Index of Non Surgical Treatment

Alendronate and Risedronate: Efficiacy in Clinical Trials
Placebo-controlled studies of each agent individually indicate that both are effective and well tolerated in preventing and treating osteoporosis.

Anti-Inflammatory Treatment of Alzheimer's Disease (AD)
A meta-analysis of 13 epidemiological surveys suggests that prolonged exposure to an anti-inflammatory treatment confers a protective influence on the development of Alzheimer's disease.

Application: Selective Nerve Root Blocks
Selective nerve root blocks can be used to treat various hypotheses.

Are Epidural Steroids Useful?
Do injections of steroids into the lumbar epidural space work for back pain? The Richeimer Pain Institute Answers....

Basic Evaluation Process for Back Pain in Children
Back pain in children must be evaluated differently than in an adult. The author provides information on diagnosis-specific steps and helpful classifications.

Bisphosphonates and Other Drugs
SERMs, such as tamoxifen are an ideal drug for long-term use in postmenopausal women as these drugs offer the benefits of estrogen without undesirable side effects and cancer risks.

Chronic Pain Update: Ziconotide - A New Class of Pharmacologic Agent
Ziconotide is the first FDA-approved agent in a promising class of drugs called the conotoxins. Its release carried the specific indication for intrathecal use in chronic pain patients.

Clinical Considerations: COX-2-Selective Inhibitors
Withthe introduction of COX-2-selective inhibitors, the question was raised as to whether patients with aspirin-sensitive respiratory disease (ASRD) would tolerate these drugs.

Clinical Guidelines for the Use of Coxibs in Osteoarthritis (OA) and Rhematoid Arthritis (RA)
Celecoxib and rofecoxib both demonstrate efficacy in OA and RA and have been included in the updated ACR recommendations for OA management.

Clinical Studies of Coxib Efficacy in Osteoarthritis (OA) and Rheumatoid Arthritis (RA): Tables 1 and 2
Tables 1 and 2 represent outcomes of clinical studies of coxib efficacy in the treatment of osteoarthritis (OA) and rheumatoid arthritis (RA).

Clinical Trials of Coxibs in Osteoarthritis (OA)
Study outcomes for the efficacy of coxibs in the treatment of osteoarthrits comparing rofecoxib and celecoxib with a nonselective NSAID or placebo.

Clinical Trials of Coxibs in Rheumatoid Arthritis (RA)
Celecoxib is approved for the treatment of rheumatoid arthritis (RA) in the United States. Efficacy of celecoxib was established in a dose-ranging study and two phase III trials.

Clinical Viewpoint: To Progress or Not Progress
Before applying force progression, the therapist should carefully consider the purpose of the progression.

Complications: Selective Nerve Root Blocks
Selective nerve root blocks are not associated with complications provided that they are performed carefully and accurately.

Conclusions and References - Part 7: Cyclooxygenase-2-Selective Inhibitors: Translating Pharmacology into Clinical Utility
The magnitude of NSAID use, the high incidence of gastropathy in NSAID users, and the significant morbidity and mortality of NSAID-associated GI outcomes underscore the need for less toxic NSAIDs.

COX-2 Inhibitors in Arthritis: Conclusion and References
The discovery of COX-2 and the development of COX-2-selective agents have renewed interest in the role of prostaglandins in the pathogenesis of arthritic illnesses.

COX-2 Selectivity - Part 5: Cyclooxygenase-2-Selective Inhibitors: Translating Pharmacology into Clinical Utility
Whole-blood assays (ex vivo), which use whole blood from healthy adults, are the most widely accepted for the determination of COX selectivity.

COX-2-Selective Inhibitors in the Treatment of Arthritis
Therapy with nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) has long been the cornerstone of pharmacologic management of patients with OA and RA.

Coxib Therapy and Colorectal Cancer
Evidence suggests that NSAIDs can prevent the development of colorectal cancer (CRC). COX-2 is believed to play a role in the development of these cancers.

Cyclooxygenase Inhibitors - Part 4: Cyclooxygenase-2-Selective Inhibitors: Translating Pharmacology into Clinical Utility
Insight into cyclooxygenase structure and function has helped clairfy the mechanisms through which NSAIDs produce their therapeutic benefits and toxicity.

Cyclooxygenase-2-Selective Inhibitors in the Management of Acute and Perioperative Pain
Understanding pain is central to the goals of medicine as pain may be both a cardinal manifestation of disease and a cause of suffering.

Cyclooxygenase-2-Selective Inhibitors: Translating Pharmacology into Clinical Utility
This review summarizes some of the key aspects of COX biochemistry, structure, and function and the evolution of understanding the mechanism of action of COX-2 selective inhibitors.

Cyclooxygenases - Part 3: Cyclooxygenase-2-Selective Inhibitors: Translating Pharmacology into Clinical Utility
Although the overall structure and essential catalytic activity of the 2 COX isoenzymes are similar, there are vivid distinctions in their regulation and expression.

Development and Clinical Application of COX-2-Selective Inhibitors for the Treatment of Osteoarthritis and Rheumatoid Arthritis
Osteoarthritis (OA) and rheumatoid arthritis (RA) are among the most prevalent chronic illnesses and leading causes of disability in the United States.

Diagnostic Injections for Lumbar Disc Disease
There are two types of lumbar spinal pain, radicular pain and axial pain.

Discussion and References
The importance of managing patients' pain reflects the core value medicine places on the alleviation of suffering.

Do Statins Reduce Fractures?
Data are mixed on whether statins reduce the incidence of fractures in humans; some studies found a lower risk in statin users that nonusers, while others did not.

Eicosanoids and Prostaglandins - Part 2: Cyclooxgenase-2-Selective Inhibitors: Translating Pharmacology into Clinical Utility
Leukotrienes, lipoxins, and related compounds are known to occupy a crucial role in many biologic processes, giving eicosanoids prominence in modern pharmacology.

Emerging Options with Coxib Therapy
Future clinical applications of cyclooxygenase (COX)-2 selective inhibitors (coxibs) are likely to extend beyond their current use as oral analgesics in high-risk arthritis patients.

Epidural Corticosteroid Injections: Conclusion
Epidural steroid injections have a role in radicular pain, as proven with some controlled and many uncontrolled studies, including meta-anaylses.

Epidural Corticosteroid Injections: Technical Considerations - Part B
Various routes for administration of epidural steroids are discussed; figures included.

Epidural Corticosteroid Injections: Technical Considerations - Part C
The selective administration of epidural corticosteroid at the presumed most symptomatic level can provide pain relief from neural irritation and inflammation.

Epidural Corticosteroid Injections: Technical Considerations, Part A
Fluoroscopic guidance and contrast medium greated increase the accuracy and safety of epidural steroid injections.

Epidural Steroid Injections: Section 2
The balance of evidence suggests that epidural steroid injections have a role in treating radicular pain, although primarily as an adjunct to a comprehensive rehabilitation program.

Evolving Concepts in Perioperative Analgesia
If analgesia is administered before painful stimuli and tissue damage (perioperative pain management), hypersensitivity can be circumvented and hyperalgesia and central sensitization prevented.

How Common are Upper Gastrointestinal (GI) Adverse Effects in Use of Alendronate and Risedronate?
Bisphosphonate-induced upper GI adverse events are commonly cited, but the risk may be overstated and more associated with inappropriate administration.

Increased Bone Density
Prospective randomized controlled trials are needed to better exclude the possibility of unmeasured confounding variables and to delineate precisely the role of statins in skeletal health.

Indications, Risks, and Contraindications: Epidural Corticosteroid Injections
A review of the indications, risks, and contraindications for epidural steroid injections including study results.

Lumbar Nerve Root Blocks: Part B - Technique
Lumbar nerve block techniques discussed and illustrated.

Lumbar Nerve Root Blocks: Part C -Technique
During the injection of contrast medium the opportunity is taken to record any pain response offered by the patient.

Lumbar Nerve Root Blocks: Technique Part A
Early techniques of lumbar nerve root blocks required that the needle be directed at the target nerve.

Lumbar Spinal Stenosis: Treatment
A number of studies reported that nonsurgical management of lumbar spinal stenosis is effective.

Nerve Blocks: Part 1
Are nerve blocks useful?

Opioid-Sparing Benefit of NSAIDs
Combining an NSAID with an opioid analgesic may provide adequate pain control with a clinically significant reduction in opioid dosage.

Options for Pain Treatment
Pain medications may be broadly divided into two major categories; opioids and nonopioids. Despite significant side effects, opioid analgesics remain the most potent and widely used.

Oral Dosing Recommendations: Alendronate and Risendronate to Prevent and Treat Osteoporosis and Paget Disease
The authors provide dosing recommendations for risedronate and alendronate for preventing and treating osteoporosis and paget disease.

Osteoporosis: Nonpharmacologic Treatments
In women with symptomatic osteoporosis, calcium and Vitamin D alone do not reduce the risk of vertebral fractures, but they do increase the efficacy of osteoporosis medications.

Osteoporosis: Who Should be Screened?
Bone density measurements can be taken of the spine, hip, or writst; when values are available for more than one site, risk is determined by the lowest value.

Overview Supportive Studies: McKenzie Method of Mechanical Diagnosis and Therapy (MDT)
If a patient with lumbar or cervical pain can have their symptoms centralized in a short time, the prognosis for rapid improvement is likely.

Patient Selection and Implantable Technology: Elective Surgery for Chronic Pain - Taking it Up a Notch
The cumulative work of Melzack and Wall regarding the Gate Control Model of Pain continues to be timely.

Patient Selection and Implantable Technology: Making Appropriate Recommendations
Particular pieces of information contribute to shape the patient's treatment plan.

Physical Examinations for Young Athletes
If there is a history of injury to the spine or other parts of the musculoskeletal system, the physician should perform an examination specific to the problem.

Precision Injection Techniques for Diagnosis and Treatment of Lumbar Disc Disease: The Next Step
Precision spine injections are potentially powerful tools for both diagnosing and treating the anatomic source of chronic spinal pain.

Preemptive and Postsurgical Analgesia
The use of long-lasting analgesics before surgery may help to avoid the establishment of a sensitized state and result in diminished postoperative pain.

Preparticipation Physical Exams and Young Athletes: Many Exams Fall Short
The examinations that many high school and college athletes receive do not meet the recommendations outlined in this article.

Preparticipation Sports Exams for Young Athletes: Components of the Exam
Parents should help fill out the medical history, because athletes often provide different information than parents do.

Procedural Safety Guidelines for Cervical Epidural Steroid Injections: Appendix 1 - Part B
Part B of Appendix 1 that outlines safety guidelines for cervical epidural steroid injections.

Procedural Safety Guidelines for Cervical Epidural Steroid Injections: Appendix 1: Part A
Safety guidelines for cervical epidural steroid injections.

Psychological Factors in Pain
Stress can increase pain perception. Learning to identify and manage stress can paly an important role in the treatment of chronic pain.

Raloxifene: A New Choice for Treating and Preventing Osteoporosis
Selective estrogen receptor modulators (SERMs) are a new class of drugs that provide an option for postmenopausal women.

Raloxifene: Conclusions
Raloxifene is used to treat and prevent osteoporosis in postmenopausal women.

Raloxifene: Risk Factors in Humans
In clinical trials in postmenopausal women, raloxifene was well tolerated. Common drug-related adverse events include hot flashes and leg cramps.

Rationale: How, When, and Why to Use Epidural Corticosteroid Injections
There is an ongoing trend toward non-surgical management of disc herniations with or without radiculopathy.

References - Epidural Steroid Injections: Section 3
References to Epidural Steroid Injections.

References: Emerging Options with Coxib Therapy
References to accompany Mark J. Lema, MD, PhD's article "Emerging Options with Coxib Therapy".

References: What Kind of Physical Examination does a Young Athlete Need Before Participating in Sports?
References supporting the article "What Kind of Physical Examination does a Young Athlete Need Before Participating in Sports?"

References: When, How, and Why to Use Epidural Corticosteroid Injections: An Overview
References for the article "When, How, and Why to Use Epidural Corticosteroid Injections."

Role of Alendronate and Risedronate in Preventing and Treating Osteoporosis
Both alendronate and risedronate have been found effective in placebo-controlled trials in preventing and treating osteoporosis.

S1 Nerve Root Blocks: Technique
The technique for blocking the S1 nerve root is governed by the different anatomy of the sacrum and its foramina.

Selective Epidural Injection: Section 1
A selective epidural injection is a variation of the selective nerve root injection.

Selective Epidural Injection: Section 2
A selective epidural approach ensures that the injection incorporates all the sites where pathology can affect the nerve.

Selective Epidural Injection: Section 3
The selective epidural injection is composed of the provocative pain response and the analgesic response.

Selective Epidural Injection: Section 4
There are factors that can lead to both false positive and false negative results from selective epidural injections.

Selective Nerve Root Blocks: Interpretation
The archetypical positive response to a selective nerve root block is that once the root is anesthetized the patient is relieved of their pain.

Selective Nerve Root Blocks: Introduction
Nerve root blocks were developed as a means by which to define the source, if not the cause, of nerve root pain.

Selective Nerve Root Blocks: References
References to "Selective Nerve Root Blocks."

Selective Nerve Root Blocks: Results - Part A
Proponents have claimed that nerve root blocks are invaluable in refining a diagnosis of nerve root compression.

Selective Nerve Root Blocks: Results - Part B
A related utility of selective nerve root blocks is their negative predictive value.

Significance of COX-1 Inhibition by NSAIDs
For decades, NSAIDs have been the cornerstone of pharmacologic management of arthritic and rheumatologic illnesses. NSAIDs are generally well tolerated but have tissue-specific toxicity.

Sports Exams and Young Athletes: Clearance and Nonclearance
A preparticipation physical examination is used to either clear an athlete for play or to play following further evaluation or treatment. Sometimes a young athlete may not be given clearance.

Sports Exams and Young Athletes: Medicolegal Considerations
The preparticipation physical examination does not eliminate the risk for potential health problems to develop.

Statins and Osteoporosis: Can These Lipid-Lowering Drugs also Bolster Bones?
The statins may not only lower cholesterol, they may stimulate bone formation, as suggested by a number of observational studies and animal research.

Therapeutic Injections for Lumbar Disc Disease
A therapeutic injection, as an isolated treatment, has the potential to provide both long-term pain relief and restoration of function.

Toward More Effective Bone-Strengthening Drugs
Currently available statins, which are designed for lipid-lowering, may be suboptimal for treating osteoporosis; however, insights from studies may lead to development of similar molecules to promote bone formation.

Treating Osteoporosis in Post-Menopausal Women: A Case Approach
Osteoporosis and osteopenia affect amost 44 million people age 50 and older in the United States. Approximately 80% of whom are postmenopausal women.

Treating Osteoporosis: Bisphosphonates
Ibandronate was approved by the Food and Drug Administration for the treatment and prevention of postmenopausal osteoporosis.

Treating Osteoporosis: Raloxifene
The Women's Health Initiatve trial found that hormone therapy reduced the risk of hip and spine fractures.

Treating Osteoporosis: References
References to Michael I. Keller, MD's article "Treating Osteoporosis in Post-Menopausal Women: A Case Approach."

What is Clinically Relevant COX Selectivity? - Part 6: Cyclooxygenase-2-Selective Inhibitors: Translating Pharmacology into Clinical Utility
Two drugs approved by the US Food and Drug Administration, rofecoxib and celecoxib, have been shown to have the greatest selectivity for COX-2.

What Kind of Physical Examination does a Young Athlete Need before Participating in Sports?
The primary goals of the preparticipation physical examination are to detect conditions that may predispose to injury, disability, or death and to meet legal and insurance requirements.

When, How, and Why to Use Epidural Corticosteroid Injections: An Overview
Spinal epidural steroid injections are commonly utilized in the treatment of acute spinal pain and may provide diagnostic confirmation of a specific "pain generator."