The Clinical journal of pain
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Healing or successful intervention usually leads to the resolution of pain. However, in some patients biologic or psychologic symptoms associated with pain persist despite treatment or apparent healing. In cases in which the etiology is not known, persistent pain is categorized as a clinical syndrome known as "chronic pain." Organic, psychologic, and socioenvironmental factors contribute to the development of chronic pain. ⋯ Before successful management can begin, the major etiologic factors and sequelae of the chronic pain syndrome must be understood. Antidepressants, neuroleptics, anticonvulsants, nonsteroidal anti-inflammatory drugs, and hydroxyzine have been proven effective in the treatment of pain syndromes. The treatment of patients who present with chronic pain must be individualized based on a comprehensive understanding of the factors underlying the chronic pain syndrome of each patient.
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An updated review of patient-controlled analgesia (PCA) for acute pain relief in the postoperative period is presented. The technique, becoming more and more popular with patients, surgeons, and nurses, is undergoing numerous clinical trials under a variety of clinical protocols that are currently being reviewed. Benefits found with PCA include the fact that it is individualized therapy, allowing optimum drug titration; it decreases a patient's anxiety in the postoperative period; and it is a safer and more efficient technique of acute pain relief than conventional therapy. ⋯ Contraindications to the technique and most current equipment in use are listed herein. Clinical experience with PCA at Georgetown University Medical Center has provided, as has been the case elsewhere, data showing the superiority of the technique and its wide acceptance as part of the Acute Pain Service. The anesthesiologist plays a vital role in coordinating the various people and aspects involved in PCA for postoperative pain relief.
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Within acute pain management, as within any rapidly expanding field of therapeutic endeavor, novel treatment modalities may on occasion overreach their scientific foundations. In general, a cautionary theme is expressed regarding the utilization of various therapies, lest their overzealous clinical implementation jeopardizes the advancement of this highly promising field. ⋯ The subject of dosing for acute pain conditions with opiates via the epidural route versus intravenous opioid administration is discussed from the perspectives of practicality and risk/benefit assignments. The advisability and means of using demand-mode techniques in order to resolve the central issue of inherent benefits of opioid administration via one route or another is also presented.
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Tyramine sulfoconjugation following an oral tyramine load was determined in 30 patients suffering from migraine and 14 controls not regularly suffering from headache. Reduced tyramine sulfoconjugation was found in those patients with a history of major depressive disorder compared with controls. When the patients with a history of major depression were removed from the analysis, no differences were found between diet-sensitive and non-diet sensitive migraine patients and controls.