Journal of pain and symptom management
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Deciding whether a child's headache is functional or organic is difficult for even the experienced physician. This review examines the diagnosis and management of headache syndromes in children and adolescents. A systematic history and examination together with selected laboratory data will enable the practitioner to establish the correct diagnosis.
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J Pain Symptom Manage · Feb 1993
Treatment considerations in headache and associated medical disorders.
As more headache sufferers seek medical care for their headaches, it is incumbent on physicians to consider all of a patient's medical illnesses in choosing therapy. The availability of new medications for headache will facilitate the tailoring of treatment to specific patient needs. The physician who treats patients with headache and concomitant medical problems must be knowledgeable about the pharmacology and adverse effects of these agents. This will permit the practitioner to use specific therapy, limit the number of medications prescribed, and prevent an exacerbation of either the medical condition or the headaches.
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J Pain Symptom Manage · Jan 1993
Intrathecal infusional therapies for intractable pain: patient management guidelines.
This article focuses on appropriate patient selection for and management of patients selected for continuous spinal infusional opioid therapy. Patients with cancer-related pain who have undergone sequential strong opioid drug trials, who have intractable, unmanageable side effects, and who have undergone a successful spinal opioid efficacy trial are candidates for implantable spinal infusional therapy. ⋯ Patients with cancer-related pain who have life expectancies less than 3 mo have implanted permanent epidural catheters connected to external pump systems. Management guidelines for complications of therapy broadly categorized as surgical, mechanical, and pharmacologic are presented.
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J Pain Symptom Manage · Nov 1992
Case ReportsA survey of complications documented in a quality-control analysis of patient-controlled analgesia in the postoperative patient.
Patient-controlled analgesia (PCA) has become a cornerstone of postoperative pain management in many institutions. Despite the extensive use of this analgesic technique, there are not large population studies to determine the frequency or types of complications associated with PCA in the literature. This study looks at 1122 patients over a 1-yr period. ⋯ These complications were attributable to overdosage (escalating dosage to meet patient analgesic needs or someone other than the patient administering drug through the PCA device) or to interaction of PCA drugs with concurrent medications. There was a much higher incidence of complications associated with PCA pumps featuring continuous infusion in addition to intermittent bolus compared with those employing intermittent bolus alone. The types of complications encountered in this survey demonstrate instances of PCA use that may present a higher risk to the patient and thus require closer monitoring.
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J Pain Symptom Manage · Nov 1992
Patient and nurse evaluation of patient-controlled analgesia delivery systems for postoperative pain management.
Five different patient-controlled analgesia (PCA) delivery systems were evaluated for the treatment of acute postoperative pain in 423 patients undergoing elective operations at a large tertiary care hospital. The PCA trial was conducted on four different postsurgical wards over a 5-mo period. All five devices were utilized on each ward for a 1-mo period. ⋯ In conclusion, 80% of the nurses at this teaching center preferred the Baxter PCA Infusor over four widely used electronic PCA devices for the management of acute postoperative pain. The Pharmacia device was felt by the nurses to be less user friendly than the other programmable PCA devices used in this trial. Of the electronic devices we studied, the Bard and IVAC devices were the most cost-effective.