The Clinical journal of pain
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Review Case Reports
Common painful sports injuries: assessment and treatment.
The increasing participation in organized sports has been paralleled by an increasing number of sports injuries. An exact diagnosis of the injury and an understanding of the mechanisms of injury are essential for proper management, relief of pain, and restoration of function. The two mechanisms of injury are single-impact macrotrauma and repetitive microtrauma. ⋯ The roles of non-narcotic analgesics, muscle relaxants, and nonsteroidal anti-inflammatory drugs (NSAIDs) in aiding recovery and restoration of function in sports injuries have been extensively studied. NSAIDs, in particular, have been demonstrated in clinical and laboratory studies to speed recovery from overuse sports injury. Their place in acute sports injuries due to single-impact macrotrauma, however, is more controversial.
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Many theories exist on the pathogenesis of migraine. However, the clinical picture of migraine is agreed on universally as a familial disorder characterized by recurrent attacks of headache that are variable in intensity, frequency, and duration. The attacks are usually unilateral and often associated with anorexia, nausea, and vomiting. ⋯ A variety of medications, including ergotamine, propranolol, the calcium channel blockers, antidepressants, and nonsteroidal anti-inflammatory drugs (NSAIDs) have been beneficial in the prophylactic treatment of migraine. Ergotamine is the drug of choice in the abortive treatment, although other agents, such as the NSAIDs, have been used successfully. Inpatient therapy in a specialized unit for headache patients may be indicated for the recidivist patient, the patient habituated to analgesics or ergotamine, or the patient with the mixed headache syndrome, i.e., migraine occurring with coexistent muscle contraction headaches.
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Comparative Study
Sufentanil and alfentanil pattern of consumption during patient-controlled analgesia: a comparison with morphine.
Pattern of drug consumption and side effects of sufentanil and alfentanil were compared to morphine, using "on-demand" patient-controlled analgesia (PCA). After a non-narcotic general anesthetic, a bolus dose of the narcotic was given intravenously towards the end of surgery. PCA was started in the recovery room. ⋯ There was a similar incidence of nausea in all the groups. Further study is needed to determine precisely the best dose regimens for sufentanil and alfentanil, especially in reference to optimum loading doses. Sufentanil appears to be a promising drug for PCA use.
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Optimal care of surgical patients includes effective control of incisional pain. Attention is beginning to be focused on new in-hospital services created to improve the management of postoperative pain. Additional information regarding the organization and operation of this type of service, especially in the framework of a university hospital, is presented. The specific roles of an academic anesthesiologist involved in acute pain management are: to provide leadership by the development of effective services, to clarify through research optimal treatments, to train future practitioners in the management of acute pain, and to serve as a consultant for improving pain control for the whole medical community.