Articles: patients.
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The aim of the study was to determine the proportion of high-risk patients who received appropriate antianginal therapy in the prodromal phase prior to a myocardial infarction, as an indicator of medical care seeking behavior. To this end, 606 male infarct patients aged 29-65 years were retrospectively interviewed 17-21 days after acute myocardial infarct. ⋯ In stepwise logistic regression analysis, high blood pressure, older age and exhaustion were found to be associated with medical treatment before infarction in the patient group with first myocardial infarction. In patients with recurrent infarction, continued smoking and denial of the risk remained predictive of nonmedication.
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The efficacy of morphine and other opioids in the treatment of severe pain, especially cancer pain, is undoubted. If opioids are used according to the WHO guidelines no severe side effects or psychological dependence develop. In Germany the use of strong opioids is controlled by law and requires a special prescription with offical forms and difficult regulations. ⋯ The prescription patterns we found demonstrate inadequate medical care of patients with severe pain. Continuous pain therapy with strong opioids was found in only a few cases. The main reason for this situation is the law pertaining the use of opioid drugs, with its difficult and restrictive regulations. This law cannot stop the development of increasing illegal drug consumption, but obstructs the medical care of patients with severe pain.
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Intravenous administration of local anaesthetics has repeatedly been recommended for the treatment of chronic pain. Some authors have also reported on their use in postoperative pain management. However, most of these publications are case reports or refer to rather old studies or investigations based on study designs that fail to meet present scientific standards. ⋯ During the first 24 h after surgery 12 patients in the lidocaine group required a total of 550 mg meperidine in addition, while 8 patients in the control group required a total of 300 mg meperidine. The postoperative meperidine consumption was not significantly diffent between the lidocaine group and the control group. Intravenous lidocaine infusion did not significantly reduce postoperative pain after tonsillectomy in the dosage used.
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Opioids have been used for analgesia in nearly all civilizations. In paediatrics their use has become widely accepted for combating severe pain, especially postoperative pain and tumour pain. Receptors in the central nervous system are the best known sites of action of opioids, but the existence of peripheral receptors is also probable. ⋯ Tramadol is widely used for emergencies, as it has the least sedative action; but it has disadvantages in causing nausea and vomiting. Codeine is widely used for its antitussive action. While the necessity of good analgesia for even the smallest infant cannot be overstated, the opioid used must be carefully selected with reference to the age of the child and the pain to be controlled.
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The subject of treatment of pain in children and elderly patients has been neglected to date. This symposium deals with the problems of pain treatment in these two age groups and shows the importance of adequate therapy to improve their quality of life.