EmuFlex Cream

Innovative natural pathway for joints and muscles pain management

PathoPhysiology Of Joints Pain There may be :

o Pain (arthralgia).o Inflammation (arthritis) - redness, warmth, and swelling

There may be:o Only a single joint involved (mono-articular).o Multiple joints involved.

The pain may occur :o Only with use, suggesting a mechanical problem (eg,

osteoarthritis, tendinitis).o At rest, suggesting inflammation (eg, crystal disease, septic

arthritis). There may or may not be fluid within the joint (effusion).

Joint pain may arise from: Structures within the joint (intra-articular):

o Sources of pain within the joint include the joint capsule, periosteum, ligaments, subchondral bone, and synovium, but not the articular cartilage, which lacks nerve endings

o Inflammatory. Infectious arthritis Rheumatoid arthritis Crystal deposition arthritis

o Non-inflammatory Osteoarthritis. internal mechanical derangement

Joint pain may arise from (cont..) Structures adjacent or a round to the joint (peri-articular)

o Bursitis o Tendinitis o Extra-articular disorders (eg, polymyalgia rheumatica, fibromyalgia).

Referred Pain from more distant sites

Aetiology of Joint PainMono-articular Pain

• Trauma : ( overuse – fractures – hemarthrosis). Most common – to all ages

• Internal derangement or intra-articular trauma (Meniscus injury – ligament tear)

• Infectious or Septic arthritis (eg, bacterial, fungal, viral, mycobacterial, spirochetal, parasitic). Most important to rule out.

• Reactive arthritis (Aseptic inflammatory arthritis).• Crystal-induced disease (gout or pseudogout)• Periarticular syndromes (eg, bursitis, epicondylitis, fasciitis,

tendinitis, tenosynovitis)

Mono-articular Pain

• Uncommon Causes :– Avascular necrosis (H/O corticosteriod use or sickle cell

anaemia) – Neuropathy (Charcot ‘s Joint).– Osteoarthritis– Osteomyelitis.– Lyme disease.– Paget’s disease (Osteitis deformans)– Tumor

Poly-articular Joint Pain

• Acute polyarticular arthritis is most often due to the following: – Infection (usually viral)– Flare of a rheumatic disease

• Chronic polyarticular arthritis in adults is most often due to the following: – RA (inflammatory)– Osteoarthritis (noninflammatory)

• Chronic polyarticular arthritis in children is most often due to the following: – Juvenile idiopathic arthritis

Symptoms of joint disease Symptoms of joint disease Pain

o Inflammatory joint disease o present both at rest and with motion. o It is worse at the beginning than at the end of usage.

o Non-inflammatory joint disease(ie, degenerative, traumatic, or mechanical) o Occurs mainly or only during motion o Improves quickly with rest. o Patients with advanced degenerative disease of the hips, spine, or

knees may also have pain at rest and at night. o Pain that arises from small peripheral joints tends to be more

accurately localized than pain arising from larger proximal joints. For example, pain arising from the hip joint may be felt in the groin or buttocks, in the anterior portion of the thigh, or in the knee.

Stiffness – Stiffness is a perceived sensation of tightness

when attempting to move joints after a period of inactivity. It typically subsides over time. Its duration may serve to distinguish inflammatory from non-inflammatory forms of joint disease.

– With inflammatory arthritis, the stiffness is present upon waking and typically lasts 30-60 minutes or longer.

– With noninflammatory arthritis, stiffness is experienced briefly (eg, 15 min) upon waking in the morning or following periods of inactivity.

Swelling –With inflammatory arthritis, joint swelling is

related to synovial hypertrophy, synovial effusion, and/or inflammation of periarticular structures. The degree of swelling often varies over time. –With noninflammatory arthritis, the

formation of osteophytes leads to bony swelling. Patients may report gnarled fingers or knobby knees. Mild degrees of soft tissue swelling do occur and are related to synovial cysts, thickening, or effusions.

Limitation of motion • Loss of joint motion may be due to structural damage,

inflammation, or contracture of surrounding soft tissues. • Patients may report restrictions on their activities of daily

living, such as fastening a bra, cutting toenails, climbing stairs, or combing hair.

Weakness • Muscle strength is often diminished around an arthritic joint

as a result of disuse atrophy. • Weakness with pain suggests a musculoskeletal cause (eg,

arthritis, tendonitis) rather than a pure myopathic or neurogenic cause.

• Manifestations include decreased grip strength, difficulty rising from a chair or climbing stairs, and the sensation that a leg is "giving way."

Fatigue • Fatigue is usually synonymous with

exhaustion and depletion of energy in patients with arthritis. • With inflammatory polyarthritis, the fatigue is

usually noted in the afternoon or early evening. • With psychogenic disorders, the fatigue is

often noted upon arising in the morning and is related to anxiety, muscle tension, and poor sleep.

Management

• General education, Physiotherapy analgesics and/or anti-inflammatory drugs

• Infection (if in doubt, treat until culture result)

Gram +ve flucloxacillin, benzylpenicillin, Gram -ve 3rd generation cephalosporin 6 weeks in total (2 iv, 4 po)

• Haemarthrosis joint aspiration

• Reactive arthritis joint injection (steroid and local anaesthetic) ophthalmology review screen partner (?) DMARD (Disease Modifying Anti-Rheumatic Drugs)

(sulphasalazine/MTX) if chronic

• Crystal arthritis NSAID/colchicine/joint injection (steroid/LA) lifestyle review Allopurinol if recurrent, tophaceous or erosive

• Sero-negative spondyloarthritis joint injection (steroid and LA) DMARD if chronic surgery (synovectomy, replacement)

• Osteoarthritis education, wt loss, physio joint injection (steroid/LA or hyuralonate) surgery

Muscles Pain and Aches

- Counter irritants are considered as an important pain reliever.

- Peppermint oil is considered as important and effective counter irritant agent.

Mechanism of action of counter irritants

counter-irritant has an effect of overriding noxious pain signals traveling to the brain through a process modulated between pain-transmitting and non-pain transmitting neurons. This process, known as "gate control" or "gating," was first described by Melzak and Wall.

Gate control theory is based on the understanding that pain is transmitted by two kinds of afferent nerve fibers. One is the larger myelinated A-delta fiber, which carries quick, intense-pain messages. The other is the smaller, unmyelinated "C" fiber, which transmits throbbing, chronic pain. A third type of nerve fiber, called A-beta, is "nonnociceptive," meaning it does not transmit pain stimuli. The gate control theory asserts that signals transmitted by the A-delta and C pain fibers can be thwarted by the activation/stimulation of the nonnociceptive A-beta fibers and thus inhibit an individual's perception of pain.

EmuFlex Cream Pharmacology Overview

Active Constituent Main active ingredient Action

Emu Oil Linolinic acid and Oleic acid

Used by the Aboriginal people of Australia for the treatment of muscle and joint pain, contains a variety of fatty acids. Modern research into the properties of emu oil has found that this is the greatest skin emollient in the world, with deep skin penetration properties better than any other natural oil. 

Active Constituent Main active ingredient Action

Glucosamine Sulfate Glucosamine Sulfate

Enhances the ability of the body to manufacture collagen and proteoglycans, which are essential for rebuilding joints. Glucosamine also enhances the ability of the body to manufacture synovial fluid, which lubricates your joints.

Active Constituent Main active ingredient Action

Methyl Sulfonyl Methane (MSM)

MSM

A major detoxifier of the body, is responsible for opening the sodium/potassium pump in every cell allowing fluids into the cell membrane, while permitting toxins to exit. Great transporter for nutrients.

Active Constituent Main active ingredient Action

Ginger root extract 6-gingerol and 6-shogaol

Is a natural herb that possesses many therapeutic properties. The most relevant to arthritis sufferers, particularly those with rheumatoid arthritis, is its ability to inhibit inflammation and bring immediate relief from

pain .

Active Constituent Main active ingredient Action

White willow bark extract Salicin and Salicortin

White willow bark has been used throughout the world as an antipyretic and analgesic.Since the development of synthetic acetylsalicylic acid in the 1890’s,

Active Constituent Main active ingredient Action

Peppermint oil Menthol and Menthone methyl acetate

Stimulates the nerves that perceive cold and depress those for pain. A feeling of warmth follows the initial cooling effect

Just try EmuFlex cream, because:

• EmuFlex cream is formulated with care by a professional Doctors and Pharmacisits

• EmuFlex cream Contains best-studied and potent ingredients for pain.

• EmuFlex cream immediately relieve arthritis pain, sore joints & muscle ache.

• EmuFlex cream stimulates blood circulation in muscles and connecting tissues with deep pain relief.

• EmuFlex cream Provide soothing and lasting joint pain relief. Improve joint flexibility and range of motion.

• EmuFlex cream formula contains Emu oil which considered as an excellent carrier and increase absorption for both of Glucosamine and MSM through the skin.

• EmuFlex cream has an excellent safety profile.