European journal of pain : EJP
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The World Health Organization document Cancer Pain Relief and Palliative Care in Children (WHO, 1998) advocates the global application of the principles of pain management and palliative care for children with cancer. The principles of pain management include the application of the WHO analgesic ladder, appropriate opioid dose escalation, the use of adjuvant analgesics, and the use of non-pharmacological methods of pain control. These principles of pain management should be incorporated into the treatment protocols of all children with cancer, acknowledging that treatment options may be limited for some children.
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Pain is a common problem in people infected with the human immunodeficiency virus (HIV), particularly when they develop the acquired immune deficiency syndrome (AIDS). Until recently AIDS was a progressive fatal illness with a short prognosis, so the assessment and treatment of AIDS-related pain was logically based on the approach taken for the management of cancer pain. The cancer pain paradigm may no longer be appropriate for pain in patients with HIV infection, however, because the natural history of HIV disease has been transformed into a chronic illness by highly active anti-retroviral therapy (HAART), available since the late 1990s. ⋯ These are compared and contrasted with the characteristics, assessment and treatment of cancer pain. Data are presented which emphasize these similarities and differences, and highlight the need for a multidisciplinary, comprehensive approach to managing pain in HIV disease, now a chronic illness. There is a great need for more research on HIV-related pain in the HAART era.
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The efficacy of pre-emptive analgesia for phantom limb pain is still unclear. It is generally accepted that pre hyphen;amputation pain increases the incidence of phantom and stump pain, even if pre-emptive analgesia is performed before and during surgery and in the postoperative period. Two cases of traumatic upper limb amputations are described here with no pre-existing pain. ⋯ Only case 2 showed significant changes of cortical reorganization. In case 1 markedly less cortical plasticity was found. A combination of relevant risk factors such as a painful neuroma, behavioural and cognitive coping strategies and the early functional use of prostheses are discussed as important mechanisms contributing to the development of phantom pain and cortical reorganization.
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Joint mobilization is a treatment approach commonly used by physical therapists for the management of a variety of painful conditions. However, the clinical effectiveness when compared to placebo and the neurophysiological mechanism of action are not known. The purpose of this study was to establish that application of a manual therapy technique will produce antihyperalgesia in an animal model of joint inflammation and that the antihyperalgesia produced by joint mobilization depends on the time of treatment application. ⋯ Both 9 and 15 min of mobilization, but not 3 min of mobilization, increased the withdrawal threshold to mechanical stimuli to baseline values when compared with control groups. The antihyperalgesic effect of joint mobilization lasted 30 min. Thus, joint mobilization (9 or 15 min duration) produces a significant reversal of secondary mechanical hyperalgesia induced by intra-articular injection of capsaicin.