The Medical clinics of North America
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Pain control is vital to the quality of life of patients with cancer. From pain assessment and pharmacologic management to interventional management, special features of cancer pain are outlined in this article. Many evidence-based national and societal guidelines were developed during the past decade on cancer pain management. Proper and adequate management of cancer pain is strongly recommended by all the clinical practice guidelines.
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Med. Clin. North Am. · May 1999
ReviewInterventional pain management. Appropriate when less invasive therapies fail to provide adequate analgesia.
Unrelieved chronic pain is costly to patients and society. Noninvasive and less costly therapies should be used before more invasive and more costly therapies. Therapies for pain control should be used according to a pain treatment continuum. Nerve-blocking techniques, neurolytic techniques, and implantable neuromodulatory technologies, such as SCC and spinal delivery of analgesics, are cost-effective when less invasive therapies fail to provide adequate analgesia.
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Opioids are a necessary and effective component of the management of chronic non-cancer-related pain in some patients. Careful structuring, monitoring, and documentation of care are important, but the therapeutic use of opioids is uncomplicated in the majority of patients using opioids and is gratifying for both the patient and the treating physician when it results in significant reduction in pain, improvement in level of function, and a higher quality of life. Opioid therapy is most often successful when combined with other pharmacologic and nonpharmacologic interventions as indicated by the type of pain and the context in which it occurs.
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Head, neck, and facial pain disorders possess characteristic features that, in some ways, distinguish them from other painful disorders. Generally speaking, the headache disorders can be reconciled within the same model of assessment as that of other painful conditions.
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Nonpharmacologic management strategies for Parkinson's disease should focus on educating the patient and family, empowering them to take control over the disease through physical, occupational and speech therapy, exercise, and good nutrition. An educated understanding of psycho-social resources will enable the patient and family to develop strategies to cope with life style changes encountered in the successful management of Parkinson's disease.