Articles: chronic.
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The practice guidelines for interventional techniques in the management of chronic pain are systematically developed statements to assist physician and patient decisions about appropriate health care related to chronic pain. These guidelines are professionally derived recommendations for practices in the diagnosis and treatment of chronic or persistent pain. They were developed utilizing a combination of evidence and consensus based techniques, to increase patient access to treatment, improve outcomes and appropriateness of care, and optimize cost-effectiveness. ⋯ These guidelines do not constitute inflexible treatment recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis, taking into account an individual patient's medical condition, personal needs, and preferences, and the physician's experience. Based on an individual patient's needs, treatment different from that outlined here could be warranted.
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This randomized clinical trial was designed to determine the effectiveness of therapeutic lumbar facet joint nerve blocks. Two hundred patients were evaluated with controlled diagnostic blocks for the presence of facet joint mediated pain. Eighty four patients, or 42% were determined to have lumbar facet joint mediated pain. ⋯ Cumulative significant relief with one to three injections was 100% up to 1 to 3 months, 82% for 4 to 6 months, 21% for 7 to 12 months, and 10% after 12 months, with a mean relief of 6.5 +/- 0.76 months. There was significant improvement noted in overall health status with improvement not only in pain relief, but also with physical, functional, and psychological status, as well as return-to-work status. In conclusion, the results of this study demonstrate that medial branch blocks with local anesthetic and Sarapin, with or without steroids, are a cost effective modality of treatment, resulting in improvement in pain status, physical status, psychological status, functional status and return to work.
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The sleep of intensive care unit (ICU) patients is remarkably disrupted. Several studies, employing both subjective and objective measures of sleep quality, have demonstrated that critically ill patients exhibit severe sleep fragmentation and reduced restorative sleep, particularly a suppression of rapid eye movement (REM) sleep. ⋯ Noise has been a significant focus of investigation, and the effects of medications, light, and patient-care activities have also been examined. Several questions remain to be answered so that caregivers can improve sleep in ICU patients, including the relative contribution of different sleep-disrupting factors and possible changes in patient susceptibility to these factors over time.
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Journal of anesthesia · Jan 2001
Tolerance to the analgesic effect of buprenorphine, butorphanol, nalbuphine, and cyclorphan, and cross-tolerance to morphine.
The increased use of opioids in the chronic treatment of pain, especially with oncologic patients, encourages the search for drugs with potent analgesic activity, but with minimal induced tolerance and cross-tolerance to morphine. ⋯ Of the four agonist-antagonists tested, butorphanol seems to be least likely to produce cross-tolerance with morphine.
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During the last 25 years, there have been substantial advances in our understanding of the physiology and pathophysiology of pain. The development of animal models that more closely mimic clinical pain in humans has helped elucidate the putative mechanisms by which chronic pain develops and is maintained. However, our increased understanding of the neurobiology of pain has not translated into breakthrough treatments for pain management. ⋯ This retrospective validation of "novel" analgesics in animal models of pain raises a question of the predictive validity of these models. This article reviews the use of several adjuvant and standard analgesics currently used to treat difficult-to-manage pain. What can these drugs teach us about the development of novel pain medicines? Within this context, the use of animal models of pain to predict analgesic efficacy in clinical pain conditions is considered.