Chronic Pain Treatment In Elderly Patients

Submitted by: Alexander Krakovsky

Elderly patient is the one of the most difficult patient to treat because there are too many additional barriers such as impaired cognition, hearing and vision lost that pain management physician facing during office visit. In addition, many elderly patients do not want to be seen as complainers secondary to their cultural background. Typically, elderly patients have multiple comorbidities such as hypertension, diabetes, chronic obstructive pulmonary disease, chronic heart failure, and chronic renal failure. There are also many psychological comorbities and social problems such as depression, anxiety, ambulation, socialization and vitality as well.

Physician has to remember that in elderly population pain intensity and drugs pharmacokinetics usually diminished as the patient ages. Drug clearance and drug half-life is altering with renal excreted medications and hepatic metabolized medications. Sensitivity of the drugs to central nervous system is also shifting when the patient aged.

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Chronic pain is tremendously affecting elderly people. It is changing their physical activities; they ability to perform activities of daily leaving; the work and their recreation activities. It is also increasing their psychological morbidity such as depression, anxiety, anger, and loss of self-esteem. Social and societal consequences transform accordingly affecting marital/family reactions; intimacy/sexual activities; increase social isolation; health care cost; disability and lost workdays.

Neuropathic pain treatment in elderly has several goals such as improving physical functioning; reducing psychological distress, and improves overall quality of life. The first-line pharmacological treatment recommendations for neuropathic pain in elderly would be Gabapentin, Lidocaine patch, Tramadol, Antidepressant and Opioid Analgesics. Second line treatment of chronic pain in elderly patients would be Spinal Cord Stimulator that will allow decreasing all oral medications including opioids. The overall effect would be dramatic changes of the quality of life with an improvement of the physical activities and decreasing all medications side affect. The third line of treatment of the chronic pain in elderly population would be an implantation of the intrathecal pump. Intrathecal pump will deliver very small dose of medications into spinal canal and this allows improving the efficacy of these medications and eliminating or decreasing general side effects.

About the Author: Dr. A. Krakovsky, M.D., PhD., Dr., Sc. is an interventional pain management physician, a professor of medicine and surgery. Dr. Krakovsky leads International Pain Institute in La Jolla, CA providing procedures to elevate pain. Call 858-5519500 or visit


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News briefs: April 18, 2014

Friday, April 18, 2014

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Interview with Innocent Watat, City Council candidate for Wards 3 & 4 in Brampton, Canada

Saturday, October 21, 2006

The upcoming 2006 Brampton municipal election, to be held November 13, features an array of candidates looking to represent their wards in city council or the council of the Peel Region.

Wikinews contributor Nick Moreau contacted many of the candidates, including Innocent Watat, asking them to answer common questions sent in an email. This ward’s incumbent is Bob Callahan; Balbir Babra, Manny Bianchi-Morfino, Dolly Khokhar, Maria Peart, Tim Turcott, and Sheila White.


  • 1 Interview
  • 2 French message
  • 3 Notes
  • 4 External links

Thevar centenary celebrations begin amidst tight security arrangements

Wednesday, October 31, 2007

The centenary celebrations of Indian freedom fighter Pasumpon U.Muthuramalingam Thevar begin in Tamil Nadu amidst tight security arrangements. The Chief Minister, M.Karunanidhi as well as the AIADMK supremo J.Jayalalithaa have organized functions in Thevar’s native village Pasumpon in Ramanathapuram district in commemoration of this event. Sporadic instances of violence and group clashes have been reported.

U.Muthuramalinga Thevar, prominently known as Pasumpon Muthuramalinga Thevar after his native village Pasumpon in Ramanathapuram district, was born on October 30, 1908 in the southern part of the then Madras province. He was a trade union leader and a close associate of Subash Chandra Bose in the independence movement.

Why Kissimmee Is The Ultimate Family Vacation Spot?

By William F. Gabriel

Kissimmee is one underrated vacation spot that deserves more praise than what it is getting right now. Compared to Orlando, this city is not so big on theme parks and attractions but it has its own charms that make people want to come back to this place for more vacation experiences. If you and your family are looking for a vacation spot that is out of the ordinary, here are top reasons why Kissimmee may just be the ultimate family getaway destination you are looking for.

Reason # 1 This City has Many Interesting Tourist Spots

Take Boggy Creek Airboat Rides to see the sights of Florida Everglades and see alligators and other wildlife attractions along the way. Eat your dinner at Capone’s Dinner and Show that features a decorated dining room reminiscent of the 1920s era in America. Visit Gatorland, a famous attraction that is home to alligators and various wildlife. The Congo River Adventure Golf is another must-experience attraction that is perfect even for those who are not crazy about this sport. Don’t forget to drop by the World of Orchids as well which will have you acquainted with some of the world’s most beautiful orchids featured in the facility’s conservatory and showroom.

Reason # 2 It is an Inexpensive But Enjoyable Place

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Kissimmee has lots to offer when it comes to tourist spots but what you’d love about it is that it is not that expensive. Some of the attractions are even free of charge. Others only charge a few dollars, which would certainly make your pockets heave a sigh of relief.

Reason # 3 Here you Get to Enjoy Peace, Quite, and Privacy

Another thing that makes this place wonderful is the peace, quiet and privacy that you get to enjoy while you are here. If you are not fond of crowds, noise, and busy cities, Kissimmee is right for you. It can give you and your family the ultimate relaxing vacation that you’ve always wanted. It certainly is the best way to escape the normal hustle and bustle lifestyle that you’ve been living for the past years.

Reason # 4 It is Near Orlando and its Long Line of Attractions

This city is near Orlando so if you still want to visit Disney World, Universal Studios, SeaWorld, or Kennedy Space Center, you can still do so! Just ask your hotel if they provide free transportation or rent a car to get there. Since it is just nearby, you can expect that a car rental won’t cost that much.

Reason # 5 Kissimmee Vacation Packages are Available to Make Planning a Cinch

If you don’t want the hassle of figuring out where to go, where to stay, and what to do, the answer to your problem would be Kissimmee Fl vacation packages. These packages are widely available online and can give you great discount deals for maximum savings.

Kissimmee may not be the first item on the list of places to go in the state of Florida. But that’s actually where the magic lies. Even though it is quite underrated, people who take time to discover and explore it go home happy and satisfied that they did.

About the Author: For more information on planning vacation in the sea world visit Nichole’s writings about: Kissimmee vacation packages Kissimmee Fl vacation packages


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Commonwealth Bank of Australia CEO apologies for financial planning scandal

Thursday, July 3, 2014

Ian Narev, the CEO of the Commonwealth Bank of Australia, this morning “unreservedly” apologised to clients who lost money in a scandal involving the bank’s financial planning services arm.

Last week, a Senate enquiry found financial advisers from the Commonwealth Bank had made high-risk investments of clients’ money without the clients’ permission, resulting in hundreds of millions of dollars lost. The Senate enquiry called for a Royal Commission into the bank, and the Australian Securities and Investments Commission (ASIC).

Mr Narev stated the bank’s performance in providing financial advice was “unacceptable”, and the bank was launching a scheme to compensate clients who lost money due to the planners’ actions.

In a statement Mr Narev said, “Poor advice provided by some of our advisers between 2003 and 2012 caused financial loss and distress and I am truly sorry for that. […] There have been changes in management, structure and culture. We have also invested in new systems, implemented new processes, enhanced adviser supervision and improved training.”

An investigation by Fairfax Media instigated the Senate inquiry into the Commonwealth Bank’s financial planning division and ASIC.

Whistleblower Jeff Morris, who reported the misconduct of the bank to ASIC six years ago, said in an article for The Sydney Morning Herald that neither the bank nor ASIC should be in control of the compensation program.

Colleges offering admission to displaced New Orleans students/OH-WY

See the discussion page for instructions on adding schools to this list and for an alphabetically arranged listing of schools.

Due to the damage by Hurricane Katrina and subsequent flooding, a number of colleges and universities in the New Orleans metropolitan area will not be able to hold classes for the fall 2005 semester. It is estimated that 75,000 to 100,000 students have been displaced. [1]. In response, institutions across the United States and Canada are offering late registration for displaced students so that their academic progress is not unduly delayed. Some are offering free or reduced admission to displaced students. At some universities, especially state universities, this offer is limited to residents of the area.


  • 1 Overview
  • 2 Ohio
  • 3 Oklahoma
  • 4 Oregon
  • 5 Pennsylvania
  • 6 Rhode Island
  • 7 South Carolina
  • 8 South Dakota
  • 9 Tennessee
  • 10 Texas
  • 11 Utah
  • 12 Vermont
  • 13 Virginia
  • 14 Washington
  • 15 West Virginia
  • 16 Wisconsin
  • 17 Wyoming

Ontario Votes 2007: Interview with Green candidate Mark Grenier, Welland

Saturday, September 15, 2007

Mark Grenier is running for the Green Party of Ontario in the Ontario provincial election, in the Welland riding. Wikinews’ Nick Moreau interviewed him regarding his values, his experience, and his campaign.

Minor alterations not affecting the content have been made to this interview; the original text is available by clicking on the tab marked “Collaboration” for.

Stay tuned for further interviews; every candidate from every party is eligible, and will be contacted. Expect interviews from Liberals, Progressive Conservatives, New Democratic Party members, Ontario Greens, as well as members from the Family Coalition, Freedom, Communist, Libertarian, and Confederation of Regions parties, as well as independents.

Germany too hot for Ecuador in Group A

Tuesday, June 20, 2006

Germany made light of heat and humidity to brush Ecuador aside 3-0 in their final Group A match, Tuesday.

The Germans got goals from Miroslav Klose, whose two tallies put him top of the Fifa World Cup scorers chart with four goals, and Lukas Podolski, his first at the competition.

Luis Suarez’s side had 57 per cent of ball possession but Jens Lehmann had to make just two saves from Edison Mendez’s and Edwin Tenorio’s 35 yard efforts.

After the third goal what there was of a contest ended. This was partly because both sides had already achieved qualification through to the round of sixteen and wanted to conserve energy.

It also was 27 degrees Celsius in the Olympiastadion and together with the 65 per cent humidity playing at a fast pace for a long time was difficult.

The first goal came on three minutes. Bastian Schweinsteiger brought down a cross level with goal and cut it back to Klose. The Polish born striker finished neatly across Cristian Mora from the edge of the six yard box.

Ecuador were no big threat going forward and had rested Carlos Tenorio, Augustin Delgado and Ivan Hurtado, the captain, for the game. Marlon Ayovi was Ecuador’s captain against Germany.

Germany’s second was set up by Michael Ballack. His brilliant chip surprised two Ecuador defenders and Klose stole in between them and before the advancing Mora to score.

In the second half there was no hurry to the German game, Ecuador had much of the possession, but Klinsmann’s team looked a constant threat on the break. On one such fast attack Bernd Schnieder on the right wing crossed low for Podolski who slid in and tipped the ball toward the far post.

Germany and Ecuador had to wait on the outcome of the Group B match between Sweden and England to know their next opponents. The winner of Group A would play the runner-up in Group B and vice versa.


  • 1 Statistics
    • 1.1 Ecuador
    • 1.2 Germany
  • 2 Table
  • 3 Related news
  • 4 Sources

Bean Bag Chairs And Childrens Furniture For Shared Rooms

Bean Bag Chairs and Childrens Furniture for Shared Rooms


Martin pit

When your kids are sharing a room, give each child a special space of their own. Help your children personalize their space with bedding and artwork. Childrens furniture like bunk beds, bean bag chairs and desks are useful for setting up a functional shared space. Here are some ideas to design a shared room that is playful and practical.

Step 1: Plan a Layout

Plan the shared room in a way so that each child has their personal space. Create separate zones for activities such as studying and sleeping while play spaces can be shared by the siblings. Childrens furniture such as desks and bunk beds are great for creating different zones in the room. You can make clever use of architectural details like alcoves to create zones in the shared room. Let the space by their desk be each child s special space a place for them to display their artwork or trophies. Design a simple layout so your kids can move about and play freely in their room.

Step 2: Furniture and Seating

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Modular childrens furniture is a smart choice for shared rooms as it can be arranged in different ways to make the most of the space available. Modular furniture also adapts better to your kids changing needs. A bookcase unit that has been used as toy storage can be easily transformed into a crafts station for school projects when your children start school.

Give your kids a cool lounge space to relax with their friends. Lay down a plush rug and furnish the spot with bean bag chairs and floor pillows. You can have the bean bag chairs monogrammed so each child has their own special seat. Portable seating options such as floor pillows are great for the kids room when friends come over.

Step 3: Personalization

When the kids are sharing a space, it s important to let each child express his or her individuality. The childrens furniture in the room and the wall color can serve as neutral backdrops while each child gets a chance to decorate the room based on their favorite colors and things. Wall decals are excellent decor accessories to let your kids personalize their space.

Design a great shared space with these creative solutions.

Authors Profile: Martin Pittt is a certified interior designer and runs his own interior decoration consultancy. Martin especially loves decorating a home in wooden furniture and believes that nothing gives a home as warm and cozy a touch as all-wood furniture and decor.

Martin loves reading up on new design ideas, and has a special interest in space saving techniques. Here Martin writes about

childrens furniture


bean bag chairs


Authors Profile: Martin Pittt is a certified interior designer and runs his own interior decoration consultancy. Martin especially loves decorating a home in wooden furniture and believes that nothing gives a home as warm and cozy a touch as all-wood furniture and decor.Martin loves reading up on new design ideas, and has a special interest in space saving techniques. Here Martin writes aboutchildrens furniture and bean bag chairs.

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