Ugeskrift for laeger
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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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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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Total knee arthroplasty (TKA) is associated with considerable postoperative pain which may be difficult to manage. This article describes advantages and disadvantages of the different analgesic techniques used for pain treatment after TKA, for example i.v. patient-controlled analgesia, epidural pain treatment, and peripheral nerve blocks (especially femoral and sciatic blocks). Randomised studies suggest that peripheral nerve blocks have the best effect and have fewest side effects. Intra-articular administration of analgesics is the most recently introduced technique.
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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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Genetic factors can explain a significant amount of the variance in the perception of pain, sensitivity to painful stimuli and development of chronic pain. Twin studies, association studies and linkage analysis have located DNA sequences and SNPs that may be involved in the regulation of pain. Individual genes have an influence on the reaction to experimental painful stimuli, and certain genes are probably involved in painful clinical conditions. Optimal pain control and counselling of patients may be achievable through research into the genetic mechanisms involved in pain.