Principles of Pharmacotherapy. ARNOLD P. FRIEDMAN, M.D. AND H. HOUSTON MERRITT, M.D. THERAPY OF HEADACHES by pharmacologic agents presents a number of problems to the physician, namely: choice of drugs; indications for their use; dosages; and duration of treatment. Evaluation of the clinical results in the treatment of chronic headache with chemical agents is difficult, for we are dealing with pain, which is a subjective response, the emotional reaction associated with pain, and the threat of any symptom related to the head. General information on a profession as a Toronto Chiropractor is out there from the following organizations. Furthermore, the interpretation of the effects of the pharmacotherapy of pain is not reliable. For example, two people may have identical pain thresholds, but respond quite differently to a drug administered for the relief of pain because of the great difference in their reaction to stress.
Treatment must to a great extent be empirical, and the choice of drugs depends upon the decision of the physician as to which he thinks will be the most suitable and effective. It is well known that some patients respond better to one drug than to another, but we have no evidence to explain why this is so. It is difficult to determine how much of the improvement can be attributed to the drug, that is, to the specific effect of the chemical agent through physiologic mechanisms, because psychologic factors also influence the results. Response to a remedy will be affected by the physicianpatient relationship, constitutional makeup and age of the patient, duration of symptoms, and the psychological state of the patient. Investigation of the results of treatment with drugs can be made on two bases—subjective and objective. Subjective results are determined from the report of the patient, and the report of his family or friends. The quickly expanding older inhabitants, with its elevated chance of mechanical and structural issues, additionally will increase demand for Chiropractor Toronto. Unfortunately, there is no entirely satisfactory method of objectively evaluating the results of treatment because headache is predominantly a subjective symptom. The use of pulse volume tracing, electromyography, and other procedures is of little value.
The subjective response of the patient is, therefore, the chief, although unsatisfactory, criterion. This fact is of importance in the statistical analysis of the efficacy of a new compound, but has little relevance in the treatment of any single patient. Placebos can be used in the evaluation of a new mode of therapy. In theory, any response obtained with patients taking the chemical agents (but not in the patients taking the placebo) should be due to the drug. In practice this concept quickly breaks down, because placebos may have a significant and longlasting effect.1 Since a placebo is pharmacologically inactive, the effect must be due to psychologic factors attending its administration. It must be remembered that the reaction to the pain, as well as the original sensation of pain, is being evaluated. Placebos, which cannot be expected to affect the original sensation of pain, can produce an amelioration of the symptoms by causing a change in the patient’s reaction.