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Do any PT's recommend anti-inflams for pts?
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Do any PT's recommend anti-inflams for pts? - September 18, 2006 12:45:00 PM
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jbird007
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Do any PT's recommend anti-inflams for pts?
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Re: Do any PT's recommend anti-inflams for pts? - September 18, 2006 1:38:00 PM
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proud
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Ah jbird007, this is a battle you are going to lose.
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Re: Do any PT's recommend anti-inflams for pts? - September 18, 2006 2:19:00 PM
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jbird007
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You know where I am headed, lol!
No battle though.
There are bigger risks here!
:)
J
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Re: Do any PT's recommend anti-inflams for pts? - September 19, 2006 3:27:00 AM
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Shill
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jbird,
Dont you have anything better to do?
How would you summarize your reason(s) for posting on this board? I think an inflammatory intent might just be the case, and hence I guess your anti-inflammatory question would be appropriate, so never mind.
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Steve Hill PT
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Re: Do any PT's recommend anti-inflams for pts? - September 19, 2006 4:37:00 AM
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jbird007
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My apologies Shill. If you have been following the discussion this posting was presented as a comparison in regards to proud alans statements concerning dangers of manipulation.
Feel free to answer it or ignore it but it was not meant to be directly inflammatory (no pun intended)
My point was that many PT's recommend pain relievers to pts although the risk of adverse effects and death are far greater than that from cerv spinal manipulation. Though it does not excuse the seriousness of stroke/manip (nor should it be dismissed) it puts a better perspective on clinical applications and dangers by comparison. I could use several other mediums as well.
IMO, most posters read between the lines and figured that out.
Jbird
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Re: Do any PT's recommend anti-inflams for pts? - September 19, 2006 5:19:00 AM
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JSPT
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Great analogy (heavy sarcasm). Recommending OTC ibuprofen vs. manipulating the cervical spine. If the intention is to stir the pot, why not use a little more imagination with your analogies?
Man, I can't believe I wasted 30 seconds of my life responding to such nonsense.
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JS
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Re: Do any PT's recommend anti-inflams for pts? - September 19, 2006 5:24:00 AM
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Tom Reeves DPT ATC
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Yes, I do sometimes recommend OTC NSAIDS, but only after obtaining a history from the patient specifically regarding GI history, Kidney problems, anticoagulation therapy etc . . . Most people know how they react to those meds and I am sure that you will agree that 99.9999999999999999999999% of the "deaths" you are citing are of people who chronically take many more milligrams than they are supposed to. Not a one-time incident.
If there is a risk of stroke from cervical manipulation (and I am not saying there is, only that it has been suggested), does it occur only after chronic manipulations? or is it potentially a response to one manip?
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Re: Do any PT's recommend anti-inflams for pts? - September 19, 2006 7:21:00 AM
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Dr.Wagner
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I recommend NSAIDs for my healthy patients with sprains and strains...I even prescribe them...usually a 5 day course. Then again, I am not a practicing PT anymore.
The bigger issue is the overuse of narcotic pain meds. The morbidity is FAR higher than that of NSAIDS. That comes from me, a "front line" physician in the ER.
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: Do any PT's recommend anti-inflams for pts? - September 19, 2006 1:26:00 PM
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jbird007
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I agree Doc Wagner and I also agree with the appropriate use of NSAIDS. :)
J
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Re: Do any PT's recommend anti-inflams for pts? - September 19, 2006 2:44:00 PM
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Karie
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jbird007
I have been reading the cervical manipulation thread so I too knew where you were headed but I actually have a follow-up question to the PT's?
In Wisconsin, I do not believe our practice act allows us to legally tell patients to take any kind of medication, OTC or prescription. I usually do that through their physician if I think something might be helpful and leave them to make the decision. Do other states allow PT's to do this? Am I not fully understanding WI practice act?
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Re: Do any PT's recommend anti-inflams for pts? - September 19, 2006 4:40:00 PM
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jbird007
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Karie,
I do not know. I think some of the PT's should know the answers. If not contact your state board. You do raise a good point though.
J
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Re: Do any PT's recommend anti-inflams for pts? - September 20, 2006 2:32:00 AM
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Sebastian Asselbergs
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Don't know about Wisconsin. I know the US army PTs have (limited) prescription rights. I know that I have the right to suggest OTC meds - not prescribe. But this is Ontario, Canada - and even here the differences between the provinces are often a bit confusing....
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Mundi vult decipi
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Re: Do any PT's recommend anti-inflams for pts? - September 20, 2006 3:59:00 AM
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Dr.Wagner
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I think it is always best to answer "That is a question best left up to your doctor". Primarily to avoid an medico-legal "gray areas".
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: Do any PT's recommend anti-inflams for pts? - September 20, 2006 9:52:00 AM
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srcase
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In Michigan, it is not part of our practice act and I always defer to the physicians.
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Re: Do any PT's recommend anti-inflams for pts? - September 20, 2006 10:48:00 AM
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nari
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Regardless of which state does or doesn't allow prescribing of NSAIDS - do PTs want to be in the firing line if we suggest/prescribe naprosen or celebrex and the patient has a large MI?
I think it should be left for the doctors to 'do' meds; it's perfectly OK to suggest meds, and the doctor can then decide if it is in the patient's best interest.
Nari
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Re: Do any PT's recommend anti-inflams for pts? - September 21, 2006 5:02:00 AM
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Tom Reeves DPT ATC
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you mean its ok for your mother or your neighbor to recommend taking Advil for a sore back when the patient has taken Advil in the past, but if it hasn't occurred to the patient this time, its bad for the PT to say it? Seems awfully paranoid to me.
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Re: Do any PT's recommend anti-inflams for pts? - September 21, 2006 5:28:00 AM
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jbird007
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Think twice:
1. Scope of practice issues
2. Risk of adverse reaction issues
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Re: Do any PT's recommend anti-inflams for pts? - September 21, 2006 5:46:00 AM
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proud
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jbird007,
What do you know, I agree with you.
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Re: Do any PT's recommend anti-inflams for pts? - September 21, 2006 5:57:00 AM
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Dr.Wagner
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It isn't paranoid...you are a paid professional actively treating the patient...neighbors aren't. That being said, you have a "professional opinion", which holds greater weight than does a neighbor. While at work your "opinions" count and come highly regarded (ie you get paid for your professional opinion). At home you do not.
Unfortunately, paranoia is where we are at in the US medico-legal society. Thank the lawyers for that.
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: Do any PT's recommend anti-inflams for pts? - September 21, 2006 6:25:00 AM
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Alex Brenner PT MPT OCS
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I am able to prescribe Naprosyn, Ibuprofen, Piroxicam, Indomethacin, cyclobenzaprine, methocarbamol and can refill celebrex and a few others. In the military we have been doing this since the 1970’s. I have not heard of a military PT prescribing a medication that resulted in a death.
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Alex Brenner, PT, MPT, OCS
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