CLINICAL FEATURES
The term BMS refers to chronic pain condition in absence of any visible mucosal abnormality or organic disease. It is defined by symptoms that persist for a long time. The pain episodes usually occur continuously for at least 4-6months and may last for 12 years or more with an average duration of 3.4years. The most common complaint is unremitting oral mucosal pain in association with dysgeusia and xerostomia. And no signs of lesions or other detectable changes in the oral mucosa even in painful areas.[21] The type of pain experienced by majority of BMS patients is a prolonged “burning” sensation. However, scalding, tingling or numb feelings of the oral mucosa have also been reported. Burning sensation is most frequently reported
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It is defined only by symptoms and the symptomatic triad rarely occurs simultaneously in one patient and due to overlapping stomatitis. Symptomatically, chronic pain conditions like traumatic/inflammatory/immune-mediated stomatitis or orofacial pain disorders present similar to BMS. Foremost it is essential to discriminate between primary and secondary BMS. Thus a thorough case history and a careful examination are the key to successful diagnosis. Systematic evaluation of masticatory system including clinical assessment of occlusion, dentition, temporomandibular joint status and masticatory muscles is essential to rule out possible joint disorders. Salivary flow rate below 0.1ml/min for unstimulated whole saliva or 0.7ml/min for stimulated whole saliva is suggestive of hyposalivation. Sialochemistry can be helpful to assess specific qualitative alterations in saliva. Nutritional deficiencies, diabetes mellitus and menopausal disorders are diagnosed through haematological assessment of nutritional status, blood glucose and estrogen/progesterone concentrations respectively. The presence of underlying psychological disorders can be revealed by appropriate structured interviews and/or psychometric instruments. If clinical or laboratory examination reveals the presence of any these factors, then speculation of secondary BMS should be made. While …show more content…
Antidepressants used for BMS treatment are broadly classified into tricyclic antidepressants (amitriptyline, imipramine, desimipramine, clomipramine, doxepin) selective serotonin reuptake inhibitors (fluoxetine, paroxetine, sertraline) and atypical antidepressants (trazodone).[32]Amitriptyline exerts its antidepressant action by blocking the neuronal reuptake of noradrenaline and serotonin. But due to its anticholinergic it may cause delirium in elderly patients. Desipramine and nortriptyline, which have least anticholinergic activity, are equally efficacious substitutes. Dosage for adults is initially 25mg thrice daily which can be increased upto 150mg daily in divided doses. For elderly population, 10mg three times a day is sufficient. Imipramine inhibits noradrenaline reuptake to a lesser extent and thus is less sedative than amitryptiline. Dosage is 25mg thrice daily upto 100mg thrice daily. Doxepin inhibits reuptake of monoamines at central synapse. Dosage is 25mg thrice daily which can be gradually increased to 50mg. Selective serotonin reuptake inhibitors inhibit drug metabolizing isoenzymes CYP2D6 and CYP3A4. Dosage for Fluoxetine is 20 mg once daily which can be increased upto 80mg in two divided doses. Sertraline is started as 50mg once daily and increased upto 200mg/day. Atypical antidepressant like trazodone selectively blocks 5HT reuptake and has
The depot preparation could ensure continuous drug delivery with a stable plasma drug concentration over long periods. Taking into account the high propensity of noncompliance to the oral medications, long-acting depot would likely be beneficial to Madam M. Therefore, the doctor initiated intramuscular fluphenazine decanoate 25mg monthly for her. As for oral antipsychotics, the doctor aimed to taper off tablet aripiprazole in the future. This was because a monotherapy (IM depot) was likely sufficient for Madam
The drug amitriptyline is antidepressant that helps with pain and the incontinence. It can be taken orally using around 25 to 150 mg dosages, the option of injection is also available for patients. One of the advantages of this drug is that it can help subdue the symptoms of PBA that resemble depression. This drug also has a few cons. It causes extreme swelling of the face, tongue, lips, and face.
#Stay on the tapering schedule your doctor prescribes. The specific tapering schedule your doctor suggests will depend on how long you have been taking the drug, which drug you have been taking, the current dose, and how you responded to previous medication changes.http://www.health.harvard.edu/diseases-and-conditions/going-off-antidepressants The purpose of tapering is to allow your brain the time to adapt to lesser amounts of the meds without negative side effects. #*Your schedule is customized and might not be the same schedule a friend or co-worker uses.
Sadly, not many doctor or parents known about its harmful side effect that could worsen their behavior over a long period of time, the best solution is your attendance to their care and needs not simply taking a
From research on the internet on several medical websites, I found out this diagnosis is often given when the doctor has no idea what is wrong with you. Well, most of the time that is true. “The pain will go away in a couple of weeks,” they told me. “And if it doesn’t?” my mom
Question 2: Considering the indications of venlafaxine, the family prescribed this drug is most likely diagnosed with major depressive disorder, generalized anxiety disorder, or some other condition relating to these.
Before taking any prescription drug, the amount of dose should be examined by a medical doctor. The average dose depends on persona age, if the person who is between 17 to 24 years old should take 2.3 to 5.0 milligrams regular, or about one to three pills a day. One in ten college students admits that they buy illegal Adderall when they do not have a prescription for it. People who are normal and take Adderall can feel more focused and can make activities better that it would normally seem boring. Adderall is addicted drug, once you take it you will ask again and again.
Pain assessment revealed the location of pain was low back and left knee. It was described as numbness and
CASE: Mrs Tan, 80 year old Chinese lady admitted to hospital post fall- was found on the bathroom floor and was unable to get up. Before falling, she attempted to get up from toilet bowl after passing motion but her knees buckles after one to two steps. There was no loss of consciousness. As she was unable to get up and did not have a pendent-alarm, she had to wait four hours before daughter come home from work. Ambulance was called and she was brought to accident and emergency unit.
Pain can affect an individual both behaviorally and cognitively. Chronic pain is a type of pain that can last for a long period of time (Gurung, 2013, p 272). Everyone experiences pain at one point or another, however, women have a harder time coping with pain. Men generally feel less pain and respond better to treatments (Gurung, 2013, p 274). Pain, however, is generally difficult to measure because of the different types people feel due to different types of physical or mental pains.
While pain is a feature of inflammation of the joints inflammation, infections can be a characteristic of rare tumors within the joint. The common causes of joint pain are as follows: 1. Arthritis Arthritis is a condition caused by inflammation of the joints. It can either affect one or multiple joints. There are several different types of arthritis, all with different causes and methods of treatment.
he results indicate the effectiveness of both drug use and improve the quality of life scores both of article related to oral health patients also made findings being independent markers of effectiveness of medications the patient is more mucosa on the rate of artificial saliva, respectively. Key words: artificial saliva , propolis , mucositis ,Leukemia Introduction: Oral mucositis (OM) is a term to describe an oral mucosa inflammation as a chemotherapy side effect. Clinical features combine erythema, edema and sensitivity, followed by painful ulceration and mucosal bleeding. Patients with severe OM are unable to eat, speak or swallow due to pain.
20mg 40mg max 60mg/day, sertraline 50mg, 100mg max 200mg/day. They are widely used because their efficacy and side-effect profiles make them attractive agents for patients with cancer.[6] • Tricyclic antidepressants: Medicines that increase the brain chemicals serotonin and norepinephrine-amitriptyline, [2]nortriptyline, and desipramine have been used frequently in the cancer setting. TCAs should be started at a low dose (10-25mg at bedtime) and increased slowly by 10- to 25-mg increments every 1-2 days until beneficial effect is achieved max 200mg/day[6] • Central nervous system (CNS) stimulants: they increase the brain chemicals dopamine and
So it is almost always a trial and error with these medicines, and the doctor has to decide which one to randomly test out first depending on other factors of their case. Antidepressants give them the option to increase or decrease the milligrams of dose if the lower dose isn’t showing any effect after a month. In David Fisher’s medical journal, he states, “The principle that more severe cases of major depression require higher doses of antidepressants is valid. It also holds true for newer selective serotonin reuptake inhibitors. For example, a study of prescribing patterns across 23,381 prescriptions show that a prescription for higher than the initial dose was required in 6.8% of patients using fluoxetine, 21.1% of patients taking paroxetine, and 51% of patients taking sertraline” (Fish 826).