Articles: pain-management.
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To control costs, the University of Tennessee Center for Pain Management added an ambulatory pain rehabilitation program to its existing inpatient hospitalization program. The impact of this program was assessed by comparing the first 25 patients treated in 1985 (prior to the introduction of outpatient management) with the first 25 patients treated in 1987 (after outpatient management was established). ⋯ Hospital charges were the greatest single cost factor in 1985 ($321,500) but were only $61,000 in 1987. Success rates as measured by a return to previous employment were not significantly changed (13 of 25 returned to work in 1985, and 11 of 25 returned to work in 1987).
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The purpose of this study was to assess the impact of outpatient group treatment for chronic pain patients and their spouses on psychological symptomatology, marital adjustment, and locus of control. There was a significant improvement in mean scores on four of the seven measures pre- and post-treatment. ⋯ It also supports other findings for the effectiveness of brief group therapy programs for chronic pain patients. Although this study has several limitations the results warrant further investigation using control groups and a larger sample size.
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One hundred-eight questionnaires were mailed to Pain and Headache Centers evenly spread throughout Italy to evaluate the current status of pain clinics and therapy. Sixty-three centers (58.3%) responded: fifty-two (82.5%) were Pain Clinics, while eleven (17.5%) were Headache Clinics. Approximately half of the clinics were run by anesthesiologists (43.3%), followed by neurosurgeons (15%), and neurologists (10%). ⋯ A multidisciplinary team approach was used by 65% of the respondents. Treatment modalities most frequently used were drugs (mean utilization index, MUI: 138), followed by anesthesiological methods (MUI: 70), neuroaugmentive procedures (MUI: 51), psychiatric and psychophysiological methods (MUI: 33), and neurosurgical procedures (MUI: 28). Mean percent immediate and long-term treatment successes (pain relief 50%) were the following: (a) cancer pain (74.7-63.3%): (b) non-oncologic pain (66.7-50.3%); (c) chronic primary headache (64.2-52.6%); and (d) orofacial pain (64.2-52.5%).(ABSTRACT TRUNCATED AT 250 WORDS)
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For people with sickle cell disease, vaso-occlusive crisis pain is a frequently encountered problem that poses unique and often perplexing challenges in management. This article reviews the natural history of vaso-occlusive crisis and discusses intervention appropriate for the care of patients with pain due to this chronic illness.
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Our approach to the management of fear and pain in the pediatric emergency department is presented. Tricks to attempt the gaining of rapport with frightened children in pain are noted, with emphasis on a developmental approach. The use of analgesic medications, local anesthetics, ketamine, and nitrous oxide as appropriate to emergency situations is outlined. Lastly, the guidelines of the American Academy of Pediatrics for outpatient sedation are reviewed.