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Iman Battikha

on 6 November 2012

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Medical Background Pain Prepared by: Ph.Iman Battikha Sensory Pain Neuropathic Pain Tissue Injury Nerve Injury Less Modulating Severe Pain Medications Neuropathic Pain Sensory Pain Neuron synape Site of tissue injury NSAIDs (COX1& COX2 inhibitors)
Celocoxib (COX2 inhibitors) Ca++ Channel Ligands: Pregabalin, Gabapentin
TCA: Amitriptyline
SSNRIs: Duloxetine
Opioids: Tramadol, Oxycodone Ca+2 Channel Opioid receptors Postsynaptic receptors TCA Ca++
Channel ligands Opioids alfa2-delta subunit at the site of injury which induced relieving Pain Prostaglandins Blocking Blocking

Treatment is successful,
if 50% reduction in pain is obtained

It takes time to relief pain

Careful titration is needed Nada case study Spinal Cord Injury Injury is healed Herniated
Disc Radiculopathy Causes of Back Neuropathic Pain Identifiable pain generator No identifiable pain generator Chronic back pain
6% to 15% in adults Advanced Age
Poor fitness level and fatty diets
Presence of other diseases
Smoking % Adults with chronic BP classified as having Neuropathic Pain Degenrative Disc
Disease Spinal Stenosis Spondylolisthesis Types of BP Musculoskeletal problems
Like: A muscle ache
1/3 turns to Chronic case Specific diagnosing is NOT always possible
Patient History and physical Examination
Imaging is Only when truly needed
Probably Mixed pain syndrome
Combination medications is recommended Pins
Electrical shock down
to your arms
to your legs "Sciatica" Duration of BP: 3 years
No history of BP surgery
Previous medication:
1- Cox2 inhibitors (celecoxib)
2- Muscle relaxants
3- Vitamins and calcium 45 years
Middle Eastern
167 cm height
80 K.g weight
Desk worker in communication company for 22 years
Dyslipidemia Mansour case study 52 years old Diabetic Neuropathy A permanent nerve damage caused by diabetes Age Duration of Diabetes Medical History Hyperlipidemia
Cigarette smoking
long-term complications, such as coronary artery disease Keeping blood sugar under good control only may stop neuropathy from worsening, but it doesn’t cure Causes Metabolic factors
Neurovascular factors
Autoimmune factors
Mechanical injury to nerves
Inherited traits
Lifestyle factors Phase 2 Phase 5 Phase 3 Phase 4 Phase 1 Tingling feeling
The problem begun Stronger Sleep problems
Burning feeling Relief of Pain
Numbness Complete loss of sensation Neuropathic Pain is the most common symptom of Diabetic neuropathy Steps of Neuropathy Diabetic Painful Neuropathy
Chronic Back Pain Sensory Pain Vs. Neuropathic Pain Chronic Back Pain Anticonvulsants
/or/Opioids Consultation Add on therapy FDA Persist Signals Lancinating Pain Pregabalin
Painful Neuropathy 50% SSNRIs Serotonin &
Reuptake Receptors Doluxetine Amitriptyline Tramadol
Oxycodone Treatment of Diabetic Painful Neuropathy FDA ONLY FDA approval: Pregabalin
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