The virtues of Avicenna as a writer and a scholar of Medicine are well known within the Muslim world and beyond (1). In The Canon, Avicenna uses a style of writing which is elegant, eloquent and articulate, and the quality of his deductive reasoning is clearly visible and has been acknowledged by modern historians (8). Avi- cenna’s originality in his investigations of a range of anatomical and surgical issues contributed much to those fields (17, 18). Nevertheless, Avicenna’s theories and his contribution to medical knowledge has been challenged with claims that Avicenna did not develop Galen’s ideas to any appreciable extent (3, 16). Our analysis of The Canon suggests that Avicenna built on Galen’s concept of pain by insisting that pain does not necessarily have to result from an ongoing injury. He also gave a more detailed description of types of pain.
We would like to present our concept of pain manage- ment during labor. Considering differences in 2 stages of labor (mentioned before) we realized that there should be 2 different blocks that require 2 different noncommuni- cating anatomical spaces to prevent motor block (com- munication on level L4L5 will create motor block) and give ability to use 2 different medications in different concentrations. One would be epidural T10L1 block with diluted local anesthetic (0.0625% - 0.125% bupivacaine). It does not create motor block. Second block should be be saddle block, performed thru spinal needle using hy- perbaric Tetracaine (or other very long acting local anes- thetic). It’s long lasting (see this article), it is purely sen- sor block (S2S4). 27 g Spinal needle that we used during CSE is not creating opening big enough for 2 spaces to communicate . Dural puncture technique  that was offered before conceptually wrong, because its goal to create communication between spinal and epidural space, and because it’s on the level L4L5 motor block is un- avoidable.
Sickle Cell Anemia is the commonest inherited disease in world which is caused by a mutation in genes that leads to abnormal hemoglobin and defectivered blood cells. Red blood cells become rigid and sticky and deforms into sickles or crescent moons which are unable to move in vessels. They, therefore, block blood flow, decrease tissue oxygen, and finally lead to ischemia. Each year 300 thousand infants are born with SCD. 300 million people in world and 2.5 million in the U.S. are affected with SCD. The disease has several symptoms and signs. Periodic episodes of pain, called crises, are a major symptom of sickle cell anemia. The recurrence of pain is completely unpredictable. This study aims to investigate the pain experience in patients with SCD. Considering the nature of the study a philosophical research method, descriptive phenomenology, was used. Participants consisted of 11 patients (4 females and 7 males) with Sickle Cell Disease in Kohkiloye-Boyerahmad Province, Iran. Sampling was done on the basis of the aim of the study. Interviews were unstructured and a 7-stage Colaizzi Method was used to analyze and codify the collected data. 100% of participants complained of pain and described it as its worst experience. 40 first-level codes and 3 second-level codes were extracted including the cause of pain recurrence, pain consequences, and the type of pain which altogether created the main concept of pain. Participants complain about irregular severe pains which disturb their normal life. It is suggested their needs and problems be addressed specifically. Particular programs are required to support these patients, meet their needs, and improve the quality of their lives.
participants again frequently appealed to authority; this time it was not the physician’s authority, however, but Jack’s authority as the person feeling the pain. For instance, participants wrote “that's where he said his pain is and people know how they feel,” “if Jack said its in his arm, its in the arm; only Jack knows what hurt him in his body,” and “the important thing here is Jack’s perspective.” And other participants focused on the felt location of the pain without specifically noting Jack’s authority: “his arm hurts regardless of the actual infection being in his liver,” “Jack can still have pain in his left arm, even if the pain is the result of an infection in a different area of his body,” “regardless of what is wrong with Jack internally, he still feels pain in his arm.” Such explanations suggest that these participants hold that we should take the phenomenal aspect of pains at face value, even if the bodily disorder occurs at a different place.
or health has been considered as the normalcy of body humours whereas, any imbalance will lead to an ruk, vedana, daha, toda, etc. each are very specific entities pertaining to some specific sites or manifesting during some specific us aspects of pain mentioned in Ayurveda and pos- sible interpretations has been drawn from the classics. Thus it can be summarised that these various interpreta-
Rupa may be defined as the absolute revelation of the disease. This is the Vyakti stage under Satkriyakala concept of Sushruta. The characteristic display of the signs and symptoms ofthe disease are called Lakshanas. With the course of disease i.e. progress orregresses, the Rupa also fluctuate. But cardinal feature of Dysmenorrhoea i.e. pain and discomfort during menstruation is also present with it. As in this disease no clear cut Rupa is mentioned thus, it may be postulated as follows keeping base line of Artava Dushti. Other associated symptoms can be taken as the features other than the pain told by Acharyas in description of many diseases which visible dysmenorrhoea up to some or great extent. Among the some features are general while others are specific to a particular condition.
of pain issues, substance abuse, and/or chronic pain, as well as overseeing pain control in the PACU of the ambulatory sur- gery center, could be critical to the ever-growing community we serve. Ambulatory pain control can be highly complex, and is probably best accomplished through risk stratification, multidisciplinary communication, the use of multimodal analgesia, which can include regional anesthesia also, and other interventions when strategies fall short preoperatively. There is a need for increased clinical research on quality of care in the ambulatory surgery setting, such as early inter- vention when problematic pain issues are recognized, in order to prevent emergency room visits, delayed discharges, and unplanned admissions. Interventions include control of anxi- ety, managing patients with a history of chronic pain, chronic opioid use, and the prevention of pain flare-ups in patients who are opioid-dependent and/or taking part in substance-abuse programs. New interventions will also be necessary when current multimodal analgesia modalities are insufficient or ineffective. It is always important to consider the cost of the interventions that may be needed after implementation of multimodal analgesia to make the strategies viable in the long term. Immediate hospital costs include services by personnel, supplies, and other resources. However, the cost of unplanned hospital admissions, returns to the emergency room for pain that is out of control, and the development of chronic pain as a result of poorly controlled acute pain is much more costly to the patient, society, and the health care system.
Development of the model of nursing education based on the explanation of the role of nurses in the health system will not be possible without analyzing the nursing concept and its infrastructures. Nursing concept is a dynamic concept and constantly evolving in response to the new health needs of the patients. It is clear that providing a single definition for the nursing concept is too limited to be able to cover all aspects of this profession. By analysing the nursing concept we can achieve the three following objectives: • To describe nursing to people who do not
Somatic or psychiatric disorders and use of prescription-based medications or allergy medications led to exclusion from participation. Pregnant women were excluded. Participants were instructed to abstain from use of nicotine- and caffeine- containing substances 3 hours before participation. The participants had to speak Norwegian as Norwegian language was used in the questionnaires, instructions, consent and mea- surements of pain, stress and activation collected in the experi- ments. Data from seven different study samples were pooled. All participants filled in the FPQ-III and an informed consent form. The studies were approved by the Regional Committee for Medical Research Ethics North Norway (project numbers: 2013/966, 2012/1888, 2610.00001, 49/2005, 5.2006.2452; 20277, 17/2006).
Inversion Table is an adjustable platform which allows positioning in an upright or inverted position in order to allow the effects of gravity to meet requirements to cure the disorders related to spine. Frederick Sheffield designed a tilt table with a highly-polished slippery top on which the patient was attached by a pelvic harness. By tilting the table head down or inverted. The efficiency and benefits from inversion define a broad spectrum of patients and conditions. Patients who present with numerous conditions such as herniated or bulging discs, sciatica, spondylolisthesis, scoliosis, muscle spasm and even lymph edema, can benefit from inversion. Inversion therapy can result in a reduction of pain, realignment of the vertebrae, rehydration of the intervertebral discs, relaxation of the muscles and reduction of recovery time. In addition to these direct benefits, the use of inversion also has been shown to stimulate venous return and the lymphatic system; stimulate the autonomic nervous system and its bar receptors; increase oxygen flow to the brain; help maintain our original body shape and avoid prolapsed internal organs; help maintain correct posture; and contribute to overall general good health.
Retrospective acceptability can be estimated by per- ceived effectiveness and self-efficacy. Most patients felt they benefitted from the consultations (which was also found elsewhere), were able to ask all the questions they wanted to and would recommend it to others . There was an increase in patients who felt they knew enough about their medicines following the intervention indicating that knowledge was increased. Pain levels in this patient group can change rapidly due to the nature of the illness although average pain levels remained the same . This may be due to a negation in the expected deterioration over time although on such a small sample it is difficult to draw any such conclusions. Patient evaluation is more likely to be obtained following a one-off intervention so this may have affected our response rates .
This thesis addresses the longstanding urgent, unmet medical need of chronic pain. Recent surveys have found that chronic pain affects up to 20% of adults in Europe and the USA 9 . One key issue is the fact that the symptomatic medication currently available is effective only in about 40% of chronic pain sufferers and even these patients struggle to maintain the balance between adequate pain relief and their ability to cope with substantial drug-induced adverse effects 138 . This creates a vicious cycle of insufficient analgesia and unbearable side effects ultimately leading to discontinuation of treatment. A greater understanding of the underlying mechanisms of chronic pain has revealed the key role the glycine receptor (GlyR) plays in nociceptive pathways 97 .
ABSTRACT: Reestablishing neuromuscular control is a crucial component in the rehabilitation process especially in human joints. The main objective of neuromuscular control activities is to refocus an athlete’s awareness of peripheral sensations and process these signals into more coordinated motor strategies (Prentice, 2004). By establishing this component, the injured athlete will be able to control the muscle activities and protect the injured joint from further injuries. Based on current research, the quadriceps strengthening exercise and taping have been used to improve neuromuscular control of Patellofemoral Pain Syndrome (PFPS) patients since the main focus of rehabilitation for (PFPS) is more on strengthening quadriceps muscle, regaining optimal patellar positioning and tracking. However, the effectiveness of this procedure may be questionable due to overlapping activities and protocols. Therefore a specific neuromuscular control exercise protocol (NCEP) will be developed focusing on individuals who had PFPS. This NCEP will involve a series of customized preprogrammed exercise protocols on Balance Trainer Software Suite using BT3 Balance Platform (HurLabs, Tampere, Finland) and will be applied to athletes who experienced PFPS where the effectiveness of this NCEP will then be evaluated.
professional formation is the concept of professionalism, which has been increased in line with the social contract, and only focuses on performing and demonstrating professional behaviors (that is, observable behaviors that proceed from medical professional norms), but does not deal with absolute and independent principles (such as development of a value system, and understanding of oneself and/or professional socialization and acculturation) that exist in the concept of professional formation. However, this process is apparently similar only to the process of professional formation with all particularly cognitive, behavioral, symbolic, emotional, and ethical elements in which structural variables such as the university and hospital, staff, power structure and so on, have regulated the stage of behavioral socialization, and on whose development, situational variables, such as role playing, role models, peer groups, mentorship, and important emotional experiences, have dramatic influence. Related Case
In this study, patients were asked to provide their response to treatment and their perceptions of improve- ment in various QoL parameters, satisfaction of treatment, and functionality. Patients in the TG group demonstrated an 87.5% increase in pain relief with a statistical separa- tion from the 12% improvement in control group. It is often dif ﬁ cult for clinicians to determine what level of analgesia constitutes clinically meaningful relief for patients. Farrar et al 45 have reported on patient responder rates and noted that a 30% improvement in pain intensity represents changes that are clinically meaningful to patients. In addition, a measure known as the Minimal Clinically Important Improvement (MCII) has been used to de ﬁ ne meaningful relief with various medications including topical nonsteroidal analgesics. 46,47 The MCII represents a patient ’ s perception of what is an important improvement. It can be de ﬁ ned as the smallest change in measurement that signi ﬁ es an important improvement. Patient reported outcome measures such as responder rate and MCII should be included in analgesic studies as changes in function and QoL are dif ﬁ cult to measure with numeric pain ratings. This type of information would con- form to recent FDA guidance which promotes the use of data from observational studies to capture real-world evi- dence of changes in patient perception – which is often lacking in traditional clinical trials. 48
The analgesic effectiveness and safety of a new technique or drug are determined in prospective controlled randomized studies usually performed in academic departments with the use of additional resources provided for research. As a result, the per-patient time, one of the components of patient safety, is usually sufficiently good. At the same time, national sur- veys reflect routine pain management that often takes place in establishments in which clinical staff resources for pain management are limited. Moreover, responses to question- naires sent to departments of anesthesiology often suggest that these limited financial resources for pain management are declining. 45,46 Thus, compared to PCA, the greater risk of pos-
As Inflammation is mainly caused by activation of inflammatory signal pathways such as the NF-κB signal pathway and release of inflammatory mediators such as the pro-inflammatory cytokines (e.g. TNF and IL-1β) and pro-inflammatory enzymes that mediate production of prostaglandins (e.g. COX-2) and leukotrienes (e.g. lipo-oxygenase), together with expression of adhesion molecules and MMPs. Cyclo-oxygenase 2 (COX-2) converts arachidonic acid into prostaglandins and prostanoids. COX-2 induction is responsible for inflammation and pain. Guggulsterone And other active principles present in aqueous solution of guggulu resin, prevent cytokine induced cell damage. Guggulsterone suppresses the inflammation by inhibiting inducible nitric oxide synthetase (iNOS) expression induced by lipopolysaccharide in macrophages. Because the inflammations are mediated through the activation of NF-κB, a nuclear transcription factor and Guggulsterone suppresses DNA binding of NF-κB induced by TNF. The COX-2–inhibitory activity of guggulu may explain in part its anti-inflammatory activity in plantar fasciitis.
Pain, atrocity and brutality are the most eminent and notorious tactics that were used and are still used against the oppressed. In another meaning, the White have a phobia from the Black. Therefore, they, the Whites, are brilliant tacticians, so to speak, in dehumanising and demoralising the colonised. On that account, this inequality finds its passionate defenders who argue for the human rights. For instance, Fanon, a great thinker, defender and author of several masterpieces that embody and exemplify the pragmatic shape of colonisation; thus, hecertainlyis an authoritative figure arguing for several human issues. As a result, inBlack Skin, White Masks (1968), Fanon attacks the ardent and the wrong beliefs about the Black man. Not only this, but he deciphers the indecipherable and delineates the exact image that is taken for granted against the Negros, thus he intentionally begins with Aime Cesaire’s few words about the misconception that is held by the white, “I am talking of millions of men who have been skilfully injected with fear, inferiority complexes, trepidation, servility, despair, abasement’’ (7).
Study 1: A neurophysiological analysis (fMRI scan) will be scheduled at a time most convenient for Group A and B subjects. Transport/remuneration for transport will be provided to and from the study venue on the day of the subject ’ s scheduled appointment. On the day of the scheduled neurophysiological analysis, subjects will again be informed of the fMRI procedure and asked to comply with all the regulations of the laboratory. This prepara- tion session will be conducted in the MRI simulation room situated within CUBIC facility. A set of the PCS and TSK will be administered prior to the commence- ment of the fMRI session and used as baseline data. Sub- jects will be escorted to the MRI room and asked to lie down inside the fMRI chamber. Foam cushions will be used to immobilize the head. The subjects will be required to wear MRI compatible earmuffs for communi- cation with the experimenter and to minimize scanner noise. For structural localization, a MEMPRAGE struc- tural sequence with a spatial resolution of 1 × 1 × 1 mm 3 will be acquired (approx 9 minutes) for each subject. The tasks/stimuli used in the MRI sequence have been derived from other cognitive-behavioural therapy studies [15-17], but have been modified for application in this study. The tasks/stimuli have been specifically and care- fully chosen and designed so as to elicit pain catastro- phizing in the FMS subjects. The tasks/stimuli, although different, are also somewhat similar in concept/idea, so that they do not elicit completely different neurophysio- logical activity responses. The following tasks/stimuli will be applied during the fMRI scanning: 1) Visuals of exer- cise/physical activities (30s clips of various exercise activ- ities) (4 minutes); 2) Visuals of everyday sedentary activities (i.e. 30s clip of reading a book/magazine) (4 minutes); and 3) Verbal visualization (30s of standardized verbal instruction where subject is instructed to imagine an activity i.e. running, cycling, skipping, etc.) (4 min- utes). The fMRI sequence which entails the application of the three tasks/stimuli will last approximately 12 min- utes and consist of 3 runs. The application of each of the three tasks/stimuli will constitute one run. Each run will last approximately 240 seconds (s) and comprises of: 4 ×