The Clinical journal of pain
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Within acute pain management, as within any rapidly expanding field of therapeutic endeavor, novel treatment modalities may on occasion overreach their scientific foundations. In general, a cautionary theme is expressed regarding the utilization of various therapies, lest their overzealous clinical implementation jeopardizes the advancement of this highly promising field. ⋯ The subject of dosing for acute pain conditions with opiates via the epidural route versus intravenous opioid administration is discussed from the perspectives of practicality and risk/benefit assignments. The advisability and means of using demand-mode techniques in order to resolve the central issue of inherent benefits of opioid administration via one route or another is also presented.
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Children often do not express pain in terms that are easily understood by adults. Distraction by parents or other factors may address the emotional component of pediatric pain, leading caregivers to assume that no physical pain exists. This review of acute pain management in children examines traditional practices as well as recent developments in acute pain management in infants and children.
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Headache is a common symptom following head trauma and not related to the degree of trauma. The term post-head-trauma syndrome is used to denote a group of symptoms following head trauma. Dizziness, vertigo, perceptual changes, memory loss, paresthesias, and tinnitus have been reported as well as psychological disturbances. ⋯ Often diagnostic studies do not reveal an abnormality. Treatment consists of diagnosing the type of headache and targeting appropriate therapy. Long-term prognosis is good, the majority of patients recovering after 1 year.
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This article reviews the literature and describes clinical methods of providing analgesia for acute pain using epidural and intrathecal (spinal) opiates. The mechanism of action of these drugs, their basic pharmacology and spinal pharmacodynamics, and useful drugs and dosages are presented. The side effects of these drugs when administered by injection and possible ways to diminish their incidence and severity are discussed. A clinical protocol for the dosage and selection of these drugs is included.
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Opioid receptors are described and differentiated by their affinities for specific agonists and antagonists. Their sites of action and receptor activities are discussed. Tachyphylaxis and tolerance are described and methods for overcoming these problems are recommended. Suggestions are made regarding future drugs to act at specific receptors.