Articles: patients.
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Two cases with perineal pain caused by recurrent carcinoma of the rectum are reported. Initially both patients suffered from predominantly nociceptive pain, which was treated adequately with spinal opioids. Tumor growth with epidural spread and infiltration of the plexus lumbosacralis caused severe neuropathic pain. ⋯ Bradycardia and hypotension occurred with initial dose titration and after dose increases and were treated with parasympathicolytic drugs and vasopressor agents. Both patients were given spinal clonidine until their death 4 1/2 and 4 months later. In the final stages, adjuvant systemic administration of morphine was necessary to control dyspnea.
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Chronic pain is often associated with an array of general psychological dimensions such as depression, somatic symptoms, anxiety, anger and a loss of quality of life. Part VIII describes various instruments concerning each dimension and comments on their applicability within a diagnostic routine for chronic pain patients. ⋯ Trait-anxiety and pain-unrelated state-anxiety seem not to be suitable because they lack significance for the therapy process. While the inventory for assessing anger still needs an empirical basis for chronic pain patients, quality of life inventories are not recommended for routine pain assessment.
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J Am Board Fam Pract · Nov 1995
Patients' attitudes about gifts to physicians from pharmaceutical companies.
Little is known about patients' awareness of and attitudes about gifts to physicians from pharmaceutical companies. ⋯ Respondents distinguished between particular gifts; approval rates were high for gifts generally considered to be trivial or that have potential value to patient care; disapproval rates were relatively high for gifts that have some monetary value but have little or no benefit for patients. Opinions about gifts were related to perceptions of their effects on prescribing behavior and costs.
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Disability is a central aspect in the assessment of chronic pain patients. Disability questionnaires in German (developed or adapted) are examined and selected for different purposes. The "Funktionsfragebogen Hannover" and the "Pain Disability Index" are recommended for both research and clinicalapplication while the "Sickness Impact Profile" is suitable only for research purposes. ⋯ There are some empirical data for three of them. Only the "Inventory of Familial Adaptability and Cohesion" has achieved a certain degree of empirical maturity. Further research and developmental activity in this area of pain assessment are urgently needed.