Type of treatment doctor
Tramadol withdrawal
Weaning goal Existen diferentes motivos para iniciar la abstinencia de tramadol: Existe un mal uso del fármaco, tomándose en ocasiones dosis superiores a la dosis terapéutica recomendada (400 mg/día) con evidente comportamiento adictivo. Tramadol se
Prolonged benzodiazepine withdrawal syndrome
Article inspired by “The prolonged benzodiazepine withdrawal syndrome. Published in Comprehensive Handbook of Drug & Alcohol Addiction 2004. Professor Ashton” For some patients treated chronically with benzodiazepines, withdrawal can be a very long process. Approximately
Benzodiazepine withdrawal protocol.
Introduction We will recall the side effects of benzodiazepines and that these drugs cause more or less dependence depending on the subjects, the duration of use and the dose. Numerous clinical studies demonstrate the benefit
Long-term side effects of benzodiazepines
Introduction Benzodiazepines (BZDs) have anxiolytic, hypnotic, muscle relaxant and anticonvulsant indications. Of these, prescribing to reduce anxiety and insomnia are the most common and have caused the greatest problems. Adverse effects and harm production are
Equivalence between benzodiazepines
Preamble There are no clearly definitive equivalencies for various benzodiazepines. The table below was chosen because it reflects Professor Ashton’s clinical experience using a Valium substitution method. Problems with benzodiazepine conversions In addition to a
Prescription of ketamine in hospitalization: protocol for nurses
You will find in the PDF file below an example of a ketamine protocol implemented in a hospitalization department which welcomes chronic pain patients: Management_of_patients_with_ketamine
Scottish baths LIBRE
Scottish baths are an alternation of cold and hot baths generally used on the extremities of the limbs (ease of realization): – Hot water at 40°C (+/- 2°) depending on tolerance – Cold water at
Mianserin
Old medicine used in depression, sleep disorders and sometimes in chronic pain You will find all the information on the latter by this link
Mirtazapine
Indications Mirtazapine is indicated in adults for the treatment of major depressive episodes. Mirtazapine is a centrally acting presynaptic α2 antagonist that increases central noradrenergic and serotonergic neurotransmission Dosage Adults: The effective daily dose is
Therapeutic Cannabis ABONNE LIBRE
Definition of medical cannabis Therapeutic cannabis is the use of different cannabis plants containing dozens of different molecules with multiple properties that can be used in certain human pathologies. In view of the growing number
Secondary hyperalgesia induced by opioids ABONNE LIBRE
We must first define hyperalgesia and allodynia, primary and secondary hyperalgesia: Hyperalgesia: for a given painful stimulus, the painful sensation is abnormally increased Allodynia: a normally non-painful sensation becomes painful. Primary hyperalgesia: it is a
Vagus nerve neurostimulation
Neurostimulation of the vagus nerve. Principle The vagus or vagus nerve: Controls the vocal cords, allows swallowing, keeps the larynx open for breathing. Slows heart rate. Starts and controls digestion, Modifies inflammatory reactions, Influence of
Treatment of low back pain of lumbosacral origin
Treatments should first aim to relieve segmental spinal pain then it is necessary to take care of the resulting cellulo-teno-periosto-myalgic (CTM) pain, finally, finally, rehabilitation and postural precautions will be put in place in order
Treatment of pudendal neuralgia
Like all entrapment syndromes, pudendal neuralgia can benefit from drug and non-drug treatments, infiltration therapy, and surgical treatment. If this fails, chronic pain management will be required. Medical treatment Like any compressive neuropathy, at the
Lamaline (paracetamol + opium + caffeine) ABONNE LIBRE
Composition : Capsule: – Paracetamol 300mg – Opium powder 10mg – Caffeine 30mg Suppository: – Paracetamol 500mg – Opium powder 15mg – Caffeine 50mg Indications : Symptomatic treatment of pain of moderate to intense intensity
Acetylsalicylic acid (Aspirin) ABONNE LIBRE
Indications: – Symptomatic treatment of mild to moderate pain and/or febrile states. – Chronic inflammatory rheumatism, acute articular rheumatism in children. – Symptomatic treatment of inflammatory rheumatism in adults. Dosage: Mild to moderate pain and/or
Equianalgesia table of main opioids
Drugs Conversion factor Equivalence Morphine LP 1 60 mg Paracetamol/codéine (500 mg/30 mg) 1/6 6 cps/j Paracetamol/codéine (400 mg/20 mg) 1/6 10 cps/j Dihydrocodéine (60 mg) 1/3 3 cps/j Tramadol 1/5 300 mg/j Hydromorphone 8
Nonsteroidal anti-inflammatory drugs (NSAIDs) ABONNE LIBRE
Many molecules have nonsteroidal anti-inflammatory effects (NSAIDs). Action mechanism : Blocks the production of inflammatory substances. Indications: Depends on the analgesic and anti-inflammatory activity of NSAIDs and the extent of the manifestations of intolerance to
Baclofen ABONNE
Indications : Adult : Baclofen is indicated as treatment for: – Spastic contractures of multiple sclerosis. – Spastic contractures of spinal cord disorders (of infectious, degenerative, traumatic, neoplastic etiology). – Spastic contractures of cerebral origin.
Lamotrigine ABONNE
Indications : Epilepsy: Adults and adolescents aged 13 and over: – Treatment in monotherapy or in combination of partial and generalized epilepsies, including tonic-clonic seizures. – Seizures associated with Lennox-Gastaut syndrome. Lamictal is administered in
TENS and phantom limb pain
After amputation two types of pain called “phantom limb pain” are possible: Stump pain which is scarring neuropathy. Central phantom limb pain that is related to the amputation and a painful afterimage of the limb
Amitriptyline ABONNE
Indications : – Major depressive episodes. – Peripheral neuropathic pain in adults. – Nocturnal enuresis in children in cases where any organic pathology has been excluded. Dosage in neuropathic pain: Treatment should start at low
Clomipramine ABONNE
Indications : – Major depressive episodes. – Peripheral neuropathic pain in adults. – Obsessive-compulsive disorders. Dosage in neuropathic pain: Treatment should start at low doses: 10 mg to 25 mg per day for 3 weeks.
Carbamazepine ABONNE
Indications : Epilepsies : – Adult and child: As monotherapy or in combination with another antiepileptic treatment: – Treatment of partial epilepsies, with or without secondary generalization. – Treatment of generalized epilepsies: tonic-clonic seizures. Psychiatry:
Clonazepam ABONNE
Indicaciones : Tablet (adult and child) and oral solution (child): Treatment of epilepsy, either as temporary monotherapy or in combination with another antiepileptic treatment: Treatment of generalized epilepsies: Clonic, tonic, tonic-clonic, absence, myoclonic, atonic, infantile
Gabapentin ABONNE
Indications : Epilepsy: Gabapentin is indicated in combination in the treatment of partial epilepsies with or without secondary generalization in adults and children from 6 years of age. Gabapentin is indicated as monotherapy in the
Milnacipran ABONNE
Indications : Treatment of major depressive disorders. This medicine does not have marketing authorization (MA) for the treatment of neuropathic pain. It is rarely used in this indication but in the case of antidepressant treatment
Oxcarbazepine ABONNE
Indications : Treatment of partial epileptic seizures with or without secondary generalization. As monotherapy or in combination with another antiepileptic treatment in adults and children from 6 years of age. Oxcarbazepine (Trileptal) does not have
Pregabalin ABONNE
Indications : Neuropathic pain: Lyrica is indicated for the treatment of peripheral and central neuropathic pain in adults. Epilepsy: Lyrica is indicated in adults in combination for the treatment of partial-onset epileptic seizures with or
Venlafaxine ABONNE
Indications : – Treatment of major depressive episodes. – Prevention of recurrence of major depressive episodes. – Treatment of generalized anxiety disorder. – Treatment of social anxiety disorder (social phobia). – Treatment of panic disorder,
Treatment of neuropathic pain MEDECIN
The treatment of neuropathic pain is sometimes difficult and is generally based on the combination of several medicinal and/or non-medicinal methods. Seeking the best relief with the fewest possible side effects is the rule. Of
Treatment of chronic migraine
Treatment of chronic migraine After having defined the chronic nature of migraine. we can use medicinal and non-drug treatments described in the article: Treatment of migraine.
Headache prevention due to medication overuse
Prevention of these headaches relies on education of patients presenting with migraine and/or tension headache. It is based on: Keeping a diary The need for the patient to know the concept of pre-abuse defined by
Treatment of medication overuse headache
There was a consensus that weaning off analgesic treatments or specific anti-migraine treatments was a mandatory step in the management of headaches. To date, with the arrival of new anti-migraine treatments, this position is more
TENS and postherpetic pain. Examples
In post zoster intercostal pain it is preferable to use the two channels of the device with 4 electrodes. The 4 electrodes are placed from the emergence of the affected nerve root towards the distality
Treatment of tension headache
Before talking about treatment for tension headaches, we will look for a triggering cause (for example a change of glasses, ill-fitting glasses, a change of workstation, etc.). The different methods described below can be combined
Cognitive behavioral therapy (CBT)
Brief psychological support: It is based on correcting negative thoughts (or cognitions) and learning new and adapted behaviors. Misconceptions about the person’s real abilities lead to avoidance and passivity, which prevent control of actions and
Physiotherapy ABONNE LIBRE
Definition of Physiotherapy: Set of therapeutic processes using natural physical agents such as water, heat, cold, light, electric currents, etc. The effectiveness of physiotherapy within functional rehabilitation is remarkable if the technique is well adapted
Paracetamol ABONNE LIBRE
Indications : Symptomatic treatment of mild to moderate pain and/or feverish states. Dosage: From 50 kg: 1 gram 3 to 4 times a day with a delay, between 2 intakes, of at least 4 hours.
Nefopam ABONNE LIBRE
Indications : Analgesic drugs not related to other classes of analgesics. No anti-inflammatory effect, no antipyretic effect, no slowing of transit, no respiratory depression. Symptomatic treatment of acute painful conditions, particularly postoperative pain. This medication
Continuous brachial plexus block
The brachial plexus is made up of all the nerve roots of the upper limb (Wikipedia description). The block of the brachial plexus consists in surrounding the sheath of the nerves constituting it by local
Méziere method ABONNE
Physiotherapy technique based on the work of postures and breathing. Used for pain of muscular origin, tension headaches. Here is a reference site on this technique.
Levocarnil (levocarnitina)
Levocarnitine and its derivatives play a major role in the energy functioning of cells. Indications and dosage 2 to 3 vials per day. Has an interest in: Hypercatabolism situation Fibromyalgia (will decrease pain level in
Ischemic muscle compression ABONNE LIBRE
Ischemic muscle compression is used in the treatment of myofascial syndromes. It consists of exerting sustained pressure on the area of muscle contracture responsible for the myofascial syndrome. To apply this technique, the responsible muscle
Botulinum toxin type A
Action mechanism : Botulinum neurotoxins are made up of proteins of 1300 amino acids, (produced by the bacterium, Clostridium botulinum). These are zinc endopeptidases, ie enzymes capable of cutting proteins. The proteins are VAMP/synaptobrevin, SNAP25
Transcutaneous electrical nerve stimulation (TENS)
Principle of operation of transcutaneous electrical nerve stimulation (TENS). Transcutaneous electrical neurostimulation is a drug-free analgesic technique that uses the properties of an electric current transmitted through electrodes placed on the skin. Its operation is
Antidepressants
Two large families of antidepressants have their own analgesic effect: Tricyclic antidepressants: Amitriptyline and Clomipramine. Amitriptyline is more sedating than Clomipramine. Tetracyclic antidepressants Mianserin and especially mirtazapine are used Serotonin reuptake inhibitors that also inhibit
Basic treatment of migraine
Basic treatment of migraine attacks. Drug treatment: Medicinal therapeutic possibility Oral medications with demonstrated effectiveness in migraine prophylaxis are listed in the table below. This effectiveness is demonstrated in the prevention of episodic diseases for
Triptans
Reference treatment for migraine attacks. Several molecules are available: The development of anti-CGRP antibodies modifies the prescription of triptans in the management of migraine. Almotriptan, Eletriptan, Frovatriptan, Naratritan, Rizatriptan, Sumatriptan, Zolmitriptan. Trade name in order:
Migraine treatment ABONNE LIBRE
Treatment of migraine attacks. The crisis is only for 2 hours for a minimum duration of 24 hours. Treatment for analgesics The initial treatment of the crisis uses the analgesics of shield 1 in first
Indomethacin
Nonsteroidal anti-inflammatory drugs (NSAIDs) It fights against inflammation and pain, lowers fever and thins the blood. It is used in adults for the short-term treatment of acute osteoarthritis pain, certain inflammations (tendinitis, bursitis, acute shoulder pain),
Spinal cord neurostimulation.
Spinal cord neurostimulation Introduction : Spinal cord neurostimulators are implantable medical devices designed to deliver current to the posterior cords of the spinal cord. They are indicated in the treatment of chronic pain not relieved by
Duloxetine ABONNE
Indications : – Treatment of major depressive disorder. – Treatment of diabetic peripheral neuropathic pain. – Treatment of generalized anxiety disorder Even though it does not have Marketing Authorization for this indication, Duloxetine is currently