Rising Stronger – Celebrating the Galt Journey and Embracing the Future

Rising Stronger – Celebrating the Galt Journey and Embracing the Future

Barry Patel
Barry Patel

CEO and Co-Founder

As 2024 draws to a close, we take a moment to reflect on an extraordinary year that marks a turning point in our journey. After eight years of perseverance, innovation, and an unwavering commitment to helping patients, 2024 has been our best year yet at Galt Companies.

Galt’s story is one of resilience and determination. As a self-funded company, we’ve faced significant challenges, from navigating the complexities of the pharmaceutical industry to weathering the storm of the Covid-19 pandemic. While the early days tested our resolve, they also defined who we are today—a company built on the foundation of grit, adaptability, and a steadfast mission to serve patients with innovative, non-opioid, non-addictive pain management solutions.

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The pandemic was a particularly difficult chapter, as it limited our ability to connect directly with healthcare providers and disrupted many of our traditional avenues for growth. Rather than retreat, we used those challenges to strengthen our core by finding ways to diversify our approaches to the market. We invested in building robust systems, refining our processes, and aligning our operations to support our unique model—one that prioritizes collaboration with entrepreneurs and local, community-based independent pharmacies. We emerged from those challenging times stronger and more prepared for the opportunities ahead.

And what a year 2024 has been! This year, we added Tolectin®DS to our Norgesic® promotions to give healthcare providers ‘muscle or bone’ options in providing effective pain relief without the risks associated with opioids. We also expanded our distribution network, welcoming new franchisees and independent pharmacy partners who share our vision and values. These collaborations bring our medications to more patients and communities across the country. Additionally, we undertook a comprehensive upgrade of our CRM platforms, empowering our sales professionals and franchisees with cutting-edge tools to better serve healthcare providers and ensure that our products reach those who need them most.

While 2024 has been a banner year, we know it’s just the beginning. The foundation we’ve laid over the past eight years positions us for even greater achievements in the years to come. Our journey continues as we are more motivated than ever to innovate, collaborate, and make a meaningful impact in the lives of patients. To our team, our franchisees, our distributors, our independent pharmacy partners, and all our supporters: thank you for believing in our vision and for being part of this incredible journey. As we look ahead to 2025 and beyond, we do so with excitement and confidence that the best is yet to come.

Here’s to rising stronger together!

 

 

 

Brief History and Proper Utilization of NSAIDs

Brief History and Proper Utilization of Nonsteroidal Anti-inflammatory Drugs

Scott Chappell
Scott Chappell

Galt Pharmaceuticals Director of Medical Affairs

Background on NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) have a long and storied history, beginning with the use of salicylate-containing willow bark for pain and fever relief in ancient cultures. The active component, salicylic acid, was chemically synthesized in 1860, leading to the development of acetylsalicylic acid (aspirin) in 1897. Aspirin’s success spurred the development of other NSAIDs, which were initially organic acids but later included non-acidic compounds.

NSAIDs exert their effects primarily through the inhibition of cyclooxygenase (COX) enzymes, which are crucial for prostaglandin synthesis. There are two main isoforms: COX-1, which is involved in maintaining physiological functions such as gastrointestinal protection and platelet aggregation, and COX-2, which is induced during inflammation and mediates pain and fever. The discovery of these isoforms in the 1990s led to the development of selective COX-2 inhibitors (coxibs), designed to reduce gastrointestinal side effects associated with non-selective NSAIDs. However, the introduction of coxibs like celecoxib and rofecoxib revealed significant cardiovascular risks, leading to the withdrawal of rofecoxib from the market in 2004. This highlighted the need for a balance between efficacy and safety in NSAID therapy.

NSAIDs have widespread use and therapeutic benefits, but note that they are associated with adverse effects, including gastrointestinal ulcers, cardiovascular events, and renal toxicity. Strategies to mitigate these risks include using the lowest effective dose for the shortest duration and co-prescribing gastroprotective agents like proton-pump inhibitors for high-risk patients. The ongoing evolution of NSAIDs aims to enhance their safety while maintaining their efficacy in treating pain, inflammation, and fever.

Mitigating the Risks for Patients Who Need to use NSAIDs

To monitor and mitigate the risks for patients who need to use NSAIDs, especially those with a history of gastrointestinal (GI) bleeding, cardiovascular disease, or renal impairment, several strategies can be employed:

  1. Use the Lowest Effective Dose for the Shortest Duration: This is a fundamental principle to minimize adverse effects. The FDA emphasizes this approach to reduce the risk of GI bleeding, cardiovascular events, and renal toxicity.
  2. Gastrointestinal Protection: For patients with a history of GI bleeding or at high risk, co-therapy with proton-pump inhibitors (PPIs) or misoprostol is recommended. The American College of Gastroenterology advises using a COX-2 inhibitor plus a PPI or misoprostol for high-risk patients. Testing and eradicating  pyloriinfection can also reduce the risk of peptic ulcers in NSAID users.
  3. Cardiovascular Risk Management: The American Heart Association recommends avoiding NSAIDs, particularly COX-2 inhibitors, in patients with cardiovascular disease. If NSAIDs are necessary, naproxen may be preferred due to its relatively lower cardiovascular risk. Monitoring blood pressure and managing other cardiovascular risk factors are crucial.
  4. Renal Function Monitoring: Regular monitoring of renal function, fluid retention, and electrolyte levels is essential, especially in patients with preexisting renal impairment, heart failure, or those on diuretics or ACE inhibitors. The FDA and other literature recommend avoiding NSAIDs in patients with advanced renal disease and using alternative therapies when possible.
  5. Patient Education and Monitoring: Educate patients about the signs and symptoms of GI bleeding, cardiovascular events, and renal impairment. Regular follow-up and prompt evaluation of any adverse symptoms are critical.

By implementing these strategies, clinicians can better manage the risks associated with NSAIDs used in vulnerable patient populations.

Patient Groups That Should Avoid NSAIDs

Certain patient groups should avoid using nonsteroidal anti-inflammatory drugs (NSAIDs) due to their potential adverse effects, including gastrointestinal (GI) ulcers, cardiovascular events, and renal toxicity.

  • Elderly patients are at increased risk for NSAID-related adverse effects, including GI bleeding, renal impairment, and cardiovascular events. Elderly patients, especially those with comorbidities, are particularly vulnerable to these risks.
  • Patients with a history of peptic ulcer disease or gastrointestinal bleeding should avoid NSAIDs due to a significantly increased risk of GI bleeding. The FDA notes that these patients have a greater than 10-fold increased risk for developing a GI bleed when using NSAIDs.
  • Patients with cardiovascular disease or patients at high risk for cardiovascular events should avoid NSAIDs, particularly COX-2 inhibitors, due to the increased risk of myocardial infarction and stroke. The American Heart Association advises against the use of NSAIDs in patients with established cardiovascular disease.
  • Patients with renal impairment, heart failure, or chronic kidney disease (CKD) should avoid NSAIDs due to the risk of worsening renal function and potential for acute kidney injury. The National Comprehensive Cancer Network (NCCN) guidelines recommend caution in these patients to prevent renal toxicities.
  • Patients on concurrent anticoagulant or corticosteroid therapy should avoid NSAIDs due to the increased risk of GI bleeding and other complications. The NCCN guidelines also emphasize the increased bleeding risk when NSAIDs are used with anticoagulants.

List of NSAIDs Available in the United States

The following is a list of commonly available NSAIDs in the United States by generic and brand name:

Ibuprofen (Advil®, Motrin®, IBU®)

Naproxen (Aleve®, Naprosyn®, Naprelan®)

Diclofenac (Voltaren®, Cataflam®)

Celecoxib (Celebrex®)

Meloxicam (Mobic®)

Indomethacin (Indocin®)

Ketorolac (Toradol®)

Etodolac (Lodine®)

Piroxicam (Feldene®)

Sulindac (Clinoril®)

Diflunisal (Dolobid®)

Salsalate (Disalcid®)

Oxaprozin (Daypro®)

Nabumetone (Relafen®)

Flurbiprofen (Ansaid®)

Fenoprofen (Nalfon®)

Meclofenamate (Meclomen®)

Tolmetin (Tolectin®DS)

NSAIDs are commonly used to treat a range of conditions, from minor aches and pains to chronic diseases such as arthritis. As a result, NSAIDs are highly effective for conditions like headaches, menstrual cramps, sprains, and inflammatory disorders such as osteoarthritis and rheumatoid arthritis.

NSAIDs are highly beneficial for managing pain and inflammation, but like all medications, they should be used with care, balancing their effectiveness against potential side effects.

References

  1. Vane JR, Botting RM. Mechanism of Action of Nonsteroidal Anti-Inflammatory Drugs. The American Journal of Medicine. 1998;104(3A):2S-8S; discussion 21S-22S.K. D.
  2. Rainsford, “ANTI-INFLAMMATORY DRUGS IN THE 21ST CENTURY,” Sub-Cellular Biochemistry. 2007;42:3-27
  3. Vonkeman HE, van de Laar MA. “Nonsteroidal Anti-Inflammatory Drugs: Adverse Effects and Their Prevention,” Seminars in Arthritis and /Rehumatism. 2010;39(4):294-312.
  4. Wehling M., Non-Steroidal Anti-Inflammatory Drug Use in Chronic Pain Conditions With Special Emphasis on the Elderly and Patients With Relevant Comorbidities: Management and Mitigation of Risks and Adverse Effects. European Journal of Clinical Pharmacology. 2014;70(10):1159-72.
  5. Antman EM, Bennett JS, Daugherty A, et al. Use of Nonsteroidal Antiinflammatory Drugs: An Update for Clinicians: A Scientific Statement From the American Heart Association. Circulation. 2007;115(12):1634-42.
  6. Bouck Z, Mecredy GC, Ivers NM, et al. Frequency and Associations of Prescription Nonsteroidal Anti-Inflammatory Drug Use Among Patients With a Musculoskeletal Disorder and Hypertension, Heart Failure, or Chronic Kidney Disease. JAMA Internal Medicine. 2018;178(11):1516-1525. doi:10.1001/jamainternmed.2018.4273.
  7. Lanza FL, Chan FK, Quigley EM. Guidelines for Prevention of NSAID-related Ulcer Complications. The American Journal of Gastroenterology. 2009;104(3):728-38.
  8. Wilcox CM, Allison J, Benzuly K, et al. Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents, Including Cyclooxygenase-2 Enzyme Inhibitors and Aspirin. Clinical Gastroenterology and Hepatology : The Official Clinical Practice Journal of the American Gastroenterological Association. 2006;4(9):1082-9.
  9. Domper Arnal MJ, Hijos-Mallada G, Lanas A. Gastrointestinal and Cardiovascular Adverse Events Associated With NSAIDs. Expert Opinion on Drug Safety. 2022;21(3):373-384.
  10. Ković SV, Vujović KS, Srebro D, Medić B, Ilic-Mostic T. Prevention of Renal Complications Induced by Non- Steroidal Anti-Inflammatory Drugs. Current Medicinal Chemistry. 2016;23(19):1953-64. 
  11. LaForge JM, Urso K, Day JM, et al. Non-Steroidal Anti-Inflammatory Drugs: Clinical Implications, Renal Impairment Risks, and AKI. Advances in Therapy. 2023;40(5):2082-2096.
  12. Ribeiro H, Rodrigues I, Napoleão L, et al. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Pain and Aging: Adjusting Prescription to Patient Features. Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie. 2022;150:112958.
  13. Domper Arnal MJ, Hijos-Mallada G, Lanas A. Gastrointestinal and Cardiovascular Adverse Events Associated With NSAIDs. Expert Opinion on Drug Safety. 2022;21(3):373-384.
  14. Nam YH, Brensinger CM, Bilker WB, et al. Nonsteroidal Anti-Inflammatory Drug Choice and Adverse Outcomes in Clopidogrel Users: A Retrospective Cohort Study. PloS One. 2018;13(3):e0193800. doi:10.1371/journal.pone.0193800.

Understanding Oral Thrush

Understanding Oral Thrush

Viral Patel
Viral Patel

Galt Pharmaceuticals Medical Affairs Fellow, 2024-2025

Overview

Oral thrush is a type of fungal infection caused by an overgrowth of yeast. This opportunistic infection is also referred to as oropharyngeal candidiasis. This condition is primarily caused by the overgrowth of Candida species, most commonly Candida albicans. This condition disrupts oral mucosa and impairs innate and adaptive immune responses, particularly in immunocompromised individuals (1-2).

Risk factors

• Immunosuppression: Conditions such as HIV/AIDS, diabetes mellitus, cancer, and the use of immunosuppressive therapies significantly increase the risk (3-5).
• Medications: Broad-spectrum antibiotics can disrupt normal oral microbiota and can facilitate Candida overgrowth (4).
• Age: Both extremes of age, such as neonates and the elderly are susceptible due to immature or declining immune function (1)(6).
• Local factors: denture use, poor oral hygiene, and xerostomia are notable local predisposing factors (1)(6).
• Lifestyle factors: smoking has been associated with an increased risk of developing oral thrush (1).

Symptoms

Oral thrush can have many different symptoms including:

• White patches on inner cheeks, tongue, roof of the mouth, and throat
• Redness or soreness
• Cotton-like feeling in the mouth
• Loss of taste
• Pain while eating or swallowing
• Cracking and redness at the corners of the mouth (7)

Prevention

Populations that are at risk can prevent oral thrush using a combination of antifungal prophylaxis, maintaining good oral hygiene, and using antibiotics as appropriate to remediate risk of infection (3).

Conclusion

Oral thrush is a fungal infection with multiple risk factors, predominantly related to immunosuppression and local oral conditions. Effective management involves addressing these risk factors and utilizing appropriate antifungal therapies.

References

1. Akpan A, Morgan R. Oral candidiasis. Postgrad Med J. 2002;78(922):455-459. doi:10.1136/pmj.78.922.455.
2. Yang L, Cheng T, Shao J. Perspective on receptor-associated immune response to Candida albicans single and mixed infections: implications for therapeutics in oropharyngeal candidiasis. Med Mycol. 2023;61(8). doi:10.1093/mmy/myad077.
3. Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4). doi:10.1093/cid/civ933.
4. Stoopler ET, Villa A, Bindakhil M, Díaz DLO, Sollecito TP. Common oral conditions: a review. JAMA. 2024;331(12):1045-1054. doi:10.1001/jama.2024.0953.
5. Erfaninejad M, Zarei Mahmoudabadi A, Maraghi E, Hashemzadeh M, Fatahinia M. Epidemiology, prevalence, and associated factors of oral candidiasis in HIV patients from southwest Iran in post-highly active antiretroviral therapy era. Front Microbiol. 2022;13:983348. doi:10.3389/fmicb.2022.983348.
6. Campisi G, Panzarella V, Matranga D, et al. Risk factors of oral candidiasis: a twofold approach of study by fuzzy logic and traditional statistics. Arch Oral Biol. 2008;53(4):388-397. doi:10.1016/j.archoralbio.2007.11.009.
7. Centers for Disease Control and Prevention. Candidiasis. Available at: CDC.

The Fentanyl Crisis in the United States

The Fentanyl Crisis in the United States: Understanding the Danger

Scott Chappell
Scott Chappell

Galt Pharmaceuticals Director of Medical Affairs

The United States is currently grappling with a severe and escalating public health crisis: the widespread abuse of fentanyl. This synthetic opioid, which is 50 to 100 times more potent than morphine, has become a major driver of overdose deaths across the nation. Understanding why fentanyl is so dangerous is crucial to addressing this urgent issue.

The Rise of Fentanyl

Originally developed for pain management in cancer patients, fentanyl’s medical use was strictly controlled. However, over the past decade, illicit production and distribution have surged. This shift is largely due to fentanyl’s potency and the relative ease with which it can be synthesized in underground laboratories.

Fentanyl is often mixed with other drugs like heroin, cocaine, and methamphetamine, sometimes without the user’s knowledge. This practice increases the risk of overdose significantly, as even a minuscule amount of fentanyl can be lethal. According to the Centers for Disease Control and Prevention (CDC), fentanyl and its analogs were involved in more than 67,000 overdose deaths in the United States in 2021 alone.

Why Fentanyl is So Dangerous

  • Extreme Potency: Fentanyl’s high potency means that very small doses can cause severe respiratory depression and death. This makes it much more dangerous than other opioids. A few milligrams—the equivalent of a few grains of salt—can be lethal.

  • Unpredictable Dosing: When mixed with other drugs, users have no way of knowing the exact dose of fentanyl they are consuming. This unpredictability greatly increases the risk of overdose. Even experienced drug users can easily misjudge the amount, leading to accidental death.

  • Rapid Onset of Effects: Fentanyl acts quickly, often faster than users can react. This rapid onset leaves little time to seek help or administer life-saving interventions such as naloxone, an opioid overdose reversal drug.

  • Availability and Distribution: The illicit production of fentanyl is widespread, and it is often pressed into counterfeit pills that mimic prescription medications. These fake pills can be nearly indistinguishable from legitimate pharmaceuticals, leading to unintentional use by individuals seeking prescription drugs for legitimate purposes.

  • Challenges in Law Enforcement and Healthcare: Detecting and seizing fentanyl is challenging due to its high potency and the small quantities needed for distribution. Additionally, first responders and law enforcement officers are at risk of accidental exposure, which can be fatal. The healthcare system is also strained by the need for increased naloxone availability and the treatment of overdose survivors.

Addressing the Crisis

Efforts to combat the fentanyl crisis require a multifaceted approach. Key strategies include:

  • Education and Prevention: Public awareness campaigns can help inform people about the dangers of fentanyl and the risks of illicit drug use.

  • Enhanced Law Enforcement: Strengthening the capabilities of law enforcement to detect and intercept fentanyl shipments is crucial. This includes international cooperation to dismantle production and distribution networks.

  • Access to Treatment: Expanding access to addiction treatment services and harm reduction programs, such as supervised injection sites and needle exchange programs, can save lives.

  • Improved Data Collection: Better data on overdose deaths and drug use trends can inform targeted interventions and policy decisions.

Conclusion

The fentanyl crisis in the United States is a complex and deadly issue that continues to devastate communities across the nation. Understanding the unique dangers posed by fentanyl is essential for developing effective responses and ultimately saving lives. Through comprehensive efforts encompassing education, enforcement, and treatment, it is possible to mitigate the impact of this crisis and work towards a safer future.

Sources

  1. Centers for Disease Control and Prevention (CDC). “Drug Overdose Deaths in the U.S. Top 100,000 Annually.” Available at: CDC Newsroom
  2. National Institute on Drug Abuse (NIDA). “Fentanyl DrugFacts.” Available at: NIDA
  3. Drug Enforcement Administration (DEA). “Counterfeit Prescription Pills Containing Fentanyls: A Global Threat.” Available at: DEA
  4. By raising awareness and taking decisive action, we can hope to turn the tide on this devastating epidemic.

Simplifying the Prescribing Process

prescriber writing

Simplifying the Prescribing Process and How It Impacts Providers and Patients

Jimmy Fanning
Jimmy Fanning

Galt Pharmaceuticals Manager of Pharmacy Solutions

One of the greatest challenges that pharmaceutical reps face in the field is the one that begins after a prescriber has been sold on a product. From insurance coverage to assistance programs, many manufacturers choose to cut corners on support systems and instead pass the burden of effort onto office staff. This can result in burnout for the staff and negative feedback to providers, limiting prescription volume.

Galt Pharmaceuticals seeks to create a better system for prescribers and their support staff, one that minimizes effort while maximizing patient value. This process begins with the pharmacy that the provider chooses to send the prescription to and helps see that every prescription makes it into the patient’s hands while avoiding added stress to office staff.

Prescribing: Galt Sales Representatives encourage providers to send prescriptions for Galt Products to a small network of partner pharmacies. These pharmacies are specially trained in patient communication and insurance processing to help each patient attain the lowest possible price for their prescription. This avoids calls back to offices regarding product availability or price that may otherwise be made by large chain pharmacies.

Prior Authorization: Galt Pharmaceuticals contracts with CloudTop Health to streamline the Prior Authorization process. Once the case is initiated by a Galt Partner Pharmacy, the provider office receives a simple, 1 page request for patient diagnosis and medical history. Each request is custom tailored to the drug under review, eliminating the ambiguity of universal forms used by most PA vendors. The provider’s office needs to simply check boxes that apply to a given patient and provide one signature. CloudTop will then handle the filing of the case to insurance and the communication to the pharmacy, which would typically be the responsibility of the provider and their staff.

Insurance Coverage: Galt’s goal is to maximize the number of patients who are able to receive their prescription through their insurance plan at no out-of-pocket cost to them. Although most insurers assign copays to patients, Galt Pharmaceuticals pays these down to $0 where eligible. As an added bonus to patients, if they have a deductible as part of their insurance plan, they receive credit for the money Galt spends toward this deductible on their behalf.

Patient Assistance: For patients who are uninsured or underinsured and not able to receive Galt Products through their insurance, Galt offers a special Patient Assistance Program, also called Cash Pay. This allows patients to fill their Galt prescriptions for as little as $30 with no exclusion criteria. Many pharmaceutical manufacturers will require patient enrollment into these programs as well as exclude patients who do not meet specific criteria. Galt removes these barriers in order to maximize the number of patients with affordable access to its products.

All these programs come together to create a streamlined process that minimizes unnecessary effort from providers. Galt Pharmaceuticals understands that providers can be most effective when their focus and effort is dedicated to the patient’s needs rather than the needs of an insurance company or pharmacy. By investing in vendors and programs that increase patient access to its products, Galt seeks to provide value in every office that it works with.

Understanding Rheumatoid Arthritis and Osteoarthritis

pain in knee

Understanding Rheumatoid Arthritis and Osteoarthritis

Dane Croxton, Pharm. D.
Dane Croxton, Pharm. D.

Galt Pharmaceuticals Medical Science Sales Specialist

Rheumatoid Arthritis (RA) and Osteoarthritis (OA) are two prevalent forms of arthritis that impact millions of people worldwide. While they share some similarities, they differ significantly in their causes, symptoms, and treatment approaches. Additionally, there are other forms of arthritis, such as Juvenile Idiopathic Arthritis (JIA), which affect children. Let’s delve into these conditions to better understand their nuances.

Rheumatoid Arthritis (RA)

RA is an autoimmune disorder where the body’s immune system mistakenly attacks its own tissues, particularly the synovium—the lining of the membranes that surround the joints. This leads to inflammation, pain, and eventual joint damage.

Symptoms:

  • Joint pain, swelling, and stiffness, particularly in the morning or after periods of inactivity.
  • Fatigue, fever, and weight loss.
  • Symmetrical pattern of affected joints, often starting with smaller joints (e.g., fingers and toes) before progressing to larger ones (e.g., wrists, knees, and ankles).

Causes:

  • The exact cause is unknown, but genetic and environmental factors play a role.
  • Hormonal factors may also influence the disease, as RA is more common in women.

Treatment:

  • Disease-modifying antirheumatic drugs (DMARDs), biologics, and NSAIDs are commonly used to manage symptoms and slow disease progression.
  • Physical therapy and lifestyle changes, such as regular exercise and a healthy diet, are also beneficial.

Osteoarthritis (OA)

OA is the most common form of arthritis, characterized by the gradual breakdown of cartilage—the cushioning material between joints. Unlike RA, OA is primarily a wear-and-tear disease.

Symptoms:

  • Joint pain and stiffness, often worsening after activity.
  • Reduced flexibility and range of motion.
  • Bone spurs and a grating sensation in the affected joints.

Causes:

  • Aging and the natural degradation of cartilage over time.
  • Joint injury or overuse, which can accelerate cartilage breakdown.
  • Genetic predisposition and obesity, which adds stress to weight-bearing joints.

Treatment:

  • Pain relief through NSAIDs, acetaminophen, and topical treatments.
  • Physical therapy, exercise, and weight management to reduce joint strain.
  • In severe cases, surgical interventions such as joint replacement may be necessary.
pain in wrist

Comparing RA and OA

While both RA and OA involve joint pain and inflammation, their underlying causes and treatment strategies differ. RA is an autoimmune condition with a symmetrical pattern of joint involvement, often affecting smaller joints first. OA, on the other hand, is a degenerative disease caused by cartilage wear and tear, typically affecting larger, weight-bearing joints. Treatments for RA focus on immune modulation and reducing inflammation, while OA treatments aim to relieve pain and improve joint function.

Juvenile Idiopathic Arthritis (JIA)

JIA is the most common type of arthritis in children under the age of 16. Like RA, JIA is an autoimmune condition, but it specifically affects children and can lead to lifelong challenges if not properly managed.

Symptoms:

  • Persistent joint swelling, pain, and stiffness.
  • Limping or difficulty with motor skills.
  • Fever, rash, and eye inflammation in some cases.

Causes:

  • The exact cause is unknown, but it involves a combination of genetic and environmental factors.

Treatment:

  • Similar to RA, treatment includes DMARDs, biologics, and NSAIDs to control inflammation, manage pain, and prevent joint damage.
  • Physical and occupational therapy to maintain joint function and mobility.
  • Regular monitoring and supportive care to manage growth and development issues.

Conclusion

Understanding the differences between RA, OA, and JIA is crucial for effective treatment and management. While RA and JIA are autoimmune conditions requiring immune system modulation, OA’s treatment focuses on managing the mechanical wear and tear of joints. NSAIDs play a significant role in providing relief from the pain and inflammation associated with these conditions, helping patients maintain a better quality of life.

Rebound Insomnia

person with insomnia

Rebound Insomnia: Understanding the Phenomenon and Implications

Dane Croxton, Pharm. D.
Dane Croxton, Pharm. D.

Galt Pharmaceuticals Medical Science Sales Specialist

Introduction: Rebound insomnia is a phenomenon characterized by the exacerbation of insomnia symptoms upon discontinuation of certain medications used for sleep. This occurrence raises important considerations in the management of sleep disorders and the use of specific medications. This overview explores the concept of rebound insomnia and its implications for individuals seeking relief from sleep disturbances.

Definition and Mechanism: Rebound insomnia refers to the temporary worsening of insomnia symptoms that occurs when a person stops taking a medication designed to aid sleep. This phenomenon is thought to result from the body’s adjustment to the presence of the sleep aid, leading to a rebound effect upon discontinuation. The exact mechanisms can vary depending on the specific medication involved.

rebound insomnia graph
Common Medications Associated with Rebound Insomnia:
  1. Short-Acting Benzodiazepines: These sedative-hypnotic drugs are known to induce sleep but may lead to rebound insomnia upon cessation1.
  2. Non-Benzodiazepine Hypnotics: These medications, often prescribed for short-term insomnia, may also be associated with rebound insomnia2.
Clinical Implications:
  1. Short-Term Use Considerations: Healthcare providers must carefully consider the duration of medication use for sleep management, aiming to minimize the risk of rebound insomnia associated with certain medications3.
  2. Gradual Tapering: To mitigate rebound effects, a gradual tapering of medications rather than abrupt discontinuation is often recommended. This approach allows the body to adjust more gradually to changes in medication4.
Research Findings:
  • A study published in the “Journal of Clinical Psychopharmacology” found that individuals discontinuing benzodiazepine therapy experienced a temporary increase in insomnia symptoms, supporting the existence of rebound insomnia5.
  • Research in the “Journal of Clinical Sleep Medicine” highlights the importance of patient education on the potential for rebound insomnia when using sleep medications, aiding in informed decision-making during treatment6.

Conclusion: Rebound insomnia serves as a crucial consideration in the management of sleep disorders and the use of sleep-inducing medications. Awareness is essential for healthcare providers and individuals seeking effective and safe solutions for sleep disturbances. Balancing the benefits and potential risks of sleep medications, along with proper communication and monitoring, is key to optimizing sleep management strategies.

References:
  1. Lader, M. (2011). Benzodiazepines revisited—will we ever learn? Addiction, 106(12), 2086–2109.
  2. Roehrs, T., & Roth, T. (2018). Medication- and Substance-Induced Insomnia. In K. L. Lichstein & C. M. Morin (Eds.), Treatment of Late-Life Insomnia (pp. 215–235). Academic Press.
  3. American Academy of Sleep Medicine. (2017). Clinical guideline for the pharmacologic treatment of chronic insomnia in adults. Journal of Clinical Sleep Medicine, 13(02), 307–349.
  4. Mendelson, W. B. (2005). A review of the evidence for the efficacy and safety of trazodone in insomnia. Journal of Clinical Psychiatry, 66(4), 469–476.
  5. Ashton, H. (2005). The diagnosis and management of benzodiazepine dependence. Current Opinion in Psychiatry, 18(3), 249–255.
  6. Roth, T., Coulouvrat, C., Hajak, G., Lakoma, M. D., Sampson, N. A., Shahly, V., … & Kessler, R. C. (2011). Prevalence and perceived health associated with insomnia based on DSM-IV-TR; international statistical classification of diseases and related health problems, tenth revision; and research diagnostic criteria/international classification of sleep disorders, second edition criteria: Results from the America Insomnia Survey. Biological Psychiatry, 69(6), 592–600.

Understanding Bone and Muscle Pain

pain in knee

Understanding Bone and Muscle Pain: Causes, Symptoms, and Treatment

Scott Chappell
Scott Chappell

Galt Pharmaceuticals Director of Medical Affairs

Bone and muscle pain can be incredibly disruptive to one’s daily life, affecting mobility, productivity, and overall well-being. Whether it’s a dull ache or a sharp, shooting sensation, these pains can vary in intensity and duration, often leaving individuals searching for relief. This blog post will provide a brief overview of bone and muscle pain, exploring the causes, symptoms, and treatment options. The information provided in this blog post is intended for general informational purposes only and should not be construed as medical advice. While efforts have been made to ensure the accuracy and reliability of the information presented, it is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.

Understanding Bone Pain

Bone pain can stem from a variety of underlying causes, ranging from injury to systemic conditions. Here are some common causes of bone pain:

  • Injury: Fractures, sprains, and strains can lead to acute bone pain. Even minor injuries can cause discomfort, especially if left untreated.
  • Arthritis: Osteoarthritis and rheumatoid arthritis are two common types of arthritis that can affect the bones and joints, leading to chronic pain and stiffness.
  • Bone Infections: Conditions such as osteomyelitis, which is an infection of the bone, can cause localized pain, swelling, and redness.

Recognizing Muscle Pain

Muscle pain, also known as myalgia, can result from various factors, including overuse, injury, or underlying medical conditions. Here are some typical causes of muscle pain:

  • Overexertion: Engaging in strenuous physical activity or lifting heavy objects beyond one’s capacity can lead to muscle strain and soreness.
  • Muscle Tension: Prolonged periods of sitting or standing in poor posture can cause muscle tension and discomfort, particularly in the neck, shoulders, and lower back.
  • Fibromyalgia: This chronic condition is characterized by widespread musculoskeletal pain, fatigue, and tenderness in specific areas of the body.
  • Infections: Certain viral infections, such as influenza (the flu) or bacterial infections like Lyme disease, can cause muscle aches and weakness as part of their symptoms. (This article focuses on injury and inflammation from bone and muscle pain; thus, care and treatment of infection is outside the scope of this article.)

Symptoms of Bone and Muscle Pain

While bone and muscle pain may have different underlying causes, they often share similar symptoms, including:

  • Persistent aching or soreness in the affected area.
  • Limited range of motion or stiffness.
  • Swelling, tenderness, or redness around the painful area.
  • Difficulty performing daily activities due to pain.
  • Sharp or shooting pains with movement or pressure on the affected area.

Treatment Options

The treatment for bone and muscle pain depends on the underlying cause and severity of the condition. Here are some common approaches to managing these types of pain:

  1. Rest and Activity Modification: For acute injuries or strains, resting the affected area and avoiding activities that exacerbate pain can aid in the healing process.
  2. Pain Relief Medications (OTC): Over-the-counter pain relievers such as ibuprofen (Advil) or acetaminophen (Tylenol) can help alleviate mild-to-moderate bone and muscle pain.
  3. Physical Therapy: Rehabilitation exercises, stretching, and strengthening techniques prescribed by a physical therapist can improve mobility, reduce pain, and prevent future injuries.
  4. Heat and Cold Therapy: Applying heat packs or cold compresses to the affected area can help reduce inflammation, soothe sore muscles, and alleviate pain.
  5. Medications: In cases of severe acute or chronic pain, prescription medications such as muscle relaxants or anti-inflammatory drugs may be recommended by a healthcare provider.
  6. Alternative Therapies: Techniques such as massage therapy, acupuncture, and chiropractic care may provide relief for some individuals by promoting relaxation, improving circulation, and reducing muscle tension.

Seeking Medical Attention

While mild bone and muscle pain can often be managed at home with self-care measures, it’s essential to seek medical attention if you experience any of the following:

  • Severe or persistent pain that does not improve with rest and over-the-counter medications.
  • Swelling, redness, or warmth around the painful area, which may indicate an infection or inflammation.
  • Difficulty moving the affected limb or performing daily activities due to pain or stiffness.
  • Pain accompanied by other symptoms such as fever, numbness, tingling, or weakness.

In conclusion, bone and muscle pain can significantly impact an individual’s quality of life, affecting their ability to perform daily tasks and engage in activities they enjoy. By understanding the causes, symptoms, and treatment options for these types of pain, individuals can take proactive steps to manage their symptoms effectively and improve their overall well-being. If you’re experiencing persistent or severe pain, don’t hesitate to consult with a healthcare professional for proper diagnosis and treatment guidance. Your health and comfort are paramount, and addressing bone and muscle pain early can lead to better outcomes and a faster return to an active, pain-free lifestyle.

 

This article was adapted from the following sources:

Arthritis – Symptoms and causes – Mayo Clinic. (2023, August 29). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/arthritis/symptoms-causes/syc-20350772. Accessed March 25. 2024.

Branch, N. S. C. a. O. (2023a, May 12). Healthy muscles matter. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/kids/healthy-muscles. Accessed March 25, 2024.

Branch, N. S. C. a. O. (2023, December 15). NIAMS health information on osteoarthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/osteoarthritis/diagnosis-treatment-and-steps-to-take. Accessed March 25, 2024.

Branch, N. S. C. a. O. (2023a, July 27). NIAMS health information on sports injuries. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/sports-injuries. Accessed March 25,2024.

Buys, LM and Wiedenfeld, SA. (2023) Chapter 110 Osteoarthritis. DiPiro’s Pharmacotherapy: A Pathophysiologic Approach (12th Edition pp. 1706-1728). DiPiro JT, Yee GC, Haines ST, Nolin TD, Ellingrod V & Posey, LM. McGraw Hill.

Grosser, T, Ricciotti, E, and FitzGerald, GA (2022) Chapter 42 Pharmacotherapy of Inflammation, Fever, Pain, and Gout. Goodman and Gilman’s The Pharmacological Basis of Therapeutics (14th Edition pp. 961-993). Brunton, L & Knollmann,B. McGraw Hill.

Havelin J, King T. Mechanisms Underlying Bone and Joint Pain. Curr Osteoporos Rep. 2018 Dec;16(6):763-771. doi: 10.1007/s11914-018-0493-1. PMID: 30370434; PMCID: PMC6554716.

Joint pain. (2023, April 5). Mayo Clinic. https://www.mayoclinic.org/symptoms/joint-pain/basics/definition/sym-20050668. Accessed March 25, 2024.

Muscle pain. (2023, April 27). Mayo Clinic. https://www.mayoclinic.org/symptoms/muscle-pain/basics/causes/sym-20050866. Accessed March 25, 2024.

Shaw, G. (2021, May 24). What to know about bone Pain. WebMD. https://www.webmd.com/pain-management/bone-pain-what-know. Accessed March 25, 2024.

Wang Y, Li S, Zhang Y, Chen Y, Yan F, Han L, Ma Y. Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: A systematic review and meta-analysis of 32 randomized controlled trials. Phys Ther Sport. 2021 Mar; 48:177-187. doi: 10.1016/j.ptsp.2021.01.004. Epub 2021 Jan 14. PMID: 33493991.

A Brief History of the Opioid Epidemic

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A Brief History of the Opioid Epidemic: What, When, How, and the Effects Today

Scott Chappell
Scott Chappell

Galt Pharmaceuticals Director of Medical Affairs

The opioid epidemic is a complex public health crisis characterized by the widespread misuse and addiction to opioid drugs, including prescription painkillers, heroin, and synthetic opioids, like fentanyl. The epidemic has had devastating consequences, leading to a surge in overdose deaths and profound social and economic impacts.

opiod epidemic

Background and Early Prescription Trends (1990s)

  • What: The opioid epidemic has its roots in the 1990s when there was a significant increase in the prescription of opioid painkillers, driven by reassurances from pharmaceutical companies about the safety and low risk of addiction associated with these medications.
  • When: The surge in opioid prescriptions began in the late 1990s.
  • How: Pharmaceutical companies, including Purdue Pharma, aggressively marketed opioids like OxyContin to healthcare professionals, downplaying the risks of addiction.
  • Citations:
    • Van Zee A. The promotion and marketing of OxyContin: commercial triumph, public health tragedy. Am J Public Health. 2009;99(2):221-227.
    • Kolodny A, Courtwright DT, Hwang CS, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36:559-574.

       

 Escalation to Heroin (2000s)

  • What: As prescription opioid misuse increased, many individuals turned to heroin as a cheaper and more accessible alternative.
  • When: The transition from prescription opioids to heroin escalated in the mid-2000s.
  • How: Individuals who were addicted to prescription opioids often switched to heroin when their prescriptions ran out or became too expensive.

 Rise of Synthetic Opioids (2010s)

  • What: The opioid crisis worsened with the emergence of powerful synthetic opioids, particularly fentanyl.
  • When: The prevalence of fentanyl increased significantly in the 2010s.
  • How: Fentanyl, often illicitly manufactured, began to be mixed with heroin or sold on its own, contributing to a spike in overdose deaths due to its potency.
  • Citations:
    • Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths – United States, 2010-2015. 
    • MMWR Morb Mortal Wkly Rep. 2016;65(5051):1445-1452.

 Current Effects and Response (2020s)

  • What: The opioid epidemic remains a critical public health challenge, with ongoing efforts to address prevention, treatment, and harm reduction.
  • How: Governments, healthcare providers, and communities are working to expand access to addiction treatment, improve prescribing practices, and enhance education about the risks of opioids.
  • Citations:
    • Substance Abuse and Mental Health Services Administration (SAMHSA). Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health.
    • Centers for Disease Control and Prevention (CDC). Provisional Drug Overdose Death Counts. National Center for Health Statistics.

Impact on Society

The opioid epidemic has had profound social and economic consequences, including strained healthcare systems, increased rates of infectious diseases (e.g., HIV, hepatitis), and a rise in children placed in foster care due to parental substance abuse.

Legal Actions and Litigation

Various lawsuits have been filed against pharmaceutical companies for their role in the opioid epidemic. Purdue Pharma, in particular, faced legal actions, leading to bankruptcy and settlement agreements.

Continued Challenges

Challenges include addressing the stigma associated with addiction, improving access to evidence-based treatment, and finding comprehensive solutions to the social determinants of substance abuse.

While progress has been made in raising awareness and implementing strategies to combat the opioid epidemic, it remains a complex and ongoing public health crisis with multifaceted challenges.