...al. published data regarding the use of topical morphine in the treatment of painful ulcers, confirming the results of a pilot study. Topical morphine seems to be safe and efficacious in the treatment of ulcer-related pain.1,2 At the Medical Oncology Department of the University of L’Aquila, five patients with malignant or benign painful ulcers were observed recently. All were affected by metastatic cancer and were receiving opioids; none was receiving disease-oriented therapies. On admission, all patients reported pain localized to ulcers, which was no longer controlled by systemic treatment; pain scores were O 5 on a numerical rating scale (NRS). Morphine was topically applied to ulcers three times daily (morphine sulfate injection 10 mg in 8 g Intrasite gelÒ, Smith & Nephew, Agrate Brianza, Italy). The morphine dose was the same in all patients, regardless of the ulcer size and the scheduled systemic treatment. Ulcers were washed before treatment with a ringer lactate and metronidazole solution. Systemic treatment was not modified. Pain was assessed daily by the patients using the NRS; nurses reported local and/or systemic adverse effects related to treatment in nursing charts. Patients were observed in the hospital for seven days. Characteristics of patients and pain scores are reported in Table 1. All patients responded References 1. National Institutes of Health NIDDK/DKUHD: Excerpts from the United States renal data system 2001. Annual data report. Am J Kidney Dis 2001; 38(Suppl...
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...July 3, 2014 Card v. American National Property and Casualty Spencer E. Richards IN ARBITRATION * * * TRAVIS CARD, Plaintiff, v. AMERICAN NATIONAL PROPERTY AND CASUALTY, Defendant. ) ) ) ) ) ) ) ) ) ) Deposition of: SPENCER E. RICHARDS * * * July 3, 2014 10:00 a.m. CHRISTENSEN & HYMAS 11693 South 700 East, Suite 100 Draper, Utah * * * Wade J. Van Tassell - Certified Realtime Reporter Registered Merit Reporter DepomaxMerit Litigation 801-328-1188 Wade J. Van Tassell July 3, 2014 Card v. American National Property and Casualty Spencer E. Richards Page 2 APPEARANCES For the Plaintiff: Kenneth L. Christensen Matthew Hansen Jake Lee CHRISTENSEN & HYMAS 11693 South 700 East, Suite 100 Draper, Utah 84020 For the Defendant: Sade A. Turner STRONG & HANNI 102 South 200 East, Suite 800 Salt Lake City, Utah 84111 Also Present: (Via Telephone) Dorothy Clay Sims Oregon Hunter Page 4 *** INDEX EXAMINATION By Mr. Christensen By Ms. Turner By Mr. Christensen PAGE 3 132 157 EXHIBITS No. 1 No. 2 3-19-14 Ltr, Turner to Richards 11-14-13 Deposition Transcript Excerpt 86 86 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Page 3 Uh-huh. MS. TURNER: Mr. Christensen, these are the medical records because we didn't print them all out. MR. CHRISTENSEN: I figured. And you had sent me those, but I appreciate you bringing them. We might open them up and refer to them, actually. Q. Did you happen to have in your file your billing for your...
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...strength. 2. Describe differences between acute pain management and chronic pain management. The differences between acute pain management and chronic pain management are: acute pain can be treated right away and the patient’s pain might be relieved. The patient with chronic pain will have to be treated long term. 3. Identify common concerns related to long-term use of opiod medications. The common concerns with opioid medications are: the risk of drug tolerance, drug abuse, respiratory depression, and accidents related to the use of opioids. 4. What are the top three nursing diagnosis priorities for a patient with an acute exacerbation of chronic pain? The top three nursing diagnosis priorities for a patient with an acute exacerbation of chronic pain are: 1. Acute or chronic lower back pain. 2. Risk for injury due to lower back pain. 3. Risk for social isolation. 5. Identify and explain at least two adjuncts, other than medications, that are used for chronic pain management. Two other treatments that can be used to treat chronic pain are the rotation of hot and cold packs to reduce inflammation, and sooth the pain. The second adjunct treatment is relaxation by giving the muscles a break. 6. Describe the possible impact of chronic pain on the psychosocial, spiritual, cultural, and developmental levels of a patient. The person with chronic pain may withdraw socially because of the fear of being in pain all of the time. The patient might not participate...
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...Carolina born and raise, for the past four years I lived in Warner Robins, Georgia, and just recently moved back home after the death of my mother. I lost my husband on December 23, 2011, from a long time illness. I have my Associates of Science in Business Administration Degree, and just recently gotten my Bachelor of Science in Business Administration Degree, and also my Master’s in Marketing and Business Administration. Hopefully, I will soon be able to open my own Gym for Patients with Fibromyalgia. I am disabled as well, I have Fibromyalgia, along with Lupus with some other chronic pain disorders I do not care to mention, but I’m maintaining my life just fine. I have accomplished a lot for myself and still plan to accomplish a lot more. This is my main reason why I want to open this Gym in order to help disabled individuals cope with their life style and deal with their pain a whole lot better. Being that, I’ve experience this first hand it would really help many others to deal with their illnesses a whole lot better. My daughter is 24; her name is Tempestt S. Gavins has graduated from Columbia College in Columbia, South Carolina, she is presently teaching English in China for one year with plans to continue to her education there. Yes, I’m very proud. My son is 21, his name is Daniel J. Gavins, and he doesn’t know what he wants to do yet. But I do have two beautiful granddaughters from him at a very young age, and they are three years old. I also...
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...Chronic Intractable Pain Diane Purcell Sophia Praskala Types of Pain: * Acute pain- short term, self-limiting, recent onset, transient often follows an injury. * Chronic pain- 6 months or longer. Persistent pain which can be divided into malignant and non-malignant. These individuals usually present with a complex array of medical and psychosocial problems that render them as a “vulnerable population.” There is evidence of prejudicial attitude esp. by Health Care Providers. * Intractable pain-severe, constant pain that is not curable by any known * means and which may cause a bed or house-bound state. It may cause adverse biologic effects on the body’s cardiovascular, hormone, and neurological systems. Common Causes of Intractable Pain: * Spine degeneration * Auto immune rheumatoid disease- Fibromyalgia, Lupus * Peripheral nerve damage or Reflex systemic dystrophy * Abdominal adhesions * Headaches- post concussion or post trauma * Malignant Fibromyalgia * Arachnoiditis * Pelvic Floor, Groin, Vulvar, or Prostatic pain * Reflex Sympathetic Dystrophy Stats: * Back pain reported as primary source of chronic pain followed by osteoarthritis. * Internet survey- 30.7% reported chronic pain, females 34.3% and males 30.7%. Increasing age and lower socioeconomic status are indicators for increase in chronic pain. * In N.C. unintentional overdose accounts for approx. 3 deaths a day...
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...Fibromyalgia All over the world there are different diseases, some chronic, some acute. Disease are common in our world. We see them every day and may not even realize it. Some diseases are easier to hide than others. For instance, it is easier to hide a sexual transmitted disease rather than hide a bad case of rickets. Fibromyalgia is easier to hide than other disease but what you can’t hide is the pain you feel when you have fibromyalgia. First, fibromyalgia is a muscular disease. It causes pain in your muscles, causing mood swings, and can even have fatigue. This disease is more common in women than men. This disease is not only a pain, but it can affect your life and your loved one’s life as well, because fibromyalgia affects your ability...
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...Prescription Concepts Applied to Patients Diagnosed With Fibromyalgia Pain is defined as an “unpleasant feeling, conveyed to the brain by sensory neurons” (Medical Dictionary, 2013). Pain is a subjective interpretation, which describes location, intensity and nature of sensory information resulted from noxious stimulation of nerve endings. The emotional response and other various conscious or unconscious responses add to the concept of pain. Acute pain usually results from tissue damage and it usually ends once the injury is healed. Chronic pain is a long term condition related to a persistent or degenerative disease or it doesn’t have an identifiable cause. Although there are different opinions about when a patient can be declared as suffering from chronic pain (after six months or twelve months), the presence of such sensation after the healing period usually leads to this diagnosis. One of the diseases with a generalized chronic pain as a symptom, which continues to generate many debates in the medical world, is fibromyalgia. Fibromyalgia, a disorder that affects the overall system and has an effect of generalized chronic pain, will be delineated in this paper, including its causes, manifestation, and part of the process of managing this disease in which a kinesiologist would have a central role. Fibromyalgia, estimated to affect 4% of the population, is a compilation of symptoms accompanying pain, which include fatigue, stiffness and sleep disturbance, along with psychiatric...
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...Stroke _________ Skin Disease ______ Bladder Infections _Kidney Disease ___________ Ulcers ________ DM _________ Dental Problems _________ Fractures _________Congenital Heart Defects Surgeries Family Health History Condition Family Members Condition Family Members Heart Disease Mom died of heart attack Tuberculosis Hypertension Asthma Stroke Mental Illness Diabetes Alcoholism Cancer Aunt died of mylethoma Kidney Disease Other Health Problems in Family: _________________________________________________________________ Medications Prior to Admission: (List) Prescription: She only takes aspirin and pain medications, but she doesn’t know the exact medications. Nonprescription: None Allergies and Reactions: Identify the drugs allergic to and describe the client’s response to them: 1.) Penicillin – Drug: causes...
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...debilitating 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...
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...Fibromyalgia (FM) is a complex chronic pain disorder that causes widespread pain and tenderness to touch that may occur body wide or migrate over the body. The pain itself waxes and wanes over time. Fibromyalgia affects people physically, mentally and socially. Approximately 10 million Americans have FM with a ratio of about 8 to 2, women over men. It occurs in people of all ages, including children. Healthcare providers diagnose FM based on a combination of relevant symptoms, including fatigue, tenderness, functionality, and overall well-being. Additional common symptoms may include depression or anxiety, migraines, tension headaches, pelvic pain, irritable or overactive bladder, irritable bowel syndrome (IBS), TMJD (including tinnitus),...
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...approximated that 3 to 17 million Americans [have] fibromyalgia.(New Harvard Guide to Women's Health, 2004). Fibromyalgia is a debilitating disease that attacks people of every age, race, and gender. It is a disease that may develop out of nowhere, or be brought on by a stressful event. With it comes pain, both physically and psychologically. There is hope though as there are several ways to try and alleviate the pain, or reduce the symptoms. Medications are available, and of course there is always hope for a cure. This disease does not only affect those afflicted, but their families and loved ones too. Cause Fibromyalgia can manifest in a person for many different reasons. One of the major causes of the disease is stress. It can be from simple everyday stresses, like working a tough job, or worrying about how to make ends meet. Other stresses are more physical, such as car crashes or childbirth, both of which put immense strain on the physical body. Another cause is Post- Traumatic Stress disorder. Post-Traumatic Stress can be the result of horrible events, such as war or abusive childhoods. In other cases the disease can simply manifest one day out of the blue (Fibromyalgia & Chronic Myofascial Syndrome, 1996). It is a disease that can hit any gender, but about 80% of known cases are women in their fifties (New Harvard Guide to Women's Health, 2004). Symptoms Many cases of Fibromyalgia are undocumented, mainly because some people don’t even know they have it. There are many...
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...Pain is a global marvel which has been rigorously contemplated and described from different points of view. However, this subject continues to bewilder health care experts and researchers from many disciplines. Moreover, Pain is a combination of different domains of responses, particularly; social, behavioral, physiologic, emotional, psychological that may influence the person’s pain fortitude. Many components could influence the pain experience, manifestation and cause a dilemma for healthcare workers and researchers who will try to gauge the pain response. It is understood that expertise in pain assessment would result in an improved pain management (Flaskerud, J.H., 2015). The Joint Commission on Accreditation of Healthcare Organizations...
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...Abstract Introduction: Fibromyalgia syndrome (FMS) can be defined as a chronic musculoskeletal disease with widespread pain and tender points on specific anatomical regions. FMS affects quality of life and causes severe chronic pain, depressed mood and possible muscle weakness. In this study we aimed to investigate the possible relationship between clinical findings, hand grip strength and quality of life in patients with FMS. Material and methods: Fifty consecutive women who fulfilled the 1990 American College of Rheumatology criterial for FMS were included in this study and compared with 40 age and BMI matched female healthy controls. Pain assessment was performed visual pain scales (VPS) and functional pain scale (FPS). Saehan hydraulic hand grip dynamometer was used for assessing patient and control groups hand grip strength. Beck Depression Inventory was used for evaluating patient and control groups’ mental status. For patients’ functional assessment were used Fibromyalgia Impact Scale. Short form 36 (SF-36) were investigated for quality of life of patients and the control group. It has a high reliability and validity for FMS patients. Results: In FMS patients, the mean number of tender points was 15.0±1.79 (range, 12-18), the mean...
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...Living with chronic musculoskeletal pain can be disappointing and unbearable. Musculoskeletal pain usually affects the support structures of your body like bones, muscles, ligaments, and tendons that allows you to move and perform your daily tasks. The excruciating pain can make you feel uneasy and keep you from getting a good night sleep. For some people, the pain takes over their daily lives and prevents them from doing activities they enjoy. Some patients who cannot stand the pain often consider undergoing joint replacement surgery to eliminate the pain. Joint replacement is a life-changing decision and could give you long-term consequences. Most patients expect pain relief, better joint function and improved quality of life after the surgery. However, this procedure also comes with risks like bone fractures and dislocation, infections, blood clots and nerve injury. Some patients complain that they feel stiffness on the implanted joint, while others feel frustrated as it did not help them regain absolute mobility. In other words, surgery is not the best remedy for your chronic musculoskeletal pain. For that reason, you should give Los Angeles prolotherapy a try before you jump the gun and decide to have drastic replacement....
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...Management of Chronic Pain Chronic pain occurs due to various reversible and irreversible disorders. But mainly causes of chronic pain are irreversible. Therefore most of the chronic pain conditions cannot be cured completely. But the pain can be managed to allow the individual to carry out a normal life style. Also it is important to remember that pain is treatable. The goal of chronic pain management is to improve function, enabling the individual to work, attend school, or participate in other day-to-day activities (7), to interrupt the reinforcement of pain behavior and modulation of pain responses (9). Despite the effectiveness of the treatment method, appropriate precautions should be...
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