Researchers at the Hebrew University of Jerusalem have found a way to maintain the pain-killing qualities of morphine over an extended period of time, thus providing a solution for the problem of having to administer increasing dosages of the drug in order to retain its effectiveness.

One of the limitations in long-term use of morphine for pain relief is the rapid development of tolerance. The effectiveness of morphine declines quickly, and one must increase the dosage in order to preserve effective pain relief. However, the increased dosage also increases negative side effects.

The Hebrew University researchers, Prof. Yehuda Shavit and his graduate student Gilly Wolf of the Psychology Department, found that administration of morphine causes a substance called interleukin-1 to be released.

Under normal circumstances, interleukin-1 plays an important role in survival. In case of tissue damage, nerve injury, or inflammatory reaction, inteleukin-1 is released and sets off a process which increases the sensitivity to pain in the injured area. This pain serves as a warning signal, telling the body that there is a problem that should be attended to. In case of chronic pain, morphine is still the drug of choice for pain relief.

However, since prolonged administration of morphine raises the level of interleukin-1, thereby enhancing pain sensitivity, the effectiveness of morphine as a pain killer is steadily reduced, requiring greater dosages with accompanying negative side effects.

The Hebrew University researchers were able to show in animal experiments that administering morphine together with another drug that blocks the activity of interleukin-1 provides more effective pain relief over the long term without having to increase the dosage.

Shavit, who is the Leon and Clara Sznajderman Professor of Psychology at the Hebrew University and whose specialty is psychoneuroimmunology, expressed hope that this research will make it possible for clinicians to make use of morphine, together with substances that block interluekin-1, in order to bring about better pain relief with lower dosages and with minimized side effects. The research will be presented at a conference on pain research on May 3 on the Mount Scopus campus of the university. The conference is open to journalists and to people in the field.

Source: Hebrew University of Jerusalem

Neuropathy is a collection of disorders that occurs when nerves of the peripheral nervous system (the part of the nervous system outside of the brain and spinal cord) are damaged. The condition is generally referred to as peripheral neuropathy, and it is most commonly due to damage to nerve axons. Neuropathy usually causes pain and numbness in the hands and feet. It can result from traumatic injuries, infections, metabolic disorders, and exposure to toxins. One of the most common causes of neuropathy is diabetes.

Neuropathy can affect nerves that control muscle movement (motor nerves) and those that detect sensations such as coldness or pain (sensory nerves). In some cases - autonomic neuropathy - it can affect internal organs, such as the heart, blood vessels, bladder, or intestines.

Pain from peripheral neuropathy is often described as a tingling or burning sensation. There is no specific length of time that the pain exists, but symptoms often improve with time - especially if the neuropathy has an underlying condition that can be cured. The condition is often associated with poor nutrition, a number of diseases, and pressure or trauma, but many cases have no known reason (called idiopathic neuropathy).

In the United States, about 20 million people suffer from neuropathy. Over half of diabetes patients also suffer from the condition.

How is neuropathy classified?

Peripheral neuropathy can be broadly classified into the following categories:

• Mononeuropathy - involvement of a single nerve. Examples include carpal tunnel syndrome, ulnar nerve palsy, radial nerve palsy, and peroneal nerve palsy.
• Multiple mononeuropathy - two or more nerves individually affected.
• Polyneuropathy - generalized involvement of peripheral nerves. Examples include diabetic neuropathy and Guillain-Barre syndrome.

Neurophathies may also be categorized based on a functional classification (motor, sensory, autonomic, or mixed) or the type of onset (acute - hours or days, subacute - weeks or months, or chronic - months or years).

The most common form of neuropathy is (symmetrical) peripheral polyneuropathy, which mainly affects the feet and legs on both sides of the body.

What causes neuropathy?

About 30% of neuropathy cases are considered idiopathic, which means they are of unknown cause. Another 30% of neuropathies are due to diabetes. In fact, about 50% of people with diabetes develop some type of neuropathy. The remaining cases of neuropathy, called acquired neuropathies, have several possible causes, including:

• Trauma or pressure on nerves, often from a cast or crutch or repetitive motion such as typing on a keyboard
• Nutritional problems and vitamin deficiencies, often from a lack of B vitamins
• Alcoholism, often through poor dietary habits and vitamin deficiencies
• Autoimmune diseases, such as lupus, rheumatoid arthritis, and Guillain-Barre syndrome
• Tumors, which often press up against nerves
• Other diseases and infections, such as kidney disease, liver disease, Lyme disease, HIV/AIDS, or an underactive thyroid (hypothyroidism)
• Inherited disorders (hereditary neuropathies), such as Charcot-Marie-Tooth disease and amyloid polyneuropathy
• Poison exposure, from toxins such as heavy metals, and certain medications and cancer treatments

Who gets neuropathy?

Risk factors for peripheral neuropathy include several conditions and behaviors. People with diabetes who poorly control their blood sugar levels are very likely to suffer from some neuropathy. Autoimmune diseases such as lupus and rheumatoid arthritis also increase one’s chance of developing a neuropathy. People who have received organ transplants, AIDS patients, and others who have had some type of immune system suppression have a higher risk of neuropathy. In addition, those who abuse alcohol or have vitamin deficiencies (especially B vitamins) are at an increased risk. Neuropathy is also more likely to occur in people with kidney, liver or thyroid disorders.

What are the symptoms of neuropathy?

Neuropathy symptoms depend on several factors, chiefly where the affected nerves are located and which type of nerves are affected (motor, sensory, autonomic). Several types of neuropathy affect all three types of nerves. Some neuropathies suddenly arise while others come on gradually over the course of years.

Motor nerve damage usually leads to symptoms that affect muscles such as muscle weakness, cramps, and spasms. It is not uncommon for this type of neuropathy to lead to a loss of balance and coordination. Patients may find it difficult to walk or run, feel like they have heavy legs, stumble, or tire easily. Damage to arm nerves may make it difficult to do routine tasks like carry bags, open jars, or turn door knobs.

Sensory nerve damage can cause various symptoms, such as an impaired sense of position, tingling, numbness, pinching and pain. Pain from this neuropathy is often described as burning, freezing, or electric-like, and many report a sensation of wearing an invisible “glove” or “stocking”. These sensations tend to be worse at night, and can become painful and sever. On the contrary, sensory nerve damage may lead to a lessening or absence of sensation, where nothing at all is felt.

Autonomic nerve damage affects internal organs and involuntary functions and can lead to abnormal blood pressure and heart rate, reduced ability to perspire, constipation, bladder dysfunction, diarrhea, incontinence, sexual dysfunction, and thinning of the skin.

How is neuropathy diagnosed?

Peripheral neuropathy is often not easy to diagnose. It is not a single disease, but a symptom with often several potential causes. The standard diagnostic process begins with a full medical history with physical and neurological exams that will examine tendon reflexes, muscle strength and tone, the ability to feel sensations, and posture and coordination. Blood tests are also common in order for doctors to measure levels of vitamin B-12. Other common tests include urinalysis, thyroid function tests, and a nerve conduction study that includes electromyography (to measure electrical discharges produced in muscles). Physicians may also recommend a nerve biopsy, where a small portion of nerve is removed and examined under a microscope.

How is neuropathy treated?

There are a variety of treatments available for peripheral neuropathy. They range from traditional pills and creams to special diets and therapies that stimulate the nervous system. Antidepressants, especially tricyclics and selective serotonin-norepinephrine re-uptake inhibitors (SNRI’s), are a favored treatment for neuropathies. They will relieve neuropathic pain in non-depressed persons. Another class of medicines commonly prescribed for neuropathy is that of anticonvulsants. These medicines block calcium channels on neurons to limit pain. Opioid narcotic treatments for neuropathy are used as well to treat the condition, but are less favored because of the risk of dependency. However, opioids have been the most consistently effective in reducing pain.

For some types of neuropathy, such as post-herpes neuralgia, physicians recommend treatment with a topical anesthetic such as lidocaine. Topical applications of capsaicin (the chemical that makes peppers hot) has also been used to treat neuropathic pain.

Alternative therapies for peripheral neuropathy include cannabinoids (an class of chemicals found in marijuana), Botulinum Toxin Type A (better known as Botox), NMDA antagonists (such as ketamine), dietary supplements (such as alpha lipoic and benfotiamine), chiropractic massages, yoga, meditation, cognitive therapy, and accupuncture.

A final class of therapies for neuropathy are called neuromodulators. These include both implantable and non-implantable technologies (electrical and chemical) such as spinal cord stimulators, implanted spinal pumps, electrodes that stimulate the motor cortex of the brain, and methods called deep brain stimulation.

How can neuropathy be managed and prevented?

There are several ways to manage neuropathy and prevent its symptoms. Good foot health is important, especially for diabetics. Patients should check feet for blisters, cuts, or calluses and avoid tight fitting shoes and socks. Doctors can recommend an exercise plan that will reduce neuropathy pain and control blood sugar levels. Patients should also quit smoking and eat healthful meals. Massages of hands and feet may also aid neuropathy management by stimulating nerves and temporarily relieving pain. Finally, it is advised to avoid prolonged pressure on knees or elbows in order to prevent new nerve damage.

Video - What is Neuropathy?

Written by Peter Crosta M.A.

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

EHOB, Inc., a leading provider of affordable products effective in the prevention and treatment of pressure ulcers, is announcing the release of the WAFFLE® Pediatric Cushion, the company’s latest static air cushion, designed for the pediatric patient and recommended for most of their seating applications.

Filled with air, which is the ideal media to support the most vulnerable soft tissues of the body, the unique design of the WAFFLE Pediatric Cushion cradles and contours the body.

The conditions of seating applications are often overlooked in hospitals, extended care settings and homecare, but when you consider the amount of time individuals spend sitting upright, it’s important to cover these surfaces to help manage pain and aid in the prevention of pressure ulcers,” said James G. Spahn, MD, FACS, founder of EHOB, Inc. “The WAFFLE Pediatric Cushion provides pressure redistribution in a place where many ill children spend the majority of their day.”

The cushion’s low profile chamber of air redistributes the patient’s weight evenly on the surface. By maintaining only one inch of air, the WAFFLE Pediatric Cushion is clinically effective in keeping the patient stable and comfortable while preventing pressure ulcers. Other recommended usages of the cushion include protecting the occiput, heel, ear, elbow or between the knees for contracted patients.

Skin temperature and moisture control are achieved through the WAFFLE’s diamond patterned holes, which naturally circulate air while allowing skin to breathe. Combined with a non-abrasive, medical grade Premature Ventricular Contraction (PVC), the cushion substantially reduces pressure and tissue shear.

EHOB offers a number of products for pressure ulcer prevention and treatment, including mattress replacements and overlays, seating cushions, day chair pads, lower limb protectors, positioning aids and more. More than 2,200 hospitals, nursing homes and home caregivers rely on EHOB’s support solutions. All WAFFLE brand products are latex free, meet Cal 129 flammability requirements and are formulated to resist bacteria growth.

The WAFFLE Pediatric Cushion is available now for purchase. The Pediatric Cushion measures 14″ x 14″ x 2″ and is shipped pre-inflated, ready for immediate use. For more information, contact EHOB by phone at (800) 899-5553 or by email at corporate@ehob.com.

Source
EHOB, Inc.

GlaxoSmithKline (NYSE:GSK) and XenoPort, Inc. (Nasdaq:XNPT) announced results from a Phase II clinical trial of GSK1838262/XP13512 (gabapentin enacarbil) for neuropathic pain associated with diabetic peripheral neuropathy (DPN) in adults. GSK1838262 did not demonstrate a statistically significant improvement on the primary endpoint when compared to placebo, based on the change from baseline to end of treatment on the Pain Intensity-Numerical Rating Scale (PI-NRS). The pregabalin active control arm also did not differentiate from placebo on this same endpoint. The failure of the study to demonstrate a statistically significant benefit on the primary endpoint may be a consequence of the unexpectedly high placebo response rate observed in the study.

This 14-week, double-blind, placebo-controlled study enrolled 421 patients who were diagnosed with either Type 1 or Type 2 diabetes mellitus with signs and symptoms of DPN. Patients were randomized to receive either 1200 mg/day, 2400 mg/day or 3600 mg/day of GSK1838262 administered in divided doses twice daily, 300 mg/day of pregabalin as an active control, administered in divided doses three times daily, or placebo.

Throughout the study, GSK1838262 was generally well tolerated; the two most frequently reported adverse events were dizziness and somnolence.

“Although we are disappointed that neither GSK1838262 nor pregabalin demonstrated a clear clinical benefit over placebo in this study, we will be evaluating the study results further in order to determine our next steps,” said Atul Pande, M.D., senior vice president, GlaxoSmithKline Neurosciences Medicines Development Center.

Ronald W. Barrett, Ph.D., chief executive officer of XenoPort, stated, “A high placebo response is not uncommon in DPN studies, and this has been a contributing factor to several failed studies testing different drugs in this patient population. The failure of pregabalin in this study makes it difficult to draw definitive conclusions about the efficacy of GSK1838262. We are encouraged by the observation that all doses of GSK1838262 were generally well tolerated, particularly since the 3600 mg dose represents the highest dose tested in a study of this length.”

GSK1838262 is a new chemical entity that is designed to improve upon the pharmacokinetics of gabapentin by taking advantage of high-capacity transport mechanisms in the gastrointestinal tract to improve absorption.

GlaxoSmithKline - one of the world’s leading research-based pharmaceutical and healthcare companies - is committed to improving the quality of human life by enabling people to do more, feel better and live longer. For further information please visit http://www.pain-killers.net

XenoPort - is a biopharmaceutical company focused on developing a portfolio of internally discovered product candidates that utilize the body’s natural nutrient transport mechanisms to improve the therapeutic benefits of existing drugs. XenoPort is developing its lead product candidate in partnership with Astellas Pharma Inc. and GSK. XenoPort’s product candidates are also being studied for the potential treatment of moderate-to-severe primary restless legs syndrome, gastroesophageal reflux disease, migraine headaches, spasticity related to spinal cord injury, acute back spasms and Parkinson’s disease. To learn more about XenoPort, please visit the Web site at http://www.pain-killers.net.

GlaxoSmithKline cautionary statement regarding forward-looking statements

Under the safe harbor provisions of the U.S. Private Securities Litigation Reform Act of 1995, GSK cautions investors that any forward-looking statements or projections made by GSK, including those made in this announcement, are subject to risks and uncertainties that may cause actual results to differ materially from those projected. Factors that may affect GSK’ s operations are described under ‘Risk Factors’ in the ‘Business Review’ in the company’ s Annual Report on Form 20-F for 2007.

Source
GlaxoSmithKline

Yet another study shows that chronic pain is a symptom of Vitamin D deficiency.

Another study, this time from the renowned Mayo Clinic, states that people with low Vitamin D levels use almost twice as much pain medicine as those who have normal levels!

This is only one of MANY STUDIES that show the relationship between chronic pain and Vitamin D levels. Many researchers are even implicating Vitamin D deficiency as The Cause of Fibromyalgia and that many with this elusive condition can be effectively treated simply with proper high dose supplementation!

Yet, it’s unlikely that this study will change policy in the Conventional Medical Field. There are a few doctors who are now starting to check? 25(OH) D levels for various reasons, yet most still are clueless about the MANY diseases that a deficiency can improve and even cure. Unfortunately, most of health care is driven by education from Pharmaceutical Companies- and Vitamin D doesn’t have any scantily clad vitamin representatives running around to doctors offices giving out samples so that awareness of it’s benefits increases.

Another problem is that even when doctors DO?happen to find Vitamin D Deficiency, they are unaware of the proper way to treat it. They will often give low doses in the range of 800 to 1000 IU’s and never recheck the patient’s blood level. When the patient doesn’t get better, they conclude that treatment of Vitamin D deficiency didn’t help their pain. But what they fail to understand is that the low dose that they prescribed is completely inadequate to treat the deficiency!

And research shows that even VERY?MILD deficiencies can cause pain! So these patients continue to suffer unnecessarily due to their doctor’s ignorance.

If you suffer from PAIN?OF?ANY?KIND, then you owe it to yourself to get your Vitamin D levels- called a 25(OH)D- checked and have AGGRESSIVE?treatment of any deficiency that you may have.

THE FOOLISH WEAR FLIP FLOPS

The warm weather has arrived and flip flops are now the shoe of choice for many. This type of footwear can be the cause of lower extremity pain in many adults and children. The next paragraphs will discuss some of the complications associated with this type of shoe gear and some tips to prevent these conditions. The following are my top ten reasons for avoiding flip flops.

1. HAMMERTOES. While wearing this type of loose fitting shoe the toes are forced to contract to “grip” the shoe in order to prevent it from falling off the foot. This sustained contraction of the toes leads to tendon imbalances which can cause contracted/hammertoes.

2. BUNIONS. Often times the foot will overpronate when not wearing supportive shoes or walking barefoot. Overpronation in its simplest of terms refers to a “rolling inward” of the feet. If this is not controlled over extended period of time tendon imbalances will occur which cause the great toe to move toward the 2nd toe. This drifting of the toe leads to bunion formation.

3. HEEL PAIN. The lack of support while wearing flip flops often lead to heel pain. This is most commonly caused by excessive pull of the plantar fascia on the bottom of the foot. The plantar fascia is a soft tissue structure which is partially responsible for helping to maintain the arch. If there is lack of support to the shoe, the fascia undergoes excessive pull which creates inflammation and pain where it inserts on the heel.

4. ARCH PAIN. As mentioned with heel pain, the lack of support to the shoe often will cause inflammation of the plantar fascia. However, instead of the heel , the source of pain will be located at the arch. The plantar fascia begins at the heel but fans out to the forefoot. Lack of support will often cause excessive stretch to the fascia along the arch thus leading to pain.

5. TIBIAL TENDON PAIN. Excessive use of flip flop type shoes can lead to pain along the medial or “inside” of the ankle. The medial side of the ankle is the same side the great toe is located. The tibial tendon is what is primarily responsible for maintaining the arch. Shoes which lack support and provide no pronation control will force the tibial tendon to work excessively to maintain the arch. This can lead to fatigue, inflammation and pain.

6. NUMBNESS. In the same anatomic area as the tibial tendon lies the tibial nerve. This is the major source of innervation to the bottom of the foot. Shoes which lack support and pronation control lead to excessive compression of this nerve which can lead to numbness and pain. This condition is referred to as tarsal tunnel syndrome.

7. CALLUSES. Because there is no back to the shoe and no sock to protect the skin, the sole of the foot undergoes excessive shear forces when walking. These forces lead to excessive callus and fissure formation most notably to the heel area.

8. ANKLE SPRAINS. When a shoe such as a sandal or flip flop has no type of back to it, (the back of the shoe is referred to as the shoe “counter”) there is an increased propensity for ankle sprains when walking on uneven terrain.

9. KNEE PAIN. Over pronation in the feet causes internal rotation of the femur (thigh bone). This internal rotation affects the alignment of the knee joint creating asymmetry in motion often leading to pain.

10. LOW BACK PAIN. As mentioned with knee pain, internal rotation of the femur also affects the alignment of the low back (sacro -illiac joint). In other words, pronation of the foot leads to internal rotation of the femur which causes abnormal alignment of sacral illiac joint thus leading to low back pain.

It is not fair to say that all these conditions are only associated with flip flops. Any type of non supportive or open back type shoe can lead to some of these problems. It should also be noted that some individuals are less inclined to suffer these symptoms than others. People with excessively high arched feet or excessively flat feet or certainly more vulnerable than those with a more neutral type of foot. If your foot is more on the flat side then a shoe with a firmer type sole with less flex and a firm counter would be a better choice. If you have a higher arched foot then shock absorption is more important.

As always, look for shoes with good arch support no matter what your foot type. If an individual is planning a day with extended weightbearing or walking on uneven terrain, flip flops should be avoided. If one develops any of these conditions while wearing flip flops, limit their use. If symptoms do not improve seek medical attention from a trained professional.

There is a misconception that people who are stressed out only lose weight. Even though people do lose weight when stressed out, the opposite is also true. Some people gain weight when they are feeling stressed. In this article we will talk about relief for stress of High Blood Pressure and Diabetes, and how you can control or avoid it.

Blood Pressure

Even though people have many answers when asked, ” does stress cause high blood pressure?” The fact of the matter is, stress may not cause (HBP), but it does raise your heart beat because your body produces a surge of stress hormones which temporary cause your heart to beat faster.

You may experience headaches, dizziness, or blurred vision. People do not seek medical care until they have symptoms arising from the organ damage caused by chronic long-term high blood pressure. Some of  these organ damage from chronic high blood pressure are: heart attack, stroke, kidney failure, eye damaged with loss of vision, and peripheral arterial disease.

To decrease your chance of (HBP), try getting plenty of sleep. When you do not have enough sleep, your problems may seem worst than they really are. Also try exercising. Just make sure to get approval from your doctor before you start any new program. Exercise is one stress-reducing activity that can actually lower your systolic blood pressure by as much as 5 to 10 millimeters of mercury (mm Hg).

Diabetes

As a diabetic, both physical and mental stress can cause your blood sugar to swing out of control very rapidly. Some symptoms are Increased fatigue, unusual weight loss, frequent urination, excessive thirst, and etc. When you are stressed, your blood sugar levels rise. Epinephrine and Cortisol are stress hormones which can raise your blood sugar usually when you need it the most. They are most needed when you find yourself in some type of danger. However, the way we respond to certain situations often cause this same reaction.

The best prevention of Diabetes is to educate yourself as much as you can. One of the first thing you should know if you already have diabetes is to find out what type you have. Example, if you have type1 diabetes, you need to take insulin every day; formally called juvenile diabetes this type is less common.

Type 2 Diabetes is most common and is controlled usually by diet and physical activity. Most people will also need to take pills or insulin to control it. Many people with type 2 diabetes have no symptoms and do not know they have diabetes.

People who are at risk are people who are inactive, or have high blood pressure, are African American, Hispanic or Latino, Asian American or Pacific Islander, or American Indian. No matter what stage you’re in, you should take it very seriously and do what ever you can to prevent or control it.

The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. has released a one-of-a-kind publication intended to educate anesthesiology residents in the art and science of advanced battlefield regional anesthesia techniques and acute pain medicine. Its aim is to serve as a resource to manage the pain of combat trauma.

“The Military Advanced Regional Anesthesia and Analgesia Handbook” is the first field guide for pain management intended for use by deployed medical forces. The illustrated manual was developed as a supplement to Emergency War Surgery - Third United States Revision.

“This book project represents the culmination of hard work by a dedicated collaborative group of anesthesiologists at MARAA. It is the first source for the military that addresses pain management and demonstrates protocols and techniques that we can apply in present and future conflicts,” said Col. Chester Buckenmaier, M.D., chief of the Army Regional Anesthesia and Pain Management Initiative and MARAA founding member.

Until now, detailed instruction, photos and illustrations on how to provide advanced regional anesthesia and acute pain medicine services on the modern battlefield were unavailable. The book, formatted for easy reference, provides a quick review of the anatomy and technique of each nerve block. The manual also features chapters on peripheral nerve block equipment, acute pain nursing in the field, acupuncture and evacuation medicine.

“Pain management is getting recognition that it hasn’t received in the past. One accomplishment of MARAA and the pain initiative is raising awareness of pain management in the military. As a result of that awareness, and the significant achievement done on the battlefield, pain management is now a priority in the military,” Buckenmaier said.

MARAA was formed as a tri-service platform to develop consensus recommendations from the Air Force, Army and Navy anesthesia services. The group studies new technology and recommends improvements in medical practice to promote regional anesthesia and analgesia in the care of military beneficiaries.

Through the organization, anesthesia providers have greatly improved the management of pain for combat wounded through the application of modern pain treatment medications and technologies, including advanced regional anesthesia. The organization serves as an advisory board, leading the knowledge transfer to individual service anesthesia consultants and the military’s surgeons general. The group has been instrumental in promoting the benefits of pain management across the continuum.

The Borden Institute, an agency of the U.S. Army Medical Department Center & School, released the handbook. The manual is printed on waterproof paper and includes a multimedia DVD. Military medical personnel may obtain a copy of the book through the Borden Institute at http://www.pain-killers.net. An electronic version of the book is available for free download at http://www.pain-killers.net. The general public may order the book online from the Government Printing Office at http://www.pain-killers.net.

The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF) is a private, not-for-profit organization established in 1983 and authorized by Congress to support medical research and education at the Uniformed Services University of the Health Sciences and throughout the broader military medical community.

The Military Advanced Regional Anesthesia & Analgesia (MARAA) is a tri-service collaborative group of anesthesiologists that work to develop consensus recommendations from the Air Force, Army, and Navy anesthesia services for improvements in medical practice and technology that will promote regional anesthesia and analgesia in the care of military beneficiaries. The organization serves as an advisory board to the individual service anesthesia consultants to the surgeons general.

The Army Regional Anesthesia & Pain Management Initiative (ARAPMI) is a collaborative research partnership between Walter Reed Army Medical Center, Washington D.C. and the Conemaugh Health System, Johnstown, PA. ARAPMI seeks to improve the management of pain in military and civilian medicine. ARAPMI serves as a model of integrated acute and chronic pain management. Emphasis is on preparedness of civilian and military medicine for austere medical environments during national disasters or acts of terrorism. Through clinical and research efforts, it has become a model for effective integration of acute and chronic pain management.

Source:
Douglas Schauss

Henry M. Jackson Foundation for the Advancement of Military Medicine

Coronary heart disease is the leading cause of death among all the major diseases. In the United States 36 percent of the people who die do so because of some form of heart or cardiovascular disease. This number is simply staggering and points to the importance of controlling and preventing the suffering that heart disease brings. The good news is that the majority of people can successfully prevent or reverse the effects of this deadly disease with some rather simple lifestyle changes.

The first change that anyone with heart disease must make is dietary. Today’s fast food and processed meal in a box are some of the worst choices anyone can make when it comes to the health of their cardiovascular system. By avoiding saturated and trans-fat that are found in fried foods and some red meats we can significantly reduce the risk posed by coronary heart disease. Both these types of fat cause LDL cholesterol (the bad cholesterol) to increase in the blood stream. This can lead to a build up of plaque which hardens and narrows the arteries leading to a heart attack or stroke.

A diet high in fiber and low in fat is the way to go in preventing heart disease. Fruits, vegetables, low fat products, and whole grains cannot only prevent heart disease it can also reverse the effects of this dangerous condition.

The second lifestyle change that needs to be made to fight the effects of coronary heart disease is exercise. It doesn’t have to be a drastic undertaking. It can be something as simple as taking a walk everyday or using the stairs instead of the elevator. The point is to gradually build up your cardiovascular strength and add to it as you get stronger.

If you smoke then you need to quit. There is nothing that increases the risk of coronary heart disease quite like smoking. Every year more than 135, 000 people in the United States die from heart disease that is caused or exacerbated by the use of tobacco. The risk of death from this disease increases two to three times with the continued use of cigarettes.

There are also certain medical treatments and procedures that are effective in the fight against coronary heart disease. There are a number of medications that help reduce blood pressure or lower levels of LDL cholesterol, but like any drug there are also side affects to using them. Surgery is also an option when the disease has reached the life threatening stage but for most people living a healthy lifestyle will prevent them from ever having to see an operating room.

Avoiding the type of lifestyle that leads to coronary heart disease can help millions of people live long and healthy lives without the fear that they may fall victim to this deadly disease.

The Food and Drug Administration issued a final rule today that requires manufacturers of over-the-counter (OTC) pain relievers and fever reducers to revise their labeling to include warnings about potential safety risks, such as internal bleeding and liver damage, associated with the use of these popular drugs.

Products covered by the FDA action include acetaminophen, and a class of drugs known as the nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include aspirin, ibuprofen, naproxen, and ketoprofen. Acetaminophen is in a class by itself. The revised labeling applies to all OTC pain relievers and fever reducers, including those that contain one of these ingredients in combination with other ingredients, such as in cold medicines containing pain relievers or fever reducers.

“Acetaminophen and NSAIDs are commonly used drugs for both children and adults because they are effective in reducing fevers and relieving minor aches and pain, such as headaches and muscle aches, ” said Charles Ganley, M.D., director, FDA’s Office of Nonprescription Drugs in the Center for Drug Evaluation and Research. “However, the risks associated with their use, need to be clearly identified on the label so that consumers taking these drugs are fully aware of the potential harm they can cause. It is important that they know how to take these medications safely to reduce their risk.”

Under the final rule, manufacturers must ensure that the active ingredients of these drugs are prominently displayed on the drug labels on both the packages and bottles. The labeling also must warn of the risks of stomach bleeding for NSAIDs and severe liver damage for acetaminophen.

Since 2006, some manufacturers have voluntarily revised their product labeling to identify these potential safety concerns. However, the voluntary changes to labeling do not address all of the labeling requirements in the new rule. For example, the new rule includes a warning on products containing acetaminophen that instructs consumers to ask a doctor before they are taking the blood thinning drug warfarin. The new rule requires all manufacturers to relabel their products within one year of today’s date.

Safety data reported in medical literature indicate that people sometimes take more acetaminophen than the labeling recommends. Others unknowingly take multiple products containing acetaminophen at the same time. Exceeding the recommended dosage of acetaminophen may increase the risks for severe liver damage. Alcohol use can also increase the risk of liver damage with acetaminophen.

The risk for stomach bleeding may increase in people who use NSAIDs and who are taking blood-thinning drugs (anticoagulants) or steroids. Stomach bleeding risks also increase for people who take multiple NSAIDs at the same time, or in people who take them longer than directed. Alcohol use can increase the risk for stomach bleeding with NSAIDs use.

An FDA Advisory Committee meeting will be convened on June 29 & 30, 2009, to discuss further steps the FDA could take to reduce the risk of liver damage associated with acetaminophen overdoses.

To read the final rule on the relabeling of OTC pain relievers and fever reducers, go here.

To read the FR Notice announcing the FDA Advisory Committee meeting, see link.

Source
Food and Drug Administration