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Advanced Therapeutics in Pain Medicine

Physiology of the Pain SystemPeripheral SystemAxonsCentral SystemSpinal CordDorsal Horn ExcitabilitySupraspinal ModulationSpinothalamic TractBrain ConsiderationsOther ConsiderationsReferencesNeuro–Endocrine–Immune Dysfunction in the Chronic Pain PatientPeripheral SensitizationMast CellsPeripheral SensitizationEndocrine and InflammationAutonomic Nervous System and InflammationMore on Peripheral SensitizationDRGCentral SensitizationDorsal Horn ModulationBrainEndocrine SystemMitochondriaLeptin and GhrelinConclusionReferencesThe Opioid EpidemicOpioid OverviewOpioid FailureNMDA PathwayNon-NMDR PathwaysGenetic ImplicationsGlial CellsHyperalgesiaEndocrine DisruptionAutonomic Nervous SystemReferencesEndogenous Cannabinoid Receptors and Medical CannabisHistorical Considerations and Clinical PrecedentMaintaining Physiologic BalancesThe Roles of Receptors and Their LigandsA Master Regulatory System’s Mechanism of ActionThe Ubiquitous Endocannabinoid SystemPlant-Derived Molecules Engage Endogenous ReceptorsThe Effects of Bioactive Cannabis Plant Chemicals Lead to the Discovery of Receptors and EndocannabinoidsCannabis Modulates Opiates as Endocannabinoids Modulate EndorphinsChemical Complexity of the Cannabis PlantΔ-9 Tetrahydrocannabinol (THC) and Cannabidiol (CBD)FDA Approval of CBD as a MedicineAdditional Bioactive Chemical Components in CannabisResearch: Evidenced-Based Data vs. Anecdotal ExperiencesInstitutes of Medicine (1999)National Academies of Sciences, Engineering, and Medicine (2017)Education: Clinical Rationale to Cannabinoids Used as MedicineA Concept Model Describing the Roles of EndocannabinoidsClinical Considerations of Cannabinoid MedicinesDosing GuidanceParadoxical Dose-Dependent Effects on PainRoutes of AdministrationRisks and ContraindicationsContaminants and TestingContemporary Cannabis and Its MedicalizationLegal Status and Accreditable Practice StandardsFuture DevelopmentsThe Contemporary Clinician’s Responsible RoleReferencesSex Hormones and Pain ControlIntroductionSex Hormones in WomenSex Hormones in MalesPregnenolone in Women and MenADRENAL HORMONES IN WOMEN AND MENThe Effects of Pain on Sex HormonesHormones and Pain ControlOpioid Suppression of HormonesConclusionReferencesManaging Pain in the Presence of Autoimmune DiseaseEtiology of AD and Immune System DysregulationGenetics and Terrain Plus Environmental TriggersLosing the Immune System Set PointDiagnostic TestingBloodworkBloodwork: InterpretationBlood Work: TreatmentSalivary CortisolSalivary Cortisol: TestingSalivary Cortisol: InterpretationSalivary Cortisol: TreatmentDiagnostic Stool AnalysisDigestive Stool Analysis: TestingDigestive Stool Analysis: InterpretationDigestive Stool Analysis: TreatmentProvocative Heavy Metal TestProvocative Heavy Metal: TestingHeavy Metal: AssessmentHeavy Metal: TreatmentFood Sensitivity TestFood Sensitivity Test: TestingFood Sensitivity Test: AssessmentFood Sensitivity Test: TreatmentTreatment Based on Empirical Knowledge Rather Than Lab ResultsCase StudiesPotential Testing LimitationsConclusionReferencesFibromyalgia: A Comprehensive PerspectiveWhat Is Fibromyalgia?Microbiome Composition in Patients with FibromyalgiaCurrent Treatments for FibromyalgiaMedication TherapiesMedications and Experimental Agents under Study for FibromyalgiaLow-Dose NaltrexoneDopamine AgonistsAmbroxolNMDAR InhibitorsAntiviral/Cyclooxygenase Inhibitor Combination (IMC-1)CannabinoidsHerbals and SupplementsNon-Drug TherapiesMind–Body PracticesConclusionReferencesA Functional Approach to Gynecologic Pain: Integrative Gynecology for the Non-GynecologistIntroductionExamination and ImagingTypes of PainMenstrualPain during the Period: DysmenorrheaThe Ovarian CystNon-Menstrual PainInfectious CausesVulvar Pain SyndromeConclusionReferencesHeadache DisordersMigraineDiagnosisPathogenesisMigraine TreatmentNew Thoughts on TreatmentNew Developments in Migraine TreatmentRole of Opiates in Migraine TreatmentMigraine and the Emergency DepartmentTrigeminal Autonomic CephalalgiasDiagnosisCluster HeadacheTreatmentNew Cluster Headache TherapiesIndomethacin-Responsive TACSChronic Paroxysmal HemicraniaHemicrania ContinuaIndomethacin TreatmentOther Potential Non-Indomethacin Treatments78SUNCT SyndromeOther Less Common Primary Headache SyndromesPrimary Exercise Headache1,82Primary Couch Headache1,82Primary Headache Associated with Sexual Activity1,82New Daily Persistent HeadacheSummaryReferencesBiotensegrity: Advancing Pain Diagnosis and Treatment by Rethinking Anatomy and BiomechanicsMyofascial Pain as an Introduction to Understanding Chronic Pain and Sports InjuryNot All Feedback and Control Are NeurologicThe Case of a Bodybuilder with Degenerative ArthrosisAn Advantage of Dynamic UltrasonographyTensegrity: The Tension Is the FrameBiotensegrity-Based Anatomy and Biomechanics: A SummaryFascia as a Body-Wide Signaling MechanismClinical Application of Biotensegrity Principles in Pain Medicine: A SummaryBiotensegrity-Informed HistoryBiotensegrity-Informed Physical ExamThe False Concept of Ligaments as the Only Controllers of PROMBiotensegrity-Informed TreatmentRestoration of Tensional Integrity: Clinical and Tissue Improvements 3 Months Post-ProcedureConclusionReferencesMyofascial Trigger Points, Sensitization, and Chronic Musculoskeletal Pain: Evaluation and ManagementSummaryIntroductionOrigin and History of MPSChronic Musculoskeletal Pain and Sensitization: Implications for Evaluation and TreatmentsAims and ObjectivesMPS, Sensitization, and Viscerosomatic InteractionsThe Role of the Limbic SystemPossible Physiological MechanismsClinical Evaluation of the MTrP and Sensitized SegmentsPrinciples and Methods of TreatmentTreating the MTrPBeyond the MTrP: Spinal Segmental SensitizationPerpetuating Factors of MPSConclusionA Case ScenarioReferencesMycotoxins and Tick-Borne Disease: Increasingly Common Causes of Unexplained Chronic PainLyme DiseaseMycotoxin IllnessPain Management in Environmentally Acquired IllnessSummaryReferencesRegenerative Medicine in Pain ManagementIntroductionMesenchymal Stem CellsBone Marrow-Derived Stem CellsAdipose-Derived Stem CellsMSCs in Pain ManagementNeuropathic PainDiscogenic PainOsteoarthritis or Inflammatory PainBone Marrow-Derived Stem Cell Studies in OAAdipose-Derived Stem Cell Studies in OAAllogeneic-Derived Stem CellsCancer PainMigraineOpioid Tolerance and Opioid-Induced HyperalgesiaExtracellular VesiclesReferencesAdenine Dinucleotide: Past, Present, and FutureIntroductionHistorical Perspective on NAD+What Is the Role of NAD+ in the Body?Current Clinical Applications of Intravenous NAD+Basic Research into the Mechanisms of NAD+ EffectivenessThe Effect of Alcohol on NAD+ Levels and Markers for Inflammation and Oxidative StressNAD+’s Effectiveness at Reducing Inflammation and Oxidative Stress Levels in Addiction PatientsIntravenous NAD+ Infusion Reduces a Second Marker for Inflammation and Oxidative Stress in Addiction PatientsIntravenous BR+NADТМ Infusions Increase the NAD+/NADH Ratio in Alcohol Abuse PatientsIntravenous BR+NADТМ Infusions Increase the NAD+/NADH Ratio in Patients Addicted to OpiatesEstablishing Baseline NAD+ LevelsAdditional NAD Research, Inc., Partnership Studies Underway or PlannedReferencesKetamine Use in Pain ManagementBackgroundMechanism of ActionPharmacokineticsPain Management with KetamineDosages and Routes of AdministrationParenteral KetamineIntranasal KetamineAdverse ReactionsDrug InteractionsContraindicationsConclusionReferencesThe Limbic System, Oxytocin, and Pain ManagementThe Limbic SystemThe Role of the Limbic System in Pain PerceptionLimbic System Retraining for Pain ManagementOxytocin and the Limbic SystemOxytocin and Pain ManagementEffect of Oxytocin on Pain via the Opioid and Cannabinoid SystemsHuman Studies of Oxytocin for PainOxytocin for FibromyalgiaOxytocin and Headache PainDuration of Oxytocin TreatmentPharmacokineticsDosage and AdministrationAdverse EffectsConclusionReferencesLow-Dose Naltrexone: Immune and Inflammatory Mediator ExtraordinaireMultiple SclerosisCrohn’s Disease and SarcoidosisFibromyalgiaPain, Complex Regional Pain Syndrome, and Diabetic NeuropathyCancerAutism Spectrum ConditionsWound Healing and InfectionMyalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)DiscussionConclusionReferencesTopical Pain Medications and Their Role in Pain ManagementCapsaicinLidocaineAmitriptylineGabapentinBaclofenKetamineClonidinePhenytoinNon-Steroidal Anti-Inflammatory Drugs (NSAIDs)Combination TherapyConclusionReferencesHerbal and Supplement Use in Pain ManagementCapsicumCat’s ClawDEVIL'S CLAWGingerIndian Frankincense (Boswellia)Limbrel (Flavocoxid)TurmericWillow BarkSuperoxide DismutaseVitamin CVitamin EChondroitin SulfateGlucosamine SulfateMethylsulfonylmethane (MSM)S-Adenosylmethionine (SAMe)-Hydroxytryptophan (5-HTP)MagnesiumCoenzyme Q10MelatoninRiboseVitamin DAcetyl L-CarnitineVitamin B1 (Thiamine)Vitamin B12BiotinEvening PrimroseMilk Thistle (Silymarin)FeverfewReferencesPEA: A Novel Fatty Acid in the Treatment of PainPain, Endometrial Pain, Fibromyalgia, and IBS-Related PainParkinson Disease, Alzheimer Disease, and Brain IschemiaTraumatic Brain Injury and Spinal Cord InjuryGlaucoma, Diabetic Retinopathy, and Diabetic NeuropathyInfluenza and Common ColdConclusionReferencesLifestyle and Its Relationship to PainIntroductionWhat Matters Most?Partial CreditExample Side BarSmoking and TobaccoInflammatory Food and PainPotatoFruit JuiceHydrogenated OilArtificial SweetenersDrinking Water and Chlorination ByproductsStages of LearningExerciseRest/SleepMeditationBody WorkSummaryReferencesDeveloping Education and Treatment Protocols for Substance Use Disorders That Are Socially Responsible, Accountable, and Integrated: Recovery Engagement—Recognize and TreatOverviewScope of the ProblemRecognition of SUD Symptoms and Patient MotivationProgressionToleranceChronicity and WithdrawalRecognizing Levels of ImpairmentIdentifying Emotional DysregulationDiagnosis of SUD—DSM-5Placement Criteria for SUD (ASAM)Patient Intervention Protocols Unique to SUDImplications for Medical ProfessionalsSummaryReferencesDetoxification StrategiesIntroductionTraditional AddictionAccidental DependenceGeneticsReferencesNaloxone Use in the Opioid EpidemicNaloxoneIncreasing Access to NaloxoneConclusionReferencesPsychological Intervention: Cognitive-Behavioral TherapyIntroductionThe BrainCognitive-Behavioral TherapyCognitionBehaviorPediatric ConsiderationsDevelopmentRelationshipsAcademicsReferences

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