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Part of the therapeutic alliance is understanding the dynamics in the room. My beliefs, my biases, the culture I come from, I bring all that into the room with me. The patient I’m working with, they have their cultural background, their beliefs, their expectations, and their past experiences.


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A cluster of conditions that frequently co-occur, can be local or widespread, and either solely or predominantly affect women are referred to as chronic overlapping pain conditions. They include:

  • Endometriosis
  • Fibromyalgia
  • Painful bladder syndrome
  • Irritable bowel syndrome
  • Chronic low back...

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Spirochetal infection symptoms include

  • Muscle pain
  • Nausea
  • Vomiting
  • Abdominal pain

Common types of infections

  • The two most common: Lyme disease and syphilis
  • Both are great masqueraders in terms of symptoms
  • They can cause and they can mimic other conditions and throw people off


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Migraine is one of the largest chronic illnesses of childhood, one of the most disabling, and one of the most underrecognized diseases of childhood:

  • Before puberty, 6% to 7% of boys and girls have headache
  • During adolescence into young adulthood, we start seeing more females than males having...

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As clinicians and patients scramble for opioid analgesic alternatives and ways to blunt opioid withdrawal, kratom (also known as mitragynine) use among desperate patients has surged. What should practitioners know?

  • Kratom is not part of the usual standard test for urine screens
  • At low doses...

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Practitioner self-care: what to do?

  • Sleep well, eat well, socialize, exercise
  • Have strong social support
  • Connect with people at work with whom you feel safe and respected
  • Share with a coworker; ask for assistance: “This has been such a bad day for me and I’m really struggling”
  • Practice...

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Enhanced recovery after surgery (ERAS) is not a new technique or modality. It’s been around since the 1980s. It was developed by a gastrointestinal surgeon from Europe, and has started to come into emergence. Why? #1 reason: improved patient outcomes. Another? Economic impact in terms of services...

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A visceral pain example is endometriosis:

  • Often affects the intraabdominal organs
  • Can be within the wall of the uterus, affecting the uterine wall
  • Can be in the pelvic peritoneum
  • Has the capability to invade organs, causing an overlap of symptoms
  • Can be in the peritoneal layer of the...

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Expert Witness Testimony

  • Expert witness testimony in the US has contributed to courtroom confusion regarding the practitioner’s duties & responsibilities; it’s led to an attempt to put some uniform recipe into all prescribing and it’s neglected the patients.
  • Many experts are hired because they...

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What to know:

  • The brain and spinal cord are surrounded by dura, a membrane, and in typical adults there’s 150 mL of cerebrospinal fluid (CSF) in that region, which gets turned over 3 times a day
  • But if a patient produces too much CSF and they can’t get rid of it in a timely fashion, there will...

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