Note: Descriptions are shown in the official language in which they were submitted.
CA 02746087 2011-07-12
P1244CA00
Title: Use for preventing and treating inflammation
BACKGROUND
(a) Field
[001] This invention relates to uses for preventing and treating
inflammation that is associated with chronic pain and surgical procedures. -
(b) Related Prior Art
[002] Pain is the most common presenting complaint to physicians in
North America. Humans suffer from two types of pain. Transitory (or acute)
pain, caused by external factors, such as impacts or certain illnesses, can
last
for short moments to a longer period of time. Acute pain, for the most part,
results from disease, inflammation, or injury to tissues. This type of pain
generally comes on suddenly, for example, after trauma or surgery, and may
be accompanied by anxiety or emotional distress. The cause of acute pain
can usually be diagnosed and treated, and the pain is self-limiting, that is,
it is
confined to a given period of time and severity. In some instances, it can
become chronic. On the other hand, long term or chronic pain, which may or
may not be the result of external factors, typically persists for
indeterminate
length of time even if the initial cause of pain has disappeared. Chronic pain
prevents a person suffering such pain from leading a normal life, pursuing an
occupation, performing many routine activities, and the like. Person suffering
chronic pain are often entitled to compensation from insurance company,
employers, even government. Chronic pain is widely believed to represent
disease itself. It can be made much worse by environmental and
psychological factors. Chronic pain persists over a longer period of time than
acute pain and is resistant to most medical treatments. It can-and often
does-cause severe problems for patients. Pains are also referred to as
nociceptive pain (being somatic or visceral) and non-nociceptive, (being
neuropathic or sympathetic). Inflammation is present in all types of pain, to
some degree.
[003] Any of these types of pain has the potential to become chronic
in nature. Chronic pain is very different from acute pain. It serves no
biological
-1-
CA 02746087 2011-07-12
P 1244CA00
purpose. For reasons not well understood, chronic pain is characterized by
physical and mental withdrawal. Vegetative signs very similar to those found
in depression, such as anorexia, anhedonia, lethargy, and sleep disturbance
are often present. Chronic pain frequently coexists with depression, making it
difficult at times to distinguish between the two.
[004] Acute aggression, such as surgical procedures, induces not only
painful response but, in some patients, can also lead to long term anatomical,
biochemical, histological and functional neurological changes. Chronic pain
has been defined as persistent or recurrent pain for two (2), three (3) or six
(6)
months after surgery. Postoperative pain would be expected to have resolved
about two (2) months after surgery. Pain that is present two (2) months after
surgery seldom resolves over the next months and is referred to as chronic
pain. Chronic pain after surgery is quite common. Average of about 23 % of
patients examined in pain clinic report surgery as the main cause of their
pain.
[005] Pain is such a major element affecting population. The analgesic
industry and its advertisement are constant reminders of the magnitude of the
problem in the population. Of the many types of medical problems involving
pain as a major symptom, chronic pain, with its overwhelming presence in the
United States and the other countries, is one of the most difficult to treat.
It is
estimated that primarily and secondarily expenditures associated with chronic
pain averages about $100 billion annually in the United States alone. The
collateral loss of private and corporate productivity, while never quantified,
is
also expected to be significant, as it may directly affect the patient's
functioning. Sleep disturbances, difficulty walking, inability to work, and
impairment of the activities of daily living may all reflect the pain
experience.
[006] Effectively treating chronic pain poses a great challenge since
the kind of pain usually affects a person's life in many ways. It can change
someone's personality, ability to function, and quality of life. Health care
professionals treating patients with chronic pain recognize the limitation of
modern diagnostic methods for assessing chronic pain. Current methods for
-2-
CA 02746087 2011-07-12
P1244CA00
pain evaluation such as, for example, history and physical examinations,
questionnaires, x-rays and imaging techniques all suffer from inherent
limitation because of their indirect nature. The prevalence of inaccurate pain
indicators, as well as the rise of pain management industries such as clinics,
practitioners and alternative treatment centers, gives testimony to the
problem.
[007] It is more and more recognized that a chronic inflammatory
process is a culprit of degenerative neurological disease, which could lead to
chronic pain and cognitive disorders, such as MCI (minimal cognitive
impairment), Alzheimer or dementia. Prevention or treatment of the underlying
inflammation by any means in an improvement in medical status. Thus, there
exists a need in the art to find efficacious methods of modulating
inflammatory
conditions with acceptable safety profiles. Since, it is becoming increasingly
clear that surgery under general, even local, anesthesia may have negatives
impacts on patients. Some may never find back their physical and cognitive
preoperative conditions despite successful surgery procedures. Additionally,
older ones, already having some gaps in their nutritional and fitness
lifestyle,
in their immune system, even in their general conditions are particularly
vulnerable to chirurgical surgery under general anesthesia. Brain reserve is
low in young children and in older people. These patients are very sensitive
to
long-term cognitive dysfunction induced by surgery and anesthesia.
SUMMARY
[008] In a first embodiment there is disclosed a use of an anti-
inflammatory medication, and/ or a NO releasing medication in combination
with at least one chosen from:
[009] an exercise regimen,
[0010] a dietary regimen,
[0011] an alternative medicine regimen,
[0012] an hyperbaric oxygen regimen,
[0013] a cerebral stimulation regimen,
-3-
CA 02746087 2011-07-12
P 1244CA00
[0014] a preconditioning,
[0015] a cognitive state improver,
[0016] an anxiety level reducer,
[0017] to improve the general state of a patient and to prevent and/or
treat inflammation in the patient.
[0018] In another embodiment there is disclosed a use of an anti-
inflammatory medication, and/ or a NO releasing medication in combination
with at least one chosen from:
[0019] an exercise regimen,
[0020] a dietary regimen,
[0021] an alternative medicine regimen,
[0022] an hyperbaric oxygen regimen,
[0023] a cerebral stimulation regimen,
[0024] a preconditioning,
[0025] a cognitive state improver,
[0026] an anxiety level reducer,
[0027] to improve a patient outcome post surgery.
[0028] In another embodiment there is disclosed a method for
preventing and treating inflammation in a patient, which includes:
a) evaluating a general state of the patient to determine the
inflammatory state, the cognitive state, the anxiety level, and the
physical condition of the patient;
b) providing a medication and/or an alternative medicine regimen
to improve the pharmacological state and/or the cognitive state
and/or the anxiety level of the patient;
c) providing at least one of a diet regimen, an exercise regimen, a
social support, medication, a cerebral stimulation, a
-4-
CA 02746087 2011-07-12
P1244CA00
preconditioning, and an hyperbaric oxygen therapy to improve
the general state of the patient.
[0029] The inflammatory state may be associated with a chronic pain.
[0030] The inflammatory state may be associated with a surgical
procedure.
[0031] The exercise regimen includes aerobic exercise, and mobility
against resistance exercise.
[0032] The preconditioning may be ischemia-induced preconditioning
and medication-induced preconditioning.
[0033] The alternative medicine regimen includes hypnosis,
acupuncture, biofeedback, art-therapy, and zootherapy.
[0034] The cerebral stimulation includes an electric stimulation, a
magnetic stimulation, a stimulation by sound, a stimulation by taste, a
stimulation by odour, and a stimulation by touch.
[0035] The medication includes lidocaine, melatonine, statin, anti-
inflammatory drugs, anti-oxidants, curcumin, omega-3 fatty acids,
acetylcysteine, erytropoetin, tetracycline, antidepressants and insulin.
[0036] The general state of the patient of step a) is evaluated using
analyses which include: health antecedent analysis, family/informal caregiver
analysis, vital signs analysis, blood analysis, physical condition analysis,
cognitive state analysis, mental state analysis, anxiety level analysis,
immune
system analysis, eating habits analysis, life habits analysis, exercising
habits
analysis, social habits analysis, quality of life perception analysis, pain
perception analysis, pharmacological profile analysis, inflammatory profile
analysis, pain control method analysis.
[0037] The physical condition analysis includes a measurement of:
height, weight, waist circumference (WC), body mass index (BMI), abdominal
fat, and adiposity.
-5-
CA 02746087 2011-07-12
P 1244CA00
[0038] The vital signs analysis includes a measurement of blood
pressure, pulse, temperature, and respiratory rate.
[0039] The blood analysis includes measurements of blood cell
formula, coagulation pressure, sodium (Na+) concentration, potassium (K+)
concentration, chlorine (CI-) concentration, phosphate concentration, calcium
(Ca 2+) concentration, urea concentration, creatine concentration, protein
concentration, albumin concentration, C-reactive protein (CRP), cholesterol
HDL and cholesterol LDL.
[0040] The pain profile includes an evaluation of a narcotic use profile,
a drug association assay, medication compliance, nitric oxide; carbon
monoxide, anti-inflammatory medication; opioid, anti-opioid;
acetylcholinesterase inhibitors; NMDA blockers; alpha 2 agonist; calcium
antagonist; sodium channel blocker; potassium channel modulator; chloride
channel modulator; neurotropine modulator; cytokine and chemokine
modulator.
[0041] The inflammatory profile includes a measurement of C-reactive
protein (CRP), cytokine, Tumor Necrosis Factor a (TNF-a), Plasminogen
Activator Inhibitor 1 (PAI-1), Retinol Binding Protein 4 (RBP-4), interleukin
1
(IL1), interleukin 6 (IL6), interleukin 10 (IL10), exhaled nitric oxide,
plasmatic
nitrate, plasmatic nitrite, endothelium dependant relaxation, heart rate, RR
variation and skin conductance.
[0042] The cognitive state analysis includes a cognitive test chosen
from R-Bans A, R-Bans B, R-Bans C, R-Bans D, verbal fluency, trail-making,
FS-36, memory span, and E-MOCA.
[0043] The anxiety level analysis includes an anxiety test chosen from
Hads scale, pain disability index, Beck hopelessness scale, and pain
catastrophisation.
[0044] The physical condition analysis includes a physical test chosen
from V02 max, and seven minute walking test.
-6-
CA 02746087 2011-07-12
P1244CA00
(0045] The pain perception analysis includes an evaluation of pain
intensity, pain duration, pain location, pain irradiation, and the McGill pain
questionnaire.
[0046] The pain control method analysis includes a pain control method
chosen from cervical epidural, thoracic epidural, lumbar epidural, caudal
epidural, sub-arachnoidal injections, celiac plexus bloc, hypogastric plexus
bloc, ganglion Impar bloc, glossopharyngeal nerve bloc, sphenopalatine
ganglion bloc, venous bloc, brachial plexus bloc, lumbar plexus bloc, facet
bloc, cervical sympathetic bloc, thoracic sympathetic bloc, lumbar sympathetic
bloc, foraminal bloc, laryngeal bloc, trigeminal nerve bloc, paravertebral
bloc
and intraveinous perfusion of a mixture of pain medication.
[0047] In another embodiment, there is disclosed a method to treat a
patient in a perioperative period prior to undergo a surgical procedure, that
reduces the side effects associated with surgery affecting the patient's
physical and/or cognitive conditions and/or immune system.
[0048] In yet another embodiment, there is disclosed a method for
preventing and treating inflammation in a patient, which further includes a
step
d) consisting of providing counselling to improve the cognitive state and the
anxiety level of the patient.
[0049] The following terms are defined below.
[0050] The expression "perioperative period" is intended to mean the
time frame including the preoperative preparation, including several weeks
before the surgery, the operative and postoperative period after the surgery,
which may vary depending on the surgery, and when the acute inflammatory
response induced by the surgical trauma has subsided. It may include the
period starting from the moment the patient is informed that he/she will
undergo surgery. It also includes the period when the patient has reached a
stable condition.
[0051] The expression "general state of a patient" is intended to mean
the general state of health and psychological well-being of a patient,
-7-
CA 02746087 2011-07-12
P1244CA00
considering the evaluation of the inflammatory and cognitive state of the
patient, as well as the level of anxiety felt by.the patient, combined to his
or
her physical condition.
[0052] The term "cognitive state improver" is intended to mean all
interventions aimed at enhancing one's mental processes, for instance,
attentational capacity, mental reasoning, problem solving, learning and
remembering.
[0053] The term "anxiety level reducer" is intended to mean all
interventions aimed at lowering emotional, physical and cognitive stress
level,
for instance relaxation techniques, physical activity, cognitive reappraisal
and
biofeedback.
[0054] Features and advantages of the subject matter hereof will
become more apparent in light of the following detailed description of
selected
embodiments, as illustrated in the accompanying figures. As will be realized,
the subject matter disclosed and claimed is capable of modifications in
various respects, all without departing from the scope of the claims.
Accordingly, the drawings and the description are to be regarded as
illustrative in nature, and not as restrictive and the full scope of the
subject
matter is set forth in the claims.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0055] In accordance with one embodiment, there is disclosed a
method for preventing and treating inflammation in a patient, which
comprises:
a) evaluating the general state of the patient to determine the
inflammatory state, the cognitive state and anxiety level, and the
physical condition of the patient;
b) providing medication regimen or alternative medicine to improve
the pharmacological state, and/or the cognitive state, and/or the
anxiety level of the patient; and
-8-
CA 02746087 2011-07-12
P1244CA00
C) providing at least one of a diet regimen, an exercise regimen, a
social support, a cerebral stimulation, including electric and
magnetic stimulation, stimulation by sound, taste, odors, and
touch, a preconditioning, and an hyperbaric oxygen therapy or
any other techniques that could modulate inflammation or brain
function to improve the general state of the patient.
[0056] First, the evaluation of the general state of the patient is effected
using different test and analysis to determine the inflammation state, the
cognitive state and anxiety level, and the physical condition of the patient.
[0057] Secondly, the patient is provided with a medication regimen or
alternative medicine regimen to improve his inflammatory state, immune
system and/or cognitive state and anxiety level. There exists numerous
medication regimen and alternative medicine regimen, which includes, without
limitation: lidocaine, melatonine, statin, anti-inflammatory drugs, anti-
oxidants,
curcumin, omega-3 fatty acids, acetylcysteine, erytropoetin, tetracyclin,
insulin, antidepressants, ocytocin, and others, modification of nutrition,
neutraceutics, alternative medicine, psychological support, group therapy,
techniques of preconditioning, and brain stimulation.
[0058] Thirdly, the patient is provided with a diet and/or exercise
regimen to improve his physical condition. Examples of such diet include,
without limitation, the following: increase in vegetable and/or fruit
consumption, decrease in red meat consumption, vitamins, antioxydants,
neutracetics, fish, nuts, berries, intermittent fasting, etc.
[0059] Examples of such exercise regimen include, without limitation
the following: aerobic exercise, and mobility against resistance exercise.
[0060] More precisely, a perioperative approach can help a patient to
strengthen its physical, cognitive and immune conditions and thereby,
increases its resistance to surgical procedures.
[0061] Pain management: Postoperative pain management is
fundamental and must be regarded as an integral part of perioperative care.
-9-
CA 02746087 2011-07-12
P1244CA00
Several techniques have been used to reduce and/or eliminate postoperative
pain. Preemptive analgesia is one such technique. It consists of delivering
pharmacological agents prior to exposure to painful stimuli to alter
peripheral
and central sensitization to nociceptive impulses.
[0062] Medication: Several types of medication can be used in the
method of the present invention. They may be used as preemptive
analgesics. These include the anti-inflammatory medications, the opioids, the
canabioids, the coanalgesics, and physical techniques (e.g. blocks and
epidurals).
Local anesthetics
[0063] Non-Steroidal Anti-Inflammatory (NSAID): NSAID may be used
as local anesthetics in the method of the present invention. They are drugs
with analgesic, antipyretic (lowering an elevated body temperature and
relieving pain without impairing consciousness) and, in higher doses, with
anti-inflammatory effects (reducing inflammation). Most NSAIDs act as non-
selective inhibitors of the enzyme cyclooxygenase, inhibiting both the
cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) isoenzymes.
members of this group of drugs are aspirin, ibuprofen, and naproxen.
[0064] Blocker of N-methyl-D-aspartic acid receptor may be used in the
method of the present invention. It is an amino acid derivative acting as a
specific agonist at the NMDA receptor, and therefore mimics the action of the
neurotransmitter glutamate on that receptor (NMDA) receptors antagonists.
[0065] O ip oids: An opioid is an analgesic that works by binding to
opioid receptors, which are found principally in the central nervous system
and the gastrointestinal tract. The receptors in these two organ systems
mediate both the beneficial effects, and the undesirable side effects of
opioids. Opioids used to treat pain could have a long term effect on the
central
nervous system (CNS) pain processing probably by stimulating the facilitary-
descending pathway. This could oppose the primary pain suppressing effect
of these medications. It has, indeed, been shown that fentanyl can prime the
-10-
CA 02746087 2011-07-12
P 1244CA00
dorsal horn to respond excessively to pain stimuli. To prolong analgesia and
inhibit central, and probably peripheral, sensitization shortly after the
surgical
procedure, optimal perioperative analgesia using a multimodal approach,
including a regional technique with local anesthetic, have been tested in
recent studies.
[0066] Other drugs such as, paracetamol (acetaminophen), alpha-2
adrenergic receptor agonist, and the like tested in animal studies have also
generated convincing data.
[0067] The advantages of a multimodal approach include the different
types of medications used to treat postoperative pain acting through different
pain mechanism, and which could have an additive or synergistic effect on
pain relief, and the dose of individual medications that can be decreased
without changing the global effect on pain management, and therefore
consequently decreasing the adverse events related to these medications.
[0068] In addition to a perioperative approach, it has been shown that
exercise has the potential to be an effective and feasible component of
preventing and treating inflammation and related complications that are
associated with surgical procedures. First, considerable evidence has
accumulated over recent decades indicating that preoperative exercise and
physical activity reduce symptoms and improve well-being among people with
chronic diseases. Result from intervention studies suggest that exercise
programs can have positive impacts on fatigue, quality of life, fitness and
immune function. Also, specific biofeedback approaches designed to regulate
imbalance of sympathetic nervous system on inflammation and pain may also
have a potential effect.
[0069] Thereby, optimal perioperative analgesia decrease acute
postoperative pain and reduce the inflammatory process and influence
cognitive habilities. Furthermore, OPA approach will reduce the occurrence of
chronic pain, the impact of pain on quality of life, and activities of life
habits
with greater efficacy that the usual analgesic treatment. Also, OPA may be
applied for surgery of any organs, thereby reducing cognitive disorders,
-11-
CA 02746087 2011-07-12
P1244CA00
decreasing acute as well as chronic pain, and sleeping disorders induced by
the surgery and the analgesic agents. Furthermore, OPA may help in
reducing the number of metastases following oncological surgeries.
[0070] EXAMPLE I
[0071] Evaluation of the general state of a patient
[0072] A questionnaire is filled by a nurse to evaluate the general state
of the patient. The questionnaire is an evaluation tool which includes
questions concerning the following aspects:
= Health antecedents of the patient,
= A listing of the patient's medication and the side effects of
the medication,
= An evaluation of the patient's life habits,
= An evaluation of the patient's general humor: good,
happy, sad, depressive, neutral,
= A listing of the family and/or informal caregiver in the
patient's entourage,
= An investigation of the patient's pain perception: the
intensity, the duration, localization, irradiation,
= An evaluation of the pain methods used to relieve the
pain.
= An evaluation of the patient's perception of quality of life,
= An auto-evaluation of anxiety level,
= An investigation of the patient's exercising and social
habits.
-12-
CA 02746087 2011-07-12
P1244CA00
[0073] Precise measurements are then taken of the patient's:
= Height,
= Weight,
= Waist circumference (WC),
= Body mass index (BMI),
= Abdominal fat, and
= Adiposity.
[0074] The vital signs of the patient are also analysed. These vital signs
include a measurement of:
= blood pressure,
= pulse,
= temperature, and
= respiratory rate.
[0075] Blood draws are performed and analyzed for:
= blood cell formula,
= coagulation pressure,
= sodium (Na+) concentration,
= potassium (K+) concentration,
= chlorine (CI-) concentration,
= phosphate concentration,
= calcium (Ca 2+) concentration,
= urea concentration,
= creatine concentration,
= protein concentration,
-13-
CA 02746087 2011-07-12
P 1244CA00
= albumin concentration,
= C-reactive protein (CRP),
= cholesterol HDL,
= cholesterol LDL, and
= hormonal status (sexual hormones, thyroxin, corticoids).
[0076] An evaluation of all these parameters is performed by the
physician at each visit of the patient.
[0077] EXAMPLE II
[0078] Evaluation of the pharmacological profile of the patient
[0079] An inflammation analysis of the patient is performed by the
physician. This analysis includes an evaluation of the narcotic use profile of
the patient, different drug association assay, the validation of the patient's
comprehension of his medication as well as his compliance in taking the
medication. The analysis may also include measurements of nitric oxide;
carbon monoxide, anti-inflammatory medication; opioid and anti-opioid;
acetylcholinesterase inhibitors; NMDA blockers; alpha 2 agonist; calcium
antagonist; sodium channel blocker; potassium channel modulator; chloride
channel modulator; neurotropine modulator; cytokine and chemokine
modulator.
[0080] Furthermore, blood draws are performed in order to perform the
inflammatory profile analysis of the patient. This analysis includes
measurements of:
= C-reactive protein (CRP),
= cytokine,
= Tumor Necrosis Factor a (TNF-a),
= Plasminogen Activator Inhibitor 1 (PAI-1),
= Retinol Binding Protein 4 (RBP-4),
-14-
CA 02746087 2011-07-12
P1244CA00
= interleukin 1 (IL1),
= interleukin 6 (IL6), and
= interleukin 10 (IL10).
In vivo test to evaluate inflammatory profile includes measurement of:
= exhaled nitric oxide,
= plasmatic nitrate and nitrite,
= endothelium dependant relaxation, and
= heart rate and RR variation and skin conductance.
[0081] EXAMPLE III
[0082] Evaluation of the cognitive state of the patient
[0083] The patient will be subjected to several cognitive tests during the
treatment program. These tests will be reviewed and corrected by a
neuropsychologist. The cognitive state analysis includes the following
cognitive test:
= R-Bans A,
= R-Bans B,
= R-Bans C,
= R-Bans D,
= verbal fluency,
= trail-making,
= FS-36,
= memory span, and
= E-MOCA.
-15-
CA 02746087 2011-07-12
P1244CA00
[0084] EXAMPLE IV
[0085] Evaluation of the anxiety level of the patient
[0086] The anxiety level of the patient is first evaluated by the nurse in
charge of the program. An evaluation is also performed by a psychologist, and
the patient will be subjected to several test recognized by the scientific
community to measure the level of anxiety. These tests include:
= Hads scale,
= Pain Disability Index,
= Beck hopelessness scale, and
= pain catastrophisation.
[0087] EXAMPLE V
[0088] Evaluation of the physical condition of the patient
[0089] The physical condition analysis of the patient will be peformed
by a kinesiologist as well as a physiotherapist that will perform several test
of
physical condition which include-
0 V02 max, and
= The six minute walking test
[0090] The patient will be seen by a multidisciplinary team which
comprise: a nurse, a nutritionist, a kinesiologist, a physiotherapist, a
psychotherapist, a psychologist, a neuropsychologist, as well as a physician.
[0091] The diet regimens, as well as the nutritional recommendations
are based on the evaluation of the patient by a nutritionist. The nutritionist
will
collect information on the patient by administering a questionnaire and the
patient will be asked to maintain a nutritional journal. The approbation of
the
physician is always required for the instauration of the regimen, with the
collaboration of the patient.
-16-
CA 02746087 2011-07-12
P1244CA00
[0092] EXAMPLE VI
[0093] Evaluation and control of the pain perception of the patient
[0094] The pain perception analysis includes the evaluation of pain
intensity, pain duration, pain location, pain irradiation, as well as the
McGill
pain questionnaire.
[0095] To relieve the pain of the patient, the patient is provided with an
appropriate medication regimen containing the drugs mentioned above. The
pain control methods also includes the following blocks:
= Cervical epidurals,
= Thoracic epidurals,
= Lumbar epidurals,
= Caudal epidurals,
= Sub-arachnoidal injections,
= Celiac plexus bloc,
= Hypogastric plexus bloc,
= Ganglion Impar bloc,
= Glossopharyngeal nerve bloc,
= Sphenopalatine ganglion bloc,
= Venous bloc,
= Brachial plexus bloc,
= Lumbar plexus bloc,
= Facet bloc,
= Cervical sympathetic bloc,
= Thoracic sympathetic bloc,
= Lumbar sympathetic bloc,
-17-
CA 02746087 2011-07-12
P 1244CA00
= Foraminal bloc,
= Laryngeal bloc,
= Trigeminal nerve bloc,
= Paravertebral bloc, and
= Intraveinous perfusion.
[0096] EXAMPLE VII
[0097] Alternative medicine treatments
[0098] The patient may be subjected to alternative medicine treatments
that include:
= Hypnosis,
= Acupuncture,
= Biofeedback,
= Art-therapy,
= Zootherapy, and
= Any other useful alternative approach.
The embodiments and examples presented herein are illustrative of the
general nature of the subject matter claimed and are not limiting. It will be
understood by those skilled in the art how these embodiments can be readily
modified and/or adapted for various applications and in various ways without
departing from the spirit and scope of the subject matter disclosed claimed.
The claims hereof are to be understood to include without limitation all
alternative embodiments and equivalents of the subject matter hereof.
Phrases, words and terms employed herein are illustrative and are not
limiting. Where permissible by law, all references cited herein are
incorporated by reference in their entirety. It will be appreciated that any
aspects of the different embodiments disclosed herein may be.combined in a
range of possible alternative embodiments, and alternative combinations of
-18-
CA 02746087 2011-07-12
P1244CA00
features, all of which varied combinations of features are to be understood to
form a part of the subject matter claimed.
-19-
