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We selected tramadol as a representative drug to address our objective because it is widely prescribed as an unscheduled opioid analgesic and can easily be purchased from NPOPs. As such, the geometric growth in the use of online pharmacies around the world should prompt intense medical and regulatory discussion about their role in the provision of medical care. These medications include HIV drugs, benzodiazepines, and cholesterol medications, as well as lifestyle drugs, such as diet pills and erectile dysfunction medications. In fact, one study demonstrated the efficacy of utilizing an accredited online pharmacy to prescribe Viagra. They also provided a more complete medical history 21. To manage the increased use of online pharmacies, however, more regulations are being proposed, including the Online Pharmacy Safety Act and the development of state-run online pharmacy programs 22, 23. It should be stressed that no matter what legislative controls are adopted, there is a simple way to bypass these restrictions: move the NPOPs offshore, which is rapidly occurring with little government control 7, 25 - 31. Finally, the medications themselves could be expired, counterfeit, or cut with other substances. The study described in this paper was designed to address these issues. Tramadol was selected as the representative drug for this study because it is extensively prescribed the third most frequently used analgesic 38 and it is one of the most commonly offered authentic drugs from NPOPs with few restrictions on refills or quantity of tablets offered 8, 10.

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Impact of Internet pharmacy regulation on opioid analgesic availability. Tell any doctor or dentist who treats you that you are using this medicine.

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Apart from the anaesthetic itself, what other types of drugs might be used during the operation. Case study The following case study shows a situation where a physiotherapist working in a pain clinic is involved in the management of a patient. A six-month history of low back pain and leg pain for pain management. The patient is otherwise fit and well, but has not worked for six months. The patient has been diagnosed as having nociceptive low back pain and neuropathic leg pain, which was confirmed by very mild nerve root compression as seen on the magnetic resonance imaging scan. In conjunction with the consultant pain physician, the patients pain management plan was devised to include listing for epidural therapy, rationalization of his medication and referral to a concurrent pain management programme.


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References Bolam v Friern Hospital Management Committee All England Law Reports Bolitho v City and Hackney Health Authority All England Law Reports Burke, L. PGDs do you know what they are saying.

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Mr Davies is quite knowledgeable about his bipolar disorder and the combination of drugs he uses to control the symptoms, but he is less sure about what having hypertension means. He tells you that he has his blood tested every three months and that last time he went to the clinic they prescribed him a new drug that he had not taken before and told him to come back in a week.

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