Ugeskrift for laeger
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Neuropathic pain (NP) occurs secondary to lesions in the nervous system. The definition includes conditions with nervous system dysfunction, which creates problems with diagnostic classification. ⋯ However, it is not yet possible to identify mechanisms in individual patients, and present knowledge of drug effects builds on diagnosis. An algorithm for treatment of NP is presented.
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The purpose of this survey was to map the sale of analgesics in the Danish primary care sector from 2000 to 2004. ⋯ In 2004, every fifth Danish citizen bought analgesics on prescription. Between 2000 and 2004, the number increased. In particular, the number of users of NSAIDs was large. The number of users of strong opioids did not increase as did the number of users of the other groups of analgesics, but within that group there was a shift to more expensive drugs.
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Pain is not the most frequent symptom in cancer patients, but it is considered the most serious and threatening symptom. Opioid analgesics are the mainstay for analgesic treatment of cancer patients. Methadone is increasingly being considered as an alternative to morphine and seems to become relatively more potent with increasing exposure to other opioids. "Newer" side effects of opioids have been demonstrated, including cognitive impairment, generalized allodynia/hyperalgesia, myoclonus and hallucinations. When the pain relief effects of oral opioids have been exhausted, other pain management approaches, including spinal delivery of analgesics, may be effective alternatives.
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Substantial progress has been made in our understanding of acute pain mechanisms, and our insight into postoperative convalescence and rehabilitation has increased dramatically. There is a lack of evidence for pre-emptive analgesia, whereas studies of antihyperalgesic drugs and multimodal analgesic regimens are promising. The use of opioids should be restricted, and it may be rational to develop procedure-specific pain treatment guidelines. There is a need for increased collaboration and integration of acute pain treatment and multimodal postoperative rehabilitation efforts.