Articles: pain-management.
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OBJECTIVES AND IMPORTANCE: Cervical spine compromise by fibrous dysplasia is rare; only 20 cases have been reported. Treatment was surgical in six cases, but the management differed among the other cases. In this retrospective case report, we analyze and discuss the surgical treatment of this condition in the context of previous reports. ⋯ The patient was discharged after 7 days. Three years later, she continued to have no pain, and spine stability was preserved. Good results can be achieved in the surgical treatment of dysplastic tissue with the use of instruments for spine reconstruction and synthetic grafting to prevent invasion.
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Anesthesia and analgesia · Jun 1999
The state of implantable pain therapies in the United States: a nationwide survey of academic teaching programs.
The purpose of this questionnaire survey was to provide an overview of anesthesiology pain fellowship programs in the United States with regard to implantation of spinal cord stimulators (SCS) and opioid infusion devices. Of the 95 programs solicited, 80% responded to questions pertaining to the prevalence of use and technical considerations of implantation. Of the responding programs, 87% report implanting SCS, and 84% report implanting neuraxial infusion pumps. All programs perform a stimulation or infusion trial before implantation, although the duration varied from a trial in the operating room at the time of implantation to 25 days. Of the programs, 83% implant cylindrical leads, and 17% implant flat leads via laminectomy for their nonrevision SCS implants. Morphine, bupivacaine, hydromorphone, and baclofen are the most commonly used drugs and are used in implanted pumps by >50% of respondents. The question of industry-sponsored pain fellow education in implantable techniques is addressed. ⋯ Of the pain teaching programs in the United States, 80% responded to a questionnaire eliciting information about the implantation of spinal cord-stimulating and opioid infusion devices. The range and diversity of responses imply a lack of agreement about implantation techniques, drugs, and protocols.
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This article outlines the project entitled "Towards a Pain Free Hospital" which aims to make both citizens and health sector workers more aware of the problem of pain in hospitalised patients. The project is already under way in some countries and is being implemented in others. It has been introduced into the local Health Authority Hospital of Vicenza for the first time in Italy and will later be introduced into other Italian hospitals. The article deals with the various initiatives which make up the project and the methods used to involve those assisting the patient in pain.
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La Revue du praticien · May 1999
Comparative Study[Pain at the end of life: assessment and management].
Pain assessment and management of pain at the end of life require a good knowledge of pain pathophysiology and of the connections between pain and facing death related suffering. Pain is a multidimensional experience. Only an interdisciplinary team is able to provide a compassionate care with a comprehensive approach.
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Med. Clin. North Am. · May 1999
ReviewInterventional pain management. Appropriate when less invasive therapies fail to provide adequate analgesia.
Unrelieved chronic pain is costly to patients and society. Noninvasive and less costly therapies should be used before more invasive and more costly therapies. Therapies for pain control should be used according to a pain treatment continuum. Nerve-blocking techniques, neurolytic techniques, and implantable neuromodulatory technologies, such as SCC and spinal delivery of analgesics, are cost-effective when less invasive therapies fail to provide adequate analgesia.