BACK PAIN. Whitepaper.
|
|
- Leo Freeman
- 5 years ago
- Views:
Transcription
1 BACK PAIN Whitepaper.
2 Whitepaper BACK PAIN Back pain is mst cmmnly related t acute r chrnic strain f the jints and sft tissues that supprt the spinal clumn. Cmmn causes f acute back pain include disc injuries and strain invlving ligaments, tendns, r muscles supprting the spine. Cmmn causes f chrnic back pain include muscle spasm, arthritis, stensis, and ther degenerative changes. Lumbar Disc Disease Discs act like shck absrbers between the mvable bny segments f the spine. These discs can be strained t the pint where they bulge, prtrude, r rupture int spaces where the spinal crd r spinal nerves are affected. If the inner gel-like substance f a disc extrudes thrugh a crack in its utside wall and int the surrunding sft tissue, the result is ften severe pain and inflammatin. Acute vs. Repetitive Muscle Strain Individual differences in spinal cntur, pelvic size and symmetry, and cnnective tissue elasticity make sme peple mre susceptible t repetitive strain than thers. Every muscle has a tendn f rigin and a tendn f insertin. The way these tendns attach t bne and jint structures determines the kind f mvements prduced by that muscle. In a repetitive strain situatin, micr-injuries t strained tendns can evlve int persistent pckets f inflammatin. Small tendn fibers r ligaments attached t bnes in the lwer spinal clumn may tear resulting in bleeding, swelling and tenderness at the site f injury. This type f muscletendn-ligament strain can be the acute result f a specific incident f bending, twisting, r lifting, an injury incurred playing sprts, r an accident f sme kind. In such cases, patients ften describe feeling like smething gave way in their lwer back, fllwed by radiating pain (ften extending t the buttcks, the hip girdle muscles, and back f the thighs). In bth acute and repetitive frms f strain, tendn r ligament irritatin causes the muscle t g int what s called reactive spasm. If the prblem cntinues, the muscle may g int what s called trigger pint spasm Keith Berndtsn, MD 1
3 Trigger pint spasms are the mst difficult type f spasm t treat. If a muscle remains in a state f reactive spasm lng enugh, the mtr neurn that cntrls cntractin and relaxatin f its muscle bundles may get irritated and stuck in a make the spasm even tighter mde. Chrnic trigger pint spasm leads t chrnic myfascial changes in which muscle fibers waste away frm pr circulatin and are replaced by cllagen. This can spread t ther muscles in the area, creating a chrnic reginal myfascial pain syndrme. Trigger pints feel like rpes r knts under the skin. When pressed they can be extremely tender. Trigger pint pain is ften described as a claw dug int a muscle. When a chrnic reginal myfascial pain syndrme spreads t invlve the right, left, upper, and lwer regins f the bdy, the cnditin becmes assciated with interrupted sleep and daily fatigue. If physical examinatin reveals widespread trigger pints (knts) in additin t multiple tender pints (withut knts) in classic lcatins, the cnditin can be called fibrmyalgia. Bth fibrmyalgia and chrnic reginal myfascial pain syndrmes can be debilitating t the pint f interfering with activities f daily living. Risks fr Chrnic Lw Back Strain The lwer back carries all the weight f the trs, and is the mst frequently injured area f the spine. What puts individuals at risk fr lw back pain may include excess bdy weight, nutritinal deficiencies, smking, diabetes, pr muscle tne r lw muscle mass, pr psture, hyper-stretchy ligaments, imprper heavy lifting, pr sleeping psitin, and stress. The effects n quality f life range frm mild t severe. Pinpinting the surce f back pain can be a challenge. If smene reprts chrnic lw back pain in a setting where physical examinatin and imaging studies cannt accunt fr the pain, the pain is ften linked t psychlgical stress. Persistent stress is knwn t amplify the perceptin f pain. In cases f benign persistent lw back pain, psychscial stress predicts a higher likelihd f lw back pain-related disability. 1 Chrnic lw back pain f uncertain cause that is resistant t cnventinal therapies may be mre amenable t integrative therapies and a mind-bdy apprach. In patients with lw back pain fr at least 6 weeks, thse wh received naturpathic care ver a threemnth perid had better utcmes at less cst than thse wh received nly patient educatin and usual care. 2 Ptentially Threatening Frms f Back Pain If the pain is cnstant and unrelenting even with rest r when trying t sleep, r a specific spinal bne seems unusually tender, imaging may be needed t rule ut a serius prblem such as a fracture, tumr, infectin, abdminal artic aneurysm, kidney disease, pelvic inflammatin r tumr, r metablic bne disease such as Paget s Disease r steprsis Keith Berndtsn, MD 2
4 If a nerve rt is invlved yu may reprt a sharp, stabbing, shting pain, the sensatin f pins and needles in the leg, r even weakness f ne r mre muscles invlve in walking. This raises the pssibility f acute r chrnic radiculpathy fancy names fr nerve rt injury r irritatin. Depending n severity, this type f back pain may warrant nerve studies and/r the higher reslutin imaging prvided by an MRI scan. Spinal stensis is an age-related degenerative change in the bnes that make up the spine that results in pain invlving bth legs that gets wrse with walking. The pain can be felt in the upper and/r lwer legs. Sufferers ften find that they can nly take s many steps befre having t sit and rest, which relieves the pain. Smetimes bending slightly frward will reduce pain r allw mre walking distance befre pain starts. An MRI scan is that standard test fr diagnsing this cnditin. Arthritis Ostearthritis is an age-related degenerative change in the sft tissue structures that supprt nrmal jint mvement. Weakened supprt allws excessive play in the jint, resulting in micr-tears and pckets f inflammatin t advanced r numerus fr the immune and hrmnal systems t cntrl and repair. The spinal clumn has ver 200 pints f articulatin that culd be affected by cumulative wear and tear accmpanied by pckets f inflammatin. Uncntrlled inflammatry stearthritis is a serius chrnic pain cnditin that warrants an integrative apprach t assessment and treatment. Ankylsing spndylitis, arthritis f the spine gives rise t inflammatin f the spine and lwer back jints. One early symptm f this cnditin is mrning back stiffness. We advise ur patients nt t get t hung up n diagnstic labels. Our gal is t understand hw each persn became plagued by lwer back pain, and t develp an integrative care plan that is tailred t the uniqueness f that persn s health situatin. Imaging Studies fr Lw Back Pain Evidence indicates that dctrs shuld nt be ding rutine X-rays, CT scans, r MRI scans fr acute lw back pain, r fr lw back persisting fr less than 6 weeks, unless they suspect a ptentially serius underlying cnditin. 3 Ding a series f X-rays, a CT scan, r an MRI scan as a reflexive rutine fr cases f acute r lw back pain des nt imprve clinical utcmes cmpared t usual care unless there are grunds t suspect that a ptentially serius cnditin is causing the prblem. Unless there is reasnable cncern abut a ptentially threatening cause, rutine imaging studies fr acute and sub-acute (nset less than 6 weeks earlier) cases f lw back pain generate pintless expsure t radiatin (in the case f x-rays and CT scans), and pintless expense (in all cases) Keith Berndtsn, MD 3
5 If significant lw back pain persists withut imprvement beynd 6 weeks despite usual care, r if the pain gets prgressively wrse despite usual care, imaging studies shuld be cnsidered. The cnventinal medical apprach: Histry investigates the nature f an injury r repetitive strain, and explres general health status. Physical exam invlves fcused examinatin f nerve and jint functin, muscle spasm, and tender spts. Bld tests and imaging studies are smetimes run t lk fr signs f inflammatin r infectin. Imaging and electrphysilgical studies may include: X-rays prvide detailed infrmatin abut bne structures. They help assess the severity f degenerative changes in the lumbar spinal segments and the sacriliac jints. Muscle ultrasund t assess sft tissues fr evidence f trauma r chrnic inflammatry changes. CT scans prvide a higher reslutin imaging f bnes than X-rays. MRI scans prvide high reslutin images f bne and sft tissue, making them especially valuable when cncerned abut ptentially serius disc r nerve prblems. Nerve cnductin studies and electrmygraphy can help determine whether nerve injury exists, and if s, lcalize the injury t ne r mre specific spinal nerve rts. Treatment emphasizes prescriptin drugs fr pain, and/r md. Cmmnly prescribed drugs include: Pain relievers: nn-steridal anti-inflammatry drugs (NSAIDs) such as naprxen (e.g., Aleve) r ibuprfen (e.g., Advil) are ften prescribed first. If these are nt effective, a dctr may prescribe a shrt-acting narctic analgesic such as tramadl (e.g., Ultram) r hydrcdne with acetminphen (e.g., Vicdin). If back pain becmes chrnic and shrtacting narctic analgesics are needed several times per day t cntrl pain, a dctr may prescribe a lng-acting narctic analgesic such as Oxycntin. Muscle relaxants (such as cyclbenzaprine r carisprll) are als used fr pain related t spasm ften with little thught given t underlying reasns r perpetuating factrs fr muscle spasm. If primary care advice desn t help, referrals may be made t a rheumatlgist, physiatrist, neurlgist, neursurgen, and/r rthpedic specialist Keith Berndtsn, MD 4
6 The integrative medical apprach: Histry investigates the nature f an injury r repetitive strain, and explres general health status frm a systems bilgy perspective. Physical exam invlves fcused examinatin f nerve and jint functin, muscle spasm, and tender spts, while taking int accunt physical signs f underlying metablic imbalance. Physical exam is fcused n tender pints, bld pressure, nutritinal status, muscle tne and reflexes, skin tne, sinuses, thrat, lymph ndes, inflammatin znes, and any ther areas warranted based n the histry. Hyper-stretchy cnnective tissue is als f interest because it predispses t excess strain and premature stearthritic changes. Bld testing may lk fr signs f txicity, inflammatin, r infectin, but may als lk fr markers f neurhrmnal imbalance, nutritinal deficiency, r ther frms f metablic imbalance, t assess a persn s capacity fr a balanced interplay f damage cntrl and restratin systems. Treatment may include prescriptin r ver-the-cunter medicatin, but it emphasizes lifestyle changes and natural therapies and is fcused n restring balance t the metablic systems that, based n histry r exam, appear t have lst their functinal integrity. They include yur systems fr: Digestin and assimilatin f nutrients (ability t break dwn and absrb gd things while keeping bad things ut f the system). Micrcirculatin f bld and lymph (ability t mve xygen and nutritin in, and trash water ut, f tissue znes). Detxificatin (txin detectin, handling, and eliminatin). Restratin (hrmne and neurtransmitter balance). Inspiratin (cnscius and uncnscius brain effects n behavir). Physical therapy, chirpractic adjustment, massage therapy, prper stretching, and exercises t imprve the strength and resilience f the lwer back and hip muscles prduce the best results when attentin is als being paid t issues invlving assimilatin, circulatin, detxificatin, and restratin systems, as well as the critically imprtant desire t get well. Mind-bdy therapy are part f a panel f treatment ptins that include ther mind-bdy techniques fr managing stress: Addressing ptentially maladaptive psychlgical defenses. Learning techniques fr quieting the mind and bdy at will. Meditative practices including cntemplative prayer, yga, and Tai Chi. Varius stretching and breathing rutines Keith Berndtsn, MD 5
7 At nebdymind.cm, we view back pain the same way we view everything else: as a multidimensinal metablic rehabilitatin prject that applies specifically t yu, and that is amenable t sme degree t prper self-care. Our system f self-assessment and care is cnsistent with an emerging understanding f the rigins f chrnic illness that is based n systems bilgy research. We believe that wise self-care methds shuld be part f any plan t get key yur bdily systems wrking better tgether as a team. In sme cases, a well-placed injectin r a carefully executed invasive prcedure will fix the prblem. In mst cases, a metablic rehabilitatin mdel will help the back pain patient achieve mre effective results. An integrative apprach t back pain lks at the unique big picture fr each patient, and cntinually adjusts itself t achieve better results by restring functinal integrity t metablic systems that have fallen ut f balance. References: 1. Discgraphic, MRI and psychscial determinants f lw back pain disability and remissin: a prspective study in subjects with benign persistent back pain. Spine J Jan-Feb;5(1): Cst-effectiveness f naturpathic care fr chrnic lw back pain. Alternative Therapies in Health and Medicine. 2008;14(2): Imaging strategies fr lw-back pain: systematic review and meta-analysis. Lancet Feb 7;373(9662): Keith Berndtsn, MD 6
Referral Criteria: Inflammation of the Spine Feb
Referral Criteria: Inflammatin f the Spine Feb 2019 1 5.7. Inflammatin f the Spine Backgrund Ankylsing spndylitis and axial spndylarthrpathy are fund in arund 0.3-1.2% f the ppulatin. Spndylarthritis encmpasses
More informationHealth for Life Chiropractic At Cloverdale Mall Unit # The East Mall Etobicoke, ON, M9B 3Y
Health fr Life Chirpractic At Clverdale Mall Unit #143-250 The East Mall Etbicke, ON, M9B 3Y8 416-232-1822 416-232-0060 Child and Adlescent Health Questinnaire Name:_ Birth date: Address:_ Telephne: Medical
More informationUnderstanding your thumb osteoarthritis
Understanding yur thumb stearthritis Intrductin The CMC jint is ne f the mst imprtant jints f the thumb and hand due t its wide range f mtin. Over time, the CMC jint is subject t large and repeated frces
More informationPain relief after surgery
Pain relief after surgery Imprtant infrmatin fr patients www.mchft.nhs.uk We care because yu matter This leaflet is designed t help yu cntrl any pain yu may have at hme fllwing yur peratin. Please read
More informationBRCA1 and BRCA2 Mutations
BRCA1 and BRCA2 Mutatins ROBERT LEVITT, MD JESSICA BERGER-WEISS, MD ADRIENNE POTTS, MD HARTAJ POWELL, MD, MPH COURTNEY LEVENSON, MD LAUREN BURNS, MSN, RN, WHNP OBGYNCWC.COM v Cancer is a cmplex disease
More informationHand Pain & Problems
Anatmy f the hand: Hand Pain & Prblems The hand is cmpsed f many different bnes, muscles, and ligaments that allw fr a large amunt f mvement and dexterity. There are three majr types f bnes in the hand
More informationOsteoarthritis. Prevalence and Colloquial Definition. Official Definition. Causes. Signs and Symptoms
Ostearthritis Prevalence and Cllquial Definitin Of the mre than 100 types f arthritis, Ostearthritis is by far the mst cmmn. OA affects nearly 27 millin peple in the United States. Like ther chrnic cnditins,
More informationImaging tests allow the cancer care team to check for cancer and other problems inside the body.
IMAGING TESTS This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice r discussin between yu
More informationWHAT IS HEAD AND NECK CANCER FACT SHEET
WHAT IS HEAD AND NECK CANCER FACT SHEET This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice
More informationBROCKTON AREA MULTI-SERVICES, INC. MEDICAL PROCEDURE GUIDE. Date(s) Reviewed/Revised:
Page 1 f 6 Subject: Range f Mtin Exercises Date Develped: 4/2010 PROTOCOL FOR: All trained staff PURPOSE: Range f Mtin (ROM) exercises are very imprtant if an individual has t stay in bed r in a wheelchair.
More informationKnee Class Fremont Physical Therapy
Fremnt Knee Facts The knee lses strength and stability after an injury. Stretching, strengthening and stability exercises are recmmended nt nly fr peple wh have injured their knees, but als t prevent injury.
More informationSwindon Joint Strategic Needs Assessment Bulletin
Swindn Jint Strategic Needs Assessment Bulletin Swindn Diabetes 2017 Key Pints: This JSNA gives health facts abut peple with diabetes r peple wh might get diabetes in Swindn. This helps us t plan fr medical
More informationUnderstanding back pain
Understanding back pain What yu need t knw abut yur wn back Patricia Zheng, MD Assistant Prfessr Nnperative Spine and Physiatry Department f Orthpedic Surgery 2 Graphics: ;https://www.facebk.cm/auntyacid/;
More informationAnterior Total Hip Arthroplasty Patient Guide & Common Questions
Intrductin: Anterir Ttal Hip Arthrplasty Patient Guide & Cmmn Questins This handut is a general guide t cmmn indicatins fr anterir ttal hip arthrplasty, what t expect when underging the prcedure, risks,
More information9200 Calumet Avenue Sincer Jacob, PA-C Munster, IN Jessica Morin, ATC Deanna Cozzi, ATC
DISCHARGE INSTRUCTIONS & PHYSICAL THERAPY PROTOCOL: Subacrmial Decmpressin, Glenhumeral Debridement, Distal Clavicle Resectin Recvery after shulder arthrscpy entails cntrlling swelling and discmfrt, return
More informationDr. Tozzi s and Dr. Roehrig s Patient Guide to Total Hip Replacement
Dr. Tzzi s and Dr. Rehrig s Patient Guide t Ttal Hip Replacement This guide is meant t help yu better understand yur upcming hip surgery. It is generalized infrmatin, and individual patients have unique,
More informationVaccine Information Statement: LIVE INTRANASAL INFLUENZA VACCINE
Vaccine Infrmatin Statement: LIVE INTRANASAL INFLUENZA VACCINE Many Vaccine Infrmatin Statements are available in Spanish and ther languages. See www.immunize.rg/vis. Hjas de Infrmacián Sbre Vacunas están
More informationCONSENT FORM - TESTOSTERONE FOR TRANSGENDER CLIENTS
CONSENT FORM - TESTOSTERONE FOR TRANSGENDER CLIENTS Yu want t take teststerne t masculinize yur bdy. Befre taking it, there are several things yu need t knw abut. They are the pssible advantages, disadvantages,
More informationVaccine Information Statement: PNEUMOCOCCAL CONJUGATE VACCINE
Vaccine Infrmatin Statement: PNEUMOCOCCAL CONJUGATE VACCINE Many Vaccine Infrmatin Statements are available in Spanish and ther languages. See www.immunize.rg/vis. Hjas de Infrmacián Sbre Vacunas están
More informationFrequently Asked Questions: IS RT-Q-PCR Testing
Questins 1. What is chrnic myelid leukemia (CML)? 2. Hw des smene knw if they have CML? 3. Hw is smene diagnsed with CML? Frequently Asked Questins: IS RT-Q-PCR Testing Answers CML is a cancer f the bld
More informationHead and neck cancers are often treated with radiotherapy. Radiotherapy can lead to faster rates of tooth decay and poor healing in the mouth.
DENTAL EXTRACTION This infrmatin aims t help yu understand the peratin, what is invlved and sme cmmn cmplicatins that may ccur. It may help answer sme f yur questins and help yu think f ther questins that
More informationCONSENT FOR KYBELLA INJECTABLE FAT REDUCTION
CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION INSTRUCTIONS This is an infrmed cnsent dcument which has been prepared t help yur Dctr infrm yu cncerning fat reductin with an injectable medicatin, its risks,
More informationYou and your back TAKE CARE OF YOUR BACK BACK CONDITIONS OVERVIEW
Take care f yur back Back cnditins verview Anatmy f yur back What is Sclisis? What is Osteprsis? Acute lw back pain TAKE CARE OF YOUR BACK Yu and yur back Intrductin: Back pain is a very cmmn health prblem.
More informationUnderstanding Common Orthopedic Conditions Among the 40s
Understanding Cmmn Orthpedic Cnditins Amng the 40s By Jsephine K Principal Physitherapist & Mark Victr Rankine Fitness Cnsultant Objectives 1. Gain understanding f the bilgical changes f the female human
More informationGlaucoma Interviews: Due Tuesday, May 22 nd
Glaucma Interviews: Due Tuesday, May 22 nd 1) Read the glaucma article well! It will explain what it is, plus tell yu sme symptms and risk factrs. Yu may want t use a highlighter r pen t mark imprtant
More informationModule 6: Goal Setting
Mdule 6: Gal Setting Objectives T understand the cncept f gal setting in Brief CBT T acquire skills t set feasible and apprpriate gals in Brief CBT What is gal setting, and why is it imprtant t set gals
More informationMEDICATION GUIDE Pioglitazone and Metformin Hydrochloride (PYE o GLI ta zone and met FOR min HYE-droe- KLOR-ide)Tablets, USP
MEDICATION GUIDE Piglitazne and Metfrmin Hydrchlride (PYE GLI ta zne and met FOR min HYE-dre- KLOR-ide)Tablets, USP Read this Medicatin Guide carefully befre yu start taking piglitazne and metfrmin hydrchlride
More informationCRANIOFACIAL RESECTION
CRANIOFACIAL RESECTION This infrmatin aims t help yu understand the peratin, what is invlved and sme cmmn cmplicatins that may ccur. It may help answer sme f yur questins and help yu think f ther questins
More informationA Phase I Study of CEP-701 in Patients with Refractory Neuroblastoma NANT (01-03) A New Approaches to Neuroblastoma Therapy (NANT) treatment protocol.
SAMPLE INFORMED CONSENT A Phase I Study f CEP-701 in Patients with Refractry Neurblastma NANT (01-03) A New Appraches t Neurblastma Therapy (NANT) treatment prtcl. The wrd yu used thrughut this dcument
More informationAdvantage EAP Employee Assistance Program
Advantage EAP Emplyee Assistance Prgram July 2014 In This Issue What might we face? Symptms f SAD Seasnal changes in biplar disrder Tips fr cmbating summer truble When t seek help Tips fr helping thse
More informationTop 10 Causes of Disability
Tp 10 Causes f Disability Disability can happen t anyne, f any age. Thugh sme may be the result f accidents r injuries that are unavidable, many disabilities are the result f diseases and health cnditins
More informationWhat is pain? Chronic pain is pain that continues after an injury has healed.
What is pain? Pain is defined as an unpleasant sensry and emtinal experience assciated with actual r ptential tissue damage. (Internatinal Assciatin fr the Study f Pain) Chrnic pain is pain that cntinues
More informationWhat is Asthma? A collaborative effort of Children s Hospital of Pittsburgh of UPMC and The Pennsylvania Child Welfare Resource Center
A cllabrative effrt f Children s Hspital f Pittsburgh f UPMC and The Pennsylvania Child Welfare Resurce Center What is Asthma? Jennifer E. Wlfrd, DO, MPH, FAAP Children s Hspital f Pittsburgh, Divisin
More informationChapter 37 The Skeletal and Muscular System:
Chapter 37 The Skeletal and Muscular System: 3.5 Learning Objectives 3.5. Respnses in the human 1. Descriptin f the structure and functins f the skeletn. 2. Label the cmpnent parts f the axial and appendicular
More informationBreast Cancer Awareness Month 2018 Key Messages (as of June 6, 2018)
Breast Cancer Awareness Mnth 2018 Key Messages (as f June 6, 2018) In this dcument there are tw sectins f messages in supprt f Cancer Care Ontari s Breast Cancer Awareness Mnth 2018: 1. Campaign key messages
More informationYou may have a higher risk of bleeding if you take warfarin sodium tablets and:
MEDICATION GUIDE Warfarin (WAR-far-in) Sdium (SO-dee-um) Tablets USP The 7.5 mg tablets cntain FD&C Yellw N. 5 (tartrazine), which may cause allergic-type reactins (including brnchial asthma) in certain
More informationOsteoporosis Fast Facts
Osteprsis Fast Facts Fast Facts n Osteprsis Definitin Osteprsis, r prus bne, is a disease characterized by lw bne mass and structural deteriratin f bne tissue, leading t bne fragility and an increased
More informationPsychological aspects of breast cancer. Dr Caroline Dancyger & Dr Esther Hansen
Psychlgical aspects f breast cancer Dr Carline Dancyger & Dr Esther Hansen Cmmn acrss all cancers Adjustment as the nrm Diagnsis End f active treatment r Discharge Palliative Care Recurrence distress t
More informationInstructions regarding referral of patients to the Persistent Pain Service
Prtsmuth Persistent Pain Service Lng Term Cnditins Suite Grund Flr, Blck A St Mary s Cmmunity Health Campus Miltn Rad Prtsmuth Hampshire PO3 6AD Tel: 23 9268 485 Fax: 23 9268 21 Dear GP Instructins regarding
More informationChronic Fatigue Syndrome
Chrnic Fatigue Syndrme (Als knwn as Myalgic encephalmyelitis/encephalmyelpathy) What is CFS/ME? CFS/ME cmprises a range f symptms that include fatigue, malaise, headaches, sleep disturbances, difficulties
More informationAnnex III. Amendments to relevant sections of the Product Information
Changes t the Prduct infrmatin as apprved by the CHMP n 13 Octber 2016, pending endrsement by the Eurpean Cmmissin Annex III Amendments t relevant sectins f the Prduct Infrmatin Nte: These amendments t
More informationObesity/Morbid Obesity/BMI
Obesity/mrbid besity/bdy mass index (adult) Obesity/Mrbid Obesity/BMI Definitins and backgrund Diagnsis cde assignment is based n the prvider s clinical judgment and crrespnding medical recrd dcumentatin
More informationMEDICATION GUIDE Pioglitazone (pie-oh-glit-ah-zohn) and Metformin (met-fore-min) Hydrochloride Tablets USP
MEDICATION GUIDE Piglitazne (pie-h-glit-ah-zhn) and Metfrmin (met-fore-min) Hydrchlride Tablets USP Read this Medicatin Guide carefully befre yu start taking piglitazne and metfrmin hydrchlride tablets
More informationMy Symptoms and Medical History for Adult Chronic Immune Thrombocytopenia (ITP)
My Symptms and Medical Histry fr Adult Chrnic Immune Thrmbcytpenia (ITP) Call t talk t a registered nurse 1-855-7Nplate (1-855-767-5283), Mnday Friday, 9:00 AM 9:00 PM ET Indicatin Nplate is a man-made
More informationPHARYNGO-OESOPHAGECTOMY
PHARYNGO-OESOPHAGECTOMY This infrmatin aims t help yu understand the peratin, what is invlved and sme cmmn cmplicatins that may ccur. It may help answer sme f yur questins and help yu think f ther questins
More informationMEDICATION GUIDE. (fingolimod) capsules
MEDICATION GUIDE GILENYA (je-len-yah) (finglimd) capsules Read this Medicatin Guide befre yu start using GILENYA and each time yu get a refill. There may be new infrmatin. This infrmatin des nt take the
More informationChapter 5 Anxiety Disorders
Test Review 2 Chapter 5 Anxiety Disrders Mst cmmn and effective frm f treatment = Expsure Anxiety Disrders Mst cmmn psychiatric disrders Phbias mst cmmn f the anxiety disrders Often Cmrbid with Majr Depressin
More informationTendon problems can happen in people of all ages who take levofloxacin. Tendons are tough cords of tissue that connect muscles to bones.
Medicatin Guide LEVOFLOXACIN (LEE ve FLOX a sin) INJECTION, 25 mg/ml and LEVOFLOXACIN (LEE ve FLOX a sin) INJECTION in 5% Dextrse fr Intravenus Use Read this Medicatin Guide befre yu start taking levflxacin
More informationA foot x-ray series is required only if there is pain in the midfoot zone and any one of the following:
RADIOGRAPHY OF THE ANKLE AND FOOT (OTTAWA ANKLE RULES) Clinical Practice Guideline January 2007 This guideline has been adapted frm the Ottawa Ankle Rules develped by Dr. Ian Stiell et al. Dr. Stiell received
More informationSay Goodbye to Test Anxiety. Kortschak Center for Learning and Creativity University of Southern California Presented by: Eliza Peña
Say Gdbye t Test Anxiety Krtschak Center fr Learning and Creativity University f Suthern Califrnia Presented by: Eliza Peña 1 Learning Objective By the end f this wrkshp, students will be able t: Recgnize
More informationDIABETES AND PANCREATIC EXOCRINE INSUFFICIENCY
YOU AND YOUR BODY DIABETES AND PANCREATIC EXOCRINE INSUFFICIENCY kk WHY IS THIS LEAFLET FOR YOU? Pancreatic excrine insufficiency (PEI) is imprtant t understand in diabetes care due t the changing functins
More informationFor our protection, we require verification that you have received this notice. Therefore, please sign below.
PATIENT INFORMATION Dear Patient: Sleep prblems are extremely cmmn. Public health and safety are threatened by the increasing prevalence f bstructive sleep apnea, which nw afflicts at least 25 millin adults
More informationPodcast Transcript Title: Common Miscoding of LARC Services Impacting Revenue Speaker Name: Ann Finn Duration: 00:16:10
Pdcast Transcript Title: Cmmn Miscding f LARC Services Impacting Revenue Speaker Name: Ann Finn Duratin: 00:16:10 NCTCFP: Welcme t this pdcast spnsred by the Natinal Clinical Training Center fr Family
More informationPatrick J McGahan, MD Orthopaedic Surgeon Specializing in Sports Medicine/Shoulder Reconstruction Surgery Instructions Hip
Patrick J McGahan, MD Orthpaedic Surgen Specializing in Sprts Medicine/Shulder Recnstructin 2801 K St, Ste 330, Sacrament, CA, 95816 (p) 916-733-5049 (f) 916-733-8914 www.patrickmcgahanmd.cm Befre Surgery
More informationMEDICATION GUIDE LEMTRADA (lem-tra-da) (alemtuzumab) Injection for intravenous infusion
MEDICATION GUIDE LEMTRADA (lem-tra-da) (alemtuzumab) Injectin fr intravenus infusin Read this Medicatin Guide befre yu start receiving LEMTRADA and befre yu begin each treatment curse. There may be new
More informationDiabetes Canada Pre-Budget Consultation Submission. Standing Committee on Finance and Economic Affairs. Government of Ontario.
Diabetes Canada 2018 Pre-Budget Cnsultatin Submissin Standing Cmmittee n Finance and Ecnmic Affairs Gvernment f Ontari January 17, 2018 1 Executive Summary Tday, abut 4.4 millin Ontarians, r 29 per cent
More informationBefore Your Visit: Mohs Skin Cancer Surgery
Befre Yur Visit: Mhs Skin Cancer Surgery Yur Kaiser Permanente Care Instructins Skin Cancer Infrmatin What is skin cancer? Skin cancers are tumrs, r malignancies, f the skin. Skin cancer is assciated with
More informationInfluenza (Flu) Fact Sheet
Influenza (Flu) Fact Sheet What is the flu? The flu is a cntagius respiratry illness caused by influenza viruses. It can cause mild t severe illness, and at times can lead t death. Sme peple, such as lder
More informationFor our protection, we require verification that you have received this notice. Therefore, please sign below.
PATIENT INFORMATION Dear Patient: Sleep prblems are extremely cmmn. Public health and safety are threatened by the increasing prevalence f bstructive sleep apnea, which nw afflicts at least 25 millin adults
More informationRECONSTRUCTIVE SURGERY: BONY FREE FLAPS
RECONSTRUCTIVE SURGERY: BONY FREE FLAPS This infrmatin aims t help yu understand the peratin, what is invlved and sme cmmn cmplicatins that may ccur. It may help answer sme f yur questins and help yu think
More informationMeeting the Nutritional Requirements of Individuals with Dementia
Unit 15: Understanding and Meeting the Nutritinal Requirements f Individuals with Dementia Unit reference number: D/616/7124 Level: 3 Unit type: Optinal Credit value: 3 Guided learning hurs: 26 Unit summary
More informationList the health concerns that brought you into this office
New Practice Member Applicatin Name Date f Birth / / Age Male/Female Address City State Zip Cell Phne Hme Phne Cellular Prvider Email Address Occupatin Emplyer s Name Single / Married / Divrced / Widwed
More informationALCAT FREQUENTLY ASKED QUESTIONS
1. Is fasting required befre taking the Alcat Test? N. It is recmmended t drink water and t avid stimulants like caffeine prir t the test. 2. With regard t testing children, must a child be a certain age
More informationAdult Preventive Care Guidelines
Adult Preventive Care Guidelines Gundersen is yur partner fr better health. We want t wrk with yu t make sure that yu and yur family are as healthy as pssible. That can be accmplished best if we wrk tgether
More informationI am having a Rotator Cuff Repair
I am having a Rtatr Cuff Repair A rtatr cuff repair is surgery t repair a trn tendn in the shulder. The rtatr cuff is a grup f muscles and tendns that frm a cuff ver the shulder jint. The muscles and tendns
More informationRisk factors in health and disease
Risk factrs in health and disease Index 1 Intrductin 2 Types f risk factrs 2.1 Behaviural risk factrs 2.2 Psychlgical risk factrs 2.3 Demgraphic risk factrs 2.4 Envirnmental risk factrs 2.5 Genetic risk
More informationEDPS 475: Instructional Objectives for Midterm Exam Behaviorism
EDPS 475: Instructinal Objectives fr Midterm Exam Behavirism 1. Given a nvel example t chse frm, identify the characteristics f classical cnditining. General mdel: Stimulus (S) elicits >Respnse (R) Based
More informationKey Points Enterovirus D68 in the United States, 2014 Note: Newly added information is in red.
Key Pints Entervirus D68 in the United States, 2014 Nte: Newly added infrmatin is in red. The United States is currently experiencing a natinwide utbreak f entervirus D68 (EV-D68) assciated with severe
More informationNEW PATIENT QUESTIONNAIRE-ADULT
3700 WASHINGTON AVENUE EVANSVILLE, IN 47750 (812) 485-7680 NEW PATIENT QUESTIONNAIRE-ADULT PART 1. PATIENT INFORMATION Name Hme Phne Date f Birth Scial Security Number Wrk Phne Tday s Date Physicians Caring
More informationTOP TIPS Lung Cancer Update Dr Andrew Wight Consultant respiratory Physician - WUTH
Tpic Circulatin list In case f query please cntact Executive Summary TOP TIPS Lung Cancer Update Dr Andrew Wight Cnsultant respiratry Physician - WUTH All Wirral GP s JaneFletcher2@nhs.net Dear Clleagues,
More informationQ 5: Is relaxation training better (more effective than/as safe as) than treatment as usual in adults with depressive episode/disorder?
updated 2012 Relaxatin training Q 5: Is relaxatin training better (mre effective than/as safe as) than treatment as usual in adults with depressive episde/disrder? Backgrund The number f general health
More informationFTD RESEARCH: The Value of Studies and Opportunities for Involvement
FTD RESEARCH: The Value f Studies and Opprtunities fr Invlvement Sarah Lawrence, MS Research Prgram Manager Ann Fishman, MBA Sr. Research Crdinatr Weiyi Mu, ScM Genetic Cunselr Suzanne Dana Spuse/Caregiver
More informationUnderstanding Your Total-Cholesterol-to-HDL Ratio
Understanding Yur Ttal-Chlesterl-t-HDL Rati Yur ttal-chlesterl-t-hdl rati is measured during a bld test called a lipid prfile. This wrksheet will help yu learn mre abut this rati. It will als help yu:
More informationThe Great Divide: Is it Operant or Classical? Lindsay Wood
The Great Divide: Is it Operant r Classical? Lindsay Wd Behavir cnsultants navigate multiple pathways in the curse f planning treatments. At the tp f ur list f cnsideratins is paradigm apprach: the chice
More informationUnderstanding and Recognizing Anxiety
Understanding and Recgnizing Anxiety Mst peple d nt recgnize their anxiety fr what it is, and instead think there is smething mre serius ging n. Myth: Reading, thinking, and learning abut anxiety will
More informationChapter 10 Chronic Pain Management and Arthritis
Chapter 10 Chrnic Pain Management and Arthritis Juvenile rheumatid arthritis a frm f arthritis that affects children befre the age f 16 Sectin I: Chrnic Pain Management - Individuals generally experience
More informationWhole Body Vibration FAQs
Whle Bdy Vibratin FAQs 1. Is Whle Bdy Vibratin training smething new? N, Whle Bdy Vibratin (WBV) has been used as an exercise and therapeutic tl since the late 1800s. The research f this technlgy really
More information2. As a caregiver, it s important to build a team/ support network around you (choose one):
Test Questins (Part 1, Chapter 1) 1. Of thse affected by dementia: 50% are nt aware they are changing and 50% are aware they are changing. Of the 50% wh are aware, they will always respnd by becming anxius
More informationIntroduction to Psychological Disorders (Myers for AP 2 nd Edition, Module 65)
Intrductin t Psychlgical Disrders (Myers fr AP 2 nd Editin, Mdule 65) Why are we s interested in learning abut psychlgical disrders? The Wrld Health Organizatin reprts that peple suffer frm mental r behavir
More information2019 Canada Winter Games Team NT Female Hockey Selection Camp August 16-19, 2018
2019 Canada Winter Games Team NT Female Hckey Selectin Camp August 16-19, 2018 Strength and Cnditining Recmmendatins As discussed in the Call Fr Players letter, it is critical fr players t get their bdies
More informationMedication Guide MORPHINE SULFATE (mor-pheen) Oral Solution (CII)
Medicatin Guide MORPHINE SULFATE (mr-pheen) Oral Slutin (CII) IMPORTANT: Keep Mrphine Sulfate Oral Slutin in a safe place away frm children. Accidental use by a child is a medical emergency and can cause
More informationClinical Orthopaedic Rehabilitation Spinal Disorders
COURSE DESCRIPTION Clinical Orthpaedic Rehabilitatin Spinal Disrders This prgram is a practical, clinical guide that prvides guidance n the evaluatin, differential diagnsis, treatment and rehabilitatin
More informationAwareness of Autistic Spectrum Conditions
Unit 21: Awareness f Autistic Spectrum Cnditins Unit reference number: H/616/7304 Level: 2 Unit type: Optinal Credit value: 2 Guided learning hurs: 17 Unit summary This unit intrduces yu t autistic spectrum
More informationIndividual Assessments for Couples Treatment with HFCA
Individual Assessments fr Cuples Treatment with HFCA Jennifer S. Ripley, Ph.D. Many appraches t cuples therapy include an individual assessment whenever a cuple cmes fr treatment. Therapists shuld be aware
More information/0515 Medication Guide Aripiprazole Tablets
8415721/0515 Medicatin Guide Aripiprazle Tablets (air-eh-pip-rah-zle) Read this Medicatin Guide befre yu start taking aripiprazle tablets and each time yu get a refill. There may be new infrmatin. This
More informationTopic PHOBIAS. (Student name) (Department name) (Professor name) (Date)
Tpic PHOBIAS (Student name) (Department name) (Prfessr name) (Date) Phbias: hw peple develp phbias and why? What is a Phbia? Phbia may be defined as an irresistibly unreasnable feeling f fear anything
More informationEXECUTIVE SUMMARY INNOVATION IS THE KEY TO CHANGING THE PARADIGM FOR THE TREATMENT OF PAIN AND ADDICTION TO CREATE AN AMERICA FREE OF OPIOID ADDICTION
EXECUTIVE SUMMARY INNOVATION IS THE KEY TO CHANGING THE PARADIGM FOR THE TREATMENT OF PAIN AND ADDICTION TO CREATE AN AMERICA FREE OF OPIOID ADDICTION The Bitechnlgy Innvatin Organizatin (BIO) and ur member
More informationMEDICATION GUIDE Levofloxacin (lee-voe-flox-a-sin) Tablets, USP 250 mg Tablets, 500 mg Tablets, and 750 mg Tablets
MEDICATION GUIDE Levflxacin (lee-ve-flox-a-sin) Tablets, USP 250 mg Tablets, 500 mg Tablets, and 750 mg Tablets Read this Medicatin Guide befre yu start taking levflxacin tablets and each time yu get a
More informationMEDICATION GUIDE. (Interferon alfa-2b)
MEDICATION GUIDE INTRON A (In-trn-aye) (Interfern alfa-2b) Read this Medicatin Guide befre yu start taking INTRON A, and each time yu get a refill. There may be new infrmatin. This infrmatin des nt take
More informationCancer Association of South Africa (CANSA) Fact Sheet on Essential Thrombocythaemia
Cancer Assciatin f Suth Africa (CANSA) Fact Sheet n Essential Thrmbcythaemia Intrductin Essential thrmbcythaemia (ET) is nt a type f bld cancer as there are n cancerus cells. It is cnsidered a chrnic haematlgical
More informationConcord Orthopaedics, P.A.
Cncrd Orthpaedics, P.A. PART IV: HOW IS THE INJECTION DONE? Why Inject? An injectin is intended t: T decrease pain T imprve functin T eliminate r reduce the need fr pain medicatin T diagnse Sme believe
More informationManaging the Symptoms of Stroke
Unit 26: Recgnising and Managing the Symptms f Strke Unit reference number: F/616/7312 Level: 2 Unit type: Optinal Credit value: 3 Guided learning hurs: 28 Unit summary A strke can be a life-threatening
More informationAssessment Field Activity Collaborative Assessment, Planning, and Support: Safety and Risk in Teams
Assessment Field Activity Cllabrative Assessment, Planning, and Supprt: Safety and Risk in Teams OBSERVATION Identify a case fr which a team meeting t discuss safety and/r safety planning is needed r scheduled.
More informationRoActemra (tocilizumab) for Giant Cell Arteritis (GCA) subcutaneous (SC) formulation
RActemra (tcilizumab) fr Giant Cell Arteritis (GCA) subcutaneus (SC) frmulatin What yu shuld knw abut RActemra This brchure prvides key infrmatin t assist in the patient s understanding f the benefits
More informationACSQHC National Consensus Statement: Essential Elements for High Quality End-oflife Care in Acute Hospitals.
27 March 2014 Prfessr Debra Picne Chief Executive Officer Australian Cmmissin n Safety and Quality in Health Care c/ Ms Jennifer Hill, Senir Prject Officer Level 5, 255 Elizabeth Street SYDNEY NSW 2000
More informationBiology 30S Unit Test Review: Digestion
Bilgy 30S Unit Test Review: Digestin Test utline: Multiple Chice: 10 Questins, 1 mark each. Shrt Answer: 5 Questins (answer 3 f them), 5 marks each. Lng Answer: 2 Lng Answer Questins, 10 marks each. Tasks
More informationUS Public Health Service Clinical Practice Guidelines for PrEP
Webcast 1.3 US Public Health Service Clinical Practice Guidelines fr PrEP P R E S ENTED BY: M A R K T H R U N, M D A S S O C I AT E P R O F E S S O R, U N I V E R S I T Y O F C O L O R A D O, D I V I S
More informationAP Biology Lab 12: Introduction to the Scientific Method and Animal Behavior
Name: AP Bilgy Lab 12: Intrductin t the Scientific Methd and Animal Behavir Overview In this lab yu will: -Observe an rganism and design an experiment t investigate their respnses t envirnmental variables.
More informationSub-Topic: Massage for Depression, Anxiety, and Sleep Disorders Level 1 Knowledge: Attain and Comprehend Skills: Observe and Imitate
Nte: Feedback frm prfessin stakehlders n the first draft f the Entry-Level Massage Educatin Blueprint indicated that this sub-tpic was beynd entry-level r unnecessary fr safe and cmpetent practice. The
More information