to treat patients in the US. The therapy involves surgically implanting a stimulator in a patient's chest that connects to the Vagus nerve. During PT or other exercises, the device sends an electric signal to the Vagus nerve. Stimulating the nerve while doing therapy has shown positive results in terms of limb use. It's interesting because it's not treating the Vagus nerve itself, but stimulating this nerve appears to make the other nerves in the brain more receptive to the therapeutic exercises. You can learn more about this research here: http://Strokecast.com/VNS. Survey What do you think of the Strokecast? Let me know what you like and what you would like to be different by completing the survey at http://Strokecast.com/Survey. I would really appreciate it. If you complete the survey by March 31, 2023, you could win a $25 Amazon gift card, too. Hack of the Week Hand grip exercisers are nice tools to encourage stretching and exercise throughout the day. These things are like a pair of pliers without the tool end. They are spring loaded. You squeeze them to exercise and they try to force your hand open. You can get them in a variety of strength levels. Start with light weight ones and move on to tougher ones as your strength improves. What I like about them is that closing a fist comes back before opening one. Closing your fist takes work. Opening your fist is often harder, but these gadgets force the hand open. So you get to practice the squeeze and you get a stretch into fingers, too, to address tone and spasticity. It's also one more way to reduce the odds of developing a contracture. Here are a couple options: https://strokecast.com/Hack/HandExerciserTraditional (Traditional design)* https://strokecast.com/Hack/HandExerciserAdjustable (Adjustable resistance)* Links Where do we go from here? Check out Dr. Feng's work at Duke University Share this episode with someone you know by giving them the link http://Strokecast.com/ToneBasics Complete the Strokecast survey at http://Strokecast.com/Survey Don't get best…get better More thoughts on Tone and Spasticity

Multiple Sclerosis News Today's multimedia associate, Price Wooldridge, discusses how Baclofen, an approved therapy for spasticity in multiple sclerosis patients, promoted myelin repair in preclinical models of the disease. He also reads “MS and Sex: Everything You Wanted to Know but Were Never Told to Ask”, a column by John Connor. =================================== Are you interested in learning more about multiple sclerosis? If so, please visit: https://multiplesclerosisnewstoday.com/ ===================================== To join in on conversations regarding multiple sclerosis, please visit: https://multiplesclerosisnewstoday.com/forums/

Multiple Sclerosis News Today's multimedia associate, Price Wooldridge, reads the news article on how a man-made molecule was able to promote myelin repair in a mouse model of MS. He also reads “A Friend Under the Skin: My Intrathecal Baclofen Pump” by Benjamin Hofmeister, from his column "Chairborne". =================================== Are you interested in learning more about multiple sclerosis? If so, please visit: https://multiplesclerosisnewstoday.com/ ===================================== To join in on conversations regarding multiple sclerosis, please visit: https://multiplesclerosisnewstoday.com/forums/

Dr. GG deFiebre of SRNA was joined by Dr. Miguel Escalón for an Ask the Expert podcast on "Managing Spasticity with a Baclofen Pump." Dr. Escalón began by giving an overview of spasticity, tone, and treatment options. He explained how the baclofen pump works, its advantages, and the impact on neurogenic bladder and bowel function. Next, Dr. Escalón described the initial surgical procedure, recovery process, and potential risks. Finally, he discussed long-term operation and maintenance, as well as safety measures and how pregnancy might impact the baclofen pump.

Dr. Roland Engelbrecht is a family physician in British Columbia, Canada, who has dedicated his medical practice to addiction treatment. He is also a member of the Canadian Alcohol Use Disorder Society, founded by Dr. Jeff Harries.The goals of CAUDS include educating the public about alcohol use disorder and how it is a medical condition that deserves compassion, not stigma. CAUDS also works to educate healthcare providers and the public about proven medical treatments that are effective in helping people to overcome alcohol addiction.While previous episodes on this podcast have focused on the use of naltrexone in treating alcohol use disorder, there are other medical treatments which can be helpful, in addition to naltrexone, or as an alternative for people who cannot tolerate naltrexone. There are also people who do not respond well to naltrexone, so adding additional medication can sometimes be helpful.Now, that medication assisted treatment of alcohol use disorder is becoming more commonplace, mainly as a harm reduction method in the form of The Sinclair Method, it is important that patients and their doctors understand that there are additional treatments available that can help to make their program more effective, if needed.I hope that this podcast episode is helpful in providing useful information to patients who can share it with their doctors, and for doctors who are looking for additional resources to offer their patients. For more information on the topics discussed in this episode, please visit http://www.cauds.org/, and please follow CAUDS on social media.Twitter handle: @cauds_orgFacebook page: https://www.facebook.com/caudsorgAlso, for more great podcast episodes and articles, please visit https://therehab.com and https://drleeds.com.

Dr Dave Maplesden and Dr Jo Scott-Jones talk about frailty of old age, medicinal cannabis, a new use for Empagliflozin, Penicillin allergy, Baclofen and a touch of the covid19s.

Peter Yeo, a C4 incomplete quadriplegic from British Columbia, Canada, shares the two surgeries that helped him regain movement after his spinal cord injury, including a groundbreaking therapy to treat spasms after maxxing the daily maximum of Baclofen. He was also the first to receive this treatment. And although he still has limited upper-body mobility, the surgeries were able to restore some function he did not have before. Peter also shares the therapy he is doing at Neuromotion Rehabilitation on a weekly basis. Run-time is 25 minutes. If you have any questions about his surgeries, or if would you like to connect with Peter, you can reach him via his Instagram at @pt_hwoarang

Gill discusses anxiety and addiction. She explains how the brain keeps itself in balance, how alcohol affects this balance, and how this causes us to feel relaxed when we drink and then anxious when we don't. You'll learn why we get hangxiety when we try to stop drinking, how genetics plays a role, how long it generally takes for the brain to balance itself out after we quit, and more about a drug called Baclofen which is prescribed off label in some countries to treat alcohol addiction.Episodes to listen to nextE22: Why You Think Alcohol Helps You AnxietyE43: Drinking to CopeAs a listener of Sober Powered you get special discounts from my sponsors!Exact Nature is giving you 20% off all of your future orders with the code SP20.  Click here to learn more or visit www.exactnature.comGruvi is giving you 10% off your first order with the code POWER10. Click here to learn more https://www.getgruvi.com/?utm_source=social&utm_medium=podcast&utm_campaign=gilltietzSign up to get emails from me.Check out my new YouTube channel, new videos every Tuesday.  Please subscribe! Key takeaways and sources are posted here.Follow Sober Powered on Instagram for more education and inspirationJoin the Sober Powered Facebook Group for extra supportAnd if you're enjoying this podcast, please use this link to leave a review on iTunes.  This podcast takes so much effort and work to create, and each review increases the possibility that this podcast can be seen by people who may need it.  Disclaimer: all of the information described in this podcast is my interpretation of the research combined with my opinion.Support the show (https://www.buymeacoffee.com/soberpowered)

Dr. Bhooma Aravamuthan, a pediatric neurologist, movement disorders expert, and lab researcher tackling HIE and dystonia, joins us during Cerebral Palsy Awareness Month to discuss diagnosis of cerebral palsy and dystonia in HIE, transitioning from pediatric to adult medicine, treatments and surgical options for dystonia, and some strategies to help partner with your child's medical team if you suspect or have confirmed dystonia. We are grateful for Dr. Aravamuthan's involvement in our Medical Advisory Board. Key show notes: Advocacy continues to push for earlier detection and diagnosis of cerebral palsy, which can improve access to therapy services and connections to other families and people in the cerebral palsy community. A call for better transitions of care for children with cerebral palsy aging out of pediatric services and transitioning into the adult medicine world, and the needs of adults with cerebral palsy. Many times getting a diagnosis for dystonia is difficult, especially in a child with CP after HIE. Dr. Aravamuthan works with both animal and human research to improve diagnostics and treatments for dystonia that comes from HIE, which traditionally has not been receptive to treatments that may benefit those with dystonia from non-HIE causes. Some signs that can help differentiate spasticity vs. dystonia = spasticity maintains pretty much the same throughout the day. Dystonia is variable and triggerable and may be triggered by trying to move or excitement-induced movement. Families can help give more insight to their pediatric neurologist by capturing movements on video and sharing with their provider and team for analysis, to augment the in-person clinical assessment. More research is needed into treatments. Evidence is now showing some medications are not as effective, and some may be more effective in treating. Surgical options such as Deep Brain Stimulation in children identified earlier than seven years old can be effective, and intrathecal Baclofen pumps may be beneficial when placed up on the spine further than when it is traditionally used for spasticity management may also be a consideration. --- Support this podcast: https://anchor.fm/justsayhie/support

The second episode of the Baclofen Series is here! If you have or are considering getting the baclofen pump you don't want to miss out on hearing this chat with Aldelly Gratereaux! https://youtu.be/ri0EIiDq_LQ You can also listen to this episode by searching Spastic Chatter on your favorite podcast platform. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/whitney-bailey/support

Sundays are for Spastic Chatter Series! Spastic Chatter began as a platform for the cerebral palsy community, but I've decided to branch out to include the entire disabled community. Introducing Spastic Chatter Series. I'll be interviewing people about different topics. The first series is "The Baclofen Series" and the episodes will feature stories of people who are taking baclofen or have the baclofen pump! https://youtu.be/MP0iB4XqAEs You can also listen to this episode on your favorite podcast platform by searching Spastic Chatter. *Regular episodes of Spastic Chatter will be uploaded on Wednesdays --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/whitney-bailey/support

Editor's Summary by Howard Bauchner, MD, Editor in Chief of JAMA, the Journal of the American Medical Association, for the February 23, 2021 issue

Baclofen is primarily used for its ability to help relieve muscle spasms. I discuss baclofen pharmacology on this podcast episode. Baclofen should not be abruptly discontinued as it can cause a significant withdrawal reaction whose symptoms may include fever, spasticity, rhabdomyolysis, and death. While baclofen generally avoids any issues with CYP enzyme interactions, it is eliminated by the kidney. Renal function changes can alter drug concentrations. Sedation, confusion, dizziness, hypotension, and GI upset are some of the more common adverse effects of baclofen.

There are 10 mg and 20 mg dosage pills available in the pharmacies. The normal starting dose of oral baclofen for the care of spasticity in adults is 5 mg given thrice daily. Depending on the response, the dosage can be increased by 5 mg per three days to a maximum of 80 mg/day in separate doses.https://recoverypartnernetwork.com/drug/illicit/baclofen-addiction

Baclofen is used in treating certain forms of spasticity (muscle tension and tightness) caused by multiple sclerosis, spinal injuries, or other spinal cord related conditions.https://recoverypartnernetwork.com/drug/illicit/baclofen-addiction

Baclofen is far more effective than Flexeril and has fewer side effects. https://recoverypartnernetwork.com/drug/illicit/baclofen-addiction

In New York, 10 mg of baclofen would cost around $0.92 per pill when obtained illegally. While in other states, the price may be as high as $2 per pill.https://recoverypartnernetwork.com/drug/illicit/baclofen-addiction

Baclofen is used as a skeletal muscle relaxant to help manage pain. https://recoverypartnernetwork.com/drug/illicit/baclofen-addiction

In addition to muscle relaxation, baclofen tends to have an anxiolytic effect that decreases anxiety. https://recoverypartnernetwork.com/drug/illicit/baclofen-addiction

Weight gain is a rare side effect of baclofen. Such side effects may fade away during treatment as the body adapts to the drug. A health care professional may also be able to tell you how to avoid or minimize some of these side effects.https://recoverypartnernetwork.com/drug/illicit/baclofen-addiction

Taking excessive amounts of baclofen or mixing it with other drugs can generate a feeling of euphoria. https://recoverypartnernetwork.com/drug/illicit/baclofen-addiction

Baclofen can be administered orally with or without food as per the directions given by your doctor, typically three times a day. To minimize side effects, your doctor may start you off at a low dose and increase the dosage gradually. https://recoverypartnernetwork.com/drug/illicit/baclofen-addiction

The baclofen pill typically starts to work about thirty minutes after taking it, but it can vary from person to person.https://recoverypartnernetwork.com/drug/illicit/baclofen-addiction

This drug may cause sleepiness. It is advised to refrain from consuming alcohol or taking any other drug while on baclofen, as it may make you more drowsy.https://recoverypartnernetwork.com/drug/illicit/baclofen-addiction

Side effects may include sleepiness, dizziness, fatigue, exhaustion, headache, sleep problems, nausea, frequent urination, or bowel problems.https://recoverypartnernetwork.com/drug/illicit/baclofen-addiction

The recommended dosage is 60 - 120 mg per day divided into three doses each day. However, the dose may change based on how it works for you and your drug tolerance. The basic starting dose is 10 mg per night.https://recoverypartnernetwork.com/drug/illicit/baclofen-addiction

PNS-- centrally acting sk.muscle relaxants --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Contributor: Erik Verzemnieks, MD Educational Pearls: Baclofen is used to treat muscle spasms or spasticity. Baclofen comes in two forms: oral and intrathecal Withdrawal is much more common with those receiving intrathecal administration from a Baclofen pump, which is typically spinal cord patients Withdrawal symptoms usually start within 1-3 days after stopping baclofen Symptoms include altered mental status, muscle rigidity, and fevers, which can mimic other severe illnesses It is nearly impossible to reverse withdrawal symptoms with oral baclofen if a patient is receiving it intrathecally, so solving the pump problem is key References Ross JC, Cook AM, Stewart GL, Fahy BG. Acute intrathecal baclofen withdrawal: a brief review of treatment options. Neurocrit Care. 2011 Feb;14(1):103-8. doi: 10.1007/s12028-010-9422-6. PMID: 20717751. Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account.

Join us in our interview with spasticity management expert, Dr. Cindy Ivanhoe, where we discuss the intricacies of intrathecal baclofen pumps including patient selection, complications and others.

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.08.14.251330v1?rss=1 Authors: Bushart, D., Huang, H., Man, L., Morrison, L., Shakkottai, V. Abstract: Background: A combination of central muscle relaxants, chlorzoxazone and baclofen (chlorzoxazone-baclofen), has been proposed for treatment of cerebellar symptoms in human spinocerebellar ataxia (SCA). However, central muscle relaxants can worsen balance. The optimal dose for target engagement without toxicity remains unknown. Objectives: Using the genetically precise Atxn1154Q/2Q model of SCA1, we determine the role of cerebellar dysfunction in motor impairment. We also aim to identify appropriate concentrations of chlorzoxazone-baclofen needed for target engagement without toxicity to plan for human clinical trials. Methods: We use patch clamp electrophysiology in acute cerebellar slices and immunostaining to identify the specific ion channels targeted by chlorzoxazone-baclofen. Behavioral assays for coordination and grip strength are used to determine specificity of chlorzoxazone-baclofen for improving cerebellar dysfunction without off-target effects in Atxn1154Q/2Q mice. Results: We identify irregular Purkinje neuron firing in association with reduced expression of the ion channels Kcnma1 and Cacna1g in Atxn1154Q/2Q mice. Using in vitro electrophysiology in brain slices, we identify concentrations of chlorzoxazone-baclofen that improve Purkinje neuron spike regularity without reducing firing frequency. At a disease stage in Atxn1154Q/2Q mice when motor impairment is due to cerebellar dysfunction, orally administered chlorzoxazone-baclofen improves motor performance without affecting muscle strength. Conclusion: We identify a tight relationship between baclofen-chlorzoxazone concentrations needed to engage target, and levels above which cerebellar function will be compromised. We propose to use this information for a novel clinical trial design, using sequential dose escalation within each subject, to identify dose levels that are likely to improve ataxia symptoms while minimizing toxicity. Copy rights belong to original authors. Visit the link for more info

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.06.29.178236v1?rss=1 Authors: Marti-Prats, L., Belin-Rauscent, A., Fouyssac, M., Puaud, M., Cocker, P. J., Everitt, B. J., Belin, D. Abstract: While most individuals with access to alcohol drink it recreationally, about 5% lose control over their intake and progressively develop an alcohol use disorder (AUD), characterised by compulsive alcohol drinking accompanied by decreased interest in alternative sources of reinforcement. The neural and molecular mechanisms underlying the vulnerability to switch from controlled to compulsive alcohol intake have not been fully characterized, so limiting the development of new treatments for AUD. It has recently been shown that rats having reduced levels of expression of the gamma-aminobutyric acid (GABA) transporter, GAT-3, in the amygdala tend to persist in seeking and drinking alcohol even when adulterated with quinine, suggesting that pharmacological interventions aimed at restoring GABA homeostasis in these individuals may provide a targeted treatment to limit compulsive alcohol drinking. Here, we tested the hypothesis that the GABAB receptor agonist baclofen, which decreases GABA release, specifically decreases compulsive alcohol drinking in vulnerable individuals. In a large cohort of Sprague-Dawley rats allowed to drink alcohol under an intermittent two-bottle choice procedure, a cluster of individuals was identified that persisted in drinking alcohol despite adulteration or the availability of an alternative ingestive reinforcer, saccharin. In these rats, that were characterised by decreased GAT-3 mRNA levels in the central amygdala, acute baclofen administration (1.5 mg/kg, intraperitoneal) resulted in a decrease in compulsive drinking. These results indicate that low GAT-3 mRNA levels in the central amygdala represent an endophenotype of AUD and that the associated compulsive alcohol drinking characteristic is sensitive to baclofen. Copy rights belong to original authors. Visit the link for more info

Podcast summary of articles from the April 2020 edition of the Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include ECG findings in Pericarditis vs. STEMI, Baclofen toxicity, POCUS for hip pain, Erector Spinae Plane Blocks, Diabetic Ketoacidosis in an ED/ICU setting and board review on Measles.  Guest speaker is Dr. Ryan Yavorksy.

In this latest episode of our Research Corner series, Dr. Hill sits down with PGY-3 Adam Gottula, MD and Amanda Peck, PharmD to discuss their recently published case report describing the use of dexmedetomidine for the management of acute intrathecal baclofen withdrawal. The discussion encompasses the mechanisms of action of baclofen, dexmedetomidine, and how dexmedetomidine might be useful in the management of these complex patients.

Dec 17--Daniel Royal, DO, CTP, JD reviews international obituaries of those who died too soon from diseases they shouldn't have had, reports on bladder cancers caused by oil refineries and Actos medicine, increased suicides from Gabapentin and Baclofen, excess sleep and strokes, the power of Olive Leaf Extract, and rules for immortality....Tired of disease management? Want health optimization? Want to know more about Stem Cells, Natural Cancer Treatments, etc.? Listen to "ROYAL MEDICAL RADIO," Tuesdays 1-2 p.m. (PST), on www.AmericaMatters.us or send an email to: droyal@royalmedicalclinic.com.

Saul and the guys sit down with Troy Shenker (Detox Technician at Soul Sanctuary) to talk about his journey getting sober. Troy tells us a funny story about taking too much Baclofen. He opens up about the loss of his mother. Troy talks about the time he got red flagged at a pharmacy. He walks us through the days leading up to going into treatment. Troy takes us through what its like working in treatment. Lastly He shares with the guys what he does to stay sober on a daily basis.

One doctor's battle with alcoholism and self-experimentation with baclofen led to a rush of people desperate to try the drug to curb their addictions. But are we simply replacing one problem with another, asks Enna Guadalupe 

In this episode we will discuss Trigeminal Neuralgia with Pamela from British Columbia, Canada.  This painful and rare condition has no cure but Pam gives us tips on dealing with severe facial pain. Transcript: s3e1 trigeminal neuralgia.mp3   Lita [00:00:07] Hello and welcome to another episode of podcastDX. The show that brings you interviews with people just like you whose lives were forever changed by a medical diagnosis. I'm Lita and one of our co-hosts. Ron is not with us today. Jean [00:00:22] And I'm Jean Marie. Lita [00:00:23] Collectively we are the hosts of podcastDX on today's show we are speaking with Pamela. Pamela is joining us once again from Victoria British Columbia in Canada. Jean [00:00:35] And we actually had the honor of speaking with Pamela last week regarding fibromyalgia this week. Pamela is here to tell us all about her experience with the trigeminal neuralgia. Lita [00:00:45] Well ok that's a mouth full. (Laughter) In case you missed last week's episode Pamela is happily married to her amazing husband Ray and they're the proud parents of two grown kids with three wonderful grandsons. Pamela worked for years whilst battling with pain from fibromyalgia and osteo arthritis while employed as an administrative specialist. She was also a certified event planner with her career behind her now and she is on long term disability. She is now a blogger. I've always wanted to blog. I'm not into blogging but maybe you can get me going on it (laughter) she really, I need to know. She writes about chronic pain chronic fatigue fibromyalgia an invisible illness in addition to blogging. Pamela is an active volunteer with the patient volunteer network or PVN in British Columbia. Outside of the PVN she has also done volunteer work for Island health as a patient advisor. She was on the advisory committee for opioid guidelines in Canada and volunteered this summer with the downtown Victoria Business Association Buskers Festival. Jean [00:01:56] Hello again Pamela and I, might I say that I'm just exhausted hearing about how much you do. Welcome back. Lita [00:02:03] Yes. Pamela [00:02:04] Thanks so much for having me back again. Lita [00:02:07] Pamela I was reading over the data sheets for the conditions that have placed you on the long term disability list. And I would venture to say that you have your plate full. We have.... Pamela [00:02:18] I do. Lita [00:02:19] ...(laughter). Jean [00:02:20] Yeah. Lita [00:02:21] ...Separated the two major conditions into the two separate episodes. We covered fibromyalgia last week and that leaves this week with trigeminal neuralgia. First to give our listeners an idea of exactly what we're talking about what is trigeminal neuralgia. Pamela [00:02:37] Trigeminal neuralgia is a chronic pain condition it involves the areas inerverated by the 5th cranial nerve so the area of the body involved is the face it can cause severe pain even when doing simple things like brushing your teeth shaving putting on makeup touching your face eating drinking speaking or even when something as simple as a breeze whispers across the face. Jean [00:03:04] Oh Pamela you mentioned the fifth cranial nerve and what is that exactly. Pamela [00:03:12] OK so the fifth cranial nerve is one of the most widely distributed nerves in the head. Jean [00:03:17] OK. Pamela [00:03:17] So the classic type of trigeminal neuralgia disorder called Type 1 or TM1 causes extreme sporadic sudden burning or shock like pain which may last from a few seconds to as long as two minutes per episode. Lita [00:03:32] mm mm. Jean [00:03:33] oh God. Pamela [00:03:33] And episodes can often come in a series of attacks that lasts for several hours. Jean [00:03:38] ohh. Pamela [00:03:38] But I have something called atypical TM. Jean [00:03:41] ok. Pamela [00:03:41] Which is when the pain comes in a long lasting wave... Jean [00:03:44] ohhh. Pamela [00:03:45] ...Instead of a short burst. So for me no but for me it's like a hundred little cameras there hitting the same area of my face... Lita [00:03:52] Oh my gosh. Pamela [00:03:53] ...For hour after hour. Lita [00:03:54] oh my God. Pamela [00:03:55]  my episodes tend to last for eight to 12 hours at a time. Lita [00:04:00] Oh. Pamela [00:04:00] They start just under my right cheekbone and then it spreads first to my sinus cavity then down towards my jaw. And I often feel spasms in my esophagus as well. Jean [00:04:11] Oh my gosh. Lita [00:04:12] Wow. Pamela [00:04:14] Yeah. Lita [00:04:14] Wow. Pamela [00:04:15] Not fun. Lita & Jean [00:04:15] No. Jean [00:04:16] Wow. Lita [00:04:17] Wow. I mean my mouth hurts just. Pamela [00:04:20] yeah. Lita [00:04:20] Listening to you. Jean [00:04:21] That's that's awful. Pamela [00:04:22] Mmhmmm Lita [00:04:23] Pamela what causes Trigeminal neuralgia. Jean [00:04:25] And how can we avoid it. Lita [00:04:27] Yeah. Pamela [00:04:27] Well there's actually several possible causes for trigeminal neuralgia. So it sometimes begins as the result of the nerve sheath being too close to a blood vessel in the neck area where it exits the brain stem. Jean [00:04:42] ok. Pamela [00:04:42] In other cases it can be caused by things like multiple sclerosis. Lita [00:04:46] Which also takes away the sheath, right. Pamela [00:04:48] Yeah exactly. Another reason for this condition can be a tumor pressing on the nerve or it might be the result of the wearing down of the sheath of the covering on the nerve. It could be the result of physical damage to the trigeminal nerve perhaps from the sinus surgery or an oral surgery or stroke or other facial trauma. Jean [00:05:10] ok.   Pamela [00:05:10] In my case we suspect that the nerve is rubbing against something based on the MRI scan that I had done. Jean [00:05:17] OK. Lita [00:05:18] Wow can you tell us. I mean you know obviously the pain right. Is that what led you to to find out what this diagnosis would be. Pamela [00:05:27] Yeah. The reason I was sought treatment was because I was suddenly having these pain episodes in my face. And after the first one or two I realized they weren't just sinus infections because I wasn't showing any other symptoms that you would typically get with an infection. Lita [00:05:42] ok. Pamela [00:05:43] So I saw my doctor and I described the pain. And I was diagnosed TM based on the description. And then when I was first put on medication it stopped the episodes from happening and that's when we knew that we'd made the right diagnosis. Lita [00:05:56] OK. Is it just a nerve pain type of a medication then. Pamela [00:06:01] Yeah. That's what we started with. One of the first drugs that they prescribed to. Yes. Lita [00:06:06] OK. Well while reading about this week's topic I read that a person with trigeminal neuralgia might feel as if they had an abscess tooth or like you were saying a sinus infection. And since it can affect the jaw area it seems like that could make it a difficult condition to diagnose. I mean like is it a tooth is it. Jean [00:06:27] Sinuses. Lita [00:06:28] Sinuses. Is it Is it the gum you know. So was it it was not that difficult for you to get the diagnosis though huh. Pamela [00:06:36] No like I said just describing the pains my doctor and how it flared into my sinuses first and then into my jaw helped him to realize that it wasn't an abscess in the jaw area. Lita [00:06:48] Yeah actually you know what about a heart attack. Jean [00:06:50] Yeah I'm you know yeah. You could have jaw pain. Lita [00:06:52] You could have had jaw pain with a heart attack. Jean [00:06:53] Sure. Lita [00:06:54] There's a lot of things that. Jean [00:06:55] Yeah. Lita [00:06:56] They could have worried about. Jean [00:06:57] well, yeah. Lita [00:06:57] I'm glad the doctor thought about it right away. Jean [00:06:59] you've had, Yeah. You had someone that really... Pamela [00:07:01] Yeah. Jean [00:07:01] ...understood what it was. Lita [00:07:01] understood it right. Jean [00:07:02] Yeah. And I understand that there are several tests that can be done to help determine the extent of the terminal neuralgia. Can you tell us a little bit more about this testing. Pamela [00:07:11] Yeah. So in most cases the doctors start by asking questions about your symptoms and ask about your medical history. Then they usually perform a physical examination of the head in the neck areas including the ears the mouth the teeth and the temporal mandibular joint with the TMJ. Jean [00:07:31] Right. Pamela [00:07:31] And other disorders that may cause facial pain and mimic TM type pain. They'll ask questions about that. So these conditions need to be ruled out first before a definitive diagnosis was made. And then often what they'll do is they'll order a magnetic resonance imaging an MRI scan. Jean [00:07:53] Ok. Pamela [00:07:53] They do that to rule out the presence of a brain tumor or multiple sclerosis or other causes. Jean [00:08:00] ok. Pamela [00:08:00] And the scans can also determine whether or not a blood vessel is pressing on the nerves. And so that's what my doctor did was he ordered the MRI for me and that's where we could see how the nerve was being compressed. Lita [00:08:12] OK. Wow that's quite a few tests. I know that when we were talking last week you said that during a procedure. Jean [00:08:21] Something was leaning on a nerve. Lita [00:08:22] Something was leaning on a nerve. Now could that have caused this. Pamela [00:08:26] Yeah. Oh yeah. They they could see that the blood vessel is pressing against the nerve. Jean [00:08:34] OK. Lita [00:08:34] So it wasn't something that the doctor was leaning against. It's right now it's just a blood vessel. That’s pressing because I'm just saying like what made what made the blood vessel all of a sudden press against the nerve. Pamela [00:08:44] You see they're not really sure. Lita [00:08:46] OK . Pamela [00:08:47] They're not really sure what's what's causing it to do that. And actually until I undergo you know some type of surgery they wouldn't be able to say for certain until that happens. Lita [00:08:59] ok When I don't know if I asked when did this problem start compared to the fibromyalgia. Pamela [00:09:05] I've had the TM for probably about 14 years now. Jean [00:09:10] oh my gosh. Pamela [00:09:10] And I didn't realize that I had it in the beginning simply because I thought it was a sinus infection. Lita [00:09:18] OK. Pamela [00:09:19] When I first had it and the episodes were really infrequent in the beginning so I just brushed it off. So when I started having them on a much more frequent basis then I knew that there was a problem. And that's when I went to the doctor. Lita [00:09:33] got it. Pamela [00:09:33] So I would say 14 years in total. But you know on a more frequent basis probably over the last four years. Lita [00:09:41] OK. Jean [00:09:42] ok And  Pamela you said that some medica.. Medications have helped a bit. Are there any other treatments available for patients with trigeminal neuralgia. Pamela [00:09:50] Yeah. There are treatments for trigeminal neuralgia which can help to reduce pain and improve quality of life. So what they normally do is they start off with a medication called carbamazepine which is also known as Tegretol. That's the first drug of choice. And if that doesn't work or if it stops working as it did in my case the other drugs that they use are called lamatrine gabapentin and pregablin and then sometimes use Baclofen which is a muscle relaxant. And then I also took a drug called topiramate. Lita [00:10:26] topiramate. Pamela [00:10:26] which I don't take right now. Lita [00:10:28] Yeah. Pamela [00:10:28] Yeah. It's an anticonvulsant and that worked for me for a long time actually for almost two years. But it has stopped working and I am now at a point where I am having flare ups about once a week. Lita & Jean [00:10:44] ohh. Pamela [00:10:44] So yeah. And so at this point unfortunately I have no other drug options left. I even tried botox botox is often used as a last resort where they inject botox along the hairline not into the actual area where you have the infection but they do it along the hairline and that's done to try and paralyze the muscles that are flaring up from, from the nerve. But that was unsuccessful for me as well. So now the only option left for me is a surgical option. Jean [00:11:17] Oh wow that's Yeah. You can't go back to a medication like if you're on a medication for sometime and it stops working. Pamela [00:11:24] There's. Yeah. There is once medication stopped working that stops working and you can't go back to the old again. They just. They just don't work again. Jean [00:11:35] Okay. Okay. And Pamela I really think we should let our listeners know that this is a disorder which is considered to be one of the most painful human conditions. Lita [00:11:45] Yes. Jean [00:11:46] And just reading that statement makes me really cringe. In your opinion how bad would you say the pain is. Pamela [00:11:54] Well the nickname of this condition is the suicide disease. When I'm in a full TM flare up I'll be honest I want to claw my face off. The pain is a 15 out of 10. It is absolutely unrelenting. And that's the worst of it. If I knew I was going to get relief in just a short period of time it would be easier to bear. But when I get the telltale pulse under my cheekbone that a flare is coming up. I know that I'm in for 12 hours of agony. It's the most painful thing that I have ever experienced. Jean [00:12:30] I'm so sorry. Lita [00:12:31] Oh goodness gracious. Jean [00:12:33] Yeah that’s. Lita [00:12:33] Pam. And too bad they can't have like. I know that this... Pamela [00:12:37] There's. Lita [00:12:37] ...sounds bad, like put you to sleep. You know like put you in a semi coma. Knock you, you know go in for a shot. You know like you you go in for this. Jean [00:12:44] Imitrex. Lita [00:12:46] no not Imitrex to get the sleep that I went in for the shots. Jean [00:12:49] Oh yeah. Pamela [00:12:49] Yeah there's times that I've I've debated going into the emergency room to see if there's anything that they can do to help me. Jean [00:12:58] Right. Pamela [00:12:58] And I've gone once or twice and I've said to them I am in the middle of a TM flare up and I just want something to break the cycle of pain. Lita [00:13:07] yeah. Jean [00:13:07] Right Pamela [00:13:07] . And even when they've given me something it hasn't always worked. Lita [00:13:13] The Twilight that's what I'm thinking. Jean [00:13:15]  the twilight sleep yeah. Lita [00:13:16] The twilight You know like when they put you out temporarily while they're doing your procedure. Jean [00:13:21] right. Lita [00:13:21] I wonder if. Have you tried it would that break it. I know, you know they have that done the dentist's office. Pamela [00:13:26] No They won't actually do something like that. But that's what they'll do is they'll give me a shot. I'm allergic to morphine. Lita [00:13:33] Yes.so am I. Pamela [00:13:34] The best that they'll do is they'll give me a shot of fentanyl. Lita [00:13:36] . Right. Pamela [00:13:37] But even Fentanyl doesn't... Lita [00:13:38] doesn't touch. Pamela [00:13:40] ...touch the pain. Lita [00:13:40] Doesn't touch it. Pamela [00:13:41] No. Jean [00:13:41] Wow. Pamela [00:13:42] Well I know that I'm going to. And actually I have to be honest with you as we're talking I can feel a tiny pulse in my cheekbone that there's going to be flare ups coming up at some point. Jean [00:13:53] I'm so sorry. Pamela [00:13:53]  in probably the next few hours. (laughter) Lita [00:13:56] Oh man. Does meditation. Does that help. Pamela [00:14:00] Nothing. Jean [00:14:00] It sounds like it's like asking someone who is in labor. "Oh have you tried this medication". Lita [00:14:03] No no. I'm thinking before it happens. Pamela [00:14:04] No Lita [00:14:05] I'm just thinking. Jean [00:14:06] Oh. Lita [00:14:06] I'm thinking before it happens. Jean [00:14:06] ok ok.  Pamela [00:14:07] nope. Lita [00:14:07] yeah. I mean yeah I remember when I was first pregnant with this one over here. Right. Jean [00:14:12] Yeah. I don't remember. Lita [00:14:14] No she doesn't remember it but I remember this. And I do have Alzheimer's and I don't remember a lot of things but I remember that when I was in labor my husband at the time pulled out a deck of cards and said "Would you like to play cards." Jean [00:14:27] You know what's really funny. I remember when my sister was in labor and her husband pulled out a deck of cards. Lita [00:14:33] What is with these guys. Jean [00:14:34] I don't know but. Pamela [00:14:35] I don't even know. (laughter). Lita [00:14:36] Oh yeah. I mean who the heck wants to play cards when you're in that much pain. Pamela [00:14:42] It's not really a distraction is it. Lita [00:14:44] No it's not. I wanted to take that deck of cards and. Jean [00:14:48] OK. Lita [00:14:49] ok. Jean [00:14:49] and back to the show. Pamela [00:14:49] Put the cards there (laughter) Lita [00:14:55] (laughter) Well how has this particular disorder affected your family or friends or your interactions with them. Pamela [00:15:01] Well when I'm in the flare I can't do anything. I can't Talk. I can't be around anyone. Lita [00:15:06] sure. Pamela [00:15:06] Everyone. I mean I'm just writhing in pain. I don't want to be touched or talked to. So any contact with my husband is out and he's he's really good. He's really understanding about this. And you know he just makes himself scarce and I just go to the bedroom in the dark and just cry. Lita [00:15:23] So it's kind of like a migraine. Jean [00:15:24] It is yeah Lita [00:15:25] Yeah a little bit but then. Pamela [00:15:26] Yeah I just. Lita [00:15:27] But different Yeah. Pamela [00:15:28] I want to isolate myself. Lita [00:15:29] Right. Jean [00:15:29] Sure Pamela [00:15:30] I just want to isolate myself my attacks are becoming so more frequent that it really interferes with my life. Lita [00:15:36] Sure. Pamela [00:15:36] I mean you know I don't want to socialize I don't want to be around anyone. Lita [00:15:41] cause You don't know if it's going to happen when you're out. Pamela [00:15:42] I don't want to do anything.... Jean [00:15:43] Right. Pamela [00:15:44] Well and that's the other thing I never know when a flare is going to happen. I don't know if it's going to happen when I'm out and if I am out I just want to get home as quickly as possible so it's ruined a lot of plans.... Lita [00:15:56] Right. Right Pamela [00:15:57] ...as well. Jean [00:15:57] Sorry. Lita [00:15:58] Well I hope the. I hope the surgery option will work for you. Pamela [00:16:03] Well I'm crossing my fingers. I do have an appointment with the neurosurgeon in April so. Jean [00:16:09] oh ok good. Pamela [00:16:09] I think well we'll talk about that in a few months. Lita [00:16:11] Yes we will. Yes. We'll have to get you back out here in May. Jean [00:16:14]  right. Lita [00:16:14] We'll be praying for you in the meantime. Jean [00:16:16] Yes. Are there any specific support groups for patients with terminal neurologic it sounds like. Lita [00:16:22] They should. Jean [00:16:23] The only person that can truly understand this is someone else that has the same condition. Lita [00:16:27] Yes. Pamela [00:16:28] Yes there are support groups available and you can certainly look online to find one suitable for you. Jean [00:16:35] ok. Pamela [00:16:35] In the States there's the American Association of neuromuscular and electro diagnostic medicine which offers information and assistance. Lita [00:16:44] I'll put that on the web site. Pamela [00:16:44] And they can be found, yep, It'll be on the website. They can be found at AANEM dot org. Lita [00:16:50] OK. Jean [00:16:50] OK. Pamela [00:16:51] And in Canada there's the tri geminal neuralgia Association of Canada. They're known as TNAC and they can be found at T N A C dot org... Lita [00:17:02] OK I will put it on our website. Yeah I didn't know if I told you but.... Pamela [00:17:06] ... but those are. Lita [00:17:06]  yeah. We. We build web pages for you and for your particular diagnosis. on our Web site. Pamela [00:17:13] oh that's wonderful. Lita [00:17:13] So that'll be on there forever. Pamela [00:17:15] so people can find that information. Lita [00:17:16] Yeah. Pamela [00:17:16] That's great. Lita [00:17:17] We put links in resources so that people can have a one shop stop to find out more about it. Pamela [00:17:23] Yeah. That's wonderful because I mean people you know the support is just immense that you know you can connect with people who are going through the same thing and like you said nobody knows what it's like except somebody who experiences it . And so you know I think it's really important that people know that there are national associations available out there for us. Lita [00:17:46] That's good. And how about on Facebook. Are there those private groups. Pamela [00:17:50] I am not sure about Facebook, there's probably lots. Lita [00:17:54] ok. Pamela [00:17:54] Of private groups that you can look for on Facebook. Lita [00:17:56] OK. Because I know that I join a bunch of them just so that I can glean information so that I can have a little bit better idea when I'm talking to our guest and I can read all kinds of you know interactions between patients that have these different issues and you know I had this or yes we have that and oh my god do you remember when this oh yeah yeah. Jean [00:18:15] and have you tried this. Lita [00:18:17] Yes. And all kinds of handsome tips. I love those. Jean [00:18:20] right. Lita [00:18:20] Well yeah obviously we found out that this problem does not go away on its own and it can get worse over time. And you are looking for possible surgery as a cure in the future. Pamela [00:18:35] That's right. Lita [00:18:36] Have you have you been told to watch for any other symptoms or is it just an increase in the severity. Pamela [00:18:42] It's really just an increase in the severity and the frequency that I have the flare ups and stuff. Lita [00:18:48] OK. Pamela [00:18:49] Some people do achieve remission. Some people have flare ups that go away. Lita [00:18:54] Oh good. Pamela [00:18:55] And they achieve remission so that there is encouraging news. Some people like myself run out of options and need to look for treatments beyond medication. Lita [00:19:04] OK. Jean [00:19:05] OK. And as we had mentioned earlier that there may be surgical procedures to help alleviate some of the pain caused by trigeminal neuralgia. And like you said your schedule coming up. Lita [00:19:18] in April Right. Jean [00:19:18] And that's umm. Pamela [00:19:20] That's right. Pamela [00:19:20] So I have an appointment on April 30th to see a neurosurgeon and we're going to be talking about a brain surgery called Microvascular decompression. Lita & Jean [00:19:30] OK. Pamela [00:19:30] So what that means is the surgeon will make a circular incision behind my right ear and remove that part of my scalp and then using small tools. He'll find the trigeminal nerve and then place a small Teflon sponge between the nerve and whatever. Lita & Jean [00:19:46] Oh wow. Pamela [00:19:47] Is pressing which is probably another nerve or you know a tendon or whatever is in there but whatever's causing the irritation he'll place the Teflon sponge between the two. Jean [00:20:01] Ok. Pamela [00:20:01] And once that's done the bone that was cut away will be. Covered with a titanium plate instead. And then the muscles in the skin are all sewn up again and I'll spend one night in the ICU. And then one or two nights in the hospital and then home to recover. Lita [00:20:17] Ok Pamela [00:20:17] So there's an excellent success rate with this particular surgery. And the reason I've chosen this surgery is because it has the lowest rate of causing facial numbness as well. There are other surgeries including one called the sensory rhizotomy which is the irreversible cutting of the trigeminal nerve root at its connection to the brain stem. Jean [00:20:41] Ok. Pamela [00:20:41] There's Gamma Knife radio surgery which is a non-invasive outpatient procedure that uses highly focused radiation beams and it destroys some of the trigeminal nerve root fibres that produce pain and then there's peripheral peripheral neurectomy which is where a nerve branch is cut. Lita [00:20:59] Well you got to become a. Pamela [00:21:00] . Yeah right. Lita [00:21:01] You're becoming quite good with the medical terminology. Pamela [00:21:04] I really am I. Lita [00:21:05] (laughter) Pamela [00:21:06] But all three of those surgeries carries a side effect of facial numbness and some to a really high degree. And I don't want that as a side effect. Jean [00:21:16] Sure. Pamela [00:21:18] I researched all four of these different surgeries very carefully and that's just not a side effect that I'm willing to put up with. Lita [00:21:27] Sure sure. Jean [00:21:28] Sure. Yeah. Lita [00:21:29] Well we're not. When your husband wants to give you a kiss you'd like to know if he's close. Pamela [00:21:34] Well exactly. You know and it sounds kind of funny to say it but there's a lot to be said for that sensation of touch. Lita [00:21:42] Right. Jean [00:21:42] Of course Pamela [00:21:42] I'm not willing to give that up. Lita [00:21:44] Absolutely. Absolutely. Do you have any additional tips hints or helpful advice for listeners. Pamela [00:21:50] Well my main advice is just to see your doctor as soon as possible if you're experiencing any type of facial pain. The sooner you get it diagnose the better. And if it is trigeminal neuralgia there's help available. Find a good support group. Facebook has groups available to help. And most importantly just know that you're not alone. There are lots of other people out there who are suffering so you know don't feel that you're the only one that's out there. Jean [00:22:18] Well thank you Pamela. And how can our listeners learn more about you and trigeminal neuralgia. Pamela [00:22:26] I blog at Pamela Justin dot com and I have a few posts about my TM. So just do a search on my Web site to find them and hopefully you'll get some help from reading those posts. Lita [00:22:37] OK. And we'll put a link at our Web site so that they can find you. Well thank you Pamela... Pamela [00:22:42] absolutely. Lita [00:22:42] ...Once again for joining us. This has been wonderful. Pamela [00:22:44] Oh it was a delight to be here again. Thank you so much for having me. Lita [00:22:48] You're welcome. And we will be contacting you again in May to find out the rest of the story. Jean [00:22:53] Yeah see how everything in April went. Pamela [00:22:54]  Wonderful I'll certainly be happy to let you know what the surgeon has to say. Lita [00:22:59] Great. Jean [00:22:59] great. Lita [00:22:59] . And for our listeners if you have any questions or comments related to today's show you can contact us at podcast D X at yahoo dot com through our Web site podcast D X dot com on Facebook Twitter Pinterest or Instagram. Jean [00:23:15] And if you like today's episode tell a friend as always please keep in mind that this podcast is not intended to be a substitute for professional medical advice diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regime never disregard professional medical advice or delay in seeking because of something you have heard on this podcast. Lita [00:23:41] Until next week.  

Join Dan (@drusyniak) &Howard (@heshiegreshie) as they chat with Dr. Laura Tormoehlen about her experience as a neurologist and toxicologist. Dispel the myths and common misperceptions about the determination of brain death in the toxicology patient and learn the mimics that you need to look out for. Beware the oculovestibular reflex and welcome to Season 2! Delicious Links ACMT Position Statement: Determining Brain Death in Adults After Drug Overdose. American Academy of Neurology. Evidence-based guideline update: Determining brain death in adults. Pediatric determination of brain death. Guidelines for the determination of brain death in infants and children: an update of the 1987 task force recommendations. Know your local regulations. Organ donation legislation and policy Scary. Baclofen overdose mimicking brain death. Grab your copy of Dr. Schaumburg's excellent textbook. Experimental and Clinical Neurotoxicology. A video demonstrating cold calorics in an awake patient. Nauseating. Fascinating article from the New Yorker. What Does It Mean to Die? Special Thanks Thank you for your continued support and determined feedback. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), Josh Shelov (@shelovj) and Witness Protection Products. Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It's like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love!  

Housekeeping While I'm typically an Android guy, I must say I have been impressed by the quality of the service I've gotten from the Apple Podcasts team. They've been responsive and helpful whenever I've had to work with them. And now, they are even faster. Generally it takes up to 2 weeks to get a new podcast in the Apple Podcasts store. It took them just 6 hours to add Strokecast. Please leave a rating and/or review for the Strokecast here. Being in the Apple Podcasts store means you can easily subscribe from an iPhone or iPad and never miss an episode. It also means that most other popular podcast apps for the Android or Samsung phone platforms also know about the Strokecast. You can subscribe in pretty much whatever app you use to listen to podcasts. Strokecast is also on Spotify. If you use Spotify on your mobile device, just search for Strokecast and it will pop right up. Tone and Spasticity  Infomercials and popular media talk about how the latest diet or the newest bow-nordi-master machine will help you build muscle and get toned. Tone in muscles is actually a bad thing in the PT/OT world. A muscle with tone is basically flexed all the time. It's contracted and in a state of tension. When my fingers curl up in a tight ball and won't release, it's because I have too much muscle tone. It my arm gets toned, that mean the muscles tighten and it curls up, useless. Tone in my legs will prevent me from bending or unbending my hip, knee, or ankle. Or cause my toes to curl up in my shoe. A muscle with tone is useless. One goal of the exercises I do with PT is to prevent tone from setting in. Working on range of motion, joint flexibility, and muscle strengthening prevents tone. What most people think of as tone is probably definition. They want to see the muscles. We often make our muscles visible be flexing them. Tone is when your muscles essentially flex themselves and then stay that way, even when you want them to stop. Imagine flexing your bicep and then keeping it flexed all day as you go about your business. That's why you don't want tone in your muscles. Treatment There are a number of ways to address tone. Some popular ones include: Movement therapy Stretching Tiring it out Massage Relaxation/mindfulness Accupuncture There are also medicinal solutions. Baclofen is a pill that can reduce tone. It can affect the whole body, though, and one of the main side affects is fatigue. Since many stroke survivors are already dealing with fatigue, this can be a challenge. Of course, not everyone experiences the side affects, and it can be a great solution. Medtronic also makes a Baclofen pump. A surgeon implants it in the abdomen and runs a tube into the spine so the pump continually deploys small amounts of Baclofen into the spinal fluid. It can be a little more targeted than the pill, and because the dosage is much lower it has few side affects. The dosage is lower because unlike a pill, it doesn't have to make its way through the digestive system into the circulatory system, and then into the nervous system. On the other hand...surgery. Botox is also an effective treatment.  Based on Botulinum Toxin, Botox is used to treat both wrinkles and tone. The director uses electrodes to monitor the firing of nerves in a muscle, and then injects Botox directly into the toned muscle to put many of the nerves to sleep for a few months. This relaxes the toned muscles and gives the other muscles a chance to recover. Hack of the Week It took me a while to figure out how to take my shirt off, and not just because people scream when I do. It simply wasn't a skill we needed to focus on the hospital. Here is my current process. Reach straight back over my head with my good hand -- follow the path of an imaginary Mohawk. Grab the back of my shirt collar. Pull that over my head. Take my right sleeve in mouth and pull the sleeve off my right arm. Grab the left sleeve with my right hand to remove that. This process also works with jackets and hoodies. It works best with long sleeves, but my short-sleeved t-shirts work out okay, too. I just skip the sleeve biting there. Where do we go from here? Do you have any tips or stories you'd like to share on a future episode? Email me at Bill@strokecast.com. I'd love to hear from stroke survivors, caretakers, medical professionals, and more. Share your thoughts on Episode 3 in the comments below. On the Apple platform , please leave a rating or review. Share this episode with anyone who might be interested. Don't get best...get better.

  Cerebral Palsy http://learntruehealth.com/cerebral-palsy/ Cerebral Palsy: Breaking The Barriers There are so many misconceptions about people who have cerebral palsy. Win Charles, is one awesome woman who will show us how she strives to live a fulfilling life devoid of medication. I am excited about today's show because despite the fact that Charles was born with a disability, her health journey is truly inspiring. Born With Cerebral Palsy "Cerebral palsy is a lack of oxygen at birth which is what I acquired. When I was born, I only weighed one pound and 17 ounces," shares Charles. Honestly, I didn't know much about cerebral palsy. I assumed that if someone were in a wheelchair, those people would immediately have spasms or tremors. Common Misconceptions I initially thought people with cerebral palsy are less intelligent than those without the condition. Yes, I admit, I was wrong. In fact, one of my favorite TV show, "Speechless," served as an eye-opener for me. The TV show stars Micah Fowler, who incidentally has cerebral palsy. I think it was brilliant that the production team opted to cast a real person with cerebral palsy rather than casting an actor who would just act out the part. It's cool, right? "Micah Fowler, the actor in the TV show Speechless, has a severe form of cerebral palsy. He can't function at all," Charles explains. She adds, "In my case, I have a hundred muscle spasms a day. And I try my best to control them without taking opioids." Aside from Fowler, one of my favorite comedians also happens to have cerebral palsy. And I must say, he is spot-on funny! So, lesson learned. Just because someone has cerebral palsy, it doesn't mean that people who have cerebral palsy are mentally slow or incapable. Effects Of Opioids Doctors incidentally prescribed the drug to Charles from 2006 to 2009. For those who are unaware, the most common opioid usually taken by people with cerebral palsy is Baclofen. "Baclofen is a muscle spasm and muscle relaxer. In 2009, my family noticed the medication was making me act like a zombie," recalls Charles. Charles for sure is not the only person to experience the adverse effect of opioids.  Why medical doctors continue to prescribe it to patients is truly appalling. Nevertheless, Charles' mom was adamant. Charles vividly recalls that her mother firmly told the doctors to take Win off the medication. Finding The Right Doctor Aside from opioids, Baclofen is a common drug for people with cerebral palsy. Nowadays, doctors go as far as prescribing it to people with back pain or muscle spasms. Traditional doctors are quick to prescribe medication rather than explore other options like physical therapy. So it is best to find a doctor who listens to you. If a doctor tells you something, please voice out. Get a second opinion. Be brave enough to explore different alternatives that work and are more efficient. Traditional Medicine Vs. Natural Medicine "My mom had a book where she noted all my surgeries and medications," Charles said. "She knew too much anesthesia in my body was not good." Incidentally, Charles also mentioned that she felt a great impact after hearing my Episode #137 where I had Dr. Cilla Whatcott on the show. Charles remembered her mom who was hospitalized for some time due to meningitis but believed in her body's ability to heal itself naturally. "Meningitis can be cured through Holistic Medicine. But traditional medicine thinks otherwise," said Charles. "Hopefully, that line of thought will change in the future." Trailblazer For Cerebral Palsy And how does someone like Charles cope with her health condition? First and foremost, Charles stays away from opioids and other drugs. Second, she makes sure to stay active by doing sports. Yes, you read it right. Charles swims, rides a bike, runs and has even competed in the prestigious Kona Ironman Triathlon. However, Charles admittingly says that because of her health condition, she has limited physical capabilities. But that is not stopping her. We truly do not have any excuse for not stepping out of our comfort zone when there are people with disabilities doing impressive feats. Understanding Cerebral Palsy I was likewise surprised to learn from Charles that cerebral palsy can also be acquired by accident. A friend of hers choked on a piece of popcorn when he was two years old. Hence, acquired cerebral palsy and is now non-verbal. Galileo Neuromuscular Tilt Table Charles explains that the device enables patients to be flexible. But because the device is big and bulky, Charles only gets to use the device at the gym. The device used by Charles was donated by Amanda Boxtel who was paralyzed after a skiing accident in 1992. Boxtel currently serves as Executive Director for Bridging Bionics Foundation. According to research, Bridging Bionics Foundation the aims to bridge human mobility with exoskeletons and bionic technology. Thanks to Boxtel's donation, people like Charles can do more than just being wheelchair-bound. Let me just say; I love technology! There is a beautiful marriage that I think we can incorporate ancient healing arts with modern science. But let me make myself clear. Modern science is not the enemy. It's how we use it and making sure that we are using it holistically. Benefits Of Reiki Charles says that willpower and mindset is a big part of dealing with cerebral palsy. She also says that Reiki, the Japanese technique for relaxation and stress reduction also helps because it promotes healing. But honestly, I was previously skeptical about Reiki. Because when I was about 15 years old, I sprained my ankle so bad. Doctors told me I wouldn't be able to walk for two weeks. Then a coworker at my summer job then offered to do Reiki on my ankle. After the painless session, the swelling had gone down, and I stood up. In fact, I remember being so happy that I even started dancing right then and there! I was a full believer in Reiki after that fateful day. Butterflies Of Wisdom Charles started the podcast, "Butterflies of Wisdom," four years ago.  The show was launched right after she wrote her autobiography. The show features inspiring people who are making a difference in this world both in business and disabilities. To check out the show, and know more about Charles' advocacy, please click the links below. If you liked this episode, please share it with someone you love.  Let's turn this ripple into a tidal wave. Have a great day everyone! Win Charles defied the odds by becoming an author despite having cerebral palsy. Her memoir "I, Win," is an amazing story of how she remembers her life through the years.  Charles is also a CEO of her own jewelry design company and motivational speaker. She tours all over the country to raise awareness about cerebral palsy.  Get Connected With Win Charles! Official Website Twitter Butterflies of Wisdom Podcast Book by Win Charles I, Win   The Links You Are Looking For: ------------------------------------------------------------------------------- Become A Health Coach Learn More About The Institute for Integrative Nutrition's Health Coaching Certification Program by checking out these four resources: 1) Integrative Nutrition's Curriculum Guide: http://geti.in/2cmUMxb 2) The IIN Curriculum Syllabus: http://geti.in/2miXTej 3) Module One of the IIN curriculum: http://geti.in/2cmWPl8 4) Get three free chapters of Joshua Rosenthal's book: http://geti.in/2cksU87 Watch my little video on how to become a Certified Health Coach! https://www.youtube.com/watch?v=CDDnofnSldI ------------------------------------------------------------------------------- If this episode made a difference in your life, please leave me a tip in the virtual tip jar by giving my podcast a great rating and review in iTunes! http://bit.ly/learntruehealth-itunes Thank you! Ashley James http://bit.ly/learntruehealth-itunes ------------------------------------------------------------------------------- Enjoyed this podcast episode? Visit my website Learn True Health with Ashley James so you can gain access to all of my episodes and more! LearnTrueHealth.com http://learntruehealth.com ------------------------------------------------------------------------------- Need Help Ordering The Right Supplements For You? Visit TakeYourSupplements.com, and a FREE health coach will help you! http://takeyoursupplements.com ------------------------------------------------------------------------------- Learn How To Achieve Optimal Health for From Naturopathic Doctors! Get Learn True Health's Seven-Day Course For FREE! Visit go.learntruehealth.com http://go.learntruehealth.com/gw-oi ------------------------------------------------------------------------------- I made a low-carb, gluten-free cookbook just for you! Download your FREE copy today! 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This week we discuss the rare, but life-threatening baclofen withdrawal. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_70_0_Final_Cut.m4a Download Leave a Comment Tags: Baclofen, Critical Care, Toxicology, Withdrawal Syndromes Show Notes Take Home Points Baclofen withdrawal is a rare complication of intrathecal baclofen pumps. It's presentation mimics sepsis and alcohol withdrawal and is characterized by hemodynamic instability, hyperthermia, increased spasticity, confusion, altered mental status and seizures. Patients can develop rhabdo from the spasticity and, eventually, can develop multi system organ dysfunction. Treating baclofen withdrawal with oral baclofen is unlikely to work even at large oral doses because only a tiny amount gets into the CSF where it needs to act for withdrawal to be treated Baclofen withdrawal can be emergently treated with increasing benzodiazepine doses, propofol infusions and baclofen administered via a lumbar puncture. Ultimately, these patients all need consultation with either neurosurgery or interventional pain management to interrogate the device and surgically correct the issue. Read more EM: RAP November 2015: Lin Sessions Intrathecal P...

This week we discuss the rare, but life-threatening baclofen withdrawal. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_70_0_Final_Cut.m4a Download Leave a Comment Tags: Baclofen, Critical Care, Toxicology, Withdrawal Syndromes Show Notes Take Home Points Baclofen withdrawal is a rare complication of intrathecal baclofen pumps. It's presentation mimics sepsis and alcohol withdrawal and is characterized by hemodynamic instability, hyperthermia, increased spasticity, confusion, altered mental status and seizures. Patients can develop rhabdo from the spasticity and, eventually, can develop multi system organ dysfunction. Treating baclofen withdrawal with oral baclofen is unlikely to work even at large oral doses because only a tiny amount gets into the CSF where it needs to act for withdrawal to be treated Baclofen withdrawal can be emergently treated with increasing benzodiazepine doses, propofol infusions and baclofen administered via a lumbar puncture. Ultimately, these patients all need consultation with either neurosurgery or interventional pain management to interrogate the device and surgically correct the issue. Read more EM: RAP November 2015: Lin Sessions Intrathecal Pumps

This week we discuss the rare, but life-threatening baclofen withdrawal. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_70_0_Final_Cut.m4a Download Leave a Comment Tags: Baclofen, Critical Care, Toxicology, Withdrawal Syndromes Show Notes Take Home Points Baclofen withdrawal is a rare complication of intrathecal baclofen pumps. It’s presentation mimics sepsis and alcohol withdrawal and is characterized by hemodynamic instability, hyperthermia, increased spasticity, confusion, altered mental status and seizures. Patients can develop rhabdo from the spasticity and, eventually, can develop multi system organ dysfunction. Treating baclofen withdrawal with oral baclofen is unlikely to work even at large oral doses because only a tiny amount gets into the CSF where it needs to act for withdrawal to be treated Baclofen withdrawal can be emergently treated with increasing benzodiazepine doses, propofol infusions and baclofen administered via a lumbar puncture. Ultimately, these patients all need consultation with either neurosurgery or interventional pain management to interrogate the device and surgically correct the issue. Read more EM: RAP November 2015: Lin Sessions Intrathecal Pumps

Breast Cancer and Bisphosphonates; an old drug for treating weak bones can reduce the risk of breast cancer spreading, but many post menopausal women are missing out. Why? Alcoholism and Baclofen; another old drug with a new use, this time a muscle relaxant to help people with an alcohol problem and news of three new trials recently presented in Germany. Complex Regional Pain Syndrome, a rare condition that often occurs after an injury or surgery and results in life changing pain. And why are some generic, non-branded medicines so expensive?

A review of Trigeminal Neuralgia for Practicing Pain Physicians For Full Access go to Painexam.com for Access to Premium Episodes PainExam Podcast For Board Review and Practice Management Updates TEXT the word  PAINEXAM to the number 33444  Download our iphone App! Download our Android App! For more information on Pain Management Topics and keywords Go to PainExam.com David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com 718 436 7246 DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment.  You should regularly consult a physician in matters relating to yours or another's health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional.    Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.       References https://en.wikipedia.org/wiki/Carbamazepine https://en.wikipedia.org/wiki/Trigeminal_neuralgia https://en.wikipedia.org/wiki/Baclofen

Headlines this week claim that 'thousands of patients die in hospital of thirst' but did the authors of the study actually analyse hydration? Mark Porter investigates the evidence for using Baclofen to treat alcoholism and hears how it helped a listener to stop drinking 6-8 bottles of wine a day. Why did NICE question the use of Paracetamol - the UK's favourite painkiller - in the treatment of osteoarthritis? And are saturated fats really bad for us?

In this VetGirl podcast, we review baclofen toxicity, a centrally-acting muscle relaxant used commonly in human medicine. Unfortunately, ingestion by veterinary patients can cause significant morbidity and mortality. Clinical signs of baclofen toxicosis include severe dysphoria, agitation, profound sedation, bradycardia, hypoventilation, coma, and death. In this VetGirl podcast, we discuss common clinical signs when ingested by dogs and cats, treatment options, and prognosis.

In this VetGirl podcast, we review baclofen toxicity, a centrally-acting muscle relaxant used commonly in human medicine. Unfortunately, ingestion by veterinary patients can cause significant morbidity and mortality. Clinical signs of baclofen toxicosis include severe dysphoria, agitation, profound sedation, bradycardia, hypoventilation, coma, and death. In this VetGirl podcast, we discuss common clinical signs when ingested by dogs and cats, treatment options, and prognosis.

Straight from the horse's mouth, or cow's stomach, this week how scientists have found the genetic clue to better biofuels; also, the brain basis of addiction, the cause of false-positive HIV tests, what causes the colours in a peacock's feathers, is Betelgeuse about to blow up, and what's neurofibromatosis? Join Dr Chris on this week's whistlestop tour of the scientific cosmos as he looks for the answers to life, the Universe and everything... Like this podcast? Please help us by supporting the Naked Scientists

Straight from the horse's mouth, or cow's stomach, this week how scientists have found the genetic clue to better biofuels; also, the brain basis of addiction, the cause of false-positive HIV tests, what causes the colours in a peacock's feathers, is Betelgeuse about to blow up, and what's neurofibromatosis? Join Dr Chris on this week's whistlestop tour of the scientific cosmos as he looks for the answers to life, the Universe and everything... Like this podcast? Please help us by supporting the Naked Scientists

Durch die Kombination verschiedener experimenteller Methoden konnten in der vorliegenden Arbeit zahlreiche Elemente eines bislang unbekannten GABAergen Steuerungssystems in der Nebennierenrinde nachgewiesen werden. Neben Markern neuroendokriner Differenzierung wie Syntaxin und VAMP-2 konnten sowohl endogene GABA-Produktion als auch GABA-Rezeptoren in steroidproduzierenden Zellen der Nebenniere identifiziert werden. Die Schlüsselenzyme GAD und VIAAT, die für die Synthese und Speicherung von GABA verantwortlich sind, wurden mittels immunologischer und molekularbiologischer Verfahren in adrenokortikalen Zellen lokalisiert. Außerdem wurde die Aktivität von GAD in einem in vitro-Assay nachgewiesen. Daneben wurden GABAA-Rezeptor-Untereinheiten und GABAB-Rezeptoren, darunter die Spleissvariante GABAB(1e), in der Nebennierenrinde vorgefunden. Diese Befunde wurden durch Untersuchung menschlicher und tierischer Gewebe sowie einer menschlichen Nebennierenrinden-Tumorzelllinie (NCI-H295R) gewonnen. Die ausgeprägten Übereinstimmungen zwischen den verschiedenen Modellsystemen unterstreichen dabei die Relevanz der Ergebnisse. Weitergehende Untersuchungen haben zudem ergeben, dass den GABAB-Rezeptoren in der Nebennierenrinde funktionelle Signifikanz zukommt: durch die Modulation von T-Typ Calcium-Strömen interagieren sie mit einem wichtigen Signalweg, dessen Bedeutung für die Steuerung der Steroid-Biosynthese gut belegt ist. In diesem Zusammenhang wurden in der vorliegenden Arbeit auch bereits publizierte Erkenntnisse zur Expression von Calciumkanälen in der Zona glomerulosa bestätigt und durch die Untersuchung humanen Gewebes erweitert. Die in der Ratte festgestellte Lokalisation des GABAergen Systems in der Zona glomerulosa, in Kombination mit dem beobachteten Einfluss von GABAB-Rezeptoren auf Calciumkanäle, deckt sich unter funktionellen Gesichtspunkten gut mit der besonderen Bedeutung des Calcium-Signalwegs für die Regulation der Aldosteronproduktion. Hingegen konnte in der vorliegenden Arbeit weder ein deutlicher Einfluss von adrenokortikalen GABAB-Rezeptoren auf die cAMP-Signaltransduktionskaskade, noch eine Beeinflussung des Proliferationsverhaltens von NCI-H295R-Zellen durch GABAerge Stimulantien festgestellt werden. Die Klärung der physiologischen Rolle von GABA im Kortex der Nebennieren bedarf noch weiterer Forschungsanstrengungen. Insbesondere ist die Frage, ob eine GABAerge Modulation des Calciumeinstroms durch T-Typ-Kanäle tatsächlich die Produktion von Steroidhormonen beeinflusst, noch unbeantwortet. Zudem existieren auffällige Unterschiede in der Verteilung von GAD, VIAAT und GABAB(2) zwischen der Nebennierenrinde der Ratte, verglichen mit der des Menschen. Daher muss noch genauer untersucht werden, ob sich auch die funktionelle Bedeutung von GABA in diesen Spezies unterscheidet. In vivo-Experimente in Ratten, die akutem Stress ausgesetzt wurden, zeigten aber, dass die Verabreichung von Baclofen die Kortikosteron-Konzentration im Blut beeinflusst [95] und unterstreichen somit eine mögliche Rolle von GABA in der Kontrolle der Nebennieren-Funktion. Zusammengefasst zeigen die in dieser Arbeit präsentierten Ergebnisse, dass in der Nebennierenrinde ein bislang unbekanntes, lokales GABAerges Signaltransduktionssystem existiert. Dieser Befund sollte zusammen mit ähnlichen, gut dokumentierten Befunden aus anderen endokrin aktiven Geweben wie der Adenohypophyse, dem endokrinen Pankreas und dem Hoden betrachtet werden. In diesen breiteren Kontext gestellt, unterstützt die vorliegende Arbeit das Konzept, dass GABA nicht nur ein wichtiger Neurotransmitter im ZNS ist, sondern auch ein weit verbreitetes Signalmolekül in peripheren Organen darstellt.

Fri, 1 Jan 1988 12:00:00 +0100 https://epub.ub.uni-muenchen.de/6085/1/6085.pdf Sutor, Bernd; Howe, James R.; Zieglgänsberger, Walter ddc:610, Medizin

1. Intracellular recordings were obtained from neurones in layers 2 and 3 of the rat frontal neocortex in an in vitro slice preparation. Three distinct types of stimulation-evoked post-synaptic potentials were recorded in these neurones: excitatory post-synaptic potentials (e.p.s.p.s); bicuculline-sensitive, chloride-dependent inhibitory post-synaptic potentials (i.p.s.p.s) with times to peak of 20-25 ms (fast(f)-i.p.s.p.s); bicuculline-insensitive, potassium-dependent i.p.s.p.s with bicuculline-insensitive, potassium-dependent i.p.s.p.s with times to peak of 150-250 ms (long(l)-i.p.s.p.s). 2. The effects of baclofen were investigated on seventy-one neurones. Baclofen was applied by ionophoresis or pressure ejection from micropipettes or was added to the superfusion medium. 3. Baclofen depressed stimulation-evoked e.p.s.p.s in fifty-seven of the sixty neurones tested. This effect was associated with an increase in the stimulation intensity required to produce a synaptically evoked action potential for thirty-nine of forty-four neurones. 4. Baclofen depressed f-i.p.s.p.s in thirty-seven of the thirty-nine neurones tested and l-i.p.s.p.s in each one of the seventeen neurones tested. Reversal potential values for each type of i.p.s.p. were not changed by baclofen and its depressions of each were independent of membrane potential (Em). Baclofen reduced the magnitude and the duration of the conductance increases that were associated with f- and l-i.p.s.p.s. 5. Baclofen hyperpolarized forty of seventy-one neurones and produced outward currents in three of four neurones recorded in voltage clamp at holding potentials between -55 and -65 mV. These actions were associated with 10-58% reductions of neuronal input resistance (RN) and 10-20% increases in neuronal input conductance (gN), respectively. Baclofen decreased the direct excitability of twenty-three of twenty-seven neurones tested. Determinations of the reversal potential for baclofen-induced changes of Em indicate that baclofen increases the conductance of rat neocortical neurones to potassium ions. 6. The EC50 for each action of DL-baclofen was approximately 1 microM. L-Baclofen was greater than 100 times more potent than D-baclofen. 7. Concentrations of bicuculline that blocked f-i.p.s.p.s and responses to ionophoretically applied gamma-aminobutyric acid (GABA) had no effect on the depressions of e.p.s.p.s or the hyperpolarizations and decreases in RN that baclofen produced. 8. Baclofen did not reduce the duration of action potentials that were prolonged with intracellular injections of caesium ions or by superfusions with medium that contained 10 mM-tetraethylammonium (TEA).