Articles: pain-management.
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Cancer pain in general responds in a predictable way to analgesic drugs and drug therapy is the mainstay of treatment, successfully controlling pain in 70 to 90% of patients. Some pains do not respond so well but can usually be ameliorated by the judicious use of adjuvant analgesics, non-drug measures and the active involvement of the multi-disciplinary team.
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Advances in therapy · Nov 1992
ReviewAdvances in electrical nerve stimulation techniques to manage chronic pain: an overview.
Pharmacologic treatments to manage chronic intractable pain have long been sought. Neuropathic pain is usually resistant to analgesics. At present, no analgesic drug totally relieves pain without producing significant unwanted side effects. ⋯ TENS is inadequate for extensive and bilateral pain, and epidural spinal cord stimulation is indicated. Dorsal column stimulation (DCS) initially was used to manage pain, but recent clinical reports show that it also can be effective in vascular disease and movement disorders. This review article reports on improvements in the electrical parameters used in neurostimulation and advances in research to overcome methodologic problems of DCS.
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Pediatr Hematol Oncol · Oct 1992
Randomized Controlled Trial Comparative Study Clinical TrialAnalgesia in children with sickle cell crisis: comparison of intermittent opioids vs. continuous intravenous infusion of morphine and placebo-controlled study of oxygen inhalation.
The objectives of the study were to compare the efficacy and safety of a continuous infusion (CIV) of morphine and intermittent parenteral opioids (IPO) in children with sickle cell vaso-occlusive crises (VOCs); to determine whether 50% oxygen administration through a face mask can reduce the duration of severe pain in patients receiving CIV morphine; and to measure morphine concentration at steady state for pharmacokinetic and pharmacodynamic analysis in patients receiving CIV morphine. The study was designed as a prospective, controlled, "before-and-after" evaluation of two different analgesic regimens. For patients receiving CIV morphine, there was a randomized, double-blind, placebo-controlled study of O2 vs. air. ⋯ Total body clearance (TBC) of morphine was greater in children before puberty than after (40.4 +/- 10 vs. 28 +/- 11 mL/kg/min; p < 0.05). In conclusion, in children with severe VOCs, continuous infusion of morphine provides better analgesia than intermittent opioid therapy. Fifty percent oxygen inhalation had no effect on the duration of pain.
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The authors present their own experience with percutaneous alcohol block of the coeliac plexus. Between April 1988 and December 1991 they used it in 22 patients. Except one patient the others suffered from severe pain of abdominal organs associated with carcinoma of the pancreas. ⋯ The intervention was repeated in four patients. The authors emphasize that the procedure is relatively simple and safe, and if successful, makes it possible to reduce or even eliminate opiates. It improves the quality of the remaining life of the patient.
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A study of 25 patients was carried out to determine the efficacy of interscalene block (ISB) for the treatment of chronic upper extremity pain. An RSD score was used to categorize these patients. Seventeen of the 25 patients had less pain after ISB, and 14 also had increased range of motion of the affected limb. ⋯ ISB was compared with stellate ganglion block (SGB) in patients undergoing both treatments. ISB seemed to be at least as effective as SGB for treatment of RSD/causalgia and may have some advantages over SGB. The role of somatic and sympathetic blockade is discussed.