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During a neurostimulation screening test, the patient receives a temporary, external neurostimulation system for 3 to 7 days and percutaneous leads are used for the screening test. During the screening test, the patient uses the external neurostimulation trialing system while completing daily activities.
Throughout the screening test, the external neurostimulator collects patient-use data and the patient records activities, neurostimulation settings, and degree of pain relief in a diary. Implanting the spinal cord neurostimulation system requires a short surgery, typically done on as an outpatient procedure.
The Failed Back Surgery Syndrome (FBSS), it was defined by North & Campbell in 1991 as persistent or recurring low back pain with or without sciatica, following one or more lumbar spine operations.
Chronic debilitating low back pain occuring in a patient after back surgery of a variety of types, such as discectomy, laminectomy, and lumbosacral fusion, that was unsuccessful in relieving the patient’s symptoms.
FBSS is considered to be a severe, long-lasting, disabling and relative frequent (5-10%) complication of lumbosacral surgery and this is the most common indication for neurostimulation.
Neurostimulation has been used for FBS since 1967 and Long-term follow-up studies have shown a success rate up to 75% for FBS at 5 years. Neurostimulation can lower the medical costs of FBS over time, by reducing office and emergency department visits. CRPS I and II are chronic pain syndromes characterized by severe pain accompanied by autonomic changes in the painful region, including edema, temperature abnormalities, sudomotor activity and skin color changes. CRPS develops in response to a traumatic physical event, such as an accident or medical procedure.
Retrospective reviews of a limited number of patients having Neurostimulation systems implanted for the management of CRPS have shown that patient satisfaction with this mode of therapy is quite high, with up to 90% finding the stimulator helpful for their pain. While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain persists and the pain signals keep firing in the nervous system for weeks, months, even years. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system). Pain perception occurs when these stimuli are transmitted to the spinal cord and then to the central areas of the brain. The basic sensation of pain occurs at the thalamus, it continues to the limbic system (emotional center) and the cerebral cortex, where pain is perceived and interpreted (Figure 1).
After this first pain, the smaller C fibers transmit dull burning or aching sensations, known as “second pain.” The C fibers transmit pain more slowly than the A fibers do because the C fibers are smaller and lack a myelin sheath.
According to the gate control theory, stimulation of the fibers that transmit nonpainful stimuli can block pain impulses at the gate in the dorsal horn and this is the basis for neurostimualtion treatment. For example, if touch receptors (A beta fibers) are stimulated, they dominate and close the gate.
The touch blocks the transmission and duration of pain impulses, and this capacity has implications for the use of touch and massage for some patients in pain. This characterization was previously the official definition of chronic pain according to the International Association for the Study of Pain. Melzack and Wall showed that repeated stimulation of C fibers results in progressive buildup of electrical response in the CNS, a phenomenon called windup, somewhat analogous to the effect of winding up a child’s windup toy.
This persistent stimulation of peripheral nerves winds up the CNS, leading to intensified stimulation of nerve fibers that is referred to as non nociceptive pain. The body’s fight-or-flight reaction, which normally occurs with acute pain, does not occur because the sympathetic nervous system has adapted to persistent pain impulses. Understanding chronic pain, therefore, requires listening to the person’s description of it, because expected physical symptoms may not be present. Some evidence indicates that chronic pain and depression share the same physiological pathway. Chronic, often intractable pain due to injury to the peripheral nerves is known as neuropathic pain. Injury to peripheral nerves should deaden sensation, much as cutting a telephone wire leaves the phone line dead, but the opposite occurs in neuropathic pain.
Injury to the peripheral nerves can cause spontaneous paresthesias, numbness, pain with movement, tenderness of a partly denervated body part, and pain that is electric shock–like, burning, shooting, or tingling. Abnormally amplified signals in the CNS due to windup result in central sensitization, which is an increased sensitivity of spinal neurons. Medications, acupuncture, local electrical stimulation, and brain stimulation, as well as surgery, are some treatments for chronic pain. Naples University asseverates that adult stem cells could be utilized in repair and regeneration of injured lung. Air passes into the lungs and flows through progressively smaller airways called bronchi and then bronchioles. All bronchioles lead to alveoli, microscopic sacs where oxygen and carbon dioxide are exchanged. Asthma is a chronic condition in which these airways undergo changes when stimulated by allergens or other environmental triggers. These actions in the airway cause coughing, wheezing, and shortness of breath (dyspnea), the classic symptoms of asthma. In the hyperreactive response, smooth muscles in the airways constrict and narrow excessively in response to inhaled allergens or other irritants. When people without asthma breathe in and out deeply, the airways relax and open in order to rid the lungs of the irritant.
When people with asthma try to take those same deep breaths, their airways do not relax but instead narrow, causing the patients to pant for breath. The immune system responds to allergens or other environmental triggers by delivering white blood cells and other immune factors to the airways. These so-called inflammatory factors cause the airways to swell, fill with fluid, and produce a thick sticky mucus.
This combination results in wheezing, breathlessness, an inability to exhale properly, and a phlegm-producing cough.
Asthma and allergies often coexist, and the allergic response plays a strong role in childhood asthma. Dust mites, specifically mite feces, which are coated with enzymes that contain a powerful allergen.
Smoking: Parental smoking has been shown to increase the airway responsiveness of infants as early as the first 2 - 10 weeks of life.
Studies suggest that most respiratory infections are not important causes of asthma in children, except in certain cases. Common respiratory infection viruses that cause colds (such as the rhinovirus) may be associated with the development of asthma in some people.
Research indicates that children who have a viral-induced wheezing during infancy may be at increased risk for later development of asthma. Asthma death rates have steadily declined and it now is rarely fatal in children Even low mortality numbers are unacceptable, however, since asthma deaths are largely preventable. African-American children have more than six times the death rate of Caucasians in the age groups of 4 years and younger and 15 - 24 years. Among younger children, asthma develops twice as frequently in boys as in girls, but after puberty it is more common in girls. African-American children have significantly higher rates of asthma than Caucasian children. A variety of pregnancy and perinatal factors have been associated with risk for asthma, although none are very well studied or proven. Any of these symptoms may worsen with exercise, viral infections, exposure to irritants, stress, or changes in weather. Asthma often progresses very slowly to a serious condition, but at times a fatal or near-fatal attack may develop within a few minutes. Exercise-induced asthma (EIA) is a limited form of asthma in which exercise triggers coughing, wheezing, or shortness of breath.
EIA is triggered only by exercise and is distinct from ordinary allergic asthma in that it does not produce a long duration of airway activity, as allergic asthma does. Asthma occurs primarily at night (nocturnal asthma) in as many as 75% of patients with asthma. If symptoms and a patient's history strongly suggest asthma, the doctor will usually perform tests known as pulmonary function tests to confirm the diagnosis and determine the severity of the disease. Peak expiratory flow rate (PEFR), commonly called the peak flow rate, the maximum flow rate that can be generated during a forced exhalation. The patient may receive skin or blood allergy tests, particularly if a specific allergen is suspected and available for testing. The severity of asthma is classified into four groups: Intermittent, Mild Persistent, Moderate Persistent, and Severe Persistent. Number of exacerbations (sudden worsening) requiring oral corticosteroids, ranging from none to two or more in the last 6 months.
The goal of asthma therapy is to maximize long-term control of the illness with medications and other treatment approaches, thereby minimizing the frequency of asthma symptoms and asthma attacks. Unfortunately, many patients do not understand the difference between medications that provide rapid, short-term relief and those that are used for long-term symptom control.
In choosing therapy, doctors must also consider the risk an individual patient has for more severe exacerbations. Long-term control therapy is recommended for children who have had four more episodes lasting longer than 1 day over the previous year and who have some of the risk factors described earlier in this section. Nebulizers and certain other devices are available to help administer medications to children this age. Only certain inhaled corticosteroids and long-acting beta2-agonists are recommended for these children. The variation between age groups consists mostly of which medications are recommended and how soon to start various medications and treatments. The spacer helps improve medication delivery by allowing the patient additional time to inhale.
Breathlessness and wheezing incite a fear of suffocation and death, even in very small children.
This anxiety produces further constriction on the muscles surrounding the airways, which makes breathing even more difficult.
Caregivers must first focus on alleviating their own anxiety, which can heighten a child's own fears. A child may also find relief by lying stomach-down on several pillows so that the head is slightly lower than the chest while the caregiver gently pats the back between the shoulder blades.
Warm liquids, such as soup or hot cider, are effective in loosening mucus and may also relax bronchial muscles. Overhydration (too much liquid) can be harmful, however, so these drinks should not be forced on the child. Visits by home health care nurses or social workers may help if the family is having trouble managing the asthma and following prescribed treatments. Beta2-agonists serve as bronchodilators, relaxing and opening constricted airways during an acute asthma attack. Short-acting bronchodilators are generally administered through inhalation and are effective for 3 - 6 hours. Beta2-agonists have serious interactions with certain drugs; parents should tell the doctor about any other medications their child is taking. Two inhaled drugs, ipratropium bromide (Atrovent) and tiotropium (Spiriva) act as bronchodilators over time.
Corticosteroids, also called glucocorticoids or steroids, are powerful anti-inflammatory drugs.
Receiving corticosteroids using an inhaler makes it possible to provide effective local anti inflammatory activity in the lungs with very few side effects elsewhere in the body.
Inhaled steroids include fluticasone (Flovent), budesonide (Pulmicort), triamcinolone (Azmacort and others), mometasone furoate (Asmanex), flunisolide (AeroBid), and ciclesonide (Alvesco). The older corticosteroid inhalants are beclomethasone (Beclovent, Vanceril) and dexamethasone (Decadron Phosphate Respihaler and others). Budesonide (Pulmicort Respules) is available in a jet nebulizer for children ages 12 months - 8 years. Inhalers that combine both long-acting beta2-agonists and corticosteroids are also available.
Since short-term growth may vary, it is important not to be alarmed by short-term slowing of growth. Rashes, wheezing, facial swelling (edema), fungal infections (thrush) in the mouth and throat, and bruising are also possible, but not common, with inhalators.
Long-acting beta2-agonists are used for preventing an asthma attack (not for treating attack symptoms). Cromolyn sodium (Intal) is both an anti-inflammatory drug and has antihistamine properties that block asthma triggers, such as allergens, cold, or exercise. Leukotriene antagonists (also called anti-leukotrienes or leukotriene modifiers) are oral medications used for prevention, NOT for treating acute asthma attacks.
Theophylline (Theo-Dur, Theolair, Slo-Phyllin, Slo-bid, Constant-T, and Respbid) is a mild-to-moderate bronchodilator that has been used to treat childhood asthma for more than 30 years. Available in tablet, liquid, and injectable forms, some theophylline sustained-release tablets and capsules work for a long time and can therefore be taken once or twice a day with good results.
If a child is taking theophylline on an ongoing basis, the doctor should monitor the drug level at the start of therapy and at regular intervals thereafter.
Studies have shown benefits of the drug, including a reduced need for corticosteroids, fewer hospitalizations, and symptomatic improvements. Omalizumab should always be injected in a doctor’s office and health care providers should observe patients for at least 2 hours after an injection. Asthma action plans create a written document for patients and parents to manage asthma during stable times and to more easily identify when asthma is worsening. Monitoring response to treatments and communicating with doctor if symptoms worsen or if severe symptoms occur. Follow-up generally depends on the severity of asthma, how recently asthma was diagnosed, patient compliance, and whether recent changes in treatment were made. Replace curtains with shades or blinds, and wash bedding using the highest temperature setting. Encase mattress and pillow in special dust mite proof covers (synthetic pillows may pose a higher risk for asthma attacks than feather pillows, or no pillow at all). Exterminate mice, and attempt to remove all dust, which might contain mouse urine and dander. Fix all leaky faucets and pipes, and eliminate collections of water around the outside of the house.
Avoid scheduling camping and hiking trips during times of high pollen count (generally, May and June for grass pollen and mid-August to October for ragweed). Avoid strenuous activity when ozone levels are highest, which usually occur in early afternoon, particularly on hot hazy summer days. Patients who are allergic to mold should avoid barns, hay, raking leaves, and mowing grass.
Parents should make sure that their child’s school has a copy of the written asthma action plan.
Encourage children with asthma to swim and play sports, such as baseball, that will be less difficult for them. Comply with long-term control medications, particularly inhaled corticosteroids, when prescribed.
Participate in activities with short bursts of exercise (such as tennis and football) over exercises involving long-duration pacing (such as cycling, soccer, and distance running).
Immunotherapy ("allergy shots") may help reduce asthma symptoms, and the use of asthma medications, in patients with known allergies. National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. For "Informational Use Only".For more detailed information, contact your health care provider about options that may be available for your specific situation.
Covering a wide rage of techniques used to ease psychological suffering, psychotherapy and counseling owe much to the work of Austrian psychiatrist Sigmund Freud at the turn of the 20th century. The origins of psychotherapy as we know it today can unquestionably be traced to the work of Sigmund Freud, who practiced psychoanalysis in Vienna from the 1880s to the 1930s.
Carl Jung, a Swiss psychoanalyst and originally one of Freud's disciples, developed his own theories about man's search for his "essential self", and the existence of a "collective unconscious" shared by all human beings.
In around 1914, a pupil of Freud, Carl Jung, broke away from his mentor to develop his own brand of analytic psychotherapy, based on the idea of a human drive toward an inner world of wholeness. Trained practitioners should be able to identify the importance not only of what clients say, but what they do not say, and suggest links between present behavior and past events. PSYCHOANALYSTS: Practitioners train for 5 to 7 years at a recognized institution, following the teachings of Sigmund Freud, Carl Jung, or Melanie Klein. PSYCHOLOGISTS: After taking a science-based university degree, studying the mind and behavior, practitioners choose a branch of psychology in which to specialize.
PSYCHOTHERAPISTS: Practitioners usually train for 4 years with a recognized organization, but do not necessarily have a degree. COUNSELORS: While some counselors may receive only a weekend's training, the better ones have 2 to 3 years' training and work under supervision. Both psychotherapists and counselors may use a variety of approaches, including psychodynamic as well as humanistic. In 1994, the British Journal of Psychiatry published research suggesting that cognitive therapy was more effective for panic attacks than other conventional medication or relaxation techniques.
Conventional health care practitioners do not doubt the value of good listening skills and communication, particularly where there has been loss or trauma. There are many reasons why you may consult a psychotherapist or counselor: a life event may have triggered powerful emotions, or you may be distressed for reasons that you do not comprehend. It can be difficult to decide which type of therapy to choose, particularly as many practitioners adapt a range of approaches. The initial consultation is a chance to see if you feel comfortable with the type of therapy and the practitioner. By asking the client to speak about himself, the practitioner can help him to identify any deep-seated reasons for his problem. When choosing a practitioner ask about training and qualifications, and whether he or she belongs to a professional body. Avoid psychoanalysis, psychotherapy, or counseling if you have any psychotic illness, such as schizophrenia or manic depression. A: Provided your practitioner has been fully trained by a recognized institution and long-term treatment is properly reviewed, there should be no negative aftereffects.
Psychoanalysis, psychodynamic therapies, and counseling rely on the verbal communications of thoughts and emotions. This therapy works with the unconscious mind, exploring connections between past and present life events and making use of transference, but emphasizing change and development. If you have a history of broken relationships, for example, you might examine possible formative childhood experiences. For severe problems, such as child abuse or autism, a child psychologist would use a psychoanalytic approach to help the child make sense of relationship experiences and learn from them. For less severe problems, such as bed-wetting, a child counselor or play therapist may work with children singly or groups, often using play - this can be the easiest way for children to express themselves. Family therapy can be effective in resolving communication difficulties between family members and in changing patterns of behavior.
Counseling usually focuses on specific problems, such as bereavement or job loss, rather than deep-seated personal issues.
Training for counselors is usually shorter and less academic than for psychotherapists, and a good counselor should know when to refer you to more expert treatment.
Couples with relationship difficulties may benefit from talking to a counselor who can help them decide how to approach the future.


Dealing with marital or relationship problems, this type of counseling aims not so much to restore the relationship as to help couples understand the nature of their difficulties, and decide what action can be taken in the future.
Known by both names, this therapy is used specifically to help people with sexual problems that may be causing relationship difficulties. At the end of the 19th century, Russian scientist Ivan Pavlov discovered that animals learn to associate certain situations with reward or punishment.
Combining cognitive therapy and psychotherapy, this approach encourages you to draw on your own resources to acquire the skills to change destructive patterns of behavior.
Pioneered by clinical psychologists in the 1960s, this approach combines cognitive and behavioral techniques.
Developed by psychologist George Kelly in 1955, this approach helps you restructure perceptions of yourself and so change your outlook. Originally developed in the US in the 1930s to treat alcohol dependency, this cognitive behavioral technique is now used for any addictive behavior, from recurring problems when forming relationships, sexually-related addictions, gambling addictions, to drug abuse and addictions.
Treatment by this cognitive behavioral approach consists of three one-hour sessions with one follow-up session three months later. Combining cognitive behavioral techniques with ideas form humanistic psychotherapy and hypnotherapy, NLP was developed in the 1970s by American psychotherapists John Ginder and Richard Bandler. Neurolinguistic Programming (NLP) teaches clients to see their connection with the world in terms of six levels, shown here as discs. In one Gestalt technique the client images a problem embodied as herself in an empty chair, with whom she talks through her feelings. Like Jungian therapy, this approach explores aspects of the mind that unite humanity, such as myth, spirituality, birth, and loss. The premise of transactional analysis - first outlined in the 1960s by Canadian psychiatrist Eric Berne - is that everyone has a child, adult, and parent self within them, and in each social interaction, one self predominates. In this psychodrama, the "protagonist" shows a drawing to her "father", the antagonist, demanding from him the praise and attention she was denied in childhood.
Based on the theory that suppressed birth or infancy traumas can resurface as neuroses, primal therapy grew out of the work of American psychologist Arthur Janov in the 1960s. Emotional or physical trauma during birth are said to create feelings of separation or fear later in life. Tri-Well is a therapeutic and consultative psychotherapy practice for those seeking an integrative approach to health, wellness and healing. Additionally Jane continues to accept referrals for individuals and families for her private psychotherapy practice. Note: If you are a local practitioner in the Salem, Massachusetts area that would like to be listed on this and my Find A Practitioner Listing, send me your information about you and your services and I will add you to the Local Practitioners list. See all our merchant banners below for products, remedies and supplements recommended on this web site. Newsletter SignupSign up here to receive our newsletter along with great discounts on all of our custom-formulated feeds and supplements.
Ask our expertsDo you have a question about your pet's health that you would like to ask our medical and nutrition team? Since medication is not recommended for long-term use, researchers from the University of Alberta have been exploring low-cost, alternative therapies to help people with chronic pain get better sleep. Their findings show that self-administered hand shiatsu—a Japanese form of massage, similar to acupressure — can help people in pain fall asleep more quickly and stay asleep for a longer period of time.
Shiatsu is a century-old massage technique in which the practitioner stimulates the patient’s acupressure points to relieve pain and stress. For the study, nine people suffering from chronic pain were trained in hand shiatsu techniques to perform just before bed. The researchers note that the strong mental attention needed for shiatsu may be enough in itself to help people fall asleep faster—there simply is no mental space left for negative thoughts (often a part of insomnia). Given the small size of the study, the researchers aren’t able to make grand conclusions just yet, but the results are very promising and have paved the way for more research. For patients suffering from chronic low back pain and other musculoskeletal injuries, the only thing that matters is finding something that works, Brown says. In that time, over 250,000 patients have benefited from spinal cord stimulation and provide clinicians and patients with reliable, best-in-class pain management systems and service. The first stage is a 3- to 7-day screening test to evaluate whether or not the patient is a candidate for the second stage – the spinal cord stimulation system implant. In some cases, the patient can use a patient control device to change some stimulation settings within physician-programmed limits. Results are evaluated to determine if the patient is a candidate for a spinal cord stimulation system implant. The neurostimulator is inserted under the skin through a small incision in the upper buttock. Typically, patients with CRPS see an average of 5 doctors before being accurately diagnosed. Acute and chronic pain are due to different physiological mechanisms and thus require different treatments. Pain impulses travel to the dorsal horn of the spine, where they synapse with dorsal horn neurons in the substantia gelatinosa and then ascend to the brain. The large A delta fibers produce sharp well-defined pain, called “fast pain” or “first pain,” typically stimulated by a cut, an electrical shock, or a physical blow. This ability to block pain impulses is the reason a person is prone to immediately grab and massage the foot when he or she stubs a toe. The term chronic is still widely used, although many pain experts now think that all forms of chronic pain are variations of the same phenomenon and should be labeled specifically, such as neuropathic pain. Chronic pain is poorly understood and is more complex and difficult to manage than is acute pain. Windup is the reason pain can continue long after the expected recovery time for an injury or a pain-initiating event.
Additionally, autonomic nervous system responses (eg, nausea, vomiting, pallor, sweating) decrease with prolonged pain. Unfortunately, because of the lack of objective evidence of pain, many patients who report chronic pain are viewed as hypochondriacs and malingerers by health care professionals.
Central sensitization causes allodynia (pain from a stimulus that does not normally produce pain, such as touch) and hyperalgesia (a heightened pain response to a stimulus that is painful). Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.
Smooth muscles in the airways of people with asthma may have a defect, perhaps a deficiency in a critical chemical that prevents the muscles from relaxing. Cats harbor significant allergens, which can even be carried on clothing; dogs usually cause fewer problems. Cockroach dust is a major trigger and may reduce lung function even in people without a history of asthma.
Studies indicate that the more indoor allergens a child is allergic to, the higher the risk for severe asthma. Viral respiratory infections certainly worsen existing asthma, but the most common ones are unlikely to cause childhood asthma. An important exception is the respiratory syncytial virus (RSV), which has been implicated in the development of asthma. More likely, these viruses do not directly cause asthma, but worsen asthma in children who already have it. In general, the more severe the childhood asthma, the greater the likelihood that it will persist.
Children born in the winter may have a greater risk for asthmatic allergies to cockroaches than children born at other times of the year. Exclusively breastfeeding for a baby’s first 3 months of life may help reduce the risk for wheezing and asthma during their early. Complications of pregnancy, specifically those involving the mother's uterus (such as post-birth hemorrhage, pre-term contractions, insufficient placenta, and restricted growth of the uterus), are associated with an increased risk of childhood asthma.
Evidence also suggests that people who are overweight (body mass index greater than 25) have more difficulty getting their asthma under control. At least half of patients with asthma also have gastroesophageal reflux disease (GERD), the cause of heartburn. Initial chest tightness without any other symptoms may be an early indicator of a serious attack. After an initial acute attack, inflammation persists for days to weeks, often without symptoms. This condition generally occurs in children and young adults, most often during intense exercise in cold dry air.
It involves administering a specific drug (histamine or methacholine) that usually increases airway resistance only when asthma is present.
Allergy skin tests help diagnose for allergic asthma, although they are not recommended for people with year-round asthma. The test involves placing a small amount of the suspected allergy-causing substance (allergen) on the skin (usually the forearm, upper arm, or the back), then scratching or pricking the skin so that the allergen is introduced under the skin surface. Medications that open the airways (bronchodilators or inhalers) are used to quickly relieve any moderate or severe asthma attack. Long-term control medications are essential to minimize long-term damage of the inflammatory response, to reduce the risk of serious exacerbations, and to enhance the overall function and well-being of patients with asthma.
Parents can greatly reduce the frequency and severity of their children’s asthma attacks by understanding the difference between coping with asthma attacks and controlling the disease over time. Many patients with moderate or severe asthma overuse their short-term medications and underuse their corticosteroid medications.
Factors that may contribute to this include parental history of asthma, atopic dermatitis, and known sensitivity to different allergens or foods.
It may also be considered for other children who are experiencing impairment from their asthma.
Long-acting beta2 agonists and leukotriene antagonists are additional therapies that are usually used in addition to inhaled corticosteroids. Inhaled drugs must be used regularly as prescribed and the patient carefully trained in their use in order for them to be effective and safe.
The standard device for administering any asthma medication is the metered-dose inhaler (MDI). Dry powder inhalers (DPIs) deliver a powdered form of beta2-agonists or corticosteroids directly into the lungs.
Children are advised to rinse their mouths out right after using these inhalers and to brush twice a day with a fluoride toothpaste.
Their use has been associated with a higher rate of hospitalizations and longer duration of symptoms than inhalers. A short-acting inhaled beta2-agonist, taken as needed, is often the only medication used by children with chronic mild asthma. Other similar beta2-agonists are isoproterenol (Isuprel, Norisodrine, and Medihaler-Iso), metaproterenol (Alupent, Metaprel), pirbuterol (Maxair), terbutaline (Brethine, Brethaire, and Bricanyl), levalbuterol (Xopenex), and bitolterol (Tornalate). They relieve the symptoms of acute attacks, but they do not control the underlying inflammation. There has been some concern that short-acting beta2-agonists become less effective when taken regularly over time, increasing the risk for overuse.
Long-Term Relief MedicationsThese medications are taken on a regular basis to prevent asthma attacks and control chronic symptoms. Steroids are not bronchodilators (they do not relax the airways) and have little immediate effect on symptoms. However, doctors caution against corticosteroids for infants and toddlers with mild asthma and urge close monitoring, especially for children under age 5 with severe asthma who are receiving high doses.
However, a number of studies report only a slight effect (about half an inch) on children's growth, which may be only temporary. Using a spacer device and rinsing the mouth after each treatment can minimize or prevent these effects. These drugs can be dangerous when used alone, because they can mask asthma symptoms, and they can increase the risk of asthma death unless paired with an inhaled steroid. A cromolyn nasal spray called NasalCrom has been approved for over-the-counter purchase, but only to relieve nasal congestion caused by allergies. Side effects of cromolyn include nasal congestion, coughing, sneezing, wheezing, nausea, nosebleeds, and dry throat.
These drugs are considered an alternative for long-term control of asthma, but inhaled corticosteroids should always be used first.
Patients who take a leukotriene-antagonist drug should be monitored for signs of behavioral and mood changes.
The use of inhaled corticosteroids and long-acting beta2-agonists has dramatically reduced the need to use theophylline in most patients with asthma. It should be considered only for children over 12 years who have moderate-to-severe persistent asthma related to allergies and for adults who have severe asthma and allergies.
However, about 1 in 1,000 patients who take omalizumab develop anaphylaxis (a life-threatening allergic reaction). Patients should also carry emergency self-treatment for anaphylaxis (such as an Epi-Pen) and know how to use it. Some doctors believe that reducing household allergens and pollutants in the home could reduce asthma in children by 40%. Dry shampoos, available for both cats and dogs, can remove allergens from the skin and fur and are easier to administer than wet shampoos. The plan should contain a list of medications the child takes (including which ones need to be taken during school hours), identified asthma triggers, and emergency contact numbers. Intense activities lasting less than 2 minutes, such as sprinting or competitive swimming, may cause fewer problems than longer-lasting exercises. EIA occurs only after exercise and is more likely to occur with regular paced activities in cold, dry air. Children older than 2 years should also receive at least one dose of the pneumococcal polysaccharide vaccination. Patients with severe seasonal allergies may need to start taking medications a few weeks before the pollen season, and to continue them until the season is over. In one study, nearly half of asthma or allergy sufferers resorted to alternative treatments.
Patients report benefits from many stress reduction and physical techniques, such as acupuncture, hypnosis, breathing relaxation techniques, the Alexander technique, massage therapy, and meditation.
Acupuncture involves the insertion of tiny sterile needles, slightly thicker than a human hair, at specific points on the body.
Breathing exercises may help improve patients’ quality of life even if they do not have a major impact on medication reduction.
Probiotics are beneficial microbes that some believe may help protect against allergies and asthma. Meta-analysis: effects of adding salmeterol to inhaled corticosteroids on serious asthma-related events.
Efficacy of inhaled corticosteroids in infants and preschoolers with recurrent wheezing and asthma: a systematic review with meta-analysis. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: a randomized, double-blind, placebo-controlled trial.
Wheezing and bronchial hyper-responsiveness in early childhood as predictors of newly diagnosed asthma in early adulthood: a longitudinal birth-cohort study. Probiotics for the treatment of allergic rhinitis and asthma: systematic review of randomized controlled trials. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Whether treating mental and emotional disorders or promoting self-awareness, these therapies offer a chance to understand and resolve difficult thoughts, feelings, and situations by talking about them with a skilled listener.
He believed that sexuality, hunger, and other drives experienced unconsciously at an early age shape emotional responses throughout life. He introduced the idea of the unconscious mind, and tried to uncover buried motives for the disturbed thoughts, feelings, and actions of his patients by allowing them to talk freely. Between World Wars I and II, she carried out research into infant behavior, believing that young children's relationships with the outside world are at least as formative as their struggles to come to terms with their own bodies. By the 1970s, psychotherapy and its sister therapy, counseling, were becoming established outside the US. Most practitioners will have undergone therapy as part of their training, and even when qualified they should receive regular supervision from another practitioner. Not only are the methods diverse but they rely on theories about human condition that are impossible to proved scientifically. When the results of such studies are compared, clients are generally found to have benefited from treatment in the long term, although no technique seems more effective than another. Giving patients the emotional help they need can be distressing for practitioners and patients alike, and most conventional practitioners stress the need for formal training. The inability to make a major decision may be affecting your life, or you may have a history of relationship problems and wish to understand why. Try to be as clear as possible about what you want to be doing differently at the end of treatment. You will be asked to explain why you think you need help, and the practitioner will decide whether she can help you.
The client is encouraged to talk freely and the practitioner interrupts only to help the client focus on his problems. Remember that you are paying for treatment and are entitled to stop therapy whenever you wish. The length of treatment varies widely, from a few months to several years or more, depending on the approach. Behavioral and cognitive therapies help to change habitual actions or perceptions by offering positive ways of behaving and thinking. The unacceptable feelings of early childhood are said to be banished to the unconscious mind, but to continue to influence thoughts, emotions, and behavior.
He developed a form of psychoanalysis in which clients examine past experiences in order to confront deep-seated personal issues affecting their identity. It is helpful for people who find it difficult to relate to others, and is also used to treat addiction.
Because the earliest relationships we form are those within a family, the attitudes and habits developed at this time can have a powerful influence on our patterns of behavior later in life. A counselor is supportive and skilled in listening, and will prompt you to talk freely, but will probe less deeply into personal problems that a psychotherapist, and offer little or no direct advice. The counselor helps couples improve their verbal and physical communication, and advises on common problems, such as impotence, difficulties in achieving an erection or becoming aroused, and premature ejaculation. The counselor encourages you to focus positively on things that you do well - to set yourself goals and work out how to achieve them. This led to the premise that behavior is learned in response to past experiences and can be unlearned, or reconditioned, without analyzing the past for reasons why the pattern had formed.
It is based on the theory that previous experiences may adversely affect your self-perception, and condition your attitudes, emotions, and ability to deal with certain situations. For example, relaxation techniques may be taught alongside ways to change your thoughts and expectations. A questionnaire helps to analyze your view of the world, and techniques may include pretending for a week to be a fictional character who views the world differently. Within the support of a group, the steps teach you new ways of behaving and thinking about yourself and your life. In the first stage, the practitioner helps you to establish the nature of the problem; over the next two sessions, you look at strategies to resolve it.


It works on the theory that life experiences, from birth onward, program the way you see the world. It invites people to explore their feelings and take responsibility for their thoughts and actions. By learning to recognize these roles, you can choose which one to adopt and so change your behavior. You act out inner conflicts, rather than talking about them, giving vent to feelings that are hard to express in everyday life. This therapy, developed in the 1970s, uses breathing techniques to release tension and help you re-experience traumatic emotions.
Their goal is to partner with patients to address issues such as transitions, parenting and family relationships and to assist them to learn practical and appropriate stress management techniques. An objective of her mindfulness based practice is to assist patients to manage their stress more effectively. At the two week and eight week follow-ups, the participants reported that they were falling asleep faster and sleeping longer as well.
Not only does sleep deprivation lower a person's pain threshold, it also affects overall health. Approximately 85% of these procedures involve laminectomy and discectomy and 15% are spinal fusions. Such conditions can include chronic fatigue syndrome, endometriosis, fibromyalgia, inflammatory bowel disease, interstitial cystitis, temporomandibular joint dysfunction, and vulvodynia.
In this document, we review theories of pain and examine the physiology of pain, with emphasis on the types and their manifestations.
Transmission through the A fibers is so fast that the body’s reflexes can actually respond faster than the pain stimulus, resulting in retraction of the affected body part even before the person perceives the pain.
Essentially, asthma is an inflammatory lung condition that makes it difficult to breathe properly.
Asthma is most likely caused by a combination of genetic (inherited) factors and environmental triggers (such as allergens and infections). Some studies suggest that children who have allergies are also at greater risk for developing asthma as adults.
People with asthma who already have pets and are not allergic to them probably have a low risk for developing such allergies later on.
In fact, early respiratory and intestinal infections may offer some protection against asthma. Rhinovirus has been reported to be the most common infection associated with asthma attacks. There is evidence that severe asthma can cause long-lasting damage and possibly permanent scarring in some patients.
Both groups of minority children are more likely to have fatal asthma than Caucasian children. Weight loss in anyone who is obese and has asthma or shortness of breath helps reduce airway obstruction and improve lung function.
It is not entirely clear which condition causes the other or whether they are both due to common factors. With this condition, asthma gets worse when patients take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs).
Any child who has frequent coughing or respiratory infections should be checked for asthma. Symptoms are generally most intense about 10 minutes after exercising, then gradually resolve.
The skin is observed closely for signs of a reaction, which usually includes swelling and redness of the site. For children over age 5 with moderate-to-severe persistent asthma, doctors recommend inhaled corticosteroids with the addition of long-acting beta2-agonists if necessary.
The overuse of bronchodilators can have serious consequences; not using steroids can lead to permanent lung damage. Based on severity of patients' asthma and their age, there are specific recommendations regarding whether to use long-term control medications and which ones to use. Studies suggest that many children fail to use the devices properly, although newer devices are easier to use than others. This device, particularly when used with a spacer, allows precise doses to be delivered directly to the lungs.
Patients should track their medicine and throw the device away when the last dose has been administered. Nebulizers are often used for children younger than 3 years and sometimes for older children who have difficulty using the MDI.
If children must use an albuterol nebulizer, parents should be sure that it does not contain the preservative benzalkonium, which actually narrows the airways. If asthma continues to worsen with the use of these drugs, a doctor may prescribe corticosteroids or other drugs to treat underlying inflammation. Over time, some patients may become tolerant to many effects of short-acting beta2-agonists.
They are most commonly prescribed for asthma flareups that do not respond to inhaler medications.
Instead, they work over time to reduce inflammation and prevent permanent injury in the lungs.
In 2008, an FDA advisory panel voted to ban the use of salmeterol (Serevent) and formoterol (Foradil) for treatment of asthma in children and adults. Other concerns are indications of liver injury in patients when taking zafirlukast at higher than standard doses. Toxicity can cause nausea, vomiting, headache, insomnia, and, rarely, disturbances in heart rhythm and convulsions. The presence of allergies must generally be proven by increased levels in the blood of a certain antibody called IgE. Patients can develop anaphylaxis after any dose of omalizumab, even if they had no reaction to a first dose. With an Epi-Pen, or similar auto-injector device, patients can quickly give themselves a life-saving dose of epinephrine. Making lifestyle changes to reduce allergy attacks and other triggers is extremely important. Peak flow monitoring should be performed in patients with moderate or severe persistent asthma or those with a history of more severe exacerbations (sudden worsening or increase in severity of symptoms). Air cleaners, filters for air conditioners, and vacuum cleaners with High Efficiency Particular Air (HEPA) filters can help remove particles and small allergens found indoors.
Other asthma triggers include irritants like smoke, pollution, fumes, cleaning chemicals, and sprays.
Studies indicate that exposure to second-hand smoke in the home increases the risk for asthma and asthma-related emergency room visits in children. Parents should also make sure that the school staff is trained in the steps to take in case of an asthma attack. Some studies indicate that long-term exercise may help control asthma and reduce hospitalization. Yoga, which uses stretching, breathing, and meditation techniques, may have particular benefits. Immunotherapy poses some risk for severe allergic reactions, especially for children with poorly controlled asthma, so it is important that the doctor carefully evaluates the child’s asthma condition.
To date, however, evidence does not support most alternative therapies, including high-dose vitamins, urine injections, homeopathic remedies, and most herbal remedies. Probiotics can be obtained in active yogurt cultures and in supplements, which are being studied for protection.
Manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Many hospitals and health care providers' practices now employ psychologists and psychotherapists, and many other practitioners offer a range of less mainstream therapies in the same field. Today, many health care providers refer patients to various types of psychotherapists and counselors, or even employ them in their practices. These approaches usually involve encouraging clients to talk about their experiences and vent emotions that have been repressed, while cognitive and behavioral therapies do not deal with the unconscious at all. Clinical psychologists often use cognitive and behavioral methods directed by the practitioner.
Often it is the skill of the practitioner, rather than the type of therapy, that determines a successful outcome.
Less research evidence is available for longer-term psychoanalytic therapies, but some studies indicate that there is little change even after the third year of treatment. Many practitioners are trained counselors in their practices, and forms of brief psychotherapy are widely available. Some practitioners offer the first consultation without charge, particularly if therapy is likely to be long term.
The humanistic psychotherapies retain ideas from all of the above but focus on a creative awareness of the present. Patients undertaking psychoanalysis are usually suffering high levels of distress, and treatment may be a lengthy process, consisting of as many as three to five 50-minute sessions a week for 2 to 5 years. Treatment is traditionally open-ended, but therapy for a core issue can be short-term work involving 15 to 40 sessions. In a dysfunctional family, one member sometimes becomes disturbed or ill when they feel they try to express something that they feel they cannot mention to the others.
Instead, your thoughts and feelings are reflected back to you to increase your self-awareness.
As counseling often explores deeper psychological problems, the counselor may refer you to a psychotherapist or sexual counselor.
Other sex-related conditions that may benefit from counseling and psychotherapy include vaginismus (muscle tension preventing penetration) and painful intercourse, loss of libido, failure to reach orgasm, dislike of sex, and fertility issues. You are taught to change certain unwanted habitual actions or emotions through mental and physical exercises, including punishment and reward strategies, employed to lever you out of destructive patterns of behavior.
By learning to identify, question, and change negative or self denigrating thoughts, it is possible to alter habitual responses and behavior. Treatment is structured and directive, and takes place over 16 weekly sessions of 50 minutes, involving diary-keeping, progress charts, and diagrams that explain the destructive emotional cycles in which you may be trapped. It has proved effective in treating stress-related ailments, phobias, obsessions, eating disorders, and in conjunction with drug treatment, major depression. The first step is to admit to the problem, while the final step includes a pledge to help others in the same situation.
You are expected to act on these strategies in the three months before the follow-up session.
A practitioner, who may be a psychotherapist or counselor, helps you discover how you have learned to think and feel so that you can take control of your actions. Emphasis is not on dysfunctional behavior or neuroses, but on self-development and achieving one's highest potential ("high-level wellness"). You gain self-awareness by analyzing your behavior and body language, and giving expression to any feelings you may be repressing. The pain causes sleep deprivation, which in turn weakens the body’s natural pain control mechanisms — leading to more pain and more insomnia. In fact, many participants said they had a hard time staying awake during shiatsu and would actually fall asleep before they had finished the treatment. Sleep-deprived people are at increased risk of obesity, diabetes, cardiovascular disease and even traffic accidents.
If it were hardwired, each noxious stimulus, such as a needle stick, would elicit exactly the same nervous system response at the same intensity every time, but pain is much more complex, involving affective and cognitive traits of the person who experiences it.
Asthma tends to run in families, so children whose parents have asthma are more likely to develop it themselves.
Studies also indicate that infants who have reduced lung function within a few days after birth are at increased risk of developing asthma by the time they are 10 years old. The condition can be very serious in children, particularly those younger than age 5, because their airways are very narrow.
The risk for such injury is highest when asthma strikes children in their first 3 - 5 years.
Ethnicity and genetics, however, are less likely to play a role in these differences than socioeconomic differences, such as having less access to optimal health care, and greater likelihood of living in an urban area. If the measurements are more normal, the drug has most likely cleared the airways, and a diagnosis of asthma is strongly suspected. Other drugs used in special cases include corticosteroids taken by mouth and anticholinergic drugs.
Patient education, environmental control measures, and management of any other conditions are also included. Humidity or extreme temperatures can affect DPIs' performance, so they should not be stored in humid places (bathroom cabinets) or locations subject to high temperatures (glove compartments during summer months).
Recent studies suggest spacers may be better than nebulizers for children, and they shorten the time spent in emergency rooms.
Doctors may provide a written prescription for patients to keep on hand, with specific instructions about when to fill it. The FDA panel decided that salmeterol-fluticasone (Advair) and formoterol-budesonide (Symbicort), long-acting beta2 agonists products that are combined with a steroid in a single inhaler, can continue to be used for treatment of moderate-to-severe asthma. The first drug of this type to be approved for asthma, omalizumab is a monoclonal antibody (MAb), a genetically developed drug designed to attack very specific targets.
Neither vacuuming nor the use of anti-mite carpet shampoo, however, is effective in removing mites in house dust.
Avoiding exposure to known allergens and respiratory irritants can substantially reduce asthma symptoms. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites.
Behavioral and cognitive therapies have been widely evaluated - for example, studies published in the Journal of Counseling & Clinical Psychology in the 1990s - have been shown to be effective for anxiety, phobias, mild to moderate depression, relationship problems, and sexual dysfunctions. It is important to be able to talk freely to your practitioner, so if you cannot do so on your first visit, do not hesitate to find someone else. The client-analyst relationship is taken as a reflection of previous significant feelings and relationships which the analyst interprets and gradually helps make acceptable to the client's conscious mind. When the whole family sits down together with a practitioner, issues that affect each member, such as a lack of communication, can be discussed without targeting any one person. The counselor also helps you to look at your situation from different perspectives in order to gain fresh insights and find your own solutions.
Specialized counselors are often available for marital and sexual problems and bereavement crises, and many health care providers now have counselors attached to their practice. The therapy works well with some stress-related illnesses, compulsive and obsessive behavior, irrational fears, phobias, and addictions. If you are pessimistic or depressed, for example, you are encouraged to view situations from different perspectives rather than always interpreting everything in the same gloomy way. This therapy can be effective in treating certain clearly defined problems linked to stress and anxiety, such as panic attacks. You are taught to consciously change your patterns of speech and body language in order to communicate better and bring about personal change. Treatment consists of one-to-one or group sessions, and often includes action out scenerios and dream recall. Through painting, movement, writing, and other techniques, you learn to recognize and value different facets of your personality. Chemicals used in household cleaning products and furniture materials can be asthma triggers. There does not appear to be any significant risk for long-term lung damage for children who develop mild-to-moderate persistent asthma between ages 5 - 12. The American Academy of Pediatrics recommends exclusively breastfeeding for the child's first 6 months. It is a particularly severe asthmatic condition, associated with many asthma-related hospitalizations. It serves as a holding chamber for the medication that is sprayed by the inhaler.) MDI-delivered drugs must be used regularly as prescribed and the patient carefully trained in their use in order for them to be effective and safe.
Because the spray is less targeted than with the inhaler, it must deliver large amounts of the drug. Studies also indicate that with the use of a face mask and a spacer, the MDI works well even for infants in the emergency room and may prove to be useable at home. The drugs are also sometimes used in the emergency room to treat children with severe asthma to enhance the effects of intravenous beta2-agonists. The use of inhaled corticosteroids in patients with moderate-to-severe asthma reduces the rate of rehospitalizations and deaths from asthma. Advair is approved for children ages 4 years and older, and Symbicort is approved for children ages 12 years and older.
There have been a number of reported cases of serious and even lethal side effects from herbal products. Always ask how long therapy is likely to last, and if there will be regular progress reviews. One or two weekly sessions are needed for at least six months, and a two-year period course of treatment is the norm. For this reason, the therapy needs the cooperation of everyone in the family to be successful.
If you are depressed or lack confidence, you may feel encouraged to stand up for yourself, or you may learn to express difficult emotions, such as anger, sadness, or fear.
For example, if you have a fear of flying you are taught relaxation methods, offered information about aerodynamics, encouraged to visit an airport, and then eventually accompanied on a flight. Sessions are held weekly, and practitioners claim that benefits can be felt after a few months' treatment.
Psychosynthesis is helpful for people seeking a new, more spiritually oriented vision of themselves. In about 5% of cases, aspirin is responsible for a syndrome that involves multiple attacks of asthma, sinusitis, and nasal congestion. Prolonged use of oral steroids has widespread and sometimes serious side effects, so they are not generally give to children for longer than 5 - 7 days. It is used only to treat patients whose symptoms are not controlled by inhaled corticosteroids. Any duplication or distribution of the information contained herein is strictly prohibited. The length and number of sessions vary, but are usually brief compared to other approaches.
Several psychodramas may be required to achieve results and extreme emotions may be released in the process. Frequent need for these medications indicates that the asthma is not well-controlled overall. ReferencesAmerican Lung Association Asthma Clinical Research Centers, Peters SP, Anthonisen N, Castro M, Holbrook JT, Irvin CG, et al. Asthma has dramatically increased worldwide over the last few decades, in both developed and developing countries. About half of all cases of asthma develop before the age of 10, and about 80% of patients develop symptoms before they are 5 years old.



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