Postgraduate medical journal
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Chronic somatic pain patients often present more than one pain location with concomitant different pain complaints (pain qualities) which may need to be treated individually. Major attention should be given to the identification of opioid insensitive neurogenic pain qualities, and to a lesser degree the pain intensity. ⋯ Other special pain qualities should be treated as specifically as possible. With this differentiated pharmacological therapy approximately 70-90% of somatic pain patients can be treated with satisfactory pain relief or freedom from pain, at least at rest.
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Metabolic acidosis and hyperlactataemia are important, independent findings in acute illness, and the combination of these abnormalities carries a grave prognosis. Despite this there is still controversy about the most appropriate therapy of lactic acidosis, and the relationship of commonly used acid base measurements to blood lactate levels. This paper details studies in shock and multiple organ failure examining these issues. ⋯ Serious acid base derangements were not seen. Significant hyperlactataemia was present throughout haemofiltration as a result of the infusion of replacement fluid containing 45 mmol/l lactate. The only alterations in acid base status were transient falls in arterial bicarbonate and base excess at one hour.
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Morphine consumption for medical purposes in Japan showed a 17-fold increase between 1979 and 1989, due to increased use in cancer pain management. This increase is a reflection of the improving attitude of the health care professionals and health policy makers towards narcotics use. The WHO Cancer Pain Relief Programme has ultimately become the basis for a national cancer pain relief programme. The Ministry of Health and Welfare amended the Narcotics and Psychotropics Control Law in 1990, to improve accessibility of morphine preparations to cancer patients with pain, and edited four manuals for palliative care, that include guidelines on cancer pain relief, and legislative management of narcotics use in hospital, clinic and pharmacy.