Articles: pain-management.
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The objective of this survey was to investigate the current status of the epidural and intrathecal management in patients with chronic cancer and non-cancer pain in Germany and Austria. ⋯ Epidural and intrathecal pain therapy is frequently used in Germany and Austria, either as a complementary or alternative treatment to systemic pain therapy. Local anaesthetics followed by opioids are the most commonly used medicaments for this treatment. For some of the applied substances neurotoxicological data are lacking. The use of these substances has to be considered very carefully.
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Outcome quality of medical treatment depends on structure quality of the treatment facility. In the present study we tried evaluate structural parameters of outpatient treatment facilities relating to management of headache, low back pain and cancer pain. ⋯ There are considerable structural deficits in outpatient treatment facilities involved in management of patients suffering from chronic headache, chronic back pain and cancer pain. Realisation of standards according to the "Schmerztherapievereinbarung" needs organisation of an interdisciplinary network between the different specialties necessary for pain management. Interdisciplinary cooperation should be supported by the official organization of the medical self-government in Germany--the Kassenärztliche Vereinigung--which has to assure optimal conditions for outpatient treatments.
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Advances in cancer pain research and management are an example of the advances that have occurred within the field of neuro-oncology, the medical discipline that includes the diagnosis and treatment of primary central nervous system neoplasms, metastatic and nonmetastatic neurological complications of cancer originating outside the nervous system, and pain associated with cancer. Progress in the diagnosis and treatment of cancer, coupled with advances in our understanding of the anatomy, physiology, pharmacology, and psychology of pain perception, has led to improved care of the patient with pain of malignant origin. Currently, specialized methods of cancer diagnosis and treatment provide the most direct approach to treating cancer pain by treating the cause of the pain. Yet, before the introduction of successful antitumor therapy, when treatment of the cause of the pain has failed or when injury to bone, soft tissue, or nerve has occurred as a result of therapy, appropriate pain management is essential.
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Int J Obstet Anesth · Apr 1999
Are women requiring unplanned intrapartum epidural analgesia different in a low-risk population?
We studied 645 full-term low-risk women in early labour in 6 units to evaluate the effects of maternal characteristics and obstetric management in early labour on the use of epidural analgesia, and to analyse the relationship between epidural analgesia, progress of labour and mode of delivery using multiple logistic regression. Among variables present in early labour, nulliparity, ethnicity and obstetric unit were the strongest predictors of epidural analgesia requirement. In nulliparous women, obstetric unit affected use of epidural analgesia (P<0.05) and induction of labour was associated with increased use of epidural analgesia (odds ratio 3.45, 95% CI: 1.45-7.90). ⋯ Furthermore, rate of cervical dilation was similar in the non epidural group throughout the first stage (mean 3.41 cm/h, 95%CI: 3.19-3.63) and in the epidural group after epidural analgesia decision (mean 3.99, 95% CI: 2.96-5.02), while the mean cervical dilatation rate before epidural analgesia was 0.88 cm/h (95% CI: 0.72-1.04). The need for epidural analgesia is, therefore, multifactorial and difficult to predict. Whereas nulliparity increases epidural analgesia requirement, data on the progress of labour before pain relief suggest that epidural analgesia is a marker of pain severity and/or labour failure rather than the cause of delayed progress in low-risk pregnancies.
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Intrathecal drug delivery improves pain relief, reduces suffering, and enhances quality of life in the small proportion of patients who do not respond well to oral analgesics, including oral morphine. Although morphine is the "gold standard," and the only drug approved for intrathecal pain therapy in the United States, off-label use of alternative agents appears promising, particularly in patients with neuropathic pain. Careful patient selection and management are significant determinants of successful treatment outcomes. ⋯ In addition, all patients (those with cancer or nonmalignant pain) must exhibit a positive response to an epidural or intrathecal screening test. A multidisciplinary team approach, involving psychologists, nurses, physical therapists, social workers, and spiritual leaders should be used to manage patients. Current practices for patient selection and management, screening tests, and dosing guidelines for intrathecal drug delivery systems are discussed.