Articles: pain-management.
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Endosonography-guided celiac plexus neurolysis is a new technique that permits chemical splanchnicectomy in patients with abdominal pain due to malignancy. The procedure can be performed on an outpatient basis in individuals undergoing endosonographic examinations for staging and biopsy purposes.
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Sickle cell disease is characterized by recurrent episodes of acute pain. Some patients also suffer from chronic pain syndromes including avascular necrosis, leg ulcers, and intractable pain. Approaches to rational therapy of sickle pain include pharmacologic, nonpharmacologic, and preventive therapeutic interventions. ⋯ Administration of opioids on a fixed schedule or by patient-controlled analgesia is ideal for effective therapy. Nonpharmacologic approaches to manage sickle pain are underutilized and more studies are needed to determine their role in sickle pain. Preventive therapy of sickle pain is best achieved with hydroxyurea, which was found to decrease the frequency of crises significantly, decrease the incidence of acute chest syndrome, and decrease the need for blood transfusion.
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Burn injury is considered by children as one of the most painful traumas (just after bone factures). Burn pain in children can and must be controlled as well as for adult patients, with almost identical techniques. ⋯ Due to very high levels of nociception, satisfactory management of procedural pain requires the use of opioid therapy. Non pharmacological methods are meaningless if pharmacological treatment is not optimal.
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Chronic pain in elderly people has only recently begun to receive serious empirical consideration. There is compelling evidence that a significant majority of the elderly experience pain which may interfere with normal functioning. ⋯ Three significant factors which may contribute to this are (1) lack of proper pain assessment; (2) potential risks of pharmacotherapy in the elderly; and (3) misconceptions regarding both the efficacy of nonpharmacological pain management strategies and the attitudes of the elderly towards such treatments. In this review the most commonly used assessment instruments and patterns of age differences in the experience of chronic pain are described and evidence for the efficacy of psychological pain management strategies for this group is reviewed.
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Randomized Controlled Trial Clinical Trial
Effect of sympathetic nerve block on acute inflammatory pain and hyperalgesia.
Sympathetic nerve blocks relieve pain in certain chronic pain states, but the role of the sympathetic pathways in acute pain is unclear. Thus the authors wanted to determine whether a sympathetic block could reduce acute pain and hyperalgesia after a heat injury in healthy volunteers. ⋯ Sympathetic nerve block did not change acute inflammatory pain or hyperalgesia after a heat injury in human skin.