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Warning: Internet Can Be a Danger to Your Health

Warning: Internet Can Be a Danger to Your Health

Teaser: 

Dr.Michael Gordon Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

Abstract
The process of prescribing medications, explaining the risks and benefits has classically been the role and responsibility of physicians with support from other health care providers such as pharmacists. In the modern age with the phenomenal expansion of the digital world, the world of the internet has become a major player. It is common for physicians to have to contend with and integrate into their practice the common phenomenon of family members looking at the internet and other sources for information about medications proposed for their loved ones.
Key Words: internet, medications, information, responsibility.

Pharmacological Options in the Management of Low Back Pain

Pharmacological Options in the Management of Low Back Pain

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2
Teaser: 

Dr. Ted Findlay, DO, CCFP, Clinical Assistant Professor, Department of Family Medicine, University of Calgary, Calgary, Alberta.

Mohammed F. Shamji, MD, PhD, FRCSC, Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Abstract
Low back pain is one of the most common conditions for which patients seek medical attention. It can be managed with lifestyle modification, or less commonly medical and surgical intervention. Appropriate selection among various pharmacological options mandates an understanding of the underlying symptomatology and the over-riding treatment plan and objectives. The range of potential medications is substantial: over-the-counter analgesics include acetaminophen and non-steroidal anti-inflammatory drugs, muscle relaxants, and weak opioid combinations including codeine or tramadol. More potent versions of many of the same components are available on prescription, commonly employing stronger opioids either singly or in a combination analgesic. When the pain involves either chronic or neuropathic features, other classes of medications, including anti-epileptic drugs and anti-depressants, may be appropriate.
Key Words: low back pain, acute, chronic, neuropathic pain, nociceptive pain, medications.

Managing Back Dominant Pain

Managing Back Dominant Pain

Teaser: 

Hamilton Hall, MD, FRCSC,1 Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH,2 Yoga Raja Rampersaud, MD, FRCSC,3

1Professor, Department of Surgery, University of Toronto; Medical Director, Canadian Back Institute; Executive Director, Canadian Spine Society, Toronto, ON.
2Associate Professor, Department of Family and Community Medicine, University of Toronto, Medical Director, Sport CARE, Women’s College Hospital, Toronto, ON.
3Associate Professor Department of Surgery, University of Toronto, Divisions of Orthopaedic and Neurosurgery, University Health Network Medical Director, Back and Neck Specialty Program, Altum Health, Immediate Past President Canadian Spine Society, Toronto, ON.

CLINICAL TOOLS

Abstract: Back dominant pain is either intensified by flexion or is not aggravated by bending forward. The most common pattern, probably discogenic, subdivides into two groups: one with pain on flexion but relief on extension, the other with pain in both directions. The second pattern has symptoms with extension only. Treatment begins with education about the true benign nature of the problem. Mechanical pain responds to posture adjustment and pattern-specific movement. Medication has a secondary role. Imaging is not required for the responding patient. The inability to detect a pattern or a lack of anticipated response combined with non-mechanical findings indicates the need for appropriate referral.
Key Words:back dominant pain, education, medication, imaging, specialist referral.

HealthPlexus is offering an eCME in support of the Back Pain Management Resource

eCME: The Latest in Back Pain Management

This CME activity offers interactive Videos, Animations, Pre- and Post-test Quizzes and you will be able to download a Certificate of Participation upon completion.

Back Dominant pain can be divided into two presentations: pain that is predominantly reproduced with flexion or pain that is reduced or unaffected by flexion.
The recognition of mechanical low back pain is based on a precise history, a validating physical examination and a positive treatment result.
Referred pain to the leg may occur with back dominant pain but, unlike radicular pain, the neurological examination will be normal.
Facilitating the patient to engage in activity that does not aggravate pain is the key to pain management and recovery.
The goal is control, not cure. Anything that relieves the pain and helps to restore mobility is valuable.
Medication has a limited and secondary role. There is no place for the routine use of narcotics or psychotropic drugs.
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Psychoactive Medications and Falls

Psychoactive Medications and Falls

Teaser: 

James W. Cooper, RPh, PhD, BCPS, CGP, FASCP, FASHP, Emeritus Professor and Consultant Pharmacist, College of Pharmacy, University of Georgia, Athens, and Assistant Clinical Professor of Family Medicine, Medical College of Georgia, Augusta, GA, USA.
Allison H. Burfield, RN, PhD, Assistant Professor, School of Nursing, College of Health and Human Services, University of North Carolina-Charlotte, Charlotte, NC, USA.

The high incidence of falls among older adults leads to increased health care costs and decrements in functional status. Psychoactive medications consumed by older adults are often implicated in falls. This article briefly reviews the associations between falls and psychoactive medications, with a focus on the long-term care setting, and offers an assessment method and strategies to reduce the risk of certain classes of medications known to contribute to fall risk.
Key words: falls, medications, psychoactive load, interventions, older adults.

Medical Management of Glaucoma: Clinical and Research Update

Medical Management of Glaucoma: Clinical and Research Update

Teaser: 


Elliott M. Kanner, MD, PhD, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA.
James C. Tsai, MD, Associate Professor and Director, Glaucoma Division, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA.

Glaucoma is a sight-threatening, progressive optic neuropathy whose incidence increases with age. Currently, the only proven treatment for glaucoma is the reduction of intraocular pressure (IOP). As medical treatment has become safer and diagnostic modalities have become more sensitive, it has become possible to detect and treat glaucoma earlier. This means that with more aggressive screening and treatment, a common cause of irreversible blindness can be prevented. As more patients are treated earlier, it is important not only for ophthalmologists but also for primary care physicians to be aware of the barriers to adherence and possible interactions and side effects of glaucoma medications. Parallels between glaucoma and other neurodegenerative disease are stimulating new approaches to therapy beyond IOP control, targeted directly at the prevention of axonal loss.
Key words: glaucoma, intraocular pressure, medications, neuroprotection, retinal ganglion cell.

Treatment of Heart Disease in the Elderly: Prescribing Practices Show Under-use of Medications

Treatment of Heart Disease in the Elderly: Prescribing Practices Show Under-use of Medications

Teaser: 

Lilia Malkin, BSc

Heart disease is a major cause of morbidity and mortality in the geriatric population. According to Health Canada, myocardial infarction (MI) and ischemic heart disease (IHD) accounted for over one-third of deaths in men and women aged 65 and older in 1995, once again firmly establishing coronary artery disease (CAD) as the leading cause of mortality in Canada. In Ontario, 23 percent of patients die within one year of experiencing MI and one-third of congestive heart failure (CHF) patients succumb within one year of being hospitalized for CHF. Importantly, as Dr. David Naylor, co-editor of the 1999 Institute for Clinical Evaluative Sciences (ICES) Cardiovascular Atlas points out, the Canadian demographic profile is shifting toward a larger geriatric population, potentially greatly increasing the number of Canadians vulnerable to heart disease. Therefore, it is imperative that both primary and secondary prevention methods be used as extensively as possible to reduce the morbidity and mortality due to CAD.