Anesthesia progress
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Anesthesia progress · Mar 1990
Pain and opiate receptors: considerations for the design of positron emission tomography studies.
Opiate receptors in the brain are the target of endogenous opioids and of exogenous synthetic opiates. These receptors play a major role in the modulation of pain perception. ⋯ Several important aspects of the in vivo opiate receptor labeling with positron emission tomography in relation to the study of pain are considered in this paper. Monitoring receptor occupancy by opiate drugs as a function of pain relief has the potential to reveal better ways to treat pain.
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Musculoskeletal disorders of the stomatognathic system comprise the majority of diagnoses responsible for chronic orofacial pain. The most common signs for these disorders include tenderness, limitation in range of motion, deviation in range of motion, and joint noise. Although these signs are used routinely for diagnosis, the reliability, validity, and accuracy of their use as diagnostic criteria or outcome measures has not been established. ⋯ Both tenderness and dysfunction improved with treatment but did not become normal. The percent agreement of these signs as diagnostic criteria for the presence and stage of a temperomandibular joint (TMJ) internal derangement was about 80% compared with arthrotomography. These studies suggest that these clinical characteristics can be used with adequate reliability and validity to diagnose and measure severity if standardized methods are used.
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To communicate, understand, and prescribe treatment, it is essential that some consensually validated criteria be used to describe groups of patients who share a set of relevant attributes. Several classification systems have been developed to described relatively homogeneous subgroups of chronic pain patients. ⋯ Some of the strengths and weaknesses of deductive and inductive approaches to classification are described, and the advantages of polydiagnostic and multiaxial approaches are described as alternatives to the traditional classification. Research on an empirically derived multiaxial classification for chronic pain is described and related to chronic orofacial pain.
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Anesthesia progress · Jan 1990
Case ReportsIneffective ventilation during conscious sedation due to chest wall rigidity after intravenous midazolam and fentanyl.
Chest wall rigidity has been reported after the administration of high-dose intravenous fentanyl. This case report supports the observation that low-dose intravenous fentanyl may also cause chest wall rigidity. The treatment of chest wall rigidity with naloxone or neuromuscular blocking agents is controversial. A discussion of the management of fentanyl-induced chest wall rigidity is presented.