The Journal of the American Osteopathic Association
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Management of cancer pain is still a significant problem in healthcare today despite the fact that such discomfort can be controlled in approximately 90% of patients. Emotional, psychosocial, and spiritual suffering associated with this disease complicates the problem. ⋯ Pain intensity scales, complementary and alternative methods, and the role of an interdisciplinary care team, as well as a need to provide spiritual support to both patient and family, are included in this discussion. A case vignette describes management of cancer pain in a typical patient admitted to hospice.
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Pain may be the most common reason patients seek treatment from physicians. When persistent and unrelieved, pain can frustrate both the person suffering with this condition and the physician trying to alleviate it. Relief from such discomfort may be particularly difficult to achieve and fraught with misconceptions. ⋯ Nociceptive pain resulting from a known or obvious source (eg, trauma, cancer metastasis, ischemia, arthritis) is often easy to identify. Neuropathic pain, however, may occur in the absence of an identifiable precipitating cause. Physicians must remain alert to differences in presentation and course of neuropathic pain syndromes, some of which may be subtle or unusual.
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Headache is one of the chief complaints among patients visiting primary care physicians. Diagnosis begins with exclusion of secondary causes for headache. More than 90% of patients will have a primary-type headache, so diagnosis can often be completed without further testing. ⋯ Management of migraine is a dynamic process, because headaches evolve over time and medication tachyphylaxis may occur, necessitating changes in therapy. Pathologic findings in the neck constitute an accepted etiology or precipitant for headache. Osteopathic manipulative treatment may reduce pain input into the trigeminal nucleus caudalis, favorably altering neuromuscular-autonomic regulatory mechanisms to reduce discomfort from headache.
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J Am Osteopath Assoc · Nov 2007
Case ReportsUsing image-guided techniques for chronic low back pain.
Image-guided spine intervention is used primarily for its precise diagnostic capabilities. This article reviews basic principles of the more common image-guided diagnostic techniques specifically as they relate to patients with low back pain. It also includes discussion of advanced modes of therapy, including spinal cord stimulation and intrathecal therapy, providing primary care physicians with an understanding of the primary indications for these therapeutic modalities. Two illustrative case presentations have been added to "refresh" this article, which was originally published in a supplement to the September 2005 issue of the JAOA and to further enhance primary care physicians' understanding of spinal intervention.
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As osteopathic physicians care for patients with complaints of pain, they commonly prescribe controlled substances. The use of these agents presents special challenges for providers, patients, and communities. ⋯ Joseph T. Rannazzisi, the deputy assistant administrator in the Office of Diversion Control, appeared before the House Government Reform Committee's Subcommittee on Criminal Justice, Drug Policy, and Human Resources on July 26, 2006.