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Course code: PHAR6205
University: The George Washington University
Country: United States
Pharmacology is a discipline of science concerned with the study of medications and their effects on biological systems, or the study of how drugs function in the body (sometimes known as 'drug activities'). To grasp this, we must analyse what a drug is, how it affects our physical, emotional, and psychological well-being, the type of drug being taken, the modalities of administration, the drug's absorption, and the identity of the individual using the drug. This module will cover neuropharmacology, which would be the study of how mind-altering or psychoactive medications work.
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Psychoactive medications are chemicals that cause changes in mood, thinking, or behaviour as a result of changes in brain activity. The term 'drug' will be used in this module to refer to all psychoactive drugs, including alcohol and other psychoactive substances (e.g. petrol). Alcohol, nicotine, and cannabis are all examples of psychoactive substances.
Specific suggestions concerning non-pharmacologic and non-opioid therapy modalities are outside the scope of the DHS Opioid Prescribing Improvement Program. The materials below give a comprehensive review and/or summary of the evidence base for non-opioid and non-pharmacologic therapeutic options.
• The Institute for Clinical Systems Improvement is a non-profit organisation dedicated to improving clinical systems (ICSI). Pain: Evaluation, Non-Opioid Treatment Options, and Opioid Management August 2017. Eighth Edition.The Agency for Health Research and Quality (AHRQ) is a federal agency that promotes health research and A Systematic Review of Noninvasive Nonpharmacological Treatments for Chronic Pain. 2018.
• Medical Directors Group of the Washington Agency. Guidelines for prescription opioids for pain from various government agencies. June 2015, 3rd Edition. See the section on non-opioid pain treatment alternatives.
• Veterans Affairs Medical Center. Chronic Pain Treatment is Being Revolutionized. Clinicians' Guide to the VA.
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For mild-to-moderate acute pain, consider alternatives to opioid analgesia. When opioids are provided for acute pain, consider alternate non-opioid pain treatment options.
During the post-acute pain period, introduce multimodal therapy to all patients. Discuss evidence-based pain management alternatives; talk about the risks and advantages of each option to help guide the conversation and enable collaborative decision-making.
Provide all patients with basic pain education during the post-acute and chronic pain periods. Patient handouts and internet tools are basic pain education options.
For patients whose pain is disproportionate to the type of the injury or disease, or who are determined to be at high risk for chronicity or impairment, consider pain education, such as therapeutic neuroscience education. Therapeutic neuroscience education entails learning about the brain, spinal cord, and pain's descending route. Patient should be referred to a qualified clinician, such as a pain psychologist or a physical therapist.
Use a comprehensive approach to treating all chronic pain sufferers. Treatment techniques should be tailored to the patient's specific needs, as indicated by the biopsychosocial evaluation.
For most pain types, non-opioid analgesics and adjuvant analgesics are as effective as or more effective than opioid analgesics, with a lower risk of patient damage. Non-opioid and adjuvant analgesics should be prescribed based on the patient's diagnosis, symptoms, kind of pain, concomitant conditions, and overall risk of adverse medication events. Non-opioid analgesics, nonsteroidal anti-inflammatory medicines (NSAIDS), certain anticonvulsants, and selected antidepressants are examples of non-opioid pharmaceuticals used to manage pain.
Physical modalities, behavioural techniques, interventional treatments, and patient education are examples of non-pharmacological therapy. Exercise treatment, Cognitive Behavioral therapy, and group support activities are just a few examples.
· Physical therapy
· Multimodal integrative treatments
· Spinal manipulation, acupuncture, or yoga
· Patient education
· Mindfulness and stress reduction
According to new study, patient education regarding the neurobiology and neurophysiology of pain can help to reduce pain, disability, anxiety, and stress related to pain (Louw, 2011). This sort of instruction, also known as therapeutic neuroscience education (TNE), usually consists of one or more educational sessions teaching the neurobiology or neurophysiology of pain and how the nervous system processes pain. The goal of this sort of pain education is to teach patients to think of pain as the nervous system's interpretation of the threat of harm, rather than a precise estimate of the degree of tissue injury.
Because of the intricacies of pain—particularly chronic pain—pain management requires a multidisciplinary approach that is tailored to the patient's specific requirements and circumstances. Providers should utilise the biopsychosocial evaluation done during the initial visit to help them decide which treatment options are best for the patient. Because of the provider's geographic location or practise environment, the capacity to treat chronic pain patients utilising a multidisciplinary approach may be constrained. Clinicians who have restricted access to specialists and other health-care professionals should consider using telemedicine to deliver interdisciplinary treatment.
Multi-modal therapy considers all biopsychosocial factors that influence pain. Options for treatment should include those that are appropriate for the patient's pain diagnosis, as well as significant psychological support. The following therapies, among others, may be used:
Psychotherapy techniques (e.g., CBT, AACT, Relaxation Therapy, Mindfulness-Based Stress Reduction, and hypnosis)
Integrative and complementary medicine (e.g., acupuncture)
Physical treatment that is active (e.g., structured exercise programme or physical therapy)
Modalities that are passive (e.g., spinal manipulation therapy)
Interventional therapy (e.g., diagnostic injections or therapeutic injections)
Pain rehabilitation programmes that are multidisciplinary
Anticonvulsants, antidepressants, glucocorticosteroids, muscle relaxants, and antispasmodics are non-opioid medications, as are non-steroid anti-inflammatory treatments.
Chronic pain is a complex disorder characterised by both physical and psychological symptoms that affects around 20% of the population in industrialised countries. Despite tremendous breakthroughs in pain management over the last few decades, chronic pain remains a major issue. This article outlines a mechanism- and evidence-based strategy for improving chronic pain medication treatment outcomes. To treat mild to moderate pain, nonopioid analgesics are usually used first. If this is insufficient, and there is a risk of sleep deprivation, an antidepressant with analgesic properties should be added. A trial with one of the gabapentinoids is recommended if there is a component of neuropathic pain or fibromyalgia. If these measures are insufficient, an opioid analgesic may be used. For moderate to severe pain, a long-term opioid study would be started sooner. Skeletal muscle relaxants and topicals may be used alone or in combination to treat skeletal muscle spasms.
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