Tag: Medicine

Pelvic pain

Pain around the vagina, penis, anus, & buttock are often experienced by patients but seldom reported. Patients should know that this is a common problem that can often respond to comprehensive pain treatments by pelvic pain specialists. Pelvic pain Pelvic pain is experienced around the vagina, penis, scrotum, anus, & buttock. It can be worsened…

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Gabapentinoids for pain

For chronic pain conditions, gabapentinoids (gabapentin & pregabalin) are often first-line treatments because of their effectiveness & safety. They bind to a2d which alters activity of calcium channels on nerves, thereby modulating pain signals before they reach the brain. Pharmacology of gabapentinoids The absorption of gabapentin & pregabalin differ. Gabapentin absorption is slow. Beyond a…

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Anti-CGRP therapy for migraine

CGRP plays a key role in central chronic pain by mediating “neurogenic inflammation”. In this process, sensory nerves which usually carry electrical signal from the body instead broadcast inflammatory signals into it. CGRP is the most important of the inflammatory signals. Treating CGRP can be helpful for chronic migraine & pain. Neurogenic inflammation Small sensory…

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Whiplash

A chronic neck pain & headache following rear-ending car accidents, whiplash is often due to widespread minor injuries to neck muscles & nerves. While each injury is negligible in isolation, the pain is severe and persistent because muscle, joint, and nerve pain reinforce each other. Whiplash requires comprehensive treatment with targeted interventions. Whiplash injury The…

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Brachial & lumbosacral plexus

While spinal nerve impingement can cause shooting arm or leg pain, many patients have instead pain from nerve entrapments. Common entrapments include Alcock canal, carpal & tarsal tunnels, meralgia paresthetica, and more than 50 others. Treatment starts with accurate diagnosis by specialist physicians familiar with the complex nerve anatomy and ultrasound visualization of the nerves.…

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Drug-herb-gene CYP2D6 interactions

Several pain medications require the liver enzyme CYP2D6 to become active. But some herbal supplements & medications can interfere with this enzyme. Patients on these medications should consult with a doctor before starting herbal supplements. Drugs activated by CYP2D6 Hydrocodone Oxycodone Codeine Tramadol Drugs deactivated by CYP2D6 Amitriptyline Nortriptyline Desipramine Duloxetine Venlafaxine CYP2D6 inhibitors Drugs: Bupropion Cimetidine…

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Drug-herb-gene CYP3A4 interactions

The liver enzyme CYP3A4 is the key body mechanism for metabolizing pain medications. Patients who take pain medications must be aware that drugs, herbs, & genes can complexly alter CYP3A4 activity. Ask your doctor before making changes. Drugs metabolized by CYP3A4 Fentanyl Buprenorphine Oxycodone Methadone Diazepam Midazolam Alprazolam Metoprolol Losartan Amlodipine Rivaroxaban Dabigatran Apixaban Tacrolimus CYP3A4…

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Fibromyalgia

Patients with fibromyalgia experience chronic, diffuse pain across the body, due to exquisitely sensitivity of the brain & spinal cord (“central sensitization”). The keys to relief are prompt diagnosis, interdisciplinary pain care, & not overlooking co-existing pain conditions. Total body pain The best way to describe the experience of fibromyalgia is total body pain including a…

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