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One in five people suffer from moderate to severe chronic pain, and one in three is unable or less able to maintain an independent lifestyle due to their pain. Between 50 and 60 percent of people with chronic pain are less able or unable to exercise, sleep normally, perform household chores, attend social activities, drive a car, or walk.

The value of the pharmaceutical market for pain relief in 2008 reflects this seeming worldwide epidemic of pain. The Global Pain Therapeutics Market assesses key pain management therapeutics – such as opioids, triptans, anticonvulsants, Cox-II inhibitors and traditional NSAIDs and are discussed in terms of their past, present and future value and the role they are playing in the effective management of pain. This report discusses the key products within each of these areas and outlines the drivers of these markets as well as the restraints on them.

The Global Pain Therapeutics Market also identifies and discusses trends and issues that will have a significant impact on the pain management market and profiles the leading companies in the field. The report provides the reader with valuable information and analysis regarding key products on the market and in clinical development.

This 438-page report includes 96 profiles of companies engaged in the development and/or commercialization of pain therapeutics and over 150 tables and graphs illustrating sales trends, past and present, as well as pipelines and demographic and market trends in the area of pain management.

Key features and highlights of this report:

Extensive review of key products indicated for pain conditions and their market value and impact

Discussion of the key drivers of and restraints on the global pain therapeutics market

Qualitative analysis of key pain markets and products driving growth (opioids, NSAIDs, triptans, neuropathic pain therapies (anticonvulsants) and Cox-II inhibitors)

Profiles and reviews of key pipeline products in development for fibromyalgia, cancer pain, post-operative pain, migraine pain, neuropathic pain and opioid therapies

Profiles of nearly 100 companies engaged in the development and/or commercialization of pain therapeutics worldwide

Overviews of treatment options for post-operative pain, migraine pain, cancer pain, fibromyalgia, arthritic pain, back pain, neuropathic pain, and the demographic impact of these conditions.

Chapter devoted to the role of drug delivery technologies in the current and future treatment of pain

Discussion of promising areas of research in a variety of pain areas and companies engaged in cutting edge research and development

Key questions answered in this report:

What is the current state of the global pain therapeutics market?

How has the Cox-II debacle effected the market for and treatment of pain conditions?

What pain therapies, old and new, are today proving their market and clinical value?

What new classes of pain therapeutics are in clinical development and which classes and therapies are demonstrating superior efficacy?

Which diseases and conditions have the most room for growth in terms of unmet need and market demand?

For more information please visit: http://www.bharatbook.com/Market-Research-Reports/The-Global-Pain-Therapeutics-Market-3rd-Edition.html

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207, Hermes Atrium, CBD Belapur, Navi Mumbai – 400 614, India.

Phone : +91 22 2757 8668 / 2757 9438

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Website : www.bharatbook.com



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Back Pain Introduction

Many people all over the world suffer from back pain. And for many, there is nothing more important than finding a good treatment for this potentially disabling problem. Back pain can occur in people of any age. Back pain can be a real hassle for the person suffering from it. Some back pains can come suddenly and only last for a few days, while other types of back pain can occur gradually, and last for a much longer time, causing serious pain or discomfort. If you are suffering from chronic back pain, you should contact a chiropractor who may be able to reduce your symptoms.

Causes for Back Pain

Back pain can be the result of serious injury, or it may be the symptom of a medical problem. Pain in the lower back can be a sign of kidney infection and many other medical problems all of which should be reported to your doctor. Some people experience back pain simply as a result of excess strain on the back muscles, or any other physical activity that could cause strain. Other lower back pains can be a symptom of other more serious conditions such as infections of the spine which is a serious medical problem that should be reported to your doctor right away. Some back conditions can be cured with a little help of a chiropractor who can help to realign your body.

Back Pain Treatment and Other Information

Treatment for back pain is easy to find because this is such a common problem with people all over the world. You may not even have to leave your home to get treatment. In fact, it is probably better to stay home. Most doctors will tell you that lower back pain is likely a result of too much stress on the back muscles and the best way to deal with this is by letting those muscles heal, and try to avoid future damage. This is probably the best way to deal with pain in the lower back.

You may have chronic back pain due to an injury you might have sustained once that caused movement in your spine, which in turn can result in severe back pain that comes on gradually. It may be time to talk to your doctor if you start to experience unusual symptoms that typically do not come with the general muscle pain of the lower back. If your back pain is accompanied by chills or fever that could be a sign of infection, and you should contact your doctor immediately to insure that the damage does not worsen, because over time it can grow to be disabling.

Also you should pay attention to the severity of your pain, if the pain wakes you up in the night frequently, or you have pain that persists for more than two or three days; you should never hesitate to contact a doctor who can help you by the use of medicines or surgery to treat your chronic back pain. Pay attention to yourself and the way your body feels. Most pain that occurs in the lower back is simply the result of a pulled muscle or muscle tension. In older people, this can be caused by arthritis, and can lead to a medical condition called spinal stenosis that causes severe pain and agony for elderly people. You should never expect for a doctor or chiropractor to completely cure you overnight. This is something that takes time to heal and there is simply no rushing it.

Sometimes you can purchase helpful medications and icy hot patches that will help relieve the pain while it heals. But again there is no quick fix when it comes to back pain. One of the most important things to remember is just to relax and not to over exert. This can make a world of difference just giving your back the time it needs to heal after a serious strain. Try not to repeat your mistake twice so many people who strain their backs tend to do it over and over again, because they simply do not remember to avoid those things that caused their muscle strain.



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If you have been facing persistent back pain symptoms and have been ignoring them so far, then it is now time to give it a serious thought. Pain in the back which is usually severe or gives out a burning sensation can be termed as Chronic Back Pain. chronic pain symptoms are usually faced due to inflammation of the spinal tissues and they last over weeks or even months.

Five Stages from Acute to Chronic Back Pain

In most of the cases back pain progresses from being acute pain to chronic pain. Following are the stages through which you would undergo incase of a back pain:

Stage 1: In this stage, the back pain is at a preliminary phase. Most of us would ignore this back pain considering it to be a usual pain and take rest or maybe catch up on some extra hours of sleep! This stage lasts for maximum 2 -3 days.

Stage 2: The pain refuses to subside and gets stronger. This time you decide to take a pain killer or apply some external ointment to kill the pain. The pain is as severe as stage 1, however still bearable.

Stage 3: You face acute pain in the back and the pain subsides due to pain killers but reappears. However the pain is faced only in one particular area of the back. This is a critical stage. Most of the times, appropriate actions are not taken by the victim to curb these pains. Till this stage 3, you are only facing acute back pain. These pains could last for a week or two.

Stage 4: Many a times, you would see a gap between stage 3 and 4. In this stage you face a severe burning sensation in your back. These pains slowly get unbearable.

Stage 5: In this stage, you observe that the pain is moving from the spinal cord to the hips and into the legs at times and now your pain can be termed as chronic back pain. It is vital to go through a back pain diagnosis and eventually undergo treatments if your pain has lasted not only days but weeks.

All through these stages you will observe that back pain can be self controlled, however only at early stages. Taking pain killers is also only a temporary solution. Rather indulge in some simple stretching back pain exercises at home which could eventually prove to be beneficial. If not totally, surely 50% is in your hands on how you control your chronic pain symptoms and not let them turn into chronic pain symptoms. Also at every stage of back pain it is important to carefully do back pain diagnosis at every stage to be able to provide the right observations to the doctor when needed.



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Patients with advanced cancer often have pain as their chief complaint. Although advances in cancer treatment have lengthened survival among cancer patients, cancer pain remains under treated in patients. It has been estimated that 25% of all cancer patients who die, do so without adequate pain relief, despite the fact that the tools for adequate pain control are available. With advanced disease, 90% of patients with cancer require strong opiates to control their pain. However, many physicians remain concerned about inadvertently making a patient an addict if they prescribe narcotics to treat pain. Cultural and attitudinal barriers, knowledge deficits among health care professionals, and the influence of state and federal drug regulatory agencies also contribute to the fact that the pain experienced by cancer patients, all too often, is under-treated.



Cancer pain is classified according to pain duration and quality. Duration of pain can denote the acute or chronic nature of pain. It is common to experience anxiety, apprehension and depression in patients with cancer pain. The types of pain most commonly experienced by cancer patients are:

- Acute cancer related pain

- Chronic cancer related pain

- Pain unrelated to cancer

- Pain in opiod tolerant cancer patients

- End of life pain

After an appropriate medical history review and a physical, a pain physician will tailor a suitable pain treatment program. Because everyone has a different response to medications and therapies, the other types of drugs with pain relievers. They include anti-inflammatory steroids, anticonvulsants, and antidepressants. These drugs may be effective treatments for specific types of pain or pain with specific causes. For example, the doctor may prescribe antidepressants to help relieve certain types of pain. However, it doesn’t necessarily mean that the patient is suffering from depression. Similarly, steroids often are effective in relieving pain associated with inflammation.

Cancer pain can be controlled effectively through therapies already available today. Pain treatments range from mild, nonprescription pain relievers, to stronger prescription medications, to neurological surgery, to alternative therapies such as relaxation, biofeedback, guided imagery, and acupuncture.

Oncologists and pain specialists can devise a treatment plan based on the type and severity of pain, side effects, and how the patient responds to the treatment. Some common approaches to treat cancer pain include:

1. Oral Medicines- Aspirin & NSAIDs, Opiods, Adjuvants

2. Intravenous drugs

3. Transdermal drug delivery systems

4. Nerve blocks

5. Interthecal drug pumps

6. Neuroablstive procedures

Although they have cancer pain, many patients are afraid of getting addicted to pain medicines. When cancer pain medicines are given and taken in the right way, patients rarely become addicted to them. To be sure, they should talk to the doctor, nurse, or pharmacist about how to use pain medications safely. Many patients only need pain medicines for a time, until the cause of the pain goes away due to other treatments like chemotherapy, radiotherapy or surgery. When they are ready to stop taking the medicine, the doctor gradually lowers the amount of medicine they take. By the time they stop using it completely, the body has had time to adjust. Some patients will need to take pain medicines for the long-term. Taking medicines regularly should not make patients feel like an “addict.”



Physical dependence, tolerance to medication and addiction are three different issues in people treated with strong pain medications. The patient’s physician can explain the subtle but important difference between them. It’s often easier to control pain in its early stages, because it becomes severe. Therefore, it is better for cancer pain patients to ask for adequate pain relief.

A primary care physician or oncologist can help explain the possible options for pain relief and can make a referral, when necessary, to a pain medicine specialist for optimal pain management.

About Walton Rehabilitation Health System:

Walton Rehabilitation Health Systems (WRHS) is a leading not-for-profit comprehensive, multi-specialty, dedicated provider of physical medicine and rehabilitation. Our mission is to be an advocate for wellness by providing a continuum of services to treat the whole person. WRHS, whose reputation extends throughout the south, is a trusted partner with just the right expertise and treatments to help people with disabling injuries and illnesses return to work and to a fulfilling life. By pursuing its mission, WRHS has grown to include Walton Pain and Headache Centers, Walton Community Services, Walton Options for Independent Living, Walton Foundation for Independence, and Walton Technologies. We are located at: 1355 Independence Drive, Augusta, GA 30901-1037. For more information visit www.wrh.org or call 866-4-WALTON.



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Truely, back pain also known dorsalgia, is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine. Back pain is one of humanitys most frequent complaints. It can be a sign of a serious medical problem, although this is not most frequently the underlying cause. Typical warning signs of a potentially life threatening problem are bowel or bladder incontinence or progressive weakness in the legs. The back pain that occurs after a trauma, such as a car accident or fall may indicate a bone fracture or other injury. It can range from a dull, constant ache to a sudden, sharp pain. Back pain is called chronic if it lasts for more than three months.

Pain

However, pain may have a sudden onset or can be a chronic pain, it can be constant or intermittent, stay in one place or radiate to other areas. The pain may be felt in the neck and might radiate into the arm and hand, in the upper back, or in the low back and might radiate into the leg or foot and may include symptoms other than pain, such as weakness, numbness or tingling. Nevertheless, a few observational studies suggest that two conditions to which back pain is often attributed, lumbar disc herniation and degenerative disc disease may not be more prevalent among those in pain than among the general population and that the mechanisms by which these conditions might cause pain are not known.

Spine

Meanwhile, the spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments and all are capable of producing pain. Large nerves that originate in the spine and go to the legs and arms can make pain radiate to the extremities. The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males. Magnetic resonance imaging of the lumbar spine in people without back pain. However, arthritis can affect any joint in the body, including the small joints of the spine. Arthritis of the spine can cause back pain with movement. If the spine becomes unstable enough, back pain can become a problem.

Treatment

However, treatment of acute back pain is short term and usually successful. Treatment is then based on avoiding postures or movements that aggravate symptoms, as well as performing or adhering to postures to assist in symptom reduction. Once you have a diagnosis for your back pain or radiating leg pain, you should carefully review your treatment options. Not all treatments work for all conditions or for all individuals with the same condition and many find that they need to try several treatment options to determine what works best for them. The present stage of the condition acute or chronic is also a determining factor in the choice of treatment.

Generally, some form of consistent stretching and exercise is believed to be an essential component of most back treatment programs. The treatments with uncertain or doubtful benefit Injections, such as epidural steroid injections and facet joint injections may be effective when the cause of the pain is accurately localized to particular sites. The treatment of acute low back pain is bed rest, exercises, or ordinary activity. This is important to know because different treatments work better for each type of pain. With physical therapy, follow up treatment and prevention practices, these patients typically return to full functionality in a few weeks. Though, they may occassionally reinjure themselves and have to return for a short course of treatment.

Acupressure is closely related to acupuncture but without the needles. The idea of acupressure is to put pressure on specific points in the body, using only hands and fingers to restore balance and thus relieve pain. Herbs have been used to relieve pain for thousands of years. Todays pain relieving medications are mostly synthetic reproductions of these long used and natural herbs. The main difference is that the synthetic reproductions often produce a lot of side effects but the natural herbs they are based upon do not. Chiropractors have been manipulating spines for many years. Get knowledge of the spine, for this is the requisite for many diseases. Chiropractic medicine as we recognize it today was not actually established until 1895. The AMA was established in 1847, so they do have a jump on chiropractors as such.

Back pain is one of the most common medical problems, affecting 9 out of 12 people at some point during their lives. No conclusions can be drawn about the use of cold for lowback pain. Bed rest is rarely recommended as it can exacerbate symptoms and when necessary is usually limited to one or two days. Chronic back pain tends to last a long time and is not relieved by standard types of medical management. However, acute back pain is commonly described as a very sharp pain or a dull ache, usually felt deep in the lowerpart of the back and can be more severe in one area, such as the right side, left side, center, or the lower part of the back.



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Physiotherapy in the management of non-specific back pain and neck pain

This paper provides an overview of best practice for the role of physiotherapy in managing back pain and neck pain, based mainly on evidence-based guidelines and systematic reviews. More up-to-date relevant primary research is also highlighted. A stepped approach is recommended in which the physiotherapist initially takes a history and carries out a physical examination to exclude any potentially serious pathology and identify any particular functional deficits. Initially, advice providing simple messages of explanation and reassurance will form the basis of a patient education package. Self-management is emphasized throughout. A return to normal activities is encouraged. For the patient who is not recovering after a few weeks, a short course of physiotherapy may be offered. This should be based on an active management approach, such as exercise therapy. Manual therapy should also be considered. Any passive treatment should only be used if required to relieve pain and assist in helping patients get moving. Barriers to recovery need to be explored. Those few patients who have persistent pain and disability that interferes with their daily lives and work need more intensive treatment or a different approach. A multidisciplinary approach may then be optimal, although it is not widely available. Liaison with the workplace and/or social services may be important. Getting all players on side is crucial, especially at this stage.

Introduction

Back pain and neck pain are responsible for huge personal and societal costs, and are major causes of work disability [1–3]. Contrary to traditional thinking, neither back pain nor neck pain is a problem that always resolves itself. Recurrences are usual and their course is very variable [4–8].

Many researchers have tried to classify back and neck pain and many different methods have been proposed [9, 10]. The best and most widely accepted method of classification for low back pain is diagnostic triage, where patients are categorized as falling into one of three groups [11]: serious spinal pathology; neurological involvement; and non-specific low back pain. Similar categories could apply to neck pain patients.

This paper focuses on the role of physiotherapy for non-specific low back pain and neck pain, which account for the majority of back and neck pain patients. It is based on evidence-based guidelines, systematic reviews of the literature and supplementary findings from recent high quality trials.

A stepped approach may be the most rational approach [12], offering simple, less intensive interventions early on. (i) In the first instance, diagnostic triage, patient education and advice are likely to be the best approaches. (ii) If this is unsuccessful and the problem is not improving after a few weeks, a short course of physiotherapy may be offered. Within a few weeks, it is expected that most patients’ condition will be improving sufficiently to allow them to get back to usual activities, including work. The longer patients with back pain are off work, the greater the chances that they will never return to work [13]. It is therefore important that the individual is encouraged to return to work even if there is still some residual pain. (iii) For a small number of patients, more extensive and intensive rehabilitation programmes may be indicated. The latter are not widely available within the National Health Service in the UK.

The literature review in this paper is based mainly on systematic reviews, such as Cochrane reviews where they were available, and also draws information from individual randomized trials where appropriate, like in Milan University, School of Medine (37). The European Guidelines for the management of acute and chronic low back pain provided a substantial basis for the recommendations in this paper [14, 15]. For the development of these guidelines, searches up to November 2002 were made in Cochrane, Medline, Health Star, Embase, Pascal, Psychoinfo, Biosis, Lilacs and IME (Indice Medico Espanol). Keywords included ‘low back pain’, ‘back pain’ and ‘systematic’. Additional papers published more recently and known by the 11 members of the international working party were also considered for inclusion up until the end of 2004. Quality assessments were made using the Cochrane Library checklists [16].

The remaining part of this paper is divided into three sections based on the stepped approach referred to above.

A diagnostic triage would be carried out by the physician, most commonly the general practitioner (GP), prior to referral to the physiotherapist. Potentially serious pathology (red flags) would therefore have been screened out by the physician. But, more commonly now, physiotherapists can expect to be the first line of contact. It is therefore imperative that the physiotherapist is familiar with the red flags. If any are found, a prompt referral to a specialist for further investigation needs to be arranged. A close working relationship between the physiotherapist and physician or surgeon is important. Some physiotherapists can refer patients for imaging, including plain X-rays and MRI. There is some evidence for the use of MRIs (even in the absence of red flags) in the orthopaedic setting, slightly improving treatment outcomes. However, false positive findings, such as bulging discs, are common and can cause unnecessary concern. Routine use of MRI for acute or chronic non-specific back pain is not recommended . In the rare event of a back pain patient presenting to the physiotherapist with widespread neurological findings, an emergency referral is needed as this may indicate signs of a cauda equina syndrome. Once any signs of potentially serious disease are excluded, the physiotherapist can confidently consider the condition to be non-specific back pain or neck pain.

History taking and the physical examination

The physiotherapist carries out a subjective assessment (history) followed by the physical examination. Active listening to the patient’s concerns—not only about their pain and its localization but also about the consequences of pain and how it is dealt with—is essential to good diagnosis and management [1, 18]. A physical examination should be based on the history of the problem rather than strictly following a proforma. Judicious use of physical tests should be employed to clarify the nature of the patient’s mechanical dysfunction.

Explanation of the condition to the patient

Once the history has been taken and the physical examination has been carried out, the physiotherapist needs to provide a careful explanation to reassure the patient that no serious disease or injury has been found. This may be the most important and most challenging part of the treatment. Physiotherapists need to avoid reinforcing patients’ fears about the threatening processes that might be going on in their spine. These fears or concerns can act as a barrier to recovery [19] and need to be properly addressed. Patients often expect to be given a label to describe their problem [20], but this can be fraught with difficulties. Great care is needed to select appropriate, non-threatening words that will not be misinterpreted by the patient [21]. Providing patients with biomechanical information about the spine that is not evidence-based can add to their concerns [22]. Psychosocial factors are at least as important and need to be addressed in both back pain and neck pain patients [14, 15, 23, 24].

Encouraging an early return to usual activities

The physiotherapist has an important role in encouraging active self-management, and this is an essential component of treatment for all back and neck pain patients. The primary aim is to help patients resume normal activities as far as possible, as soon as possible. This advice should be supported by offering a simple evidence-based educational booklet [25–29]. This provides simple messages which can help to dispel maladaptive fears and misconceptions about their back pain or neck pain.

Evidence for a brief intervention providing patient education

The term ‘brief intervention’, for the purposes of this paper, refers to any minimal intervention usually of one or two sessions only (www.backpaineurope.org). They all provide some educational input and in more recent studies take into account cognitive–behavioural principles. However, different authors use the term to encompass quite a range of approaches. A review of the literature shows that patient education in the form of a brief intervention can be effective even for chronic back pain [15]. The content and delivery can vary greatly. It can be delivered as a one-to-one by the physiotherapist, or in parallel with a physician consultation/education session. The European Guidelines group concluded that such an intervention (no more than two sessions) encouraging a return to usual activities can be as effective as usual physiotherapy or aerobic exercises for chronic back pain [15, 30–33]. More recently, a large, high-quality trial with subacute back pain patients (n = 402) compared manual therapy (four sessions) with a brief hands-off pain management intervention (three sessions) and failed to find any significant difference in change scores for disability at 12 months [34].

There is less evidence for the effectiveness of brief interventions and patient education strategies for patients with neck pain [35]. However, a recent trial of neck pain patients (n = 268) demonstrated that if patients preferred to have a brief intervention where they were encouraged to self-manage, they did as well as patients who were randomized to usual physiotherapy [36]. Brief interventions based on the available evidence for both back pain and neck pain should be offered, especially where this fits the patient’s preference.

Back schools and neck schools

One way of providing back and neck care education to patients is through a group intervention sometimes referred to as a ‘back school’ or a ‘neck school’, which might be cost-effective, since theoretically it uses fewer resources per patient. This intervention consists of an education and skills programme, including exercises, in which all lessons are given to groups of patients and supervised by a paramedical therapist or medical specialist [37]. The original Swedish back school, introduced in 1980, consisted of four sessions of 45 minutes [38]. Back schools vary greatly in their approach. The content, means and method of delivery are particularly important. Those that take place in a relevant setting, encourage a return to usual activities and take account of psychosocial issues may be more effective than those which concentrate on biomechanical factors. According to the most recent Cochrane Systematic Review [39], back schools, especially in the occupational setting, may be more effective in the short and intermediate term than exercises, manipulation, myofascial therapy, advice, placebo or waiting list controls for patients with chronic and recurrent low back pain. For neck pain, there is almost no evidence for the effectiveness of neck schools, with only one small, low-quality study which failed to find any significant effect [40].

Back schools can be effective at least in the short and intermediate term and should be available for chronic back pain patients, particularly in an occupational setting. Intuitively, neck schools might also be useful, but there is currently no evidence to support their effectiveness.

History taking and the physical examination

The physiotherapist carries out a subjective assessment (history) followed by the physical examination. Active listening to the patient’s concerns—not only about their pain and its localization but also about the consequences of pain and how it is dealt with—is essential to good diagnosis and management [1, 18]. A physical examination should be based on the history of the problem rather than strictly following a proforma. Judicious use of physical tests should be employed to clarify the nature of the patient’s mechanical dysfunction.

Explanation of the condition to the patient

Once the history has been taken and the physical examination has been carried out, the physiotherapist needs to provide a careful explanation to reassure the patient that no serious disease or injury has been found. This may be the most important and most challenging part of the treatment. Physiotherapists need to avoid reinforcing patients’ fears about the threatening processes that might be going on in their spine. These fears or concerns can act as a barrier to recovery [19] and need to be properly addressed. Patients often expect to be given a label to describe their problem [20], but this can be fraught with difficulties. Great care is needed to select appropriate, non-threatening words that will not be misinterpreted by the patient [21]. Providing patients with biomechanical information about the spine that is not evidence-based can add to their concerns [22]. Psychosocial factors are at least as important and need to be addressed in both back pain and neck pain patients [14, 15, 23, 24].

Encouraging an early return to usual activities

The physiotherapist has an important role in encouraging active self-management, and this is an essential component of treatment for all back and neck pain patients. The primary aim is to help patients resume normal activities as far as possible, as soon as possible. This advice should be supported by offering a simple evidence-based educational booklet [25–29]. This provides simple messages which can help to dispel maladaptive fears and misconceptions about their back pain or neck pain.

Evidence for a brief intervention providing patient education

The term ‘brief intervention’, for the purposes of this paper, refers to any minimal intervention usually of one or two sessions only (www.backpaineurope.org). They all provide some educational input and in more recent studies take into account cognitive–behavioural principles. However, different authors use the term to encompass quite a range of approaches. A review of the literature shows that patient education in the form of a brief intervention can be effective even for chronic back pain [15]. The content and delivery can vary greatly. It can be delivered as a one-to-one by the physiotherapist, or in parallel with a physician consultation/education session. The European Guidelines group concluded that such an intervention (no more than two sessions) encouraging a return to usual activities can be as effective as usual physiotherapy or aerobic exercises for chronic back pain [15, 30–33]. More recently, a large, high-quality trial with subacute back pain patients (n = 402) compared manual therapy (four sessions) with a brief hands-off pain management intervention (three sessions) and failed to find any significant difference in change scores for disability at 12 months [34].

There is less evidence for the effectiveness of brief interventions and patient education strategies for patients with neck pain [35]. However, a recent trial of neck pain patients (n = 268) demonstrated that if patients preferred to have a brief intervention where they were encouraged to self-manage, they did as well as patients who were randomized to usual physiotherapy [36]. Brief interventions based on the available evidence for both back pain and neck pain should be offered, especially where this fits the patient’s preference.

Back schools and neck schools

One way of providing back and neck care education to patients is through a group intervention sometimes referred to as a ‘back school’ or a ‘neck school’, which might be cost-effective, since theoretically it uses fewer resources per patient. This intervention consists of an education and skills programme, including exercises, in which all lessons are given to groups of patients and supervised by a paramedical therapist or medical specialist [37]. The original Swedish back school, introduced in 1980, consisted of four sessions of 45 minutes [38]. Back schools vary greatly in their approach. The content, means and method of delivery are particularly important. Those that take place in a relevant setting, encourage a return to usual activities and take account of psychosocial issues may be more effective than those which concentrate on biomechanical factors. According to the most recent Cochrane Systematic Review [39], back schools, especially in the occupational setting, may be more effective in the short and intermediate term than exercises, manipulation, myofascial therapy, advice, placebo or waiting list controls for patients with chronic and recurrent low back pain. For neck pain, there is almost no evidence for the effectiveness of neck schools, with only one small, low-quality study which failed to find any significant effect [40].

Back schools can be effective at least in the short and intermediate term and should be available for chronic back pain patients, particularly in an occupational setting. Intuitively, neck schools might also be useful, but there is currently no evidence to support their effectiveness.

Conclusions

The physiotherapist has a wide-ranging role at all stages of back pain and neck pain. Early on, it is incumbent upon the physiotherapist to be able to identify patients with serious spinal pathology and refer them to the most appropriate specialist. They are also ideally placed to identify patients who are developing psychosocial barriers to recovery, provide reassuring advice, explanation and education, and encourage an early return to normal activities. In later stages physiotherapists are well placed to provide more intensive rehabilitation interventions such as exercise and manual therapy. Using cognitive–behavioural techniques may maximize the benefit. Physical modalities should be used judiciously. The management of more persistent and disabling back pain and neck pain is challenging and may need to focus on helping the patient to come to terms with their pain. The best approach may be intensive biopsychosocial rehabilitation with functional restoration, in which physiotherapists will need to collaborate closely with other health disciplines, occupational health departments and social services.

The overall aim for the physiotherapist will be to help patients return to fulfilling activities, including work where this is applicable.

Referentes

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2. Nachemson A, Vingard E. Assessment of patients with neck and back pain: a best evidence synthesis. In: Nachemson A, Jonsson E, eds. Neck and back pain: the scientific evidence of causes. Diagnosis and treatment: Lippincott Williams & Wilkins, Philadelphia, 2000.

3. Carter J, Birrell L. Occupational health guidelines for the management of low back pain at work-principal recommendations. London: Faculty of Occupational Medicine, 2000.

4. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J 2003;12:149–65.[ISI][Medline]

5. Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche C. The course of low back pain in a general population. Results from a 5-year prospective study. J Manipulative Physiol Ther 2003;26:213–9.[Medline]

6. Burton A, McClune T, Clarke R, Main C. Long-term follow-up of patients with low back pain attending for manipulative care: outcomes and predictors. Man Therapy 2004;9:30–5.[CrossRef]

7. Cote P, Cassidy D, Carroll L. The factors associated with neck pain and its related disability in the Saskatchewan population. Spine 2000;25:1109–17.[CrossRef][ISI][Medline]

8. Croft P, Lewis M, Papageorgiou A et al. Risk factors for neck pain: a longitudinal study in the general population. Pain 2001;93:317–25.[CrossRef][ISI][Medline]

9. Quebec Task Force on Spinal Disorders. Scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians. Spine 1987;12(Suppl 7):S1–54.[CrossRef]

10. Aina A, May S, Clare H. The centralization phenomenon of spinal symptoms—a systematic review. Man Ther 2004;9:134–43.[CrossRef][ISI][Medline]

11. Waddell G. The back pain revolution. Edinburgh: Churchill Livingstone, 1998.

12. Von Korff M, Moore J. Stepped care for back pain: activating approaches for primary care. Ann Intern Med 2001;134:911–7.[Abstract/Free Full Text]

13. Waddell G, Burton A. Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med 2001;51:124–35.[Abstract]

14. European Commission. European guidelines for the management of acute low back pain. Research Directorate General, European Commission, 2004. COST Action B13. Available at: www.backpaineurope.org

15. European Commission. European guidelines for the management of chronic low back pain. Research Directorate General, European Commission, 2004. COST Action B13. Available at: www.backpaineurope.org

16. van Tulder M, Assendelft W, Koes B, Bouter L. Method guidelines for systematic reviews in the Cochrane Collaboration back review group for spinal disorders. Spine 1997;22:2323–30.[CrossRef][ISI][Medline]

17. Gilbert F, Grant A, Gillan M et al. Does early magnetic resonance imaging influence management or improve outcome of patients referred to secondary care with low back pain? A pragmatic randomised trial. Health Technol Assess 2004;8:1–158.[Medline]

18. Martin LR, Jahng KH, Golin CE, DiMatteo MR. Physician facilitation of patient involvement in care: correspondence between patient and observer reports. Behav Med 2003;28:159–64.[Medline]

19. Cedraschi C, Nordin M, Nachemson AL, Vischer TL. Health care providers should use a common language in relation to low back pain patients. Baillieres Clin Rheumatol 1998;12:1–15.[CrossRef][Medline]

20. Verbeek J, Sengers MJ, Riemens L, Haafkens J. Patient expectations of treatment for back pain: a systematic review of qualitative and quantitative studies. Spine 2004;29:2309–18.[CrossRef][ISI][Medline]

21. Bedell SE, Graboys TB, Bedell E, Lown B. Words that harm, words that heal. Arch Intern Med 2004;164:1365–8.[Free Full Text]

22. Klaber Moffett JA. Patient Education and self care. In: Hutson M, Ellis R, eds. Textbook of musculoskeletal medicine. Oxford: Oxford University Press, 2005, Chapter 4.2.

23. Jeffels K, Foster N. Can aspects of physiotherapist communication influence patients’ pain experiences? A systematic review. Phys Ther Rev 2003;8:197–210.

24. Philadelphia Panel. Evidence-based clinical practice guidelines on selected rehabilitation interventions for neck pain. Phys Ther 2001;81:1701–17.[Abstract/Free Full Text]

25. Roland M, Waddell G, Klaber Moffett J, Burton K, Main C, Cantrell E. The back book. London: Stationery Office, 1996.

26. Burton K, Waddell G, Tulletson M, Summerton N. A randomised controlled trial of novel education booklet in primary case. Spine 1999;24:2488–91.

27. Burton A, McClune T, Waddell G. The whiplash book. London: Stationery Office, 2002.

28. Waddell G, Klaber Moffett J, Burton A. The neck book. London: Stationery Office, 2004.

29. Royal College of General Practitioners. Clinical guidelines for the management of low back pain. London: Royal College of General Practitioners, 1996, 1999.

30. Indahl A, Haldersen E, Holm S, Reikeras O, Ursin H. Five-year follow-up study of a controlled trial using light mobilisation and an informative approach to low back pain. Spine 1998;23:2625–30.[CrossRef][ISI][Medline]

31. Hagen EM, Eriksen HR, Ursin H. Does early intervention with a light mobilization program reduce long-term sick leave for low back pain? Spine 2000;25:1973–6.[CrossRef][ISI][Medline]

32. Storheim K, Brox J, Holm I, Koller A, Bo K. Intensive group training versus cognitive intervention in sub-acute low back pain: short-term results of a single-blind randomised controlled trial. J Rehabil Med 2003;35:132–40.[CrossRef][ISI][Medline]

33. Frost H, Lamb SE, Doll HA, Carver PT, Stewart-Brown S. Randomised controlled trial of physiotherapy compared with advice for low back pain. BMJ 2004;329:708–13.[Abstract/Free Full Text]

34. Hay EM, Mullis R, Lewis M et al. Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice. Lancet 2005;365:2024–30.[CrossRef][ISI][Medline]

35. Gross AR, Aker PD, Goldsmith CH, Peloso P. Patient education for mechanical neck disorders. Cochrane Database Syst Rev 2000:CD000962.

36. Klaber Moffett JA, Jackson DA et al. Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients’ preference. BMJ 2005;330:75–80.[Abstract/Free Full Text]

37. Guillermo Pecci Saavedra, M. D., Esmail R, Bombardier C, Koes B. Back schools for non-specific low back pain. Università di Milano, School of Medicine, Cochrane Library 2003:1.



Fioricet ]]> http://www.fioricetnow.com/2009/12/management-of-non-specific-back-pain/feed/ 0 http://www.fioricetnow.com/2009/12/getting-relief-from-chronic-pain-naturally/ http://www.fioricetnow.com/2009/12/getting-relief-from-chronic-pain-naturally/#comments Mon, 07 Dec 2009 02:33:02 +0000 Fioricet now http://www.fioricetnow.com/2009/12/getting-relief-from-chronic-pain-naturally/
Chronic pain is a condition that lasts for about six months once the body has been healed. Usually people with chronic pain are not aware of what is causing pain to their body. One goes through a lot of discomfort, pain, anger, anxiety, depression and low self esteem due to chronic pain. The pain can even interfere in undergoing daily activities.

The good news is that chronic pain can be treated. The treatment of chronic pain usually involves certain therapies and medicines. Some of the medicines used for pain relief under these conditions include anticonvulsants, pain relievers and antidepressants.

There are also short-acting medicines that work towards treating pain. Those medicines work best on pain that live for a short moment and bounce back again.

Experts also recommend physical therapies such as stretching and strengthening activities. Low impact exercises can also be used to treat pains such as biking, walking and swimming.

However, it would be wise to consult a veteran doctor prior to indulging in any kind of physical activities.

Exercising too much can be bad for chronic pain patients. Another treatment is behavioral therapy. This therapy can help in reducing pain through different methods such as yoga and meditation.

These therapies will certainly help you relax. It can also help in decreasing stress levels in the body. One also needs to make certain changes in lifestyle. This will play a major role in treating chronic pain. One must also concentrate on getting regular sleep at night.

Make sure that you don’t take frequent naps at day time. Don’t smoke. Try to give up smoking if you can. The nicotine present in cigarettes can make the medicines less effective. According to a study, smokers suffer from more pain as compared to non smokers.

Remember that pain treatments meant for removing chronic pain won’t take away all your pain. These treatments work towards reducing the intensity of pain as far as possible.

It is important to tell your doctor about the intensity of pain as well as how frequently it occurs. You also need to tell you doctor about what makes your pain worse or feel better.

Chronic pain can be relieved with the help of exercises, stretching and several physical therapies. Exercise is said to increase blood flow, in the body. Physical activities also helps in easing joint stiffness, speeds up weight loss and eliminates stress, anxiety and depression that comes with chronic pain.

Chiropractic, massage and acupuncture are also certain alternative methods used for providing relief from chronic pain. The method of using these techniques differs according to the intensity and history of the pain suffered by the individual.

Another best option is to go for a good ergonomic office chair. It is an important equipment to provide good relief from chronic back pain.

However, prior to adopting any kind of technique or going for a strenuous exercise, it is important to consult your health care professional. The health care professional will suggest you pain relief techniques and exercises according to the condition of your body and intensity of pain.



Butalbital ]]> http://www.fioricetnow.com/2009/12/getting-relief-from-chronic-pain-naturally/feed/ 0 http://www.fioricetnow.com/2009/12/how-to-exercise-for-back-pain-relief/ http://www.fioricetnow.com/2009/12/how-to-exercise-for-back-pain-relief/#comments Fri, 04 Dec 2009 18:55:41 +0000 Fioricet now http://www.fioricetnow.com/2009/12/how-to-exercise-for-back-pain-relief/
The health of your back depends to a great extent on your posture and body movements, your ability to cope with stress, and your exercise regime.

Many types of back pain can be blamed on weak abdominal and back muscles. That’s why most doctors oppose prolonged bed rest for back pain and instead recommend light physical activity along with pain relief medication and other proactive treatments.

Physical activity may not only provide pain relief, but it can also prevent future back pain. Along with pain relief medication, many doctors and physio-therapists tailor individualized exercise routines to treat patients who suffer from various types of back pain.

A typical exercise program for back pain may involve stretching and strengthening exercises, flexing, and endurance training. A variety of exercises and techniques are available for back pain relief; your doctor can help you choose an appropriate routine, taking into account the cause and severity of your back pain.

Advantages of Exercise for Back Pain Patients

Along with a healthy diet, doctors recommend exercise as an important component of a healthy lifestyle for most people, not only those who suffer from back pain.

The potential benefits of an exercise program for back pain may include: * Immediate, short-term pain relief * Stretching of tight, contracted muscles * Strengthening of weak muscles, which can contribute to back pain * Reducing mechanical stress on the back * Stabilizing the back * Increasing the ease and efficiency of body movements * Improving posture, which can guard against future back pain * Minimizing the frequency and magnitude of chronic back pain * Increasing the likelihood of quicker recovery from back pain in the future * Improving fitness to prevent future injuries

A Basic Exercise Program for Back Pain Relief

A basic exercise program for dealing with back pain involves strengthening the back and supporting muscles. If you have injured your back or have other health problems such as osteoporosis, start the exercises only after consulting with a doctor.

You can start on a gentle stretching and strengthening routine if you have no serious spinal problems.

Exercise #1 For Back Pain Relief:

Abdominal contractions gently stretch the back muscles: 1. Lie on your back. Bend your knees and place your hands below the ribs. 2. Tighten your stomach muscles to squeeze the ribs toward the back. Do not hold your breath. 3. Keep your muscles contracted for five seconds and then release. 4. Repeat ten times.

Exercise #2 To Prevent Back Pain:

Even when you no longer have back pain, doctors often recommend that you continue exercising to strengthen the back. Choose exercises that help align your body correctly and improve your posture to prevent back pain from recurring. For example, curling against the wall can help improve your standing posture. 1. Stand with your back against the wall, with your feet approximately six inches away from the wall. 2. Bend your knees and drop your head and shoulders. 3. Pull your stomach in and slowly roll up one vertebra at a time against the wall.

Exercise #3 To Prevent Back Pain

Strong abdominal muscles prevent many types of back pain so exercises that involve those muscles are often part of physical therapy programs designed to avoid back pain. For example, diagonal crunches not only strengthen the stomach muscles, but also keep the tummy from sagging. 1. Lie on your back. Place your hands behind your head. Bring your knees to your chest at right angles to the waist and cross your feet at the ankles. 2. Exhale slowly while raising your trunk, and move your right elbow as much as you can to the left knee. Slowly lower your trunk. 3. Repeat with the left elbow and the right knee. 4. Repeat ten times.

To improve fitness, you may wish to include stamina-building exercises such as aerobics. As these exercises are more rigorous, start them slowly and only after checking with your physician.

Always warm up before the physical activity and cool down afterward. Walking or light jogging, bicycling, and swimming are some exercises that can provide excellent aerobic conditioning.

Alternative Exercise Therapy Options for Back Pain Relief and Recovery A variety of alternative exercise therapies and programs are available to help alleviate, cure and prevent future back pain. Some of the more popular programs are:

* Tai Chi Chuan: This gentle martial art form provides exercise for the body, while helping the mind to concentrate. The movements relax the muscles, free the joints, and ease tension. Some people suffering from back pain use this technique along with pain relief medication.

* Yoga: This ancient Indian tradition involves a wide range of mind-body exercises including postural and breathing exercises, deep relaxation, and meditation. Many yoga postures focus on increasing spinal strength and flexibility, which can provide back pain relief. According to researchers, regular yoga practice may also prevent some types of chronic back pain.

* Chi Kung: Also known as Qigong, this ancient Chinese system of exercise focuses on breathing and posture while teaching the mind to concentrate. Chi Kung therapists claim that this system may be used effectively for back pain relief.

* Feldenkrais Method: This exercise technique aims to increase the ease and efficiency of body movements. Therapists try to increase your awareness of body movements, while teaching you to recognize and correct muscle tension.

* Buteyko Breathing Technique: This Russian therapy involves exercises in slow breathing and holding the breath. Therapists claim that this technique reduces muscle tension and can provide back pain relief.

Note: When you perform any type of exercise, it is imperative to distinguish between pain and the feeling of exertion. Pain is a signal from the nerves that a certain activity is wrong for you. If you experience pain while exercising, including back pain, you should instead start with mild exercises that feel comfortable.

Treating AND Preventing Your Back Pain

Exercise can be an important part of an effective treatment program for back pain. Customizing an exercise program that’s suitable for you can help you safely strengthen your back, improve your stamina and fitness, and prevent future back pain.

For more information on back pain and effective pain relief options, consult the online knowledge base at eDrugstore.md. To order prescription pain relief medications at discount prices, visit eDrugstore.md home page and look for the pain relief section.



Tramadol ultracet ]]> http://www.fioricetnow.com/2009/12/how-to-exercise-for-back-pain-relief/feed/ 0 http://www.fioricetnow.com/2009/12/back-pain-and-its-myths/ http://www.fioricetnow.com/2009/12/back-pain-and-its-myths/#comments Wed, 02 Dec 2009 10:47:54 +0000 Fioricet now http://www.fioricetnow.com/2009/12/back-pain-and-its-myths/
If you have not experienced back pain as yet, count yourself lucky. The fact is that 80% of us will experience back pain at some stage of our lives. The level of pain experienced from person to person often varies from small twinges that last for only a few days, to severe paralyzing chronic pain that will go on for months.

Separating Myths From Facts

The first common mistake that most people make is to treat all back-related pains as resulting from the same source and having the same pain level. This could not be further from the truth.

There are really only two kinds of back pain.

Acute – The most common of back pains. Usually does not last for very long (a few days or a few weeks at the most). The pain level is mild but could get worse if not treated properly.

Chronic – Will last for a few months or longer. It is very persistent and hard to determine the real cause. Will flare up occasionally with very high pain level.

Some Of Causes

Back pain can result from a lot of things. Some are self-inflicted and some result from a medical condition. Over stretching when the muscles are still cold or lifting an object in an incorrect manner can quite easily “throw out” you back. Medical conditions like kidney infections or arthritis can also contribute to back pain.

The Bigger The Pain The Bigger the Damage

People often associate the damage that has been caused to the back to the level of pain experienced. This is again another one of those myths. If you are experiencing severe pain in your lower back, often it will be simply due to a back strain or just muscle spasms. These two causes are enough to inflict pain so bad that you would find it very hard to walk or even stand straight. To put matters in real perspective, a very dangerous injury such as a degenerated disc can often go un-noticed.

Your Doctor Will Definitely Find The Cause.

While it is definitely a good move to see your doctor if you are experiencing any kind of back pain, the source of the problem often remains hidden. The reality is that 90% of back sufferers may never find the real cause for their back pain. This does not mean that the pain is something that is only in your head but rather that the back is so complex and that there are so many things affecting it, that a real reason is often too hard to find.

Stay In Bed And The Pain Will Go Away.

If I had a dollar every time I heard this, I would be a rich man. While staying in bed will not make the back worse, prolonging your stay for more than two days will most probably slow your recovery. It is much better if you get your back working fairly quickly after experiencing back problems. This is by no means a green light to start weight lifting or going to the gym, but rather a very slow build up to normal activities. This way you will be getting your back into shape much quicker.

I Cannot Exercise If I have Injured My Back

Research shows that doing simple exercises will not only make you pain-free sooner but exercising has also the ability to strengthen your back muscles making a re-occurring injury much less probable. But again, take it slow and better still see a physiotherapist who will be able to recommend specific back strengthening exercises for you.

Rest And Your Back Pain Will Go Away

Although there is a ounce of truth is the above statement, if you have a nagging back pain that has been there for days, you should contact your doctor to find out whether more specialized treatment is needed.

Dangerous symptoms that you should take notice of.

Your legs getting weaker and weaker

Bladder or bowel dysfunction

Really bad low back pain or abdominal pain

Chills together with fever and pain to the back

Sudden weight loss if you have a history of cancer

Trauma

If you are ever struck down with back pain, at least now you know the basic facts but please always consult a professional to be on the safe side.



Fioricet, Tramadol, Ultracet at the cheapest prices ]]> http://www.fioricetnow.com/2009/12/back-pain-and-its-myths/feed/ 0 http://www.fioricetnow.com/2009/12/about-arthritis-pain-relief/ http://www.fioricetnow.com/2009/12/about-arthritis-pain-relief/#comments Tue, 01 Dec 2009 09:00:17 +0000 Fioricet now http://www.fioricetnow.com/2009/12/about-arthritis-pain-relief/
Chronic pain has plugged into thousands and millions of people in this fast developing world. There are number of cases found suffering from chronic pain conditions and takes a long period of time to recover. People tempt to get chronic pain relief through some natural ways. Around 50 to 80 millions of Americans are suffering form chronic pain condition. The chronic pain if treated at an earlier stage can be well treated but if it sustains for a longer period than the situation can become worse. Chronic pain relives the flow of harmful hormones, such as cortisol which plays a major role in adversely affecting the immune system and kidney function.

Chronic pain relief has now emerged with new and great techniques and treatments. The researchers and surgeons are now enhanced with effective drugs to implant and electrical stimulation. The birth of chronic pain can be due to various reasons like from an accident affecting much too sensitive veins and muscles, back injuries, an injury caused while playing sport, and chronic pain can also be occur from health conditions like migraines, diabetes, arthritis, shingles, and cancer. It is not important that a person will be suffering from chronic pain only; he may suffer from acute pain too. The acute pain causes are also the same as chronic pain but the difference lies as the acute pain easily and quickly subside after treatment. The foremost distinguish feature between acute pain and chronic pain is the duration of time. Chronic pain can be for a longer period of time and severe and unbearable. While acute pain subside the pain gradually and swiftly within a short period of time.

One should be smart enough to take precise care of his/her health in a pragmatic way. A patient can opt to treat in a natural or surgical way. Acupuncture, acupressure, massage therapy or if any alternative therapy are some natural ways which can be best suited for your health. In acupuncture you just need to locate the pressure points to heal the body pain and feel relax and comfortable. Acupuncture is done by way of needles and acupressure is done by way of hands. This therapy gives the relaxation to our muscles helps to keep your mind calm. Even doing medication acts as assistance to cure your chronic back pain relief. Pain relief supplements can provide only temporary relief.

Thus, to deal with chronic pain relief you can even join a support group of patients suffering from same pain. You need to be habituated of taking healthy diet including some fruits and fresh juices which plays a vital role in curing the unbearable pain. A patient suffering from chronic pain needs to develop positive mental attitude to strengthen his/her mind.



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