The Clinical journal of pain
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The three general methods of treating pain are pharmacologic, physical and psychological. The goal of medical management of the patient with pain and inflammation is to relieve these symptoms with minimal side effects and inconvenience. Pain associated with inflammation may be relieved with nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin. ⋯ Relatively small doses of epidural or intrathecal opiates can also be used to achieve postoperative pain relief. Thus, treatment for orthopaedic pain begins with NSAIDs, followed by an oral opiate combined with acetaminophen, aspirin, or another NSAID. If these regimens are ineffective, oral opiates followed by parenteral opiates may be tried.
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An updated review of patient-controlled analgesia (PCA) for acute pain relief in the postoperative period is presented. The technique, becoming more and more popular with patients, surgeons, and nurses, is undergoing numerous clinical trials under a variety of clinical protocols that are currently being reviewed. Benefits found with PCA include the fact that it is individualized therapy, allowing optimum drug titration; it decreases a patient's anxiety in the postoperative period; and it is a safer and more efficient technique of acute pain relief than conventional therapy. ⋯ Contraindications to the technique and most current equipment in use are listed herein. Clinical experience with PCA at Georgetown University Medical Center has provided, as has been the case elsewhere, data showing the superiority of the technique and its wide acceptance as part of the Acute Pain Service. The anesthesiologist plays a vital role in coordinating the various people and aspects involved in PCA for postoperative pain relief.
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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.
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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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Many theories exist on the pathogenesis of migraine. However, the clinical picture of migraine is agreed on universally as a familial disorder characterized by recurrent attacks of headache that are variable in intensity, frequency, and duration. The attacks are usually unilateral and often associated with anorexia, nausea, and vomiting. ⋯ A variety of medications, including ergotamine, propranolol, the calcium channel blockers, antidepressants, and nonsteroidal anti-inflammatory drugs (NSAIDs) have been beneficial in the prophylactic treatment of migraine. Ergotamine is the drug of choice in the abortive treatment, although other agents, such as the NSAIDs, have been used successfully. Inpatient therapy in a specialized unit for headache patients may be indicated for the recidivist patient, the patient habituated to analgesics or ergotamine, or the patient with the mixed headache syndrome, i.e., migraine occurring with coexistent muscle contraction headaches.