Articles: analgesia.
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Studies in US emergency departments have demonstrated that pain is undertreated in adults and children. Previous studies have also demonstrated cultural differences in the expression and perception of pain. The objective of this investigation was to describe the analgesic practices and patient pain responses in two Costa Rican EDs in light of possible differences due to cultural variation. ⋯ Our data illustrate that both adults and children with severe pain resulting from orthopedic injury in the Costa Rican EDs we studied often receive inadequate or no analgesic treatment. This finding suggests that the phenomenon of oligoanalgesia is more widespread and resistant to cultural differences. We also noted a reluctance to use opioids in this setting.
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Pain treatment with centrally acting opiates is limited by tolerance. Tolerance is a decreasing effect of a drug with prolonged administration of that drug or of a related (e.g., endogenous) compound acting at the same receptor. This is often associated with a downregulation of receptors. ⋯ We found that, despite an abundance of opioid-containing cells in pronounced synovitis, morphine is at least as effective as in patients without such cellular infiltrations, and there is no major downregulation of peripheral opioid receptors. Thus, opioids expressed in inflamed tissue do not produce tolerance to peripheral morphine analgesia. Tolerance may be less pronounced for peripherally than for centrally acting opioids, which provides a promising perspective for the treatment of chronic pain in arthritis and other inflammatory conditions.
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Methadone is a very useful drug in cancer pain because of its low cost, lack of active metabolites, high oral availability, and the rapid onset of its analgesic effect. It seems to be well tolerated in patients with difficult pain syndromes who are receiving high doses of opioids, and it may deter the development of tolerance, but a high individual variation in terminal elimination half-life can result in different rates and extents of drug accumulation. For this reason, oral patient-controlled analgesia with methadone was used in 24 advanced-disease patients with pain. ⋯ Patient-administered analgesia with oral methadone appears to be a simple, cheap and relatively safe technique for controlling cancer pain, permitting individualization by the patient him- or herself and avoiding the risk of accumulation. Continuous assessment is necessary.
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Back pain and minor neurological symptoms are commonly experienced postpartum, often being attributed to non-specific causes such as maternal obstetric factors, or the use of epidural analgesia. We report a case in which neurological problems associated with a prolapsed intervertebral disc occurred after epidural analgesia in labour and a normal vaginal delivery.