Journal of back and musculoskeletal rehabilitation
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The purpose of this study was to assess the amount of thoracic segmental flexion associated with cervical forward bending. Twenty-four healthy men and women between the ages of 21-29, with no past or present cervical or thoracic dysfunction, participated. Spinal segmental mobility in the thoracic region was measured in the neutral sitting position and sitting with the cervical spine in the forward bent position. ⋯ The ranges of the motion and the "representative angle" (most likely the mean angle) in degrees for each thoracic segment are T1-T5 2-5 (4); T6 2-7 (5); T7-T9 3-8 (6); T10 4-14 (9); and T11-T12 6-20 (12). However, they did not state how their estimated range and "representative angle" in degrees of segmental spinal mobility were measured.10,11 Valencia in the book Physical Therapy of the Cervical and Thoracic Spine states similar motion for the thoracic segments.12The upper-thoracic spine, T1-T6, has been related to the cervical region anatomically. The upper-thoracic facet joints are orientated like the cervical facet joints and have a similar pattern of movement.11,13 Additionally, the caudal attachment of many cervical muscles is in the thoracic region.13.
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Chronic pain is experienced by approximately one-third of all cancer patients and as many as 70 to 90% of those with advanced disease.1 Although established pharmacotherapeutic strategies have been demonstrated to benefit most patients, undertreatment remains common.1 This unacceptable situation must be remedied; relief of cancer pain is an ethical imperative and it is incumbent upon clinicians to maximize the knowledge, skill, and diligence needed to attend to this task.2Analgesic pharmacotherapy is the mainstay approach in the management of cancer pain.3,4 Optimal therapy depends on an understanding of the clinical pharmacology of analgesic drugs and comprehensive assessment of the pain, medical condition, and psychosocial status of the patient. Through a process of repeated evaluations, therapy with opioid, nonopioid, and adjuvant analgesics is individualized to achieve and maintain a favorable balance between pain relief and adverse effects. An expert committee convened by the Cancer Unit of the World Health Organization has proposed a useful approach to drug selection for cancer pain, which has become known as the "analgesic ladder" (Fig. 1).3 When combined with appropriate dosing guidelines, this approach is capable of providing adequate relief to 70 to 90% of patients.5-9 Emphasizing that the intensity of pain, rather than its specific etiology, should be the prime consideration in analgesic selection, the approach advocates the following three basic steps:Step 1. ⋯ Patients who are relatively nontolerant and present with moderate to severe pain, or who tail to achieve adequate relief after a trial of a nonopioid analgesic, should be treated with a socalled "weak" opioid; this drug is typically combined with a nonopioid and may be coadministered with an adjuvant analgesic or other adjuvant drug, if there is an indication for one. Step 3. Patients who present with severe pain, or fail to achieve adequate relief following appropriate administration of drugs on the second rung of the analgesic ladder, should receive a so-called strong opioid, which may be combined with a nonopioid analgesic or an adjuvant drug as indicated.