Archive for the ‘Alternative Medicine’ Category

Chronic Pain Management Clinics


Pain management is one area of medicine which has seen several technological advancements across the globe. Spurred by this global happening, chronic pain management clinics in developing countries have also begun using novel techniques in the areas of pain imaging, pain assessment, and intervention for chronic pain management.  

Chronic pain can refer to any type of pain that endures even after an injury has been healed, pain connected to any degenerative or relentless disease, long-standing pain for which the cause cannot be identified, or cancer pain. In general, pain that continues even after six months is chronic and requires treatment.

The diagnosis and treatment of a particular patient at a chronic pain management clinic usually requires the involvement of several specialists including anesthesiologists, psychiatrists, physiatrists, neurologists, and nurses. Several therapies are combined in order to at least make the patient feel more comfortable if the pain cannot be stopped, to help him/her return to work, to do away with his/her depression, and to improve his/her physical functioning. Thus, these therapies are medication, surgery, psychological counselling, therapies to stimulate the nerves, lifestyle changes, anesthesiological therapies, and rehabilitation.

Medication recommended for patients in chronic pain management clinics can vary from NSAIDS for pain that is not too bad to narcotic drugs for more severe pain. Physical therapy is one common therapeutic technique used in the management of chronic pain in such clinics. It involves training the patient to enhance his flexibility, endurance, and strength; to move in a way that is structurally correct and safe; and most importantly to handle pain. Therapeutic exercise is an important feature of physical therapy.

Another important technique used in chronic pain management clinics is Transcutaneous Electrical Nerve Stimulation (TENS). This technique provides relief for patients suffering from conditions such as arthritic pain or pain in the lower back, by the use of low-voltage electric current.

To sum up, once pain has become chronic, complete freedom from the pain is difficult. However, chronic pain management clinics, through the use of multiple techniques used in conjunction with one another, can help sufferers of chronic pain enjoy a happier and more active life.



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Dr. Morrow’s Arthritis Secrets


An overwhelming amount of information about arthritis exists on the internet—and sadly, much of it is outdated or just plain wrong. In this booklet, Jarret D. Morrow, MD, president and chief scientific officer of University Health Industries (OTC: UVHI, Dietary Supplement Company), presents an overview of known facts based on current research. For a free sample of Arthroleve, please visit: arthroleve.com.

How many types of arthritis are there?

Researchers have identified more than 100 different types of arthritis. The most common are osteoarthritis, rheumatoid arthritis, and gout.

What is osteoarthritis?

The most common type of arthritis, osteoarthritis (OA) is generally associated with aging and joint wear and tear. It can also result from other disorders such as diabetes. OA affects many joints, from the large, weight-bearing joints of the hips and knees to the smaller joints of the spine, hands, feet, and shoulders.

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a long-lasting disease where the immune system—the body’s defense against disease—mistakenly attacks itself and causes the joint lining to swell. The inflammation then spreads to the surrounding tissues, where it can damage cartilage and bone. RA can affect joints in any part of the body, but the hands, wrists, and knees are the most common. In more severe cases, rheumatoid arthritis can affect the skin, eyes, nerves, and internal organs.

What is gout?

Gout is a painful condition that occurs when the body cannot eliminate a natural substance called uric acid. The excess uric acid forms needle-like crystals in the joints that cause swelling and severe pain. Gout most often affects the big toe, knee, and wrist joints.

How many people suffer from arthritis?

More than 46 million adults in America suffer from arthritis and chronic pain. Approximately one-half of these individuals suffer from OA, and that number is growing rapidly as the population over age 50 increases. By 2030, the CDC’s National Center for Chronic Disease Prevention and Health Promotion estimates that 67 million Americans will have been diagnosed with an arthritic condition.

What is the societal impact of arthritis?

According to the Centers for Disease Control and Prevention (CDC), arthritic conditions are the main cause of disability in the USA. These conditions cost the U.S. economy more than $128 billion annually, and that figure will continue to increase as the population ages.

What causes osteoarthritis?

In OA, biochemical and metabolic changes in the body result in the breakdown of joint cartilage. Over time, the joint cartilage wears away and bony growths (osteophytes) may form at the edges of joints. The cartilage loses its ability to effectively cushion the area between the two bones, and osteophytes may press on surrounding tissue. This results in pain that may range from mild to disabling.

How do joint injuries result in OA?

Chondrocytes are cells in the joint that produce cartilage. They normally die off (apoptosis) at a rate of less than 1 percent. But within 48 hours of trauma to a joint, the cell death rate shoots up dramatically—sometimes as high as 37 percent. The dying cells stimulate the release of enzymes that destroy cartilage, which in turn can lead to arthritis.

What is the association between allergies and OA?

There is some evidence of a potential link between food sensitivities and joint inflammation in certain individuals. More research in this area is needed to determine the nature of this connection.

Risk Factors

What are the risk factors for OA?

· Advancing age

· Obesity

· Insulin resistance or diabetes

· Congenital abnormalities

· Joint injuries

· Lack of physical activity

· Hereditary susceptibility

What is primary OA?

Osteoarthritis is classified as primary (idiopathic) when the exact cause is unknown, and secondary if it is associated with a specific disease or condition such as diabetes. Most primary OA is related to aging. Approximately 80-90 percent of men and women have evidence of OA by the time they reach age 65.

In the vast majority of cases, OA develops silently before causing noticeable pain and stiffness. Affected individuals often do not have any symptoms until after age 50.

What factors increase the likelihood of developing type 2 diabetes, a major risk factor for OA?

Your likelihood of developing type 2 diabetes increases with the number of risk factors. If any of the risk factors below apply to you, please talk to a health care professional about how to lower your risk and determine if testing is needed.

· Obesity. Excessive body weight increases diabetes risk.

· Apple-shaped figure. Individuals whose bodies store fat in the abdominal area have a higher risk of diabetes than those who store excess weight in the hips and thighs.

· Age. Age increases the risk of type 2 diabetes.

· Sedentary lifestyle. Regular physical activity can prevent excess weight, which is a significant risk factor for type 2 diabetes. A second benefit of regular physical activity is improved blood sugar control in people who already have type 2 diabetes.

· Family history. The genetic link for type 2 diabetes is stronger than the genetic link for type 1. Having a blood relative with type 2 diabetes increases the risk. If that person is a first-degree relative, such as a parent, sibling or child, the risk is even higher.

· History of diabetes in pregnancy. If you had diabetes during pregnancy (gestational diabetes), you have an increased risk of developing type 2 diabetes.

· Impaired glucose tolerance (IGT). Also known as pre-diabetes, IGT means that the individual’s blood sugar level is elevated, but still below the level that qualifies as diabetes.

· Ethnic ancestry. Being of Aboriginal, African, Latin, or Asian descent increases the risk of developing type 2 diabetes. Risk levels for these groups are two to six times higher than for Americans of Caucasian origin.

· High blood pressure. People with high blood pressure are more likely to have or develop diabetes.

. High cholesterol or other fats in the blood. People with diabetic conditions often have high levels of harmful LDL cholesterol and triglycerides, and low levels of “good” HDL cholesterol.

Symptoms and Diagnosis

What are the symptoms of OA?

Pain is the most frequent symptom of OA. Other common symptoms are morning stiffness in the joint, limited range of movement, and crepitus (a crackling sound or feeling) when the joint is moved.

The pain of osteoarthritis is described as a sharp ache or burning sensation that worsens with use. Pain increases as cartilage erodes and bone surfaces lose their protection. The chronic pain and stiffness leads to decreased movement, which in turn allows the muscles to atrophy and ligaments to become lax.

What joints are affected by OA?

Osteoarthritis can affect any joint in the body. The most common are the large weight-bearing joints such as the knees or hips, but OA can also develop in the fingers, hands, feet, shoulders, lower lumbar vertebrae, and the cervical spine.

Could my back or neck problem be related to OA?

Yes, it could. Vertebrae are bones, and areas between them are joints protected by cartilage disks. In addition to the problems resulting from disk erosion, osteophytes can also grow around the vertebrae in the neck or back. These can put pressure on the nerve root or other surrounding tissues (impingement on the spinal foramina), creating symptoms such as

· pain that radiates down the leg or arms (radicular pain)

· muscle spasms

· muscle atrophy

· neurological deficits

How is OA diagnosed?

If you suspect osteoarthritis, your doctor will make a diagnosis based on your medical history, a physical exam, and X-rays of the affected joints. Your physician may also order an MRI (magnetic resonance imaging), an arthroscopy (examining the joint through a small incision), or arthrocentesis (drawing fluid from a swollen joint)

Researchers are currently attempting to identify markers in the blood that are associated with the severity of OA in each patient. A recent study found that patients with especially high levels of TNF alpha (a protein that is part of the immune system) generally had lower physical function, more OA symptoms, and worse knee radiographic scores. (Pennix et al, 2004)

What does the doctor see on an X-ray to diagnose OA?

In a joint affected by osteoarthritis, the space where the two bones meet is abnormally narrow. This condition, known as joint space narrowing, results from the cartilage breakdown that occurs with OA. The radiologist will also look for bony outgrowths at the edges of joints (osteophytes), another characteristic of OA.

What is the association between depressed mood and the chronic pain of osteoarthritis?

Arthritis and depression are common and important health problems, and older adults are more likely to suffer from both. Patients with both conditions generally experience more pain and functional impairment than individuals dealing with pain alone (Bair et al, 2004). Systematic depression management has been demonstrated to be effective in decreasing pain severity among arthritis patients (Lin et al, 2006).

Treatment Options Options

What are some of the treatment options for OA?

A multifaceted approach is best for maximum control over osteoarthritis. Every patient is unique and should—in conjunction with a physician—use whatever combination of treatments works best:

· patient education about OA

· exercise

· weight control

· physiotherapy

· anti-inflammatory drugs

· non-narcotic analgesics such as acetaminophen

· alternative medicines and natural remedies

· acupuncture

· local injections of glucorticoids

· surgery to relieve chronic pain in damaged joints

What is the connection between food and OA?

Although the current consensus within the medical community is that is diet and arthritis are not connected, there is some evidence that certain types of diets, with specific amounts of calories, protein, and fatty acids, may affect the inflammation that occurs with arthritis. An increasing number of physicians recognize the need to re-evaluate this position in light of new knowledge about food and its potential role in treating or preventing chronic conditions such as arthritis.

How does weight loss affect arthritis?

Recent studies indicate that that weight loss through diet and exercise improves physical function in older obese adults with knee OA, and that those with the most weight loss show the greatest improvement (Miller et al, 2006). One clinical study showed that a weight loss of just 10 percent resulted in a functional improvement of 28 percent (Christensen et al, 2005).

A recent meta-analysis demonstrated that patient education and exercise regimens each had a modest, yet clinically important, influence on well-being for OA patients. (Devos-Comby L et al, 2006).

What is evidence based medicine (EBM)?

Evidence based medicine (EBM) is a new paradigm for making decisions about a patient’s health. Rather than relying exclusively on their own professional expertise, physicians using EBM also evaluate current clinical research to help make decisions about medical treatments and patient care. The evidence used may include randomized controlled trials, systematic reviews of series of trials, meta-analyses, and other information collection and research activities.

RECENT STUDIES

How effective are NSAIDs at treating the pain associated with OA?

A recent meta-analysis published in the European Journal of Pain concluded that the clinical effects of oral NSAID therapy in patients with moderate to severe arthritis are small and limited to the first three weeks after the start of treatment (Bjordal et al, 2007).

What impact does weight reduction have on OA?

A recent randomized trial concluded that an intensive weight loss intervention program of diet and exercise improved physical function in older obese adults with knee OA (Miller et al, 2006).

How effective is chondroitin sulfate for treating OA?

A very recent meta-analysis published in the Annals of Internal Medicine concluded that the “symptomatic benefit of chondroitin is minimal or nonexistent. Use of chondroitin in routine clinical practice should therefore be discouraged” (Reichenbach et al, 2007).

How effective is acupuncture for treating OA?

A recent meta-analysis on acupuncture for peripheral joint arthritis concluded that although further studies are needed to adequately evaluate its effectiveness for OA, acupuncture’s favorable safety profile makes it an option worth considering (Kwon et al, 2006).

Which drug is more effective for treating OA: acetaminophen or NSAIDS?

A recent review from the Cochrane Collaboration database concluded that NSAIDS appear to be more effective than acetaminophen for the treatment of arthritis (Towheed et al, 2006).

How effective are physical interventions in the treatment of knee osteoarthritic pain?

Osteoarthritis (OA) of the knee is the most common knee joint affected by OA. A recent meta-analysis published in BMC Musculoskeltal Disorders (Bjordal JM, et), concluded that “TENS, EA and LLLT administered with optimal doses in an intensive 2-4 week treatment regimen, seem to offer clinically relevant short-term pain relief for OAK.” [Transcutaneous electrical nerve stimulation (TENS, including interferential currents), electro-acupuncture (EA) and low level laser therapy (LLLT)]. If you suffer from OA of the knees, you may want to talk to your doctor about these treatment options.

How effective are hyaluronic acid injections in relieving knee pain?

“Intra-articular viscosupplementation was moderately effective in relieving knee pain in patients with osteoarthritis at 5 to 7 and 8 to 10 weeks after the last injection but not at 15 to 22 weeks (Modawal et al, 2005).”

This study additionally included these practice recommendations:

“1. Consider injections of hyaluronic acid injections only after conservative therapy has been tried for atleast three months or the patient is unable to tolerate NSAIDS.

2. Stress to patients that pain relief may not be fully experienced until 5-7 weeks following the last injection.”

What this means? HA injections should be tried after other treatment options have been explored. In addition, HA injections may offer moderate pain relief, but the pain relief can take up to a month to reach the maximum effect.

How much do HA injections cost? Each injection costs approximately $230 and the recommendations include patients receiving one injection per week for a total of five weeks which amounts to about $1150.

REFERENCES

Miller GD, Niclas BJ, Davis C, Loeser RF, Lenchik L, Messier SP. Intensive weight loss program improves physical function in older obese adults with knee osteoarthritis. Obesity (Silver Spring). 2006 July;14(7):1219-30.

Christensen R, Astrup A, Bliddal H. Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial. Osteoarthritis Cartilage. 2005 Jan;3(1):20-7.

Penninx BW, Abbas H, Ambrosius W, Nicklas BJ, Davis C, Messier SP, Pahor M. Inflammatory markers and physical function among older adults with knee osteoarthritis. J Rheumatol. 2004 Oct;31(10):2027-31.

Devos-Comby L, Cronan T, Roesch SC. Do exercise and self-management interventions benefit patients with osteoarthritis of the knee? A metaanalytic review. J Rheumatol. 2006 Apr;33(4):744-56.

Bjordal JM, Klovning A, Ljunggren AE, Slordal L. Short-term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: A meta-analysis of randomized placebo-controlled trials. European Journal of Pain. 2007;11:125-138.

Miller GD, Nicklas BJ, Davis C, Loeser RF, Lenchik L, Messier SP. Intensive weight loss program improves physical function in older obese adults with knee osteoarthritis. Obesity. 2006 Jul;14(7):1219-30.

Reichenbach S, Sterchi R, Scherer M, Trelle S, Burgi E, Burgi U, Dieppe PA, Juni P. Meta-analysis: chondroitin for osteoarthritis of the knee or hip. Ann Intern Med. 2007 April 17;146(8):580-90.

Kwon YD, Pittler MH, Ernst E. Acupuncture for peripheral joint osteoarthritis: a systematic review and meta-analysis. Rheumatology (Oxford). 2006 Nov;45(11):1331-7.

Towheed TE, Maxwell L, Judd MG, Catton M, Hochberg MC, Wells G. Acetaminophen for osteoarthritis. Cochrane Database Syst Rev. 2006 Jan 25;1:CD004257.

Bjordal JM, Johnson MI, Lopes-Martins RA, Bogen B, Chow R, Ljunggren AE. Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials. BMC Musculoskelet Disord. 2007 Jun 22;8:51.

Modawal A, Ferrer M, Choi HK, Castle JA. Hyaluronic acid injections relieve knee pain. J Fam Pract. 2005 Sep;54(9):758-67.

Links:

Arthroleve: http://arthroleve.com

Dr. Jarret Morrow’s Dietary Supplement Research blog:

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Natural Migraine Treatment.Natural Treatment Gets To The Root Cause


Not all headaches are migraines. I’m sure  that the 12% of the population, mostly of whom are women, that get migraines can easily tell you the difference. To these sufferers it is an intense pounding in the head that can last a few hours, or a few days. There are basically three different types of migraines:

Hormonal Migraines - Women often experience migraines which correlate with their menstrual cycle.

Optical/Ocular Migraines – Affecting fewer people, optical/ocular migraine sufferers experience visual symptoms with no corresponding headache.

Abdominal Migraines – Mostly affects children.

There are many different schools of thought on natural migraine remedies. All of them will, in some form, relieve the sufferer of their symptoms. Three major methods of natural relief are;

Herbals, Supplemental, and Homeopathic.

Herbalism is an age old medicinal practice which uses substances from herbs to relieve the sufferers  ailments. In much the same way as conventional medicine is used, the Herbalist uses various natural substances which contain active ingredients to help address specific problems .Some popular herbal medicines in the treatment of migraines are feverfew, butterbur, passionflower, peppermint, rosemary and lavender.

Supplementation is exactly what it sounds like. It is a technique that supplements the sufferers dietary intake. This natural treatment provides the patient the extra substances needed to fight the symptoms that increase the likelihood of migraine attacks. Supplements such as magnesium, co-enzyme Q10 and riboflavin are found to be helpful in treating migraines.

Homeopathy is a natural method of treating illnesses in which a

disease is treated by minute doses of natural substances that in large quantities would produce symptoms of the disease. This is not a home remedy, and should only be administered by highly trained and experienced homeopaths.

So as you can see, these are a few  ways you can naturally reduce the symptoms of migraines. In some cases billion dollar industries have been built around the fact that they can significantly reduce the symptoms. Here is where the difficulty lies. Each of the methods I have outlined above will work to some degree, however they have the inherent problem that they aim to treat the symptoms of the illness, NOT the cause.

If you are looking for a holistic treatment which aims to refresh your entire system and treat the root cause of your migraines, there is The Migraine Solution Program. It is an effective, natural migraine treatment system which works for both men and women. The program was developed and perfected by Chris Holmes, a migraine sufferer for more than 5 years. It is a culmination of in-depth study into the nature of migraines, and patients who had relieved their own symptoms. After extensive research Mr. Holmes correlated the findings of hundreds of cured cases to form his program, that is used by thousands of people around the world

with astonishing results.

Even though you may have tried many natural therapies for migraine treatment, The Migraine Solution addresses the root cause of migraines and will work for you where others have failed. It works equally well on all forms of migraines. You will cure your migraine GUARANTEED. Don’t just relieve the pain, cure the ROOT CAUSE. Find out all about The Migraine Solution at:

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Discover this and other Natural Cures such as; Acid Reflux, Anxiety and Panic Attacks, Sinus Infection, Foot Pain, and much more.



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Roseola Disease – the Facts


Roseola is a viral illness in young children, most commonly affecting those between the ages of 6 months and 2 years. Roseola is probably caused by more than one virus. The most common cause appears to be human herpesvirus 6 (HHV-6). It occurs mostly in children under the age of 3. It occurs mostly in the spring and fall. Roseola occurs throughout the year. Roseola begins with a high fever that generally responds well to acetaminophen. Between the 2nd and 4th day of illness, the fever falls dramatically, and a rash appears (often as the fever falls) on the trunk and spreads to the limbs, neck, and face. The rash lasts from a few hours to 2 days. Roseola is most commonly seen in children between 6 months and 3 years of age. Most children will have had roseola by the age of 2 years. Infection during childhood probably confers lifelong immunity to the disease. Roseola is spread from person to person via respiratory fluids or saliva of infected individuals. In most cases, particularly if fever is low, the child is well. In about 5-15% of young children, high fevers may trigger febrile seizures.

Roseola typically isn’t serious. The disease usually resolves without complications. Measures should be taken to control a fever. There is no specific vaccine against or treatment for exanthem subitum, and most children with the disease are not seriously ill. A child with fever should be given plenty of fluids to drink, and acetaminophen or ibuprofen to reduce their temperature. Medications to reduce fever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). Most people have antibodies to roseola by the time they’re of school age, making them immune to a second infection. Roseola as children can become infected later in life, though the disease tends to be mild in healthy. The main concern is that infected can pass the virus on to children. In some cases, a child may be infected with the virus and never develop the rash. Less commonly, the rash may appear without a preceding fever. The fever of roseola lasts from 3 to 7 days, followed by a rash lasting from hours to a few days.

There is no specific treatment for roseola. Rest, maintaining fluid intake and paracetamol for fever is all that is usually required. Lukewarm baths or sponges can also be used to help reduce fever. Antiviral medication ganciclovir (Cytovene) to treat the infection in people with weakened immunity. Never give aspirin to a child or teenager with a fever as this can increase the risk of Reye’s syndrome, a rare, but potentially fatal, liver and brain disorder. Do not use ice, cold water, alcohol rubs, fans, or cold baths. Acetaminophen (such as Tylenol) or ibuprofen can help to reduce your child’s fever. Avoid giving aspirin to a child who has a viral illness because the use of aspirin in such cases has been associated with the development of Reye syndrome, which can lead to liver failure and death. Acetaminophen and cool sponge baths may be given. If convulsions occur, call your health care provider, or go to the closest emergency room.



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Back Pain 101


So you thought your back pain would go away by itself…

A recent study involving sufferers of low back pain in the British Medical Journal (2/05/98), contradicted the previous claim in the BMJ that back pain resolved itself naturally. A follow up found that 91% of those in the survey were still experiencing back pain 12 months later.

Make no mistake; if you have low back pain, you have a problem.

Most low back pain is the result of an injury. Sometimes these injuries happened years ago. I often have patients tell me that they have had low back pain before, but it has “always gone away”. This is usually the worst type of problem. Our body uses pain to tell us that we have a problem. (I promise the problem is not a shortage of Motrin in your body!) In our infinite wisdom, we take the drugs, cover up the back pain without fixing the problem, and our back pain temporarily goes away. We think we are fine, until it happens again and it always does. This time the back pain is a little worst and takes longer to go away and we continue this insanity until the problem is severe.

What causes low back injuries resulting in low back pain?

There are many ways low back injuries occur. The more important question is what do I do now?

Few GP’s will admit, as Dr Phil Hammond does in his book Trust Me I’m A Doctor that “they are not very good at treating back pain”. Most GP’s are reluctant to refer outside the NHS, even though chiropractors are specially trained to identify and advise on the specific cause of your spinal dysfunction (back pain). The bones of your spine protect the spinal cord as well as the nerve roots, sometimes they lose their normal motion or position (vertebral subluxation complex), and this can irritate the nerves that branch off the spinal cord to all the tissues of your body, resulting in back pain being experienced.

In order for the spine to be flexible, the vertebrae are joined together by soft tissue structures known as discs. Each disc is made up of two parts – a central soft core and outer rings of tough cartilage. The discs allow movement and also help to absorb shock. A slipped disc is the rather inaccurate term used to describe the condition, often in the lower back, where trauma or ‘wear and tear’ have caused damage to the outer rings of cartilage, so that the core is squeezed outwards. This can result in a bulge which can press on the spinal cord, the nerve root or the nerve itself. It can cause excruciating back pain, or referred elsewhere – for example in the lower leg or foot. Over my 22 years in practice, I have developed techniques that mobilize the spine to reduce any pressure around the spinal cord or nerves; offering patients not only back pain relief, but correction of the problem that is causing the back pain.

Do Medical Treatments and Surgery help?

The medical approach is at times necessary – even back surgery has a place. But according to some studies, most spinal surgery for acute lower back pain should be rarely performed. Many people who have had back surgery report a recurrence of their back pain within a year or two of the operation and may return to the operating table. In some cases the surgery makes no difference in their back pain whatsoever, and in some cases it does not give long-term relief.

The Chiropractic Approach:

Barton Chiropractic in Concord has helped thousands of people with low back pain, saving them from pain, disability, drugs and surgery. The approach at Barton Chiropractic in Concord is to make your spine and its nerves, discs ligaments and muscles healthier, stronger and more stable by correcting your vertebral subluxation. Anyone suffering from back pain should contact Barton Chiropractic in Concord to make sure they have no subluxations and have them corrected with a chiropractic adjustment if necessary. This may make the difference between a life of ease, health and comfort and a life of back pain, disease and disability.

What did the Government Studies reveal?

Major government studies from the US, Canada and UK have reaffirmed what chiropractic patients have been telling their friends with back pain for years: “Why don’t you see my chiropractor? You’ll get better much faster than from drugs or surgery- and it’s safer too.

In 1991 the Medical Research Council established chiropractic as one of the preferred and most effective methods of care for acute low back pain. “Chiropractic almost certainly confers worthwhile long term benefits in comparison with hospital outpatient management”. “If all these patients were referred for chiropractic instead of hospital treatment, the annual cost would be a reduction of some 290,000 days in sickness absence during 2 years, saving about 13 million in output and 2.9 million in social security payments”. British Medical Journal, June 2nd 1990 – www.chiropractic-uk.co.uk.

A panel of medical experts spent 2.5 years reviewing nearly 4,000 studies and reported that expensive tests (MRI, CAT scans) and therapies typically used to diagnose and treat acute lower back pain are largely useless. Instead the experts recommended the non-drug chiropractic approach.

The Manga Report commissioned by the government of Ontario in Canada, found that chiropractic care for patients with low back pain is superior to medical care in terms of safety, scientific evidence of effectiveness, cost and patient satisfaction.

Chiropractic is better for you!

Studies have shown chiropractic works better, is safer and less costly than standard medicine for lower back pain.Why are the results so overwhelmingly in favor of Barton Chiropractic in Concord? Because Drugs (painkillers, muscle relaxants, Valium…), physical therapy and surgery are not designed to correct vertebral subluxation only cover up your back pain and allow you to die more comfortably. Call us today at 925 685-2002 to make an appointment. We Can Help You!



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Patent Ruling Turns an ‘About’ Face


he meaning of the word “of” when used in a patent? The Federal Circuit Court of Appeals that deal elusive question in a recent dispute between two pharmaceutical manufacturers and expert testimony of great help to find the answer.

But while the court has accepted the advice of experts on the meaning of “approximately” used in the patent, it appeared an about-face and rejected their testimony as to the ultimate question of infringement.

Ortho-McNeil Pharmaceutical brought the lawsuit against the manufacturer of generic drugs-Caraco Pharmaceutical Laboratories, alleging infringement of its U.S. Patent No. 5,336,691. Ortho patent covered a painkiller composed of two well-known analgesics, tramadol and acetaminophen.

The patent has shown that when combined in certain ratios the effects of both drugs were increased. Involved in this case was the claim of the patent No. 6, which involved a composition where the ratio of the material to acetaminophen is tramadol a weight of about 1:5. “

Ortho continued after Caraco filed an application for abbreviated new drug to disclose its plan to manufacture and sell his own composition containing tramadol and acetaminophen. Caraco said the medicine had an average ratio of tramadol to acetaminophen of 1:8.67 and no less than 1:7.5. Ortho Caraco argued that the drug would infringe its patent.

The district court granted the summary trial and Ortho appealed to the Federal Circuit. Both the district court and on appeal, the case focused on the construction of the term “about 1:5.” Ortho argued that covered a radius of at least 1:3.6 to 1:7.1, and that, under the doctrine of equivalents, the wording of Caraco infringed. Caraco argued for a restrictive interpretation.

The district court adopted the construction asserted by Ortho, the “about 1:5″ means “approximately 1:5, encompassing a range of ratios of no more than 1:3.6 to 1:7.1.” He came to this conclusion relying in part on the intrinsic evidence of the application and the specification and in part to the extrinsic evidence of Ortho experts, Dr. Donald R. Stanski and Dr. Eric Smith. The two experts gave the Notice that one of ordinary skill in the art to conclude that “about 1:5″ limitation include a series of reports that would extend to include and 1:7.1.

The Federal Circuit upheld that construction. As the district court, he found support for this construction as in the claim itself and the testimony of the expert Ortho, Dr. Stanski. “Dr. Stanski has estimated that” about 1:5 “means” about 1:5, which includes up to and including 1:7.1 “, noted the court.

Caraco Accepting this construction means that the product did not literally infringe Ortho patent. Ortho patent covered a maximum ratio of 1:7.1, while Caraco started 1:7.5. The question, therefore, became Caraco if the drug under the violation of the doctrine of equivalents.

Building on its experts, Ortho said it did. One expert, Dr. Stanski, said that the weight of 1:8.76 is substantially similar to a weight ratio of 1:5. Another expert, Dr. Smith said in its report that the “degree of synergy of a composition with a weight of tramadol to acetaminophen of 1:5 is identical to the measure of the synergy of a composition with a weight of tramadol to acetaminophen of 1:8.67.

But the district court agreed. It concluded that a finding of infringement by a formulation with an average weight of 1:8.67 would render meaningless “about 1:5″ limitation.

The Federal Circuit affirmed, finding that the 1:5 critical parameter for the invention. Stretching the limits of this parameter Caraco to cover the drug would be in direct conflict with the patent for the express both the claim of 1:1 and 1:5 ratios, the court said.

“In this case, if the ratio of 1:5 of the analgesic response is statistically different from that of other ratios any time,” the court said. “The intrinsic evidence points to the desirability and thus the criticality of the ratio of 1:5 compared to other ratios.”

“Ortho can not now claim that the parameter is sufficiently broad to encompass, through the doctrine of equivalents, the rate outside the confidence interval expressly identified in the patent,” continued the court. “We agree with the district court that eviscerate the limitation.”

For these reasons, the court said, he concluded that the drug Caraco does not infringe Ortho’s patent and that the district court properly granted a summary of non-infringement.

Ortho-McNeil Pharmaceutical, Inc. v. Caraco Pharmaceutical Laboratories, Ltd., Case No. 06-1102 (Fed. Cir. January 19, 2007).

Written by Robert Ambrogi for Bullseye, IMS Expert Services Publication

Robert Ambrogi is the editor of Bullseye, a monthly newsletter distributed by IMS Expert Services. IMS Expert Services is the first expert witness consulting and litigation research firm in the legal industry, focused exclusively on providing custom expert witness in search of lawyers.

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What About Aura & Migraine Pain?


Migraine without aura is a common migraine without aura but exhibits the same symptoms as a classic migraine except that it does not exhibit any aura.

People who primarily suffer from migraine with aura may also have attacks of migraine without aura. Headache with the features of “migraine without aura” usually follows the aura symptoms. Less commonly, the aura may occur without a subsequent headache or the headache may be non-migrainous in type.

Migraine with aura is a classical migraine preceded by an aura before the attack. The aura occurs for about 10-30 minutes and then is usually followed by a headache. It is quite similar to a common migraine except in the aspect of the aura.

About 15% of migraine sufferers have a early warning that the headache is coming on. This change in brain function is called an “aura”. It is usually a visual symptom, such as an arc of sparkling (scintillating) zig-zag lines or a blotting out of vision or both. The aura is due to changes that take place in the cortex, the outer layer of the brain. This slowly spreading depression of nerve cell activity is believed to account for the pattern of development of the typical aura.

Auras set in about 20-30 minutes before the migraine attack. Some patients also describe the presence of a strange odor, before the onset of a migraine. They also experience a tingling sensation in an arm or leg.

In the classic migraine aura, symptoms build up gradually and move slowly from one visual region or one part of the body to another. For example, the migraine aura sufferer may first notice a black spot in the field of vision. This black spot is often surrounded by flashing lights or bright zig-zag lines as mentioned.

What starts this sequence of events that leads to the aura and migraine? The answers to thisquestion are not fully understood. Migraine sufferers have an inborn susceptibility to factors that normally do not trigger headaches.

In people with migraines, changes in body chemistry, such as menstruation, certain foods, and dozens of environmental influences, such as a change in weather, may trigger a migraine attack. A migraine trigger is any factor that, on exposure or withdrawal, leads to the development of an acute migraine headache. Triggers may be categorized as behavioral, environmental, infectious, dietary, chemical, or hormonal. In medical literature, these factors are known as ‘precipitants.’

Neither type of migraine denotes a life-threatening disorder but, they can be chronic and recurrent, thus interfering with a person’s daily lifestyle.

Both migraine types have the usual pain, nausea, vomiting and intolerance to light and sound, which is worsened by any physical activity.

Treatment? The treatment for migraines begins with simple painkillers for headache and anti-emetics for nausea, and avoidance of triggers if present. Specific anti-migraine drugs can be used to treat migraine. Homeopathic Drugs and Special all natural ingredient products such as those at the Centre for Pain Relief in Burlington, New Jersey have proven effective. If the migraine condition is severe and frequent enough, preventative drugs might be considered.

The most commonly used “reversal” medicines are triptans. Triptans work by boosting the effects of the brain chemical serotonin, which reduces the severity and duration of an attack. Propranolol, a beta blocker, and Topiramate have proven effective for migraine sufferers as well.

When it comes to treatment however, “Migraine is the most misunderstood, misdiagnosed, and mistreated condition in medical practice,” states Dr. Seymour Diamond, M.D., who is the executive chairman for the National Headache Foundation and director of the Diamond Headache Clinic in Chicago.

As always, talk to your doctor about whether or not you have with Aura or without Aura to find the medication that works best for you.



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Buy Fioricet and Lose the Headache


We all know how distracting and waving a nagging headache or other pain in the body can be in our daily lives. Pain, even if minor or transient, affects us, what makes us cranky, miserable, ineffective, unproductive and unnecessary. Therefore, whenever it is, we begin to feel the symptoms of fever or headache, we do everything we can to ease the pain before it grows to an unbearable height. Fioricet is a barbiturate sedative combined with an analgesic that can most ardent painful headaches before they become out of control and you pay a little more than a zombie grimacing.

Barbiturates have been around most of the last century, and were used in different situations and for different patients to sleep and calm nerves in cases of anxiety or shock. Because Fioricet is a barbiturate sedative effect, it is important to know that when you swallow the pill, it will effectively make you drowsy and cause you less than optimal control of your engine. This means of course that Fioricet is not to be taken at a time when you need to be in total control of your faculties.

This means not taking Fioricet if you operate heavy machinery, driving or in a less physically dangerous situation, prepare a presentation at your next meeting of the society. There are too many unnecessary accidents by taking prescription medications or who have an effect of drowsiness, but these types of accidents can be avoided by knowing exactly what kind of drug you take, and what it could not do your sensory perceptions.

Want to know all the side effects, risks and limitations of dose of a medication you are taking, and Fioricet is no exception. Like all medicines, the risk of side effects are small, but possible, and there are considerations to make that relates to your own bill of health as well as stories of health and of allergies that could make you react negatively to Fioricet. In addition, there are dose limits for the daily use and must be respected for your own safety, but it is common sense – what you really want to do is get rid of this pesky headaches.

And that’s what Fioricet can do for you. Once you feel the first pangs of a painful headache, it is always best to take all the pain reliever you choose to use as soon as possible, because the pain is worse, the harder it is dispose of them. Thus, it is important if you feel the onset of a fever – usually something difficult to detect – in my opinion Fioricet as soon as you can, in the hope that the body temperature can be reduced to the normal soon as possible. The last thing you want when you have fever is to see the temperature creep up to a level that is hazardous to health, and you want to do and that the stem rise in body temperature when you notice the symptoms.

Made under good conditions the right to appease the pain, Fioricet may be just the thing you need to use your day and start to feel normal again.

Christopher M. Luck has an extensive medical experience in dealing directly with Fioricet and now offers its Fioricet free professional advice to the public. If you are at all interested in Christopher’s professional car health advice, tips, or secrets, you can visit his health blog.



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Modern Pain Management Techniques


Pain is a massive problem in our society, in fact it is estimated that at any given time, around one third of the population are in pain. Pain of any type is the most frequent reason for physician consultation. It is a major symptom in many medical conditions, significantly interfering with quality of life and general functioning.

Pain management is therefore an extremely important part of health care because people forced to continue living with extreme pain often become depressed and have poor treatment outcomes.

Some types of pain are still not really understood with as many as a third of cases having unknown origins.

Here are some of the things we do know:

* Pain is constant for about 20% of people.

* Back pain is the most common pain.

* Most chronic pain sufferers have had pain for at least 3 years.

* As can be expected, the incidence of pain increases with advancing age.

* Women report pain more often than men.

* Only 70% of sufferers look for professional help.

Pain Management

Modern pain management programs should be multidisciplinary combining the input of Medical practitioners, Acupuncturists, Physiotherapists, Chiropractors, Clinical psychologists and Occupational therapists, amongst others.

1. Narcotics are often prescribed for severe pain, but narcotics carry with them a potential for side effects and addiction, so patients and caregivers must weigh the level of pain against these dangers in the pain management process.

2. Numerous studies have found that certain complementary therapies are effective in pain management.

3. Massage therapy can hasten pain relief, soothe stiff sore muscles, and reduce inflammation and swelling.

4. Psychological pain management teaches people skills to cope with pain. Research has shown that having realistic, helpful thoughts is an important part of pain management.

5. Natural pain relief is a sought after alternative to medication and drugs based on chemicals and other synthetic medication. Herbs have been used for centuries for pain relief, but many have not undergone extensive study. Some allergic reactions might occur with some patients using natural pain relief, but these can be easily controlled or prevented by doing a skin test before using the natural pain relief.

6. One of the pain management modalities are trigger point injections and nerve blocks utilizing long acting anesthetics and small doses of steroids.

7. NSAID pain relief medication will not only relieve pain, but also reduce fever and inflammation. However there are real disadvantages associated with the long term use of these drugs.

8. Aspirins, Paracetamol, Ibuprofen are other common remedies used for the relief of acute pain.

9. Morphine is the major active substance in opium and a very potent pain relief medication. Morphine will act directly on the central nervous system and is commonly used as a pain relief medication for acute and severe pain caused by surgery or major trauma. Morphine is also used as a pain relief medication for moderate and severe chronic pain, such as pain caused by cancer.

10. TENS machines give short term pain relief to many people. These machines are fairly cumbersome but at least they do not have side effects.

11. Finally there is a new modality which has just been released on to the market and that is the rather unique pain patch which combines nano technology with crystals activated by body heat to produce an energy wave. The waves are transmitted to the origin of the pain where they produce an acupuncture effect which relieves pain.

There are reports of pain of 40 year duration being relieved instantly.



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Patent Ruling Turns an ‘About’ Face


What is the meaning of the word “of” when used in a patent? The Federal Circuit Court of Appeals that deal elusive question in a recent dispute between two pharmaceutical manufacturers and expert testimony of great help to find the answer.

But while the court has accepted the advice of experts on the meaning of “approximately” used in the patent, it appeared an about-face and rejected their testimony as to the ultimate question of infringement.

Ortho-McNeil Pharmaceutical brought the lawsuit against the manufacturer of generic drugs-Caraco Pharmaceutical Laboratories, alleging infringement of its U.S. Patent No. 5,336,691. Ortho patent covered a painkiller composed of two well-known analgesics, tramadol and acetaminophen.

The patent has shown that when combined in certain ratios the effects of both drugs were increased. Involved in this case was the claim of the patent No. 6, which involved a composition where the ratio of the material to acetaminophen is tramadol   a weight of about 1:5. “

Ortho continued after Caraco filed an application for abbreviated new drug to disclose its plan to manufacture and sell his own composition containing tramadol and acetaminophen. Caraco said the medicine had an average ratio of tramadol to acetaminophen of 1:8.67 and no less than 1:7.5. Ortho Caraco argued that the drug would infringe its patent.

The district court granted the summary trial and Ortho appealed to the Federal Circuit. Both the district court and on appeal, the case focused on the construction of the term “about 1:5.” Ortho argued that covered a radius of at least 1:3.6 to 1:7.1, and that, under the doctrine of equivalents, the wording of Caraco infringed. Caraco argued for a restrictive interpretation.

The district court adopted the construction asserted by Ortho, the “about 1:5″ means “approximately 1:5, encompassing a range of ratios of no more than 1:3.6 to 1:7.1.” He came to this conclusion relying in part on the intrinsic evidence of the application and the specification and in part to the extrinsic evidence of Ortho experts, Dr. Donald R. Stanski and Dr. Eric Smith. The two experts gave the Notice that one of ordinary skill in the art to conclude that “about 1:5″ limitation include a series of reports that would extend to include and 1:7.1.

The Federal Circuit upheld that construction. As the district court, he found support for this construction as in the claim itself and the testimony of the expert Ortho, Dr. Stanski. “Dr. Stanski has estimated that” about 1:5 “means” about 1:5, which includes up to and including 1:7.1 “, noted the court.

Caraco Accepting this construction means that the product did not literally infringe Ortho patent. Ortho patent covered a maximum ratio of 1:7.1, while Caraco started 1:7.5. The question, therefore, became Caraco if the drug under the violation of the doctrine of equivalents.

Building on its experts, Ortho said it did. One expert, Dr. Stanski, said that the weight of 1:8.76 is substantially similar to a weight ratio of 1:5. Another expert, Dr. Smith said in its report that the “degree of synergy of a composition with a weight of tramadol to acetaminophen of 1:5 is identical to the measure of the synergy of a composition with a weight of tramadol to acetaminophen of 1:8.67.

But the district court agreed. It concluded that a finding of infringement by a formulation with an average weight of 1:8.67 would render meaningless “about 1:5″ limitation.

The Federal Circuit affirmed, finding that the 1:5 critical parameter for the invention. Stretching the limits of this parameter Caraco to cover the drug would be in direct conflict with the patent for the express both the claim of 1:1 and 1:5 ratios, the court said.

“In this case, if the ratio of 1:5 of the analgesic response is statistically different from that of other ratios any time,” the court said. “The intrinsic evidence points to the desirability and thus the criticality of the ratio of 1:5 compared to other ratios.”

“Ortho can not now claim that the parameter is sufficiently broad to encompass, through the doctrine of equivalents, the rate outside the confidence interval expressly identified in the patent,” continued the court. “We agree with the district court that eviscerate the limitation.”

For these reasons, the court said, he concluded that the drug Caraco does not infringe Ortho’s patent and that the district court properly granted a summary of non-infringement.

Ortho-McNeil Pharmaceutical, Inc. v. Caraco Pharmaceutical Laboratories, Ltd., Case No. 06-1102 (Fed. Cir. January 19, 2007).

Written by Robert Ambrogi for Bullseye, IMS Expert Services Publication

Robert Ambrogi is the editor of Bullseye, a monthly newsletter distributed by IMS Expert Services. IMS Expert Services is the first expert witness consulting and litigation research firm in the legal industry, focused exclusively on providing custom expert witness in search of lawyers.



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This page is provided for educational and informational purposes only and is not intended as a substitute for the advice of a medical doctor, nurse, nurse practitioner or other qualified health professional.