European journal of pain : EJP
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After thoracotomy, patients often suffer from a persistent pain syndrome called post-thoracotomy pain. To elucidate morbidity, time course, and predictive factors for this syndrome, we analyzed follow-up data for 85 post-thoracotomy patients. We used a four-point scale to assess pain: none, slight, moderate and severe. ⋯ Among 35 patients with persistent pain 1 year after surgery, 24 cases reported paresthesia-dysesthesia, and 14 cases reported hypoesthesia. The present data thus suggests that persistent pain is common and often severe 1 month after surgery but is alleviated after 1 year. Clinical time course and symptoms indicate that nerve impairment rather than simple nociceptive impact may be involved in this syndrome.
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China is a large country with a huge population. It is estimated that 1.8 million patients suffer initially from cancer and 1.4 million patients die from it each year in Mainland China. Cancer ranks as the primary reason for death among the common diseases in cities and the second in rural areas. ⋯ As a result, the three-step analgesic ladder of the World Health Organization (WHO) has been gradually accepted by medical personnel and patients. Although pain management has been improved since the WHO's strategy of the three-step approach was implemented in China, variations still exist in different regions of the Mainland. Currently the three main aspects of work on pain measurement are going to be undertaken including (1) continuous support from government policy; (2) consistent education and training; and (3) better availability of drugs for medical use throughout the whole country.
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There is continuing reluctance to prescribe strong opioids for the management of chronic non-cancer pain due to concerns about side-effects, physical tolerance, withdrawal and addiction. Randomized controlled trials have now provided evidence for the efficacy of opioids against both nociceptive and neuropathic pain. However, there is considerable variability in response rates, possibly depending on the type of pain, the type of opioid and its route of administration, the time to follow-up, compliance and the development of tolerance. ⋯ There were no withdrawal effects or addictive behaviour on treatment cessation, regardless of duration of the treatment. In conclusion, strong opioids may provide prolonged effective pain relief in selected patients with nociceptive and neuropathic non-cancer pain. Transdermal fentanyl treatment can often be temporary and can easily be stopped following adequate pain relief without withdrawal effects or any evidence of addictive behaviour.
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Clinical Trial
Computer-controlled pneumatic pressure algometry--a new technique for quantitative sensory testing.
Hand-held pressure algometry usually assesses pressure-pain detection thresholds and provides little information on pressure-pain stimulus-response function. In this article, a cuff pressure algometry for advanced pressure-pain function evaluation is proposed. The experimental set-up consisted of a pneumatic tourniquet cuff, a computer-controlled air compressor and an electronic visual analogue scale (VAS) for constant pain intensity rating. ⋯ There was a direct correlation between the number of compressions, the compression rate and pain thresholds. The cuff algometry technique is appropriate for pressure-pain stimulus-response studies. Cuff algometry allowed quantification of psychophysical response to the change of stimulus configuration.
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Optimal pharmacologic management of pain requires selection of the appropriate analgesic drug, prescription of the appropriate dose, administration of the analgesic by the appropriate route, scheduling of the appropriate dosing interval, prevention of persistent pain and relief of breakthrough pain, aggressive titration of the dose of the analgesic, prevention, anticipation, and management of analgesic side-effects, use of appropriate co-analgesic drugs, and consideration of sequential trials of opioid analgesics. Controlled-release oxycodone (CRO) has the characteristics of an 'ideal' opioid analgesic drug: short half-life, long duration of action, predictable pharmacokinetics, absence of clinically active metabolites, rapid onset of action, easy titration, no ceiling dose, minimal adverse effects, and minimal associated stigma. CRO has been shown to be effective in the control of pain caused by cancer, osteoarthritis, post-herpetic neuralgia, major surgery, and degenerative spine disease.