Articles: acute-pain.
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In contrast to pain from the skin, muscle pain is often referred to regions remote from the lesion. For instance, trigger points in neck muscles can elicit pain in the head. The convergence-projection theory of Ruch is still the central concept for the explanation of pain referral. ⋯ Therefore, the present paper presents another mechanism, which consists in acute changes in dorsal horn synaptic connections following nociceptive input from muscle. Results from animal experiments indicate that dorsal horn neurons possess ineffective synaptic connections with the body periphery, which become effective under the influence of a painful stimulus and lead to a mislocalization of pain. The neuropeptide substance P is probably involved in the changes in functional organization that occur in the dorsal horn during muscle pain and its referral.
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Modern concepts of pain therapy involve neuronal mechanisms of endogenous analgesia. Recent animal experiments have provided new insights into the anatomy, physiology and neurobiology of endogenous antinociception. We have shown that antinociception can be maximally activated by disinhibition-and not by direct electrical or chemical excitation-in the midbrain periaqueductal grey matter. ⋯ The high order in the discharges of these neurons is maintained, at least in part, by tonically active descending systems. Thus, the spinal shock syndrome seen in some species after acute spinalisation may result from the loss of order in spinal neuronal discharges normally provided by the brain. The use of modern methods in studies of the functional neuroanatomy, neurophysiology and neurobiology of endogenous antinociception may help in the achievement of better application of results from basic sciences to clinically relevant pain problems.
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Anxieties and emotional disturbances associated with cancer often cause pain therapy to be unsuccessful. When psychological support is required it is mostly aimed at supporting cancer patients in attempts to cope with their disease so as to improve the efficiency of pain therapy. In our study we focused on the barriers to cancer pain management that lie in patient's beliefs about pain and their coping behavior. ⋯ Those patients who used cognitive coping strategies and did not communicate often received inadequate pain therapy. Those who talked about pain but did not use any other coping strategies were mostly well treated. We have designed a brochure, "What tumour patients should know about pain" directly oriented on the above pain beliefs; this is now being evaluated with reference to its educational effect.
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The spectrum of perioperative pain treatment is discussed in the present review. The analgesic efficacy of various drugs and the dosage methods of administration and side effects reported for them in such reference works as the practical guide on the management of acute pain recently published by the International Association for the Study of Pain (IASP) are described. Effective postoperative analgesia can diminish stress reactions following surgery. ⋯ Investigations performed by the author of this review have shown that epidural infusion of highly diluted mixtures of bupivacaine/fentanyl is highly effective in the analgesic treatment of patients undergoing prostatectomy, providing excellent physical mobilization. The potential dangers of drug combinations and contraindications are also discussed. The concept of using balanced analgesia to induce additive or synergistic effects following the administration of analgesic drugs requires further clinical studies.
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Despite regular administration of analgesics, a high percentage of patients with chronic malignant pain experience break-through cancer pain or incident pain. Such pain peaks in patients with chronic malignant pain require "rescue" medication in addition to basic analgesia with for example slow-release morphine or buprenorphine. For rescue medication a fast acting and powerful analgesic should be available to the patient. Recent studies have shown that intranasal fentanyl provides rapid onset of pain relief. ⋯ The patients received 2, 4, 6, 7 or 8 fentanyl boluses (totalling 0.054 mg, 0.108 mg, 0.162 mg, 0.189 mg or 0.216 mg, respectively). Rapid onset and marked reduction of pain intensity was achieved in all five patients. There were no clinically relevant changes in arterial haemoglobin oxygen saturation, heart rate, arterial blood pressure or respiratory rate. All five patients scored the pain relief obtained as good or very good. There were no reports of pain or burning sensations in the nose or other side-effects.