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Disorders of the nervous system
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Those taking drugs (commonly muscle relaxants, immunosuppressants or antimuscarinics) should have their medication reviewed for a potential effect on a fetus and perhaps change or modify their drugs before pregnancy (Ferrero, et al., 2006).
Gastrointestinal disorders
Published in Anne Lee, Sally Inch, David Finnigan, Therapeutics in Pregnancy and Lactation, 2019
Treatment aims to relieve the major symptoms. Avoidance of ‘trigger’ foods and simple dietary change may help. Bulking agents, with an adequate fluid intake, relieve constipation and are better tolerated than bran. Anticholinergic agents (dicyclomine and hyoscine) and smooth muscle relaxants (mebeverine and alverine) are not recommended in pregnancy because there is inadequate safety data.7,20 Peppermint is widely used in confectionery and peppermint oil is probably safe, though pharmacological safety data is lacking.
The Crucial Role of Craniofacial Growth on Airway, Sleep, and the Temporomandibular Joint
Published in Aruna Bakhru, Nutrition and Integrative Medicine, 2018
Nonsteroidal anti-inflammatory agents are often of value in the acute stage (Dionne 1997, Schütz, Andersen, and Tufik 2007, Ta and Dionne 2004). Treatment is usually administered for 10–14 days, at which time the patient should be reevaluated. Muscle relaxants are frequently used for episodes of acute pain but have not been proven efficacious in chronic conditions. Long-term use of opioid analgesics should be avoided, if at all possible (Dionne 1997). Antidepressants have a long history of effectiveness for the treatment of chronic pain. Their use is often justified, especially when the pain and dysfunction are part of the complex of generalized muscle pain with signs and symptoms of depression (Onghena and Van Houdenhove 1992, Max et al. 1992, Rowbotham et al. 2004).
Prescribing patterns for treating common complications of spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2023
Shikha Gupta, Mary Ann McColl, Karen Smith, Alexander McColl
According to the available evidence, baclofen and tizanidine are considered first-line treatments for SCI-induced spasticity, while diazepam and dantrium are second-line treatments with varying effectiveness.13,31,41,42 However, lorazepam may be used with patients having adverse effects from diazepam. A small proportion of individuals in our sample were also prescribed general muscle relaxants such as lorazepam, Flexiril or other short-acting benzodiazepines to treat spasticity. These are usually not recommended due to their negative effects on individual’s ability to void and ambulate.7,43 Therefore, it is possible that some patients received general muscle relaxants as an adjuvant to a baclofen pump or chemo-denervation, as per the clinical judgement of prescribing physician, treatment goals, patient preference and their tolerance for adverse events.
Preventing pediatric chronic postsurgical pain: Time for increased rigor
Published in Canadian Journal of Pain, 2022
Christine B. Sieberg, Keerthana Deepti Karunakaran, Barry Kussman, David Borsook
What happens to central neural networks from surgical trauma during general anesthesia is not well understood. Animal and human imaging data suggest that ongoing nociceptive drive may continue following peripheral tissue damage, resulting in peripheral sensitization from nociceptive molecules such as bradykinin and neuroinflammatory changes.49,50 As a result of peripheral sensitization, the afferent barrage (including incomplete nerve conduction block with regional analgesic techniques) may continue. The analgesic status of a patient under general anesthesia is determined by weight-based dosing and the clinical and autonomic responses (patient movement, blood pressure, heart rate, respiratory rate, sweating) to noxious stimulation. The administration of muscle relaxants during anesthesia removes signs of inadequate analgesia such as patient movement and increased respiratory rate. With fMRI, spinal reflex responses, and somatosensory evoked potentials, Lichtner and colleagues51 showed that nociceptive activation in the spinal cord and brain of young adults persists during deep general anesthesia with propofol and remifentanil despite abolished clinical responses regarded as sufficient.51 Without an objective monitor of afferent nociceptive activity in C and A delta fibers, and even with the administration of analgesia, ongoing pain perception is likely in a significant number of patients under general anesthesia.
Phenprobamate use disorder: a case report
Published in Journal of Substance Use, 2021
Harun Olcay Sonkurt, Melis Danisman Sonkurt
Tolerance and dependence of centrally acting muscle relaxants have been reported in the medical literature for nearly 50 years (Elder, 1991). Meprobamate, one of the best-known examples, had been a controlled substance after studies indicating its addictive effects, shortly after its introduction in the 1950 s. Fifty years after its launch, it was withdrawn from the European Union and Canada market, with the statement: “its harms outweigh the benefits.” (Lane et al., 2018). Following the increasing reports of tolerance and dependence about carisoprodol, another frequently used centrally acting muscle relaxant, it has been taken under the controlled substance status by the Food and Drug Administration and withdrawn from the market due to the risk of addiction in several countries (Reeves et al., 2012). Similarly, cases of dependence related to drugs such as cyclobenzaprine, butabarbital, triazolam have been reported (Zawertailo et al., 2003). In addition to these, phenprobamate, which has been reported to be similar to meprobamate in terms of effects, side effects, and toxicity, is not a controlled substance and is frequently used as a centrally acting muscle relaxant (Emet et al., 2009).