...and Technology, Hisar, Haryana, India Article Received on: 13/11/12 Revised on: 17/12/12 Approved for publication: 23/12/12 *Email: mparle@rediffmail.com ABSTRACT Pain is a complex unpleasant phenomenon composed of sensory experiences that include time, space, intensity, emotion, cognition and motivation. Analgesics are the agents, which selectively relieve pain by acting in the CNS or by peripheral pain mechanisms without significantly altering consciousness. Analgesics may be narcotic or non-narcotic. The study of pain in animals raises ethical, philosophical and technical problems. Philosophically, there is a problem that pain cannot be monitored directly in animals but can only be measured by examining their responses to nociceptive stimuli. The observed reactions are almost always motor responses ranging from spinal reflexes to complex behavior. The animal models employed for screening of analgesic agents, include Pain-state models based on the use of thermal stimuli, mechanical stimuli, electrical stimuli and chemical stimuli. The neuronal basis of most of the above laboratory models is poorly understood, however their application is profitable in predicting analgesic activity of newly discovered substances. Keywords: Analgesics, Nociception, Thermal, Mechanical, Chemical. INTRODUCTION Pain is a complex unpleasant phenomenon composed of sensory experiences that include time, space, intensity, emotion, cognition and motivation originating from damaged tissue...
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...fluctuating clinical spectrum. The symptoms of Fibromyalgia are musculoskeletal pain and tenderness, sleep issues and significant levels of fatigue. The other key symptoms include cognitive disturbances, particularly problems with concentration, memory, and high distress levels.2 Fibromyalgia can be considered part of a group of clinical syndromes, including chronic fatigue syndrome, multiple chemical sensitivities and irritable bowel syndrome, whose clinical features reflect similar pathophysiological processes – termed by some as ‘central sensitivity syndromes’.3 These different diagnoses are used depending on the predominant clinical features. For example, patients with fatigue as their most severe symptom may receive a diagnosis of chronic fatigue syndrome. Fibromyalgia has been thought to be caused by the development of changes in the central nervous system (CNS)4,5 that alter the processing of afferent sensory input, and can be grouped together under the term ‘central sensitisation’.6 Central sensitisation changes are often triggered by long-standing psychological or physical stress.7 These changes result in the intensity of usually non-painful stimuli being amplified and experienced as painful. Other effects include abnormality in the sleep cycle, where patients are unable to achieve deep, restorative, stage IV non-REM sleep, and disturbances in the hypothalamic-pituitary axis, with altered levels of serum cortisol, decreased 24-hour urinary free cortisol and blunted cortisol...
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...CASE STUDY 1 Acute coronary syndrome Patrick Gallagher Case outline Peter Brown is a 58-year-old gentleman who has experienced an episode of crushing central chest pain while at work. Peter works as a taxi driver and a colleague has taken him to the Accident and Emergency Department. On admission, Peter is sweaty, clammy, nauseated and short of breath. He is complaining of chest pain radiating to his left arm. This is Peter’s first presentation to hospital and he has no relevant past medical history. Peter smokes approximately 20–30 cigarettes per day and takes alcohol at weekends only. Peter is anxious and is concerned that his wife and children are informed. He also states his father died suddenly following a heart attack a number of years ago. Peter is immediately triaged and taken to the resuscitation room. You are the receiving nurse. Observations on admission include: Respiratory rate: 18 breaths per minute Oxygen saturations: 95% Blood pressure: 150/90 mmHg Pulse: 94 beats per minute Temperature: 37ºC. On admission to hospital an electrocardiograph (ECG) has been undertaken. Peter has been diagnosed with an anterior ST segment elevation myocardial infarction (anterior STEMI). Blood samples have also been drawn for urea and electrolytes (U&E), full blood picture (FBP) and highly sensitive troponin T. 1 Discuss Peter’s immediate problems and explain these using your knowledge of pathophysiology. A On admission to Accident and Emergency...
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...However, Boland, Satterlee, & Jansen (2014) suggest that in the case of low-level falls with hip injury in the elderly, this criterion should be eliminated. The purpose of the study was as follows: “because the elderly are at increased risk of hip fracture from low-level falls, and are also particularly susceptible to the discomfort and morbidity associated with immobilization, the prevalence of cervical spine (c-spine) fracture in this patient population was examined” (Boland, Satterlee & Jansen). After evaluating 1,394 patients, the study concluded that c-spine fracture is extremely rare in elderly patients who sustain a hip fracture that results from a low-level fall. When c-spine injury does occur, it appears to be in conjunction with other known predictors of spinal injury besides the distracting injury (Boland, Satterlee & Jansen). Because the elderly population is more susceptible to isolated hip injuries, and also to the discomfort of full spinal immobilization, this type of trauma should be specifically considered in the development of spinal clearance...
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...headaches. Headache is a pain in the head or upper neck. The intensity varies according to the seriousness of the underlying causes. When the structure inside the brain (which is sensitive to pain) is over-exercised headache results – it’s then headache all you have in your head....
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...psychiatric said no the pain of the disease gives you depression and anxiety , and they pushed it off to musculoskeletal system. Where ever it starts, for the patient, the pain is real, it’s their perception. It’s not up to us to judge, but up to us to help ease the pain, and hopefully one day find a cure. But first we must understand how it manifests. With no concrete scientific evidence and only theories to date, we can at least see ways to help ease the pain; therapies to help make the patients more active and have a better quality of life. Fibromyalgia: The Pathophysiology Much debate of Fibromyalgia has existed since the first diagnosis. Some people are lead to believe that it replaced Chronic Pain Syndrome and/or Chronic Fatigue Syndrome. Did it, we will examine that here. Depending on who you talk to Fibromyalgia exists, Endocrinology says no and Neurology says yes. Who’s right, which is what we will find out? What we do know; “Fibromyalgia is a chronic musculoskeletal syndrome characterized by widespread joint and muscle pain, fatigue, and tender points” (McCance RN & Huether RN, 2010, p. 1606). If that is Fibromyalgia does that not describe Chronic Pain Syndrome? Well yes and no, Chronic Pain Syndrome usually stays, is always with you all the time, whereas Fibromyalgia has exacerbations that come and go. Chronic pain Syndrome can also incorporate two different syndromes such as Fibromyalgia and Chronic Fatigue Syndrome together ("Pain," n.d.). While the exacerbations...
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...psychiatric said no the pain of the disease gives you depression and anxiety , and they pushed it off to musculoskeletal system. Where ever it starts, for the patient, the pain is real, it’s their perception. It’s not up to us to judge, but up to us to help ease the pain, and hopefully one day find a cure. But first we must understand how it manifests. With no concrete scientific evidence and only theories to date, we can at least see ways to help ease the pain; therapies to help make the patients more active and have a better quality of life. Fibromyalgia: The Pathophysiology Much debate of Fibromyalgia has existed since the first diagnosis. Some people are lead to believe that it replaced Chronic Pain Syndrome and/or Chronic Fatigue Syndrome. Did it, we will examine that here. Depending on who you talk to Fibromyalgia exists, Endocrinology says no and Neurology says yes. Who’s right, which is what we will find out? What we do know; “Fibromyalgia is a chronic musculoskeletal syndrome characterized by widespread joint and muscle pain, fatigue, and tender points” (McCance RN & Huether RN, 2010, p. 1606). If that is Fibromyalgia does that not describe Chronic Pain Syndrome? Well yes and no, Chronic Pain Syndrome usually stays, is always with you all the time, whereas Fibromyalgia has exacerbations that come and go. Chronic pain Syndrome can also incorporate two different syndromes such as Fibromyalgia and Chronic Fatigue Syndrome together ("Pain," n.d.). While the exacerbations...
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...neurological disorder characterized by chronic widespread pain and fatigue. It affects approximately 2% of the population, and is more common in women than in men. Central nervous system sensitization affects the entire body, leading to many secondary symptoms. This paper will cover the history, symptoms, and causes of FMS as well as known treatments and exercise prescription for the syndrome. Fibromyalgia has been described as a full-body migraine. Another common explanation is to compare everyday life with FMS as being similar to the aches and pains associated with a severe case of the flu. FMS patients experience intermittent flares, which are episodes of increased symptoms. Flares usually occur in response to physical or emotional stress, a schedule change, an illness or injury, a new job, the birth of a child, etc. While fibromyalgia is not considered a degenerative disorder, its symptoms usually become more severe if the patient also has a degenerative disorder such as arthritis. First, a patient must have experienced continuous pain in all four quadrants of the body for at least three months (Wolfe et al., 1990). Doctors will usually order many tests in order to rule out other conditions that might be confused with fibromyalgia. The key diagnostic tool for FMS is the tender point exam. No more than 4kg/1.54km2 of pressure is applied to 18 specific points (see Table 1). If there is significant pain in at least 11 of the 18 points, the patient may be diagnosed...
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...individuals perceive pain to a lesser degree or that sensitivity is diminished. Although pain is a common experience among individuals 65 years of age and older, it is not a normal process of aging. Pain indicates pathology or injury. Pain should never be considered something to tolerate or accept in one's later years. Unfortunately, many clinicians and older adults wrongfully assume that pain should be expected in aging, which leads to less aggressive treatment. Older adults have additional fears about becoming dependent, undergoing invasive procedures, taking pain medications, and having a financial burden. The most common pain-producing conditions for aging adults include pathologies such as arthritis, osteoarthritis, osteoporosis, peripheral vascular disease, cancer, peripheral neuropathies, angina, and chronic constipation. People with dementia do feel pain. The somatosensory cortex is generally unaffected by dementia of the Alzheimer type. Sensory discrimination is preserved in cognitively intact and impaired adults.1 Because the limbic system is affected by Alzheimer disease, current research focuses on how the person interprets and reports these pain messages.24 See further discussion on pain assessment with dementia on p. 170. Gender Differences Gender differences are influenced by societal expectations, hormones, and genetic makeup. Traditionally, men have been raised to be more stoic about pain and more affective or emotional displays of pain are accepted for women...
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...Abdelhamid Hadjahmed Drug: Metformin 1. Introduction of the medication (Case Study) A 54 year old male with obesity, and 6 year history poorly controlled type 2 diabetes. Complains of polyuria, polydipsia, fatigue, blurred vision, and headaches. Recently admitted to the hospital for diabetic ketoacidosis. He would like to get control over his diabetes so this doesn't happen again. 2. Demonstrates knowledge of the content through a teaching presentation? Actions of the medication- Metformin decreases the production of glucose or sugar in the liver, it decreases the absorption of glucose in the intestines, and it also helps increase the sensitivity of the insulin your body produces by increasing uptake and utilisation. Why is the patient taking...
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...internal and external forces. * Iris - The part of the eye which is colored. The iris is a diaphragm that regulates the expansion and contraction of the pupil to allow in the required amount of light. * Choroid – contains blood vessels and supplies nutrients to the retina. * Ciliary Body - Connects the choroids with the iris and secretes aqueous humor that helps the eye its shape. * Retina - The retina is the link between the brain and the light entering the eye. The retina is a complex structure able to convert the impacting light into nerve impulses that are then sent to the brain along the optic nerve. * Rods are photoreceptors responsible for peripheral vision and function at reduced levels of illumination. * Cones function at bright levels of illumination and are responsible for color vision and central vision. * Vitreous body – transmits light and gives shape to the posterior eye. * Vitreous (behind the lens) – gel-like substance that maintains the shape of the eye that provides additional support to the retina. * Optic disk – “blind spot”; it contains nerve fibers, lacks photoreceptor cells, and is insensitive to light. * Macula Lutea – it is where most acute vision occurs; concentration of photoreceptors. * Aqueous Humor – a fluid that...
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...1 NUR 201 DRUG CARD Student: ________________________ Generic Name: Bupropion hydrobromide________ Trade Name(s): Wellbutrin, Aplenzin, Zyban_ Classification: Antidepressant – atypical (heterocyclic), Aminoketone_____________________________ Administration Routes: PO _√_ SQ ___ IM ___ IV ___ Transdermal ____ Ophth_____ Action: Mechanism of action is not known; the drug does not inhibit MAO, and it only weakly blocks neuronal uptake of epinephrine, serotonin, and dopamine. However, its action is believed to be mediated by noradrenergic and/or dopaminergic mechanisms. Exerts moderate anticholinergic and sedative effects, but only slight orthostatic hypotension. Indications: (1) Treatment of major depressive disorder (immediate-release and extended-release). (2) Major depressive episodes in those with a history of seasonal affective disorder (Wellbutrin XL only). (3) Aid to stop smoking (Zyban only); may be combined with a nicotine transdermal system. Contraindications: Hypersensitivity to bupropion or any ingredients. Seizure disorders; presence or history of bulimia or anorexia nervosa due to the higher incidence of seizures in such clients. Concomitant use of an MAOI. Use in clients undergoing abrupt discontinuation of alcohol and sedatives, including benzodiazepines. Use in clients who have shown an allergic response to bupropion or other components of the various products. Wellbutrin, Wellbutrin SR, Wellbutrin XL, and Zyban all contain bupropion; do not use together. Lactation...
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...A migraine is a headache that can range in severity and is often accompanied by various symptoms.Causes of migraine headaches are not currently understood, though environmental factors and genetics seem to play a part. Research, though little has been conducted, suggests that migraines may be caused by changes occurring within the brainstem and its interactions with a major pain pathway called the trigeminal nerve. A current theory is that an imbalance in brain chemicals such as serotonin, a pain regulating chemical, may also contribute to these severe headaches. During a migraine attack, serotonin levels may drop, which can cause the trigeminal nerve to release neuropeptides that travel throughout the brain's outer covering. The resulting...
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...Since symptoms vary from person to person, the best treatment approach is to have a health care team that will tailor treatment to the specific conditions of the patient. Often physical therapy, pain management, and psychiatric treatment are needed in addition to Doctors who specialize in the treatment of the systems affected. Current pharmacotherapies include: *Biological DMARDs (disease-modifying anti-rheumatic drugs); cyclosporine, leflunomide, mycophenolate, methotrexate *Nonbiologic DMARDs; MTX, HCQ, LEF, SSZ *Nonsteroidal anti-inflammatory drugs (NSAIDs); ibuprofen, naproxen, diclofenac *Corticosteroids; methyl prednisone, prednisone *Antimalarial; hydroxychloroquine Prognosis: Before 1955, the 5 year survival rate in SLE was less than 50 percent. The natural history of SLE ranges from relatively benign disease to rapidly progressive disease, and even death. Because symptoms of SLE are different for every person, the mortality rate...
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...factors that could lead up to this injury. The highest incidence of SLAP lesions is seen in the 20 to 29 and 40 to 49 years of age. In order to understand the mechanism of a SLAP lesion it is best to understand the anatomy of the shoulder. The shoulder is a ball and socket joint made up of three bones: humerus that is the upper arm bone, shoulder blade of the scapula, and the clavicle. The humerus bone fits into the rounded socket of the scapula, which is called the glenoid fossa. Surrounding the outside edge of the glenoid fossa is a rim of strong, fibrous tissue called the labrum. The labrum helps deepen and stabilize the socket glenoid-humeral joint and allows the arm to circumduct. Injuries to the superior labrum can be caused by acute pain or by repetitive shoulder motion. This can result from a fall onto an outstretched arm, a motor vehicle accident, a forceful movement of the arm...
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