Duodecim; lääketieteellinen aikakauskirja
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Respiratory symptoms cause much of suffering in palliative care. Opioids are the first-line drugs in symptomatic treatment, and a therapeutic intervention with benzodiazepines may also be justified. ⋯ Physical therapy and methods of respiratory management are profitable in the treatment of respiratory symptoms. Radiation therapy relieves cancer-induced hemoptysis, cough, chest pain and dyspnea.
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The health-promoting effects of physical exercise are scientifically proven, but the health risks of sitting still remain rather poorly known. Technological development of the society will by no means cut down sitting. Should too much sitting be considered as one of the independent factors increasing the risk of metabolic diseases and its reduction as a health-promoting measure? Innovative solutions made possible by the new technology to cut down on sitting and to increase physical activity may prove to be important future tools for promoting health.
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Palliative pain management is usually successful, if the medication is strengthened in a stepwise manner in accordance with pain intensity, and initiation of a strong opioid is not delayed. Finding of a sufficiently effective dose of the opioid drug with simultaneous management of adverse effects requires continuous pain assessment and patient monitoring. In many cases it is possible to enhance analgesia by supplementing the medication with an antidepressant or an antiepileptic along with the opioid and paracetamol or the analgesic. Palliative radiotherapy will relieve tissue injury pain caused by bone metastases and soft tissue tumors as well as pain due to the possible nerve entrapments caused by them.
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New starting points are available for the diagnosis, classification and treatment of prolonged pain conditions in the foot and ankle region. Mechanisms maintaining the pain should be clarified, and a comprehensive patient interview must be conducted. ⋯ By careful examination and treatment of motor control and movement disorders it is possible to completely refrain from surgical treatment. If surgery has instead been decided upon, the loading defect underlying the problem must also be treated.
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Spinal claudication refers to symptoms caused by nerve compression in the spinal canal brought on during strain. The symptoms are felt as lower limb pain, numbness or fatigue, but back pain that becomes worse under stress is also common. ⋯ While the diagnosis is often clear, MRI imaging is worth conducting if the symptoms are atypical or cause a clear-cut disability or functional limitation. Most patients are treated conservatively.