Sunday, 15 July 2012

Pain management - A basic idea of symtoms and drugs

Pain management is an art, You have to learn it and go through multiple cases and experiences. I have tried many drugs on myself, my colleagues and my family members as an experiment sessions and through all those experiments I kept learning. I know it's a vast topic but I can assert few basic things which are primitive to understand and quite safe to try.

First thing, we should know the origin and the level of pain. 
1. Muscle and Spasm pain 
2. Joint pain
3. Headache
4. Body ache
5. Stomach pain/Bowel syndrome
6. Back pain

A little bit of idea about class of drugs related to pain management.

1. NSAID (non-steroidal anti-inflammatory drugs - All the NSAIDs differ in structure but they all have similar antipyretic, anti-inflammatory and analgesic properties. NSAIDs work by blocking the cyclo-oxygenase (COX) enzyme, so inhibit production of prostaglandins and thromboxanes, which are produced as part of the inflammatory response. Some classes of NSAIDs are:

  • Aspirin, ibuprofen, naproxen, ketoprofen
  • Dicelofanac family of drugs - used to treat pain or inflammation caused by arthritis or ankylosing spondylitis
  • Mefnomic acid drug family - It works by reducing hormones that cause inflammation and pain in the body

2. Acetaminophen/Paracetamol - One of the finest invented drug in medical science which works for almost everything without knowing how exactly it works.

3. Antispasmodics/Anticholinergics - Antispasmodic agents inhibit the action of acetylcholine. They stop the transmission of parasympathetic nerve impulses therefore lessen the spasms of smooth muscle, such as in the gastrointestinal tract and in the bladder. They are used to treat spasms or conditions with disturbances in the bladder or gastrointestinal motility.

4. Muscle relaxants - They are agents that reduce tension in muscles. Centrally acting muscle relaxants work by reducing the tone of skeletal muscle causing muscles to relax. These are generally used to relieve skeletal muscle spasms due to spastic conditions, and can be used to relieve musculoskeletal pain.

Now you just need a mapping which drugs is suitable for what kind of pain.

1. Normal muscle pain, minor headache, minor sore throat - Aspirin is good enough (Don't give it you kids, it may induce Reye's syndrome)

2. A littel bit more muscle pain, fever, body ache, sore throat, flu, headache - Paracetamol is awesome (marketed as Crocin, Dolo650, Calpol), Dolo650 and Calpol is better in terms of usages and safty for adult and as well as to kids.

3. Muslce pain - ACECLO-MR, ACENT-MR, ASOACT FORTE  (aceclofenac + chlorzoxazone + paracetamol)

4. Stomach pain - For common cause and stomach irritation,  You need an antispasmodics, like Cyclominol or Cyclopam, both contains Dicycloverine which is antispasmodics

4. Abdominal pain/Menstrual cramp - You need "mefenamic acid" drug, like MEFTAL-P is too good.

5. Joint pain - Required is something like non-steroidal antiinflammatory and antirheumatic products, which can be found in drugs which contains Diclofenac or Mefenamic acid,  like Meftal-Force (which contains paracetamol and Mefenamic acid), or Diclofenac + Paracetamol like Acetonac,  or Bindac by gsk, or Ibugesic plus, or Paracip plus by Cipla

6. Back painDiclofenac + Paracetamol works pretty well, if not then try Meftal-spas, if not then Mobizox (which contains Diclofenac + paracetamol + chlorzoxazone) which works extremely well, but these are not long term solutions

7. Headache 

First try Aspirin, then Paracetamol, then Ibugesic plus or Combiflam then try DART which contains caffeine also but don't take it much. If headache is persisting then you need to figure out root cause of it, don't just keep taking drugs.

Disclaimer: This post for your information only and not intended to replace your relationship with your treating physician.

Saturday, 21 April 2012

How to treat yourself with common Cold, Flu, Viral and Fever

Trust me I have gone through this several many time and I have good experience of trying multiple class of drug to treat this.

A common cold is pretty common thing to happen ha ha ha, As an insight It is a group of symptoms in the upper respiratory tract caused by a large number of different viruses  may be more than 200. Though seasonal flu mostly caused by either influenza A or B viruses. But here in this post I am not covering influenza which is completely a different aspect of disease and so treatment. But I would like just mention that influenza virus is curable by a prescription drug Tamiflu. Common dude come back to the point...ok, ok.  Cold and flu is related with throat infection and sore throat also, So let me first clear the difference in these all terminologies.

What's the Difference Between a Cold, Strep Throat, and Tonsillitis?

  1. A sore throat is often the first sign of a cold. However, a sore throat from a cold often gets better or goes away after the first day or two. Other cold symptoms such as a runny nose and congestion may follow the sore throat. 
  2. Strep throat, which is an infection due to streptococcus bacteria, is another cause of sore throats and tonsillitis. With strep throat, the sore throat is often more severe and persists. 
  3. Tonsillitis is a painful inflammation or infection of the tonsils, the tissue masses located at the back of the throat.

What is the treatment?

Few basic things, if you have cold and flu symptoms from more than 3-4 days then don't read this further and just consult a physician. Now there are two possible state of the symptoms, one is before getting consistent fever and other is after getting consistent fever. If you do not have consistent fever or if you have fever less than 100 Fahrenheit then possibly use of anti-inflammatory drug and precautions should be good enough to get cured but if you have fever more than or equal to 100 Fahrenheit and consistent then you should also take anti-infective. 

How to choose Anti-Inflammatory?

The best one I have seen to be performing is acetaminophen(or paracetamol) which as analgesic and anti-pyretic (ant fever) and works like wonder. But this is not enough because usually based on cough, cold, congestion, you have to choose the anti-inflammatory very wisely. Following are basic rules:
  1. only fever - paracetamol is good enough
  2. only cold, running nose - cetirizine is good enough
  3. cold and mild fever - paracetamol + cetirizine
  4. cold, chest congestion, fever - Cheston cold (by cipla) is too good which contains paracetamol + cetirizine + phenylephrine 
  5. fever, cold, chest congestion, headache - Okacet cold (which contains caffeine also to induce the sleep), or Sinarest which is like too good drug for common usage.
  6. fever, body ache, headache - paracetamol + ibuprofen (marketed as combiflam)
  7. throat pain, fever - combiflam
In short Sinarest or Cheston cold is a pretty good but if you don't have much of cold and chest congestion then only paracetamol is enough. In case of throat infection which has induced the fever and cold, then paracetamol is enough but must do the gargling and take some logenze(like Tusq-D) for throat relief. In case of kids also Cinarest syrup is pretty good. Sometime if fever is not getting down you can try Paracetamol and Mefenamic acid which works much better mechanism to get the fever down. 

How to choose antibiotic?

As a suggested use of Anti-infective you can try Amoxicilin as a mild antibiotic, but for me Azythromycin  worked like wonder. But if you have taken these before you can try something more powerful as 3rd generation antibiotic like Cefpodoxime

The same kind of drug can be given to kids also as a syrup but the best one I have seen to be performing is "amoxicillin + clavulanic acid" whoseTrade names include Augmentin (by GlaxoSmithKline), Finemox CV (by Finecure Pharmaceuticals), Clavamox (by Pfizer), CLAMP (by Dr. Reddy's Laboratories), Advent (by cipla). Even an adult can try the tablet form of Augmentin as antibiotic but of course for kids you have to use syrup.

Before taking this medication, tell your doctor if you are allergic to any drugs (especially penicillin).  Also tell your doctor if you have kidney disease or a history of intestinal problems. 

As a moderate cases I'll prefer to use Azythromycin, if you have higher level of infection then take 500mg tablets (only 3 tablets are enough as a course of anti-biotic), or else take 250mg tablets (only 6 tablets are enough). If you are taking 500mg then one tablet should be good enough, if you are taking 250mg then take 2 times in a day, so in both the cases, let it run for 3 days. And slowly try to observe that which anti-biotic suits you when, it can be quite personal. For me Azythromycin works better, but for my daughter when any infection happens,  "amoxicillin + clavulanic acid" works better. Your you should keep consulting the same doctor always so that your doctors keeps the track of which suits you better. And slowly you should always try to build a better immune system so that anti-biotic is not required. Take good amount of Vitamin C, D, B. Try to do good amount of exercise daily to increase you metabolism which essentially helps a lot in building immune system. 

And finally the food, what to take what not to take?

Take food with lots of vitamin C, and fruits, and liquid stuff. And don't take pickle, cold things (like banana, cold water, cold rice etc.), try taking warm water only. You can eat anything you want but avoid cold things, try easy digestible, 

Disclaimer: This post for your information only and not intended to replace your relationship with your treating physician.