Journal of pain and symptom management
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J Pain Symptom Manage · Jun 1996
ReviewIntraspinal opioid therapy for chronic nonmalignant pain: current practice and clinical guidelines.
The multidimensional nature of chronic nonmalignant pain lends itself to numerous treatment options, which vary in cost and invasiveness. Based on the principle that less invasive and less costly interventions for pain treatment should be attempted first, a continuum of interventions for chronic pain states is presented. Although intraspinal opioid therapy is a relatively invasive and costly modality for pain treatment, it has a rational place in the treatment continuum for some chronic nonmalignant pain patients. A thorough review of the literature, supplemented by clinical experience, provides a foundation for the development of management guidelines.
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J Pain Symptom Manage · Jun 1996
Clinical Trial Controlled Clinical TrialA volunteer model for the comparison of laxatives in opioid-related constipation.
Loperamide was used to provide a source of opioid-induced constipation in healthy volunteers. Each volunteer took a sequence of three dose levels of loperamide. One of three laxatives was used to counterbalance the effect of loperamide and restore bowel function to what the individual considered normal at each stage before the dose of loperamide was increased. ⋯ The mean final dose of lactulose was excessive for use in ill patients. Senna was associated with significantly more adverse effects than the other laxatives, mainly abdominal pain (P < 0.001). This model of constipation may provide a standardized means of assaying the clinical effectiveness of oral laxatives.