British medical bulletin
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Psychological factors are contributory to the genesis and maintenance of many chronic pain syndromes. Treatment can be delivered either as one component of multimodal therapy or as the sole approach in a pain management programme. ⋯ Relaxation training is also of benefit. The documented success of these techniques in various settings suggests that psychological treatment should be considered a necessary component of any multidisciplinary clinic offering therapies to chronic pain sufferers.
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Interest in the management and study of pain in children has increased in recent years. A range of techniques appropriate to children with different developmental levels is now available for the assessment of various aspects of childhood pain. A management plan can be developed depending on the cause of pain and choosing from a range of therapeutic techniques. ⋯ Suitable drugs are now available but inexperience and myths may still result in reluctance to use appropriate strong analgesics in children. Postoperative pain control and the analgesic needs of neonates have been particularly neglected areas. Management can be dramatically improved by increasing staff sensitivity and the use of an integrated programme of drugs, physical techniques and psychological approaches.
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Mild breast pain and nodularity are common and may be considered normal. Only when symptoms are severe enough to affect the patient's lifestyle should drug treatment be considered. Using danazol, bromocriptine or evening primrose oil a clinically useful improvement in pain can be anticipated in 77% of patients with cyclical mastalgia and 44% with non-cyclical mastalgia. Benign nodularity should not be biopsied surgically as it is unnecessary and makes subsequent assessment of the breast difficult.
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Oocyte donation offers the prospect of achieving a successful pregnancy to a group of patients traditionally considered to be irreversibly sterile. In patients with ovarian failure, it is possible to create an endometrial milieu that is receptive to embryonic implantation by giving exogenous steroid replacement. A high fertility potential can be achieved with a low miscarriage rate in oocyte recipients irrespective of the patient's age. ⋯ In oocyte recipients, it is now feasible to dissociate the stages of embryonic development and endometrial maturation. Hence, oocyte donation can provide insights into as yet unresolved questions such as the duration of the 'implantation window' in humans. Oocyte donation will undoubtedly complement basic IVF in trying to elucidate the biological interactions between the conceptus, endometrium and steroid environment in human reproduction.
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British medical bulletin · Jul 1990
ReviewEthics and the law: the law and assisted human conception.
This article aims to provide no more than a brief summary and overview of some of the principal legal questions which arise in connection with assisted human conception. There is no requirement of legal suitability for natural parenthood, though a child may be removed from parental care at birth if its welfare is considered to be at risk. Where medical or other assistance is required, however, the law and social judgments may impinge on the freedom of individuals to procreate. ⋯ AID does not constitute adultery, and the law has recently been reformed to recognize children born following AID as legitimate to their social parents. A child may be regarded as the legitimate child of a surrogate mother's marriage, but where the baby is genetically distinct from the surrogate mother, the law, and is uncertain and as yet could be conflicting claims of parenthood without legislation. The storage and disposal of human gametes and embryos may raise problems of 'ownership'.