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266 Neck and back pain – mechanical strain n Summary and recommendations First line: NSAIDs (e.g. ibuprofen 600–800 mg PO TID) Reasonable: n oral opioids (e.g. oxycodone 5–10 mg q4–6 h, with or without acetaminophen) n cyclobenzaprine 5 mg PO TID or methocarbamol 1000 mg PO QID Pregnancy: acetaminophen (650–1000 mg PO QID), oral opioids (e.g. oxycodone 5–10 mg PO q4–6 h), cyclobenzaprine (5 mg PO TID) Pediatric: NSAIDs (e.g. ibuprofen 10 mg/kg PO QID) Special cases: n NSAIDs and opioids not indicated, or benzodiazepines previously efficacious: benzodiazepines (e.g. diazepam 5 mg PO QID) n discrete trigger points identified on examination: injection with local anesthetics (e.g. lidocaine) n refractory symptoms, opioids are to be avoided: combination therapy with NSAID (e.g. ibuprofen 600–800 mg PO TID) and a skeletal muscle relaxant (e.g. cyclobenzaprine 5 mg PO TID) References 1. Bigos S, Bowyer O, Braen G. Clinical Practice Guideline No. 14: Acute Low Back Problems in Adults. [AHCPR Publication 95–0642.] Rockville, MD: Agency for Health Care Policy and Research, 1994. 2. Beebe FA, Barkin RL, Barkin S. A clinical and pharmacologic review of skeletal muscle relaxants for musculoskeletal conditions. Am J Ther. 2005;12(2): 151–171. 3. van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine. 1997;22(18):2128–2156. 4. van Tulder MW, Scholten RJ, Koes BW, et al. Nonsteroidal anti-inflammatory drugs for low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine. 2000;25(19):2501–2513.
Neck and back pain – mechanical strain 267 5. Jamison RN, Raymond SA, Slawsby EA, et al. Opioid therapy for chronic noncancer back pain. A randomized prospective study. Spine. 1998;23 (23):2591–2600. 6. Waldman HJ. Centrally acting skeletal muscle relaxants and associated drugs. J Pain Symptom Manage. 1994;9(7):434–441. 7. Borenstein DG, Korn S. Efficacy of a low-dose regimen of cyclobenzaprine hydrochloride in acute skeletal muscle spasm: results of two placebocontrolled trials. Clin Ther. 2003;25(4):1056–1073. 8. van Tulder MW, Touray T, Furlan AD, et al. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. 2003(2):CD004252. 9. Childers MK, Borenstein D, Brown RL, et al. Low-dose cyclobenzaprine versus combination therapy with ibuprofen for acute neck or back pain with muscle spasm: a randomized trial. Curr Med Res Opin. 2005;21(9):1485–1493. 10. Turturro MA, Frater CR, D’Amico FJ. Cyclobenzaprine with ibuprofen versus ibuprofen alone in acute myofascial strain: a randomized, double-blind clinical trial. Ann Emerg Med. 2003;41(6):818–826. 11. Chou R, Peterson K, Helfand M. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: a systematic review. J Pain Symptom Manage. 2004;28(2):140–175. 12. Powers BJ, Cattau EL, Jr., Zimmerman HJ. Chlorzoxazone hepatotoxic reactions. An analysis of 21 identified or presumed cases. Arch <strong>Int</strong>ern Med. 1986;146(6):1183–1186. 13. Bailey DN, Briggs JR. Carisoprodol: an unrecognized drug of abuse. Am J Clin Pathol. 2002;117(3):396–400. 14. Srivastava M, Walsh D. Diazepam as an adjuvant analgesic to morphine for pain due to skeletal muscle spasm. Support Care Cancer. 2003;11(1):66–69. 15. Finckh A, Zufferey P, Schurch MA, et al. Short-term efficacy of intravenous pulse glucocorticoids in acute discogenic sciatica. A randomized controlled trial. Spine. 2006;31(4):377–381. 16. Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician. 2002;65(4):653–660.
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Emergency Department Analgesia An E
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Contents List of contributors page
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Tension-type headache 384 Trigemina
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Michel Galinski, MD Attending Physi
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Benjamin A. White, MD Resident, Har
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xiv Foreword code to light up the p
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xvi Foreword The authors of the boo
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Preface A typical shift in the Emer
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Acknowledgments Many thanks to this
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General considerations
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4 Introduction and general approach
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10 Assessment of pain CATHERINE A.
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12 Assessment of pain n Pain assess
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14 Assessment of pain The Face, Leg
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16 Assessment of pain 3. Silka P, R
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18 Assessment of pain 33. Melzack R
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20 Prehospital analgesia and protoc
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22 Prehospital analgesia prehospita
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24 Prehospital analgesia care provi
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26 Prehospital analgesia EMS settin
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28 Prehospital analgesia 18. Kurtz
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30 Prehospital analgesia 48. Helm M
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32 Epidemiologic overview of ED pai
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42 Geriatric analgesia ULA HWANG AN
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44 Geriatric analgesia physiologic
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46 Geriatric analgesia Analgesic ap
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48 Geriatric analgesia The common e
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50 Geriatric analgesia 12. Hohl C,
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52 Chronic pain DAVID CLINE AND STE
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54 Chronic pain care providers, it
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56 Chronic pain the agent’s monoa
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58 Chronic pain be in the ED record
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60 Chronic pain 7. Freynhagen R, Bu
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62 NSAIDs and opioids applicable sa
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64 NSAIDs and opioids We believe th
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66 NSAIDs and opioids well-demonstr
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68 NSAIDs and opioids 5. Navascues
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70 Nonstandard medication delivery
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78 Reflections on ED analgesia of u
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80 Reflections on ED analgesia para
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82 Reflections on ED analgesia chem
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Chief complaints and diagnoses
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88 Abdominal aortic aneurysm occurs
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90 Abdominal aortic aneurysm 19. Le
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92 Aortic dissection Citing sedativ
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94 Arthritis TODD M. LISTWA AND STE
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96 Arthritis NSAIDs may be safer th
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98 Arthritis for patients with high
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100 Arthritis rofecoxib, ordiclofen
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102 Arthritis For breakthrough pain
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104 Arthritis Pediatric: NSAID (e.g
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106 Arthritis 13. Hur C, Chan AT, T
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108 Arthritis 38. Curtis SP, Ko AT,
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110 Arthritis 63. Bliddal H, Tersle
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112 Biliary tract pain A retrospect
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114 Biliary tract pain n Summary an
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116 Biliary tract pain 20. Malesci
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118 Bites and stings - marine enven
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120 Bites and stings - marine jelly
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122 Bites and stings - marine 11. C
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124 Bites and stings - terrestrial
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134 Breast pain COX-2 selective NSA
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136 Breast pain Pregnancy: acetamin
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138 Burns JEREMY ACKERMAN AND ADAM
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140 Burns for moderate-to-severe bu
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142 Burns References 1. Singer AJM,
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144 Burns 30. Patterson DR, Ptacek
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146 Bursitis and periarticular infl
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152 Cancer and tumor pain bony (or
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154 Cancer and tumor pain (20 mg ev
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156 Cancer and tumor pain existing
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158 Cancer and tumor pain n Summary
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160 Cancer and tumor pain 21. Carac
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162 Cardiac chest pain KALANI OLMST
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164 Cardiac chest pain has traditio
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166 Cardiac chest pain Practice Gui
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168 Chest wall trauma MICHEL GALINS
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170 Chest wall trauma NSAIDs. As is
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172 Chest wall trauma n Summary and
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174 Chest wall trauma 21. Seltzer J
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176 Chronic low-back pain limited t
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178 Chronic low-back pain n Summary
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180 Cluster headache SOHAN PAREKH A
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182 Cluster headache n Summary and
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184 Corneal abrasion LISA CALDER n
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186 Corneal abrasion 6. Patrone G,
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188 Cystitis, urethritis, and prost
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194 Dysmenorrhea to that achieved w
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196 Dysmenorrhea 12. Fine PG. The r
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198 Endometriosis by 50-74% compare
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200 Esophageal spasm KALANI OLMSTED
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202 Esophageal spasm via central mo
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204 Fibromyalgia MICHAEL WALTA AND
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206 Fibromyalgia A multicenter plac
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208 Fibromyalgia n Summary and reco
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210 Fibromyalgia 15. Sayar K, Aksu
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212 Fibromyalgia 41. Russell IJ, Mi
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214 Gastritis and peptic ulcer dise
Page 240 and 241: 216 Gastritis and peptic ulcer dise
Page 250 and 251: 226 Gastroesophageal reflux disease
Page 256 and 257: 232 Hemorrhoids and perianal pain B
Page 258 and 259: 234 Hemorrhoids and perianal pain a
Page 260 and 261: 236 Hemorrhoids and perianal pain t
Page 262 and 263: 238 Hemorrhoids and perianal pain C
Page 264 and 265: 240 Hemorrhoids and perianal pain 9
Page 266 and 267: 242 Hemorrhoids and perianal pain 3
Page 268 and 269: 244 Migraine and undifferentiated h
Page 278 and 279: 254 Mucositis and stomatitis KELLY
Page 280 and 281: 256 Mucositis and stomatitis eviden
Page 282 and 283: 258 Mucositis and stomatitis above)
Page 284 and 285: 260 Mucositis and stomatitis 5. Dem
Page 286 and 287: 262 Mucositis and stomatitis 30. Mu
Page 288 and 289: 264 Neck and back pain - mechanical
Page 292 and 293: 268 Neck and back pain - radicular
Page 298 and 299: 274 Neck and back pain - spinal spo
Page 300 and 301: 276 Neck and back pain - spinal spo
Page 302 and 303: 278 Neuropathy - complex regional p
Page 304 and 305: 280 Neuropathy - diabetic DAVID CLI
Page 306 and 307: 282 Neuropathy - diabetic n Summary
Page 308 and 309: 284 Neuropathy - diabetic 16. Lesse
Page 310 and 311: 286 Neuropathy - HIV related 3600 m
Page 312 and 313: 288 Neuropathy - HIV related 12. Le
Page 314 and 315: 290 Neuropathy - overview OVER-THE-
Page 316 and 317: 292 Neuropathy - overview The TCAs,
Page 318 and 319: 294 Neuropathy - overview Gabapenti
Page 320 and 321: 296 Neuropathy - overview However,
Page 322 and 323: 298 Neuropathy - overview Reference
Page 324 and 325: 300 Neuropathy - overview 27. Wiffe
Page 326 and 327: 302 Neuropathy - phantom limb pain
Page 328 and 329: 304 Neuropathy - phantom limb pain
Page 330 and 331: 306 Ocular inflammation STEPHEN H.
Page 332 and 333: 308 Ocular inflammation Other RCT d
Page 334 and 335: 310 Ocular inflammation Pregnancy:
Page 336 and 337: 312 Ocular inflammation 20. Frucht-
Page 338 and 339: 314 Odontalgia MICHAEL T. SCHULTZ A
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316 Odontalgia 100 mg caffeine and
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318 Odontalgia TOPICAL THERAPY Topi
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320 Odontalgia 4. Cooper SA, Engel
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322 Odontalgia 32. Sveen OB, Yaekel
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324 Orthopedic extremity trauma inf
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326 Orthopedic extremity trauma The
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328 Orthopedic extremity trauma fem
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330 Orthopedic extremity trauma 35.
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332 Osteoporotic vertebral compress
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334 Osteoporotic vertebral compress
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336 Otitis media and externa benefi
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338 Otitis media and externa 5. Var
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340 Pancreatitis (which lacks effec
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342 Pancreatitis 5. Hubbard GP, Wol
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344 Pharyngitis KELLY YOUNG n Agent
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346 Pharyngitis complete pain relie
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348 Pharyngitis 7. Blagden M, Chris
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350 Pharyngitis 31. Shi Y, Gu R, Li
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352 Postdural puncture headache Cas
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354 Post-herpetic neuralgia JEREMY
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356 Post-herpetic neuralgia virtual
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358 Post-herpetic neuralgia 11. Raj
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360 Renal colic scores. 3 The Cochr
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362 Renal colic References 1. O’C
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364 Sialolithiasis n Summary and re
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366 Sickle cell crisis concluded th
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368 Sickle cell crisis One potentia
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370 Sickle cell crisis titrated in
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372 Sickle cell crisis but acute ca
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374 Sickle cell crisis treatment ti
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376 Sickle cell crisis 3. Dunlop RJ
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378 Sickle cell crisis Disease-rela
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380 Temporomandibular disorders NAT
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382 Temporomandibular disorders n S
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384 Tension-type headache SOHAN PAR
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386 Tension-type headache for TH, b
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388 Tension-type headache 18. Lance
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390 Trigeminal neuralgia as the ini
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392 Undifferentiated abdominal pain
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Tables
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Selected nonsteroidal anti-inflamma
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Selected opioids Maintenance pediat
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Other analgesic drugs Lactation Dos
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Other analgesic drugs (cont.) Lacta
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Other analgesic drugs (cont.) Lacta
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