Articles: treatment.
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The prevalence of illicit drug use by patients in a chronic pain management practice who concomitantly abuse prescription-controlled substances is not known. The purpose of this study was to determine the prevalence of illicit drug use by patients in an interventional pain management practice, based on whether or not there was evidence of simultaneous abuse of prescription drugs. One hundred and fifty patients in an interventional pain management practice who were prescribed controlled substances for pain treatment were selected for assessment of concomitant illicit drug use by urine drug testing. ⋯ Marijuana was the drug of choice in both groups, with 22% in the prescription abuse group and 10% in the non-abuse group. The second most commonly used illicit drug in both groups was cocaine. This study demonstrated a clinically significant use of illicit drugs, particularly marijuana and cocaine in an interventional pain management setting, in patients with or without evidence of concomitant abuse of prescription controlled substances.
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We previously reported that 25% (108/441) of consecutive patients presenting to the emergency department (ED) of the Montreal Heart Institute with a chief complaint of chest pain suffered from panic disorder (PD). The purpose of the present study was to re-examine these patients (with and without PD) 2 years after their initial ED visit to determine their psychiatric and psychosocial status. ⋯ Unrecognized and untreated PD has a chronic and disabling course. Greater efforts should be made to screen for PD in patients complaining of chest pain in EDs.
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Spinal Cord Stimulation (SCS) is a treatment option for chronic pain patients. The most common indication for SCS is the failed back syndrome with leg pain. In the last decade, advances in our understanding of appropriate stimulation programming, lead placement and the physiology of SCS, have led to changes in multi-site stimulation, and stimulation with differing programs. In the past, low back, axial neuropathic type pain was not responsive to SCS. With dual electrode arrays, and dual stimulation with alternating programs of stimulation, steering of stimulation paresthesia, and versatile programmable stimulation parameters, SCS has become a more versatile form of analgesia. ⋯ SCS is the most effective treatment for limb pain not amenable to surgical decompression. The success of SCS in this chronic pain group is 80% successful in treatment of leg pain, and much less effective in treatment of axial pain.
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Curr Opin Anaesthesiol · Jun 2003
Anaesthetic considerations in patients with chronic pulmonary disease.
Chronic pulmonary diseases are getting more important in daily anaesthetic practice, because prevalence is increasing and improved anaesthetic techniques have led to the abandonment of previous contraindications to anaesthesia. It is therefore essential for the anaesthetist to be up to date with current clinical concepts and their impact on the conduction of anaesthesia as well as new insights into how to anaesthetise these patients safely. ⋯ Assessing the functional status of patients admitted for surgery remains a difficult task, and in patients identified as being at risk by clinical examination additional spirometry and blood gas measurements may be helpful. If there are flow limitations and signs of respiratory failure, the anaesthetist should be highly alarmed and monitor the patient closely and invasively, yet there is no reason to deny any patient a substantially beneficial operation.
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Although postoperative analgesia in infants and children should be an integral part of the perioperative management, undertreatment of pain is not rare in clinical practice and may influence outcome and long term behaviour. Therefore, this review summarizes results of recent papers and discusses actual trends and future perspectives concerning postoperative pharmacologic pain therapy in infants and children. ⋯ The reviewed studies suggest that there are many reliable agents and techniques available to provide a safe and effective postoperative analgesia even in neonates and small infants.