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Re: Do any PT's recommend anti-inflams for pts?
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Re: Do any PT's recommend anti-inflams for pts? - September 21, 2006 6:50:00 AM
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jbird007
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In a 1999 analysis, NSAIDs accounted for more than 16,000 deaths and 100,000 hospitalizations each year.
Wolfe, MM, Lichtenstein, DR, Singh, G. Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. New England Journal of Medicine 1999;340(24):1888?]99.
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..What would happen if DC's were stroking out 16,000 patients a year from cervical manipulation?
JBird
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Re: Do any PT's recommend anti-inflams for pts? - September 21, 2006 6:59:00 AM
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proud
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Jbird007,
I will leave that one alone. I am sure our clever panel will produce the actual facts on this.
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Re: Do any PT's recommend anti-inflams for pts? - September 21, 2006 7:20:00 AM
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jbird007
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Creativity will not count. :)
Admit it Proud, if you had one study like this
(anyway similar in numbers of deaths) involving DC/stroke issues you would "go to town".
JBird
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Re: Do any PT's recommend anti-inflams for pts? - September 21, 2006 7:23:00 AM
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proud
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I think Tom above was on the right track.
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Re: Do any PT's recommend anti-inflams for pts? - September 21, 2006 7:24:00 AM
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jbird007
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IMO Tom is asking for trouble. DocWags summed it up as well.
J
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Re: Do any PT's recommend anti-inflams for pts? - September 21, 2006 7:45:00 AM
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proud
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Jbird007,
I was speaking about Tom's first post.
And here is the thing: Risk factors with NSAIDS are multi-variable. Patient error, multiple health concerns which predisposes the individual(I.e the complexity of the case). Etc.
With the manip, the only variable is the manip, in complete control of the clinician. And when you look at the number of NSAIDS prescribed worldwide and compare that the the number of cervical manips, there is no comparison.
Most credible health care providers recognize these facts.
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Re: Do any PT's recommend anti-inflams for pts? - September 21, 2006 7:48:00 AM
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jbird007
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Proud,
Another question you can't answer, so "spin" away.
J
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Re: Do any PT's recommend anti-inflams for pts? - September 21, 2006 7:50:00 AM
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proud
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Jbird007,
All factual info. No spin. And judging from your response, I think you know that.
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Re: Do any PT's recommend anti-inflams for pts? - September 21, 2006 7:56:00 AM
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SJBird55
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I make recommendations on over the counter products. Anyone can purchase and use over the counter products.... there are over the counter anti-inflammatory products. I don't pick up the phone and have a conversation with my physician if I want to pop some Ibuprofen...
Prescribed medications are a different story. If a patient has questions, I can look up the medication in my handy dandy PDR. Generally I advise the patient to speak to the pharmacist. Pharmacists are supposed to know the prescribed medications, side effects, toxicity and interaction between prescribed medications. If after the patient speaks to the pharmacist and has additional concerns, then I suggest the conversation be taken up with his/her physician.
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Re: Do any PT's recommend anti-inflams for pts? - September 21, 2006 8:14:00 AM
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Tom Reeves DPT ATC
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I understand the point Doc Wag. I just find it hard to stomach
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Re: Do any PT's recommend anti-inflams for pts? - September 21, 2006 11:02:00 AM
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PHSPT
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I work at a gov facility, and therefore have more freedom as to what I do w my pnts. Although i dont have direct prescribing priviledges, I do recommend NSAIDS, Joint Supplementation, after doing a throughout review of past med hx.
As far as NSAIDS,it is my exp that pnts do not stay on these, or follow instructions properly. Most of NSAIDs low half-life require that they be taken more consistently. Typically i tell my pnts to stay on them for at least 5 days. When pnts c/o GI difficulties, I recommend a product w longer half-life, therefore less frequent dosages e.g Naproxen.
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Re: Do any PT's recommend anti-inflams for pts? - September 22, 2006 6:22:00 AM
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mcap56
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I beleive it is out of our scope of practice to recommend medications - even over the counter products. You can't take off the healthcare hat and become a neighbor temporarily during the eval.
I go through quite a few case studies that address this in my pathology class.
It's currently out of scope and I don't think we should be offering advice about it. Just because they are OTC doesn't mean they aren't powerful or potentially dangerous. It may seem silly when you are discussing something like Advil but we need to mind the scope of practice.
I don't think we should ignore the issue. Particularly with patients who aren't taking their medication correctly or who double up with an Rx med and an OTC med we have a role to play. That role is encouraging them to discuss it with their physician. When we think one may be indicated, we can also mention that but mention it as something they should consult their physician about.
As I tell my students, when they start paying us to accept certain types of liability, then we can look closer. this is the physician's responsibility. Military excepted.
Marc
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Re: Do any PT's recommend anti-inflams for pts? - September 22, 2006 12:01:00 PM
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PHSPT
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Marc,
As PT's our role is shifting towards well-medically-rounded and elite musculoskeletal practicioners. Hence our DPT differential diagnostics, advanced pharmacology courses, radiology courses and such. The days of PT's being "Modality Flippers" are over.
You have to admit that at the least we have to be able to conduct an intelligent conversation in terms of the basic NSAIDS composition, effects, red flags, and how it can affect both positively and, or negatively in terms of your POC/Tx/Prognosis.
You cant just turn your back and say Thats not within my scope! so dont ask me!!
Now Im not advocating for Joe nobody to begin throwing NSAID's names left and right, basic and advanced pharmacology courses would be required in my opinion prior to anyone having such priviledges. Alex can chime in on this, i know the Army has specific pre-reqs prior to having prescription rights.
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Re: Do any PT's recommend anti-inflams for pts? - September 25, 2006 5:44:00 AM
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Alex Brenner PT MPT OCS
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We took some pharmacology classes while in PT school. We also had a probationary period (I don't remember how long, maybe a few months) during our first assignment where our records were peer reviewed by a physician to ensure we were prescribing appropriately. After this peer review process our prescription credentials were granted.
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Alex Brenner, PT, MPT, OCS
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Re: Do any PT's recommend anti-inflams for pts? - September 25, 2006 4:06:00 PM
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mcap56
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We have pharmacology in our program - a good course. I also cover it in pathology. And I am not saying we should ignore the issue. We can certainly discuss them, mechanism of action, indications, side effects, etc. But....it is not in our scope of practice to recommend them.
When considering our credentials, many PTs go back to what they had in school. That is not the issue. Physicians training does not simply consist of what courses they took before and after school. There are pharm classes and pharm is integrated into ALL of their other coures as well. They have major exams that cover pharmacology and they have 2 years of clinical education where pharmacology is paramount and then residency for at least 3 years.
Despite all of that, I have known some physicians who have not done a great job handling their patient's medications. PTs can be a nice backup or check if something is wrong.
And we can engage patients about their medications. But....it isn't in our scope of practice (civilian) right now. As such, you need to tread carefully. And adding a course here and there, isn't the full story.
Marc
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Re: Do any PT's recommend anti-inflams for pts? - September 25, 2006 4:12:00 PM
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Jon Newman
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I'd like to ask what people think is meant by the phrase "prescribing medication".
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Re: Do any PT's recommend anti-inflams for pts? - September 25, 2006 4:35:00 PM
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SJBird55
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Marc... a physical therapist shouldn't recommend over the counter products if a patient asks, but can be a nice back up if there appears to be something wrong with what a physician prescribes? Your argument definitely seems flawed if I'm interpreting you correctly.
Jon, to me there is a big difference between prescribing and recommending. Prescribing, to me, is more like an order of what a patient should do and it is something that is written up and signed. I generally view it as more of a formal process and a way in which a person can acquire medications other than over the counter.
If taken appropriately with the right dosage and as the box entails, I don't view over the counter stuff as dangerous. Common sense applies.
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Re: Do any PT's recommend anti-inflams for pts? - September 25, 2006 4:55:00 PM
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Dr.Wagner
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mcap, I really agree with your thinking. I has nothing to do with knowledge base...but understood liability. Regardless of whether we "agree or disagree", your professional opinion matters to patients and holds more weight and certainly higher liability than does the neighbor across the street.
Example: Pt x has been taking high dose ibuprofen for 3 months without a break. During a therapy session, she asks your opinion if she should take Naproxyn. You say "take as it stated on the box, but no more". She now takes Naproxyn and Ibuprofen. A simple and HONEST mistake, she then sues you for 10k for the hospital stay and lost work for a GI bleed. Now, this could just as easily happen to a physician...we accept it. But when it happens to you, an allied health provider discussing a "gray area" that is not clearly defined in state practice acts...it will likely pose a huge problem. It is liability that we, as physicians, are covered for...you are not. Honest mistakes happen to honest people...good people.
One could argue it was the 3 months of ibuprofen that caused the bleed...and yet it didn't start or become relevent until AFTER the discussion with you. You could argue "she was not disclosing fully her medications"...they argue back "why were you discussing medications in the first place"...etc etc etc.
I am telling you, from experience, patient do not disclose information. And this opens up issues that if you are NOT prepared for this type of liability, then do not enter into the realm.
The US is run afowl by lawyers and dishonesty.
Yes, I can be a bit jaded.
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Dr. Wagner DO
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Re: Do any PT's recommend anti-inflams for pts? - September 25, 2006 5:52:00 PM
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MikeBptatc
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21 yom with an acute sprained ankle. Lets all picture swelling beyond belief without a fracture.
Is a NSAID the right medication at this point?
Do we really want to inhibit the early stages of the inflammatory process and impair platelet function?
Will this delay healing and promote swelling just for some pain relief?
I am allergic to NSAIDs and did not know it until I was a fr in college. Therefore, I rarely make any recommendations on what a patient should take for fear of suit. However, I generally find myself discouraging the use of nasids during the acute stages of injury. As an athletic trainer I work in a setting with acute injuries.
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Re: Do any PT's recommend anti-inflams for pts? - September 26, 2006 1:25:00 AM
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Sebastian Asselbergs
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"Is a NSAID the right medication at this point?"
No. I agree with your points.
I too would advise against it.
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