The Clinical journal of pain
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The development of an acute pain service in a community hospital is described. A plan of operation is proposed, including accurate record maintenance to avoid complications. Results are presented on over 10,000 patients treated by the acute pain service.
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Migraine headache variants consist of the complicated migraine headache subtypes such as basilar artery migraine, migraine equivalents, and late-life migraine accompanients. Although these disorders occur infrequently, diagnosis may be more difficult. Generally, comprehensive diagnostic studies are required to rule out underlying pathogenic conditions that may present with similar symptom complexes. Standard migraine treatment is often useful in these disorders; however, migrainous variants deserve special therapeutic considerations.
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Healing or successful intervention usually leads to the resolution of pain. However, in some patients biologic or psychologic symptoms associated with pain persist despite treatment or apparent healing. In cases in which the etiology is not known, persistent pain is categorized as a clinical syndrome known as "chronic pain." Organic, psychologic, and socioenvironmental factors contribute to the development of chronic pain. ⋯ Before successful management can begin, the major etiologic factors and sequelae of the chronic pain syndrome must be understood. Antidepressants, neuroleptics, anticonvulsants, nonsteroidal anti-inflammatory drugs, and hydroxyzine have been proven effective in the treatment of pain syndromes. The treatment of patients who present with chronic pain must be individualized based on a comprehensive understanding of the factors underlying the chronic pain syndrome of each patient.
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Psychological factors are known to increase the severity and intensity of headaches. When they are shown to be present, an appropriate psychiatric diagnosis is the Diagnostic and Statistical Manual's (DSMIII-R) category of psychological factors affecting physical condition (code no. 316.0). ⋯ The factors overlap and intertwine in the average headache patient. Attention to these factors in a systematic way should enhance our understanding and treatment of the chronic headache patient.
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Comparative Study
Sufentanil and alfentanil pattern of consumption during patient-controlled analgesia: a comparison with morphine.
Pattern of drug consumption and side effects of sufentanil and alfentanil were compared to morphine, using "on-demand" patient-controlled analgesia (PCA). After a non-narcotic general anesthetic, a bolus dose of the narcotic was given intravenously towards the end of surgery. PCA was started in the recovery room. ⋯ There was a similar incidence of nausea in all the groups. Further study is needed to determine precisely the best dose regimens for sufentanil and alfentanil, especially in reference to optimum loading doses. Sufentanil appears to be a promising drug for PCA use.