EmuFlex Cream is on of the most effective joints and muscles pain products.

1. EmuFlex Cream
Innovative natural pathway for joints
and muscles pain management

3. PathoPhysiology Of Joints Pain
 There may be :
o Pain (arthralgia).
o Inflammation (arthritis) - redness, warmth, and swelling
 There may be:
o Only a single joint involved (mono-articular).
o Multiple joints involved.
 The pain may occur :
o Only with use, suggesting a mechanical problem (eg,
osteoarthritis, tendinitis).
o At rest, suggesting inflammation (eg, crystal disease, septic
arthritis).
 There may or may not be fluid within the joint (effusion).

4. Joint pain may arise from:
 Structures within the joint (intra-articular):
o Sources of pain within the joint include the joint capsule,
periosteum, ligaments, subchondral bone, and synovium,
but not the articular cartilage, which lacks nerve endings
o Inflammatory.
 Infectious arthritis
 Rheumatoid arthritis
 Crystal deposition arthritis
o Non-inflammatory
 Osteoarthritis.
 internal mechanical derangement

5. Joint pain may arise from (cont..)
 Structures adjacent or a round to the joint (peri-articular)
o Bursitis
o Tendinitis
o Extra-articular disorders (eg, polymyalgia rheumatica, fibromyalgia).
 Referred Pain from more distant sites

6. Aetiology of Joint Pain
Mono-articular Pain
• Trauma : ( overuse – fractures – hemarthrosis). Most
common – to all ages
• Internal derangement or intra-articular trauma (Meniscus
injury – ligament tear)
• Infectious or Septic arthritis (eg, bacterial, fungal, viral,
mycobacterial, spirochetal, parasitic). Most important to
rule out.
• Reactive arthritis (Aseptic inflammatory arthritis).
• Crystal-induced disease (gout or pseudogout)
• Periarticular syndromes (eg, bursitis, epicondylitis, fasciitis,
tendinitis, tenosynovitis)

7. Mono-articular Pain
• Uncommon Causes :
– Avascular necrosis (H/O corticosteriod use or sickle cell
anaemia)
– Neuropathy (Charcot ‘s Joint).
– Osteoarthritis
– Osteomyelitis.
– Lyme disease.
– Paget’s disease (Osteitis deformans)
– Tumor

8. Poly-articular Joint Pain
• Acute polyarticular arthritis is most often due to
the following:
– Infection (usually viral)
– Flare of a rheumatic disease
• Chronic polyarticular arthritis in adults is most
often due to the following:
– RA (inflammatory)
– Osteoarthritis (noninflammatory)
• Chronic polyarticular arthritis in children is most
often due to the following:
– Juvenile idiopathic arthritis

9. Symptoms of joint disease
Symptoms of joint disease
 Pain
o Inflammatory joint disease
o present both at rest and with motion.
o It is worse at the beginning than at the end of usage.
o Non-inflammatory joint disease(ie, degenerative, traumatic, or
mechanical)
o Occurs mainly or only during motion
o Improves quickly with rest.
o Patients with advanced degenerative disease of the hips, spine, or
knees may also have pain at rest and at night.
o Pain that arises from small peripheral joints tends to be more
accurately localized than pain arising from larger proximal joints. For
example, pain arising from the hip joint may be felt in the groin or
buttocks, in the anterior portion of the thigh, or in the knee.

10.  Stiffness
– Stiffness is a perceived sensation of tightness
when attempting to move joints after a period of
inactivity. It typically subsides over time. Its
duration may serve to distinguish inflammatory
from non-inflammatory forms of joint disease.
– With inflammatory arthritis, the stiffness is
present upon waking and typically lasts 30-60
minutes or longer.
– With noninflammatory arthritis, stiffness is
experienced briefly (eg, 15 min) upon waking in
the morning or following periods of inactivity.

11. Swelling
– With inflammatory arthritis, joint swelling is
related to synovial hypertrophy, synovial
effusion, and/or inflammation of periarticular
structures. The degree of swelling often
varies over time.
– With noninflammatory arthritis, the
formation of osteophytes leads to bony
swelling. Patients may report gnarled fingers
or knobby knees. Mild degrees of soft tissue
swelling do occur and are related to synovial
cysts, thickening, or effusions.

12.  Limitation of motion
• Loss of joint motion may be due to structural damage,
inflammation, or contracture of surrounding soft tissues.
• Patients may report restrictions on their activities of daily
living, such as fastening a bra, cutting toenails, climbing
stairs, or combing hair.
 Weakness
• Muscle strength is often diminished around an arthritic joint
as a result of disuse atrophy.
• Weakness with pain suggests a musculoskeletal cause (eg,
arthritis, tendonitis) rather than a pure myopathic or
neurogenic cause.
• Manifestations include decreased grip strength, difficulty
rising from a chair or climbing stairs, and the sensation that
a leg is "giving way."

13.  Fatigue
• Fatigue is usually synonymous with
exhaustion and depletion of energy in
patients with arthritis.
• With inflammatory polyarthritis, the fatigue is
usually noted in the afternoon or early
evening.
• With psychogenic disorders, the fatigue is
often noted upon arising in the morning and
is related to anxiety, muscle tension, and
poor sleep.

14. Management
• General
 education, Physiotherapy
 analgesics and/or anti-inflammatory drugs
• Infection
 (if in doubt, treat until culture result)
 Gram +ve flucloxacillin, benzylpenicillin,
 Gram -ve 3rd generation cephalosporin
 6 weeks in total (2 iv, 4 po)
• Haemarthrosis
 joint aspiration

15. • Reactive arthritis
 joint injection (steroid and local anaesthetic)
 ophthalmology review
 screen partner (?)
 DMARD (Disease Modifying Anti-Rheumatic Drugs)
(sulphasalazine/MTX) if chronic
• Crystal arthritis
 NSAID/colchicine/joint injection (steroid/LA)
 lifestyle review
 Allopurinol if recurrent, tophaceous or erosive

16. • Sero-negative spondyloarthritis
 joint injection (steroid and LA)
 DMARD if chronic
 surgery (synovectomy, replacement)
• Osteoarthritis
 education, wt loss, physio
 joint injection (steroid/LA or hyuralonate)
 surgery

17. Muscles Pain and Aches
- Counter irritants are considered as an
important pain reliever.
- Peppermint oil is considered as important and
effective counter irritant agent.

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

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

21. EmuFlex Cream Pharmacology
Overview
Active Constituent Main active ingredient Action
Used by the Aboriginal
people of Australia for the
treatment of muscle and
joint pain, contains a
Emu Oil Linolinic acid and Oleic acid variety of fatty acids.
Modern research into the
properties of emu oil has
found that this is the
greatest skin emollient in
the world, with deep skin
penetration properties
better than any other
.natural oil

22. Active Constituent Main active ingredient Action
Enhances the ability of the
body to manufacture
collagen and proteoglycans,
which are essential for
Glucosamine Sulfate Glucosamine Sulfate rebuilding
joints. Glucosamine also
enhances the ability of the
body to manufacture
synovial fluid, which
.lubricates your joints

23. Active Constituent Main active ingredient Action
A major detoxifier of the
body, is responsible for
Methyl Sulfonyl Methane MSM opening the
((MSM sodium/potassium pump in
every cell allowing fluids
into the cell membrane,
while permitting toxins to
exit. Great transporter for
.nutrients

24. Active Constituent Main active ingredient Action
Is a natural herb that
possesses many
therapeutic properties.
The most relevant to
Ginger root extract gingerol and 6-shogaol-6 arthritis sufferers,
particularly those with
rheumatoid arthritis, is its
ability to inhibit
inflammation and bring
immediate relief from
.pain

25. Active Constituent Main active ingredient Action
White willow bark has been
used throughout the world
as an antipyretic and
White willow bark extract Salicin and Salicortin analgesic.
Since the development of
synthetic acetylsalicylic acid
in the 1890’s,

26. Active Constituent Main active ingredient Action
Stimulates the nerves that
Peppermint oil Menthol and Menthone perceive cold and depress
methyl acetate those for pain. A feeling of
warmth follows the initial
cooling effect

27. Just try EmuFlex cream, because:
•  EmuFlex cream is formulated with care by
a professional Doctors and Pharmacisits
•  EmuFlex cream Contains best-studied and
potent ingredients for pain.
•  EmuFlex cream immediately relieve
arthritis pain, sore joints & muscle ache.

28. •  EmuFlex cream stimulates blood circulation in
muscles and connecting tissues with deep pain
relief.
•  EmuFlex cream Provide soothing and lasting
joint pain relief. Improve joint flexibility and
range of motion.
•  EmuFlex cream formula contains Emu oil
which considered as an excellent carrier and
increase absorption for both of Glucosamine and
MSM through the skin.
•  EmuFlex cream has an excellent safety profile.