SlideShare une entreprise Scribd logo
1  sur  102
Pain Management in the 21 st  Centuary. Dr. Christopher A. Jenner MB BS, FRCA Consultant in Pain Medicine, Imperial Healthcare NHS Trust Medical Director London Pain Consultants and Spinal Healthcare 17 th  June 2009
Agenda ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Definitions  ,[object Object],[object Object]
Definitions (2) ,[object Object],[object Object],[object Object],[object Object]
Definitions (3) ,[object Object],[object Object],[object Object],[object Object]
Nociceptive Pain www.londonpainconsultants.com
 
 
 
 
 
Neuropathic Pain www.londonpainconsultants.com
 
 
Pain Physiology ,[object Object],[object Object]
 
Pain Physiology  (funky version)  www.londonpainconsultants.com
 
Noxious Stimulus
Impulse Transmission
Afferent sensory fibres
Spinal cord
Dorsal Horn
Synapse
Ca and Glutamate
Synaptic Cleft
Post Synaptic
Nociceptive Neuron
Pain perception
Brain
Prevalence ,[object Object],[object Object],[object Object]
Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Challenges of Acute Pain ,[object Object],[object Object],[object Object],[object Object],[object Object]
Acute Pain Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Massive Financial Burden ,[object Object],[object Object],[object Object],[object Object],[object Object]
Physical and Alternative Treatments
Pain Management –  A Physiotherapist’s Perspective Helen Dawson MSc, BSc, MCSP Extended Scope Physiotherapy Practitioner in Pain Management [email_address]
Physical/ Alternative Treatments ,[object Object],[object Object],[object Object]
Any Vets in the audience? ,[object Object]
5. (a)  Veterinary practitioners?
Headache!
Pharmacological Treatment
Pharmacological Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]
Opioid Therapy ,[object Object]
 
 
Pharmacological treatment of Neuropathic Pain ,[object Object]
Neuropathic Pain Management ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Future Agents for Neuropathic Pain ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Psychologicaly based therapy
Pain Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pain Management Programmes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Functional Restoration Programmes www.londonpainconsultants.com
MRI scans
 
 
 
Other Imaging
 
Minimally Invasive Pain Management
 
C-arm
Targets www.londonpainconsultants.com
 
Spine Pain Cervical/ Thoracic/ Lumbar >65% workload
Epidural Steroid Injections
Facet Joint Injections
Nerve Root Injections
Sacroiliac Joint Injection
Radiofrequency
[object Object],[object Object],[object Object],[object Object],[object Object]
Botulinum Toxin A
Other Minimally Invasive Techniques  www.londonpainconsultants.com
Epiduroscopy
IDET
Disc Dekompressor
Vertebroplasty/ Kyphoplasty
Musculoskeletal www.londonpainconsultants.com
Shoulder ,[object Object],[object Object],[object Object],[object Object],[object Object]
Limbs ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Neuropathic Pain www.londonpainconsultants.com
Complex Regional Pain Syndrome (CRPS) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other Neuropathic Pain ,[object Object],[object Object],[object Object],[object Object],[object Object]
Advanced Pain Management Techniques www.londonpainconsultants.com
Nerve Stimulation
Nerve Stimulation (2)
Intrathecal Pumps
Intrathecal Pumps (2)
The Future? www.londonpainconsultants.com
The Future? ,[object Object],[object Object],[object Object],[object Object]
www.londonpainconsultants.com
London Pain Consultants Clinics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Team ,[object Object],[object Object],[object Object],[object Object]
The Team (2) ,[object Object],[object Object],[object Object],[object Object]
www.spinal-healthcare.com
Summary www.londonpainconsultants.com
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object]
Case reports/ Blogs/ Links/ Appointments [email_address] 0845 045 0250
[object Object]

Contenu connexe

Tendances

Chronic pain Managment
Chronic pain ManagmentChronic pain Managment
Chronic pain ManagmentRahul Varshney
 
Chronic pain management
Chronic pain managementChronic pain management
Chronic pain managementSubrat Nayak
 
Interventional pain management
Interventional pain managementInterventional pain management
Interventional pain managementAnurag Aggarwal
 
Pain management in cancer
Pain management in cancerPain management in cancer
Pain management in cancerNabeel Yahiya
 
Pain definition, pathway,analgesic pathway, types of pain
Pain definition, pathway,analgesic pathway, types of painPain definition, pathway,analgesic pathway, types of pain
Pain definition, pathway,analgesic pathway, types of painekta dwivedi
 
Interventional pain management by dr rajeev harshe
Interventional pain management  by dr  rajeev harsheInterventional pain management  by dr  rajeev harshe
Interventional pain management by dr rajeev harsheRajeev Harshe
 
Recent advances in pain management
Recent advances in pain managementRecent advances in pain management
Recent advances in pain managementKrishna Kishore
 
Interventional Techniques For Cancer Pain Management.
Interventional Techniques For Cancer Pain Management.Interventional Techniques For Cancer Pain Management.
Interventional Techniques For Cancer Pain Management.guest7342323
 
Neuropathic pain
Neuropathic painNeuropathic pain
Neuropathic painAmr Hassan
 
Cancer pain dr. varun
Cancer pain dr. varunCancer pain dr. varun
Cancer pain dr. varunVarun Goel
 
cancer pain management
cancer pain managementcancer pain management
cancer pain managementGowri Shankar
 
Principles in cancer pain management = j ansen 2014
Principles in cancer pain management = j ansen 2014Principles in cancer pain management = j ansen 2014
Principles in cancer pain management = j ansen 2014Muhamad Ivan
 
Pain management in total knee replacement
Pain management in total knee replacementPain management in total knee replacement
Pain management in total knee replacementApollo Hospitals
 
Chronic pain management
Chronic pain managementChronic pain management
Chronic pain managementAnkit Gajjar
 

Tendances (20)

Chronic pain Managment
Chronic pain ManagmentChronic pain Managment
Chronic pain Managment
 
Chronic pain management
Chronic pain managementChronic pain management
Chronic pain management
 
dr. Ho Kok Yuen - Updates in Interventional Pain Management
dr. Ho Kok Yuen - Updates in Interventional Pain Managementdr. Ho Kok Yuen - Updates in Interventional Pain Management
dr. Ho Kok Yuen - Updates in Interventional Pain Management
 
Interventional pain management
Interventional pain managementInterventional pain management
Interventional pain management
 
Interventional Pain Management In Cancer - P N Jain, MD MNAMS
Interventional Pain Management In Cancer - P N Jain, MD MNAMSInterventional Pain Management In Cancer - P N Jain, MD MNAMS
Interventional Pain Management In Cancer - P N Jain, MD MNAMS
 
1. introduction to Interventional Pain Management
1. introduction to Interventional Pain Management 1. introduction to Interventional Pain Management
1. introduction to Interventional Pain Management
 
Pain management in cancer
Pain management in cancerPain management in cancer
Pain management in cancer
 
Pain definition, pathway,analgesic pathway, types of pain
Pain definition, pathway,analgesic pathway, types of painPain definition, pathway,analgesic pathway, types of pain
Pain definition, pathway,analgesic pathway, types of pain
 
Interventional pain management by dr rajeev harshe
Interventional pain management  by dr  rajeev harsheInterventional pain management  by dr  rajeev harshe
Interventional pain management by dr rajeev harshe
 
Recent advances in pain management
Recent advances in pain managementRecent advances in pain management
Recent advances in pain management
 
Cancer pain
Cancer painCancer pain
Cancer pain
 
Interventional Techniques For Cancer Pain Management.
Interventional Techniques For Cancer Pain Management.Interventional Techniques For Cancer Pain Management.
Interventional Techniques For Cancer Pain Management.
 
Neuropathic pain
Neuropathic painNeuropathic pain
Neuropathic pain
 
Neuropathic pain
Neuropathic painNeuropathic pain
Neuropathic pain
 
Cancer pain dr. varun
Cancer pain dr. varunCancer pain dr. varun
Cancer pain dr. varun
 
cancer pain management
cancer pain managementcancer pain management
cancer pain management
 
Principles in cancer pain management = j ansen 2014
Principles in cancer pain management = j ansen 2014Principles in cancer pain management = j ansen 2014
Principles in cancer pain management = j ansen 2014
 
Cancer pain concept
Cancer pain concept  Cancer pain concept
Cancer pain concept
 
Pain management in total knee replacement
Pain management in total knee replacementPain management in total knee replacement
Pain management in total knee replacement
 
Chronic pain management
Chronic pain managementChronic pain management
Chronic pain management
 

En vedette

Innovations in ost formulations and programme delivery
Innovations in ost formulations and programme deliveryInnovations in ost formulations and programme delivery
Innovations in ost formulations and programme deliverymailrishigupta
 
Pain & Addiction 2009
Pain & Addiction 2009Pain & Addiction 2009
Pain & Addiction 2009Stacy Seikel
 
The philippines market research presentation
The philippines market research presentationThe philippines market research presentation
The philippines market research presentationNadia Dias
 
Econony analysis - Philippines
Econony analysis - PhilippinesEconony analysis - Philippines
Econony analysis - PhilippinesPallav Tyagi
 
New directions in the psychology of chronic pain management
New directions in the psychology of chronic pain managementNew directions in the psychology of chronic pain management
New directions in the psychology of chronic pain managementepicyclops
 
Spinal Injections
Spinal InjectionsSpinal Injections
Spinal Injectionsstdawodu
 
Chronic pain management
Chronic pain managementChronic pain management
Chronic pain managementwebzforu
 
Basic spine injections
Basic spine injectionsBasic spine injections
Basic spine injectionsTim M
 
Interventional spine & pain management dr manish raj
Interventional spine & pain management  dr manish rajInterventional spine & pain management  dr manish raj
Interventional spine & pain management dr manish rajManish Raj
 
Post operative pain management
Post operative pain managementPost operative pain management
Post operative pain managementHriday Ranjan Roy
 

En vedette (20)

PAIN MANAGEMENT
PAIN MANAGEMENTPAIN MANAGEMENT
PAIN MANAGEMENT
 
2016 CDC MED Update
2016 CDC MED Update2016 CDC MED Update
2016 CDC MED Update
 
Session 3 ballantyne management of the patient who is failing
Session 3   ballantyne management of the patient who is failingSession 3   ballantyne management of the patient who is failing
Session 3 ballantyne management of the patient who is failing
 
Innovations in ost formulations and programme delivery
Innovations in ost formulations and programme deliveryInnovations in ost formulations and programme delivery
Innovations in ost formulations and programme delivery
 
Pain & Addiction 2009
Pain & Addiction 2009Pain & Addiction 2009
Pain & Addiction 2009
 
The philippines market research presentation
The philippines market research presentationThe philippines market research presentation
The philippines market research presentation
 
Econony analysis - Philippines
Econony analysis - PhilippinesEconony analysis - Philippines
Econony analysis - Philippines
 
Pain management
Pain managementPain management
Pain management
 
Cox1&2
Cox1&2Cox1&2
Cox1&2
 
New directions in the psychology of chronic pain management
New directions in the psychology of chronic pain managementNew directions in the psychology of chronic pain management
New directions in the psychology of chronic pain management
 
Opioid analgesics (VK)
Opioid analgesics (VK)Opioid analgesics (VK)
Opioid analgesics (VK)
 
Spinal Injections
Spinal InjectionsSpinal Injections
Spinal Injections
 
Chronic pain management
Chronic pain managementChronic pain management
Chronic pain management
 
Chpn hpna ppt #2 pain management
Chpn hpna ppt #2 pain managementChpn hpna ppt #2 pain management
Chpn hpna ppt #2 pain management
 
Interventional approach to back pain dr surange
Interventional approach to back pain  dr surangeInterventional approach to back pain  dr surange
Interventional approach to back pain dr surange
 
Basic spine injections
Basic spine injectionsBasic spine injections
Basic spine injections
 
Neuropathic Pain
Neuropathic PainNeuropathic Pain
Neuropathic Pain
 
Skull radiography
Skull radiography Skull radiography
Skull radiography
 
Interventional spine & pain management dr manish raj
Interventional spine & pain management  dr manish rajInterventional spine & pain management  dr manish raj
Interventional spine & pain management dr manish raj
 
Post operative pain management
Post operative pain managementPost operative pain management
Post operative pain management
 

Similaire à Pain Management In The 21st Century Presented At Vista Diagnostics 17.6.09

The Management Of Spinal Pain Presented At Back Show 4.10.09
The Management Of Spinal Pain Presented At Back Show 4.10.09The Management Of Spinal Pain Presented At Back Show 4.10.09
The Management Of Spinal Pain Presented At Back Show 4.10.09London Pain Clinic
 
Medicolegal Overview Of Pain Medicine 11.11.10
Medicolegal Overview Of Pain Medicine 11.11.10Medicolegal Overview Of Pain Medicine 11.11.10
Medicolegal Overview Of Pain Medicine 11.11.10London Pain Clinic
 
Neuropathic Pain Presented At Primed 5.11.09
Neuropathic Pain Presented At Primed 5.11.09Neuropathic Pain Presented At Primed 5.11.09
Neuropathic Pain Presented At Primed 5.11.09London Pain Clinic
 
Current Concepts and Strategies in Pain Management
Current Concepts and Strategies in Pain ManagementCurrent Concepts and Strategies in Pain Management
Current Concepts and Strategies in Pain Managementcpppaincenter
 
SEDATIVES & ANALGESICS in ICU
SEDATIVES & ANALGESICS in ICUSEDATIVES & ANALGESICS in ICU
SEDATIVES & ANALGESICS in ICUSubhankar Paul
 
Pain management novel trends
Pain management   novel trendsPain management   novel trends
Pain management novel trendsHaripriya Uppala
 
Pain management.pptx
Pain management.pptxPain management.pptx
Pain management.pptxMunewar Usman
 
painmanagement-230429154957-314b998a.pdf
painmanagement-230429154957-314b998a.pdfpainmanagement-230429154957-314b998a.pdf
painmanagement-230429154957-314b998a.pdfknowuwho
 
S Humble Sept Syst RV Postsurg NeuP 2016
S Humble Sept Syst RV Postsurg NeuP 2016S Humble Sept Syst RV Postsurg NeuP 2016
S Humble Sept Syst RV Postsurg NeuP 2016Dr Stephen Humble
 

Similaire à Pain Management In The 21st Century Presented At Vista Diagnostics 17.6.09 (20)

The Management Of Spinal Pain Presented At Back Show 4.10.09
The Management Of Spinal Pain Presented At Back Show 4.10.09The Management Of Spinal Pain Presented At Back Show 4.10.09
The Management Of Spinal Pain Presented At Back Show 4.10.09
 
Medicolegal Overview Of Pain Medicine 11.11.10
Medicolegal Overview Of Pain Medicine 11.11.10Medicolegal Overview Of Pain Medicine 11.11.10
Medicolegal Overview Of Pain Medicine 11.11.10
 
Neuropathic Pain 25.9.07
Neuropathic Pain 25.9.07Neuropathic Pain 25.9.07
Neuropathic Pain 25.9.07
 
Neuropathic Pain Presented At Primed 5.11.09
Neuropathic Pain Presented At Primed 5.11.09Neuropathic Pain Presented At Primed 5.11.09
Neuropathic Pain Presented At Primed 5.11.09
 
Current Concepts and Strategies in Pain Management
Current Concepts and Strategies in Pain ManagementCurrent Concepts and Strategies in Pain Management
Current Concepts and Strategies in Pain Management
 
Pedoman penatalaksanaan nyeri kanker.
Pedoman penatalaksanaan nyeri kanker.Pedoman penatalaksanaan nyeri kanker.
Pedoman penatalaksanaan nyeri kanker.
 
SEDATIVES & ANALGESICS in ICU
SEDATIVES & ANALGESICS in ICUSEDATIVES & ANALGESICS in ICU
SEDATIVES & ANALGESICS in ICU
 
Pain Management in Oncology
Pain Management in OncologyPain Management in Oncology
Pain Management in Oncology
 
Pain management novel trends
Pain management   novel trendsPain management   novel trends
Pain management novel trends
 
Pain Relief
Pain ReliefPain Relief
Pain Relief
 
Pain management.pptx
Pain management.pptxPain management.pptx
Pain management.pptx
 
painmanagement-230429154957-314b998a.pdf
painmanagement-230429154957-314b998a.pdfpainmanagement-230429154957-314b998a.pdf
painmanagement-230429154957-314b998a.pdf
 
The Paradox of Pain
The Paradox of PainThe Paradox of Pain
The Paradox of Pain
 
Chronic Pains, Dr Rohitha Jayamaha MD FIPP
Chronic Pains, Dr Rohitha Jayamaha MD FIPPChronic Pains, Dr Rohitha Jayamaha MD FIPP
Chronic Pains, Dr Rohitha Jayamaha MD FIPP
 
Pain
PainPain
Pain
 
osteoarthritis.ppt
osteoarthritis.pptosteoarthritis.ppt
osteoarthritis.ppt
 
osteoarthritis.ppt
osteoarthritis.pptosteoarthritis.ppt
osteoarthritis.ppt
 
ERAHF Grand Rounds
ERAHF Grand RoundsERAHF Grand Rounds
ERAHF Grand Rounds
 
Osteoarthritis Diagnosis and Treatment
Osteoarthritis Diagnosis and TreatmentOsteoarthritis Diagnosis and Treatment
Osteoarthritis Diagnosis and Treatment
 
S Humble Sept Syst RV Postsurg NeuP 2016
S Humble Sept Syst RV Postsurg NeuP 2016S Humble Sept Syst RV Postsurg NeuP 2016
S Humble Sept Syst RV Postsurg NeuP 2016
 

Plus de London Pain Clinic

Dr Chris Jenner Personal Injury Law Journal_June_2008
Dr Chris Jenner Personal Injury Law Journal_June_2008Dr Chris Jenner Personal Injury Law Journal_June_2008
Dr Chris Jenner Personal Injury Law Journal_June_2008London Pain Clinic
 
Dr Chris Jenner Medicolegal CV_2013
Dr Chris Jenner Medicolegal CV_2013Dr Chris Jenner Medicolegal CV_2013
Dr Chris Jenner Medicolegal CV_2013London Pain Clinic
 
Rough guide to chronic pain 8.9.08
Rough guide to chronic pain 8.9.08Rough guide to chronic pain 8.9.08
Rough guide to chronic pain 8.9.08London Pain Clinic
 
Advancing the field in pain medicine 19.5.09
Advancing the field in pain medicine 19.5.09Advancing the field in pain medicine 19.5.09
Advancing the field in pain medicine 19.5.09London Pain Clinic
 
Medicolegal Pain Medicine 11.11.10
Medicolegal Pain Medicine 11.11.10Medicolegal Pain Medicine 11.11.10
Medicolegal Pain Medicine 11.11.10London Pain Clinic
 
The Independent Doctors Forum breakfast tutorials
The Independent Doctors Forum breakfast tutorialsThe Independent Doctors Forum breakfast tutorials
The Independent Doctors Forum breakfast tutorialsLondon Pain Clinic
 
St Mary's programme - Treatment strategies for managing acute back pain in t...
St Mary's programme -  Treatment strategies for managing acute back pain in t...St Mary's programme -  Treatment strategies for managing acute back pain in t...
St Mary's programme - Treatment strategies for managing acute back pain in t...London Pain Clinic
 
St Anthony's pain pharmacology
St Anthony's   pain pharmacologySt Anthony's   pain pharmacology
St Anthony's pain pharmacologyLondon Pain Clinic
 
Smgp shared care scheme GP training day 17.11.05
Smgp shared care scheme GP training day 17.11.05Smgp shared care scheme GP training day 17.11.05
Smgp shared care scheme GP training day 17.11.05London Pain Clinic
 

Plus de London Pain Clinic (20)

Dr Chris Jenner Personal Injury Law Journal_June_2008
Dr Chris Jenner Personal Injury Law Journal_June_2008Dr Chris Jenner Personal Injury Law Journal_June_2008
Dr Chris Jenner Personal Injury Law Journal_June_2008
 
Dr Chris Jenner Medicolegal CV_2013
Dr Chris Jenner Medicolegal CV_2013Dr Chris Jenner Medicolegal CV_2013
Dr Chris Jenner Medicolegal CV_2013
 
Sth frca course 13.3.09
Sth frca course 13.3.09Sth frca course 13.3.09
Sth frca course 13.3.09
 
Sth frca course 9.3.12
Sth frca course 9.3.12Sth frca course 9.3.12
Sth frca course 9.3.12
 
Smh frca course 26.3.10
Smh frca course 26.3.10Smh frca course 26.3.10
Smh frca course 26.3.10
 
Smh final frca course 26.5.12
Smh final frca course 26.5.12Smh final frca course 26.5.12
Smh final frca course 26.5.12
 
Smh tutor group 13.5.09
Smh tutor group 13.5.09Smh tutor group 13.5.09
Smh tutor group 13.5.09
 
Rough guide to chronic pain 8.9.08
Rough guide to chronic pain 8.9.08Rough guide to chronic pain 8.9.08
Rough guide to chronic pain 8.9.08
 
Managing pain 10.7.10
Managing pain 10.7.10Managing pain 10.7.10
Managing pain 10.7.10
 
Imperial ortho course 22.9.11
Imperial ortho course 22.9.11Imperial ortho course 22.9.11
Imperial ortho course 22.9.11
 
Iapos 9.11.12 shell building
Iapos 9.11.12 shell buildingIapos 9.11.12 shell building
Iapos 9.11.12 shell building
 
Gp talk 1.8.12
Gp talk 1.8.12Gp talk 1.8.12
Gp talk 1.8.12
 
Advancing the field in pain medicine 19.5.09
Advancing the field in pain medicine 19.5.09Advancing the field in pain medicine 19.5.09
Advancing the field in pain medicine 19.5.09
 
Sth frca course 11.3.11
Sth frca course 11.3.11Sth frca course 11.3.11
Sth frca course 11.3.11
 
Whiplash Injury 10.5.12
Whiplash Injury 10.5.12Whiplash Injury 10.5.12
Whiplash Injury 10.5.12
 
Medicolegal Pain Medicine 11.11.10
Medicolegal Pain Medicine 11.11.10Medicolegal Pain Medicine 11.11.10
Medicolegal Pain Medicine 11.11.10
 
The Independent Doctors Forum breakfast tutorials
The Independent Doctors Forum breakfast tutorialsThe Independent Doctors Forum breakfast tutorials
The Independent Doctors Forum breakfast tutorials
 
St Mary's programme - Treatment strategies for managing acute back pain in t...
St Mary's programme -  Treatment strategies for managing acute back pain in t...St Mary's programme -  Treatment strategies for managing acute back pain in t...
St Mary's programme - Treatment strategies for managing acute back pain in t...
 
St Anthony's pain pharmacology
St Anthony's   pain pharmacologySt Anthony's   pain pharmacology
St Anthony's pain pharmacology
 
Smgp shared care scheme GP training day 17.11.05
Smgp shared care scheme GP training day 17.11.05Smgp shared care scheme GP training day 17.11.05
Smgp shared care scheme GP training day 17.11.05
 

Dernier

Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Housewife Call Girls Hsr Layout - Call 7001305949 Rs-3500 with A/C Room Cash ...
Housewife Call Girls Hsr Layout - Call 7001305949 Rs-3500 with A/C Room Cash ...Housewife Call Girls Hsr Layout - Call 7001305949 Rs-3500 with A/C Room Cash ...
Housewife Call Girls Hsr Layout - Call 7001305949 Rs-3500 with A/C Room Cash ...narwatsonia7
 
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment BookingCall Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment BookingNehru place Escorts
 
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceCollege Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceNehru place Escorts
 
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment BookingCall Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Bookingnarwatsonia7
 
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Glomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptxGlomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptxDr.Nusrat Tariq
 
Call Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
Call Girl Lucknow Mallika 7001305949 Independent Escort Service LucknowCall Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
Call Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknownarwatsonia7
 
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hosur Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any TimeCall Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Timevijaych2041
 
Pharmaceutical Marketting: Unit-5, Pricing
Pharmaceutical Marketting: Unit-5, PricingPharmaceutical Marketting: Unit-5, Pricing
Pharmaceutical Marketting: Unit-5, PricingArunagarwal328757
 
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbers
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbersBook Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbers
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbersnarwatsonia7
 
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service ChennaiCall Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service ChennaiNehru place Escorts
 
Call Girl Nagpur Sia 7001305949 Independent Escort Service Nagpur
Call Girl Nagpur Sia 7001305949 Independent Escort Service NagpurCall Girl Nagpur Sia 7001305949 Independent Escort Service Nagpur
Call Girl Nagpur Sia 7001305949 Independent Escort Service NagpurRiya Pathan
 
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...narwatsonia7
 
Hematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes FunctionsHematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes FunctionsMedicoseAcademics
 
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...narwatsonia7
 
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...rajnisinghkjn
 

Dernier (20)

Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
 
Housewife Call Girls Hsr Layout - Call 7001305949 Rs-3500 with A/C Room Cash ...
Housewife Call Girls Hsr Layout - Call 7001305949 Rs-3500 with A/C Room Cash ...Housewife Call Girls Hsr Layout - Call 7001305949 Rs-3500 with A/C Room Cash ...
Housewife Call Girls Hsr Layout - Call 7001305949 Rs-3500 with A/C Room Cash ...
 
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment BookingCall Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
 
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort ServiceCollege Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
College Call Girls Vyasarpadi Whatsapp 7001305949 Independent Escort Service
 
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment BookingCall Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
Call Girl Koramangala | 7001305949 At Low Cost Cash Payment Booking
 
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Jp Nagar Just Call 7001305949 Top Class Call Girl Service Available
 
Glomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptxGlomerular Filtration rate and its determinants.pptx
Glomerular Filtration rate and its determinants.pptx
 
Call Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
Call Girl Lucknow Mallika 7001305949 Independent Escort Service LucknowCall Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
Call Girl Lucknow Mallika 7001305949 Independent Escort Service Lucknow
 
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hosur Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service Available
 
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any TimeCall Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Time
 
Pharmaceutical Marketting: Unit-5, Pricing
Pharmaceutical Marketting: Unit-5, PricingPharmaceutical Marketting: Unit-5, Pricing
Pharmaceutical Marketting: Unit-5, Pricing
 
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
 
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbers
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbersBook Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbers
Book Call Girls in Kasavanahalli - 7001305949 with real photos and phone numbers
 
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service ChennaiCall Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
 
Call Girl Nagpur Sia 7001305949 Independent Escort Service Nagpur
Call Girl Nagpur Sia 7001305949 Independent Escort Service NagpurCall Girl Nagpur Sia 7001305949 Independent Escort Service Nagpur
Call Girl Nagpur Sia 7001305949 Independent Escort Service Nagpur
 
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...
Russian Call Girl Brookfield - 7001305949 Escorts Service 50% Off with Cash O...
 
Hematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes FunctionsHematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes Functions
 
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
 
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
Call Girls Kanakapura Road Just Call 7001305949 Top Class Call Girl Service A...
 
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Dwarka Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
 

Pain Management In The 21st Century Presented At Vista Diagnostics 17.6.09