Pain management
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Intrathecal infusion of medications allows for a direct delivery of agents to the receptors in which they act. This method of treatment is indicated in severe chronic pain of cancer or noncancer origin. In recent years, the use of these devices has increased and the general pain physician, referring doctor and concerned parties such as insurers, needs a better understanding of safety and efficacy. This article is an overview of this therapeutic option and also provides an update on new innovations and forward thinking approaches at improving patient selection and appropriateness of use.
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The use of opioids for both benign and cancer-related chronic pain has increased exponentially over the last few years. For this reason, increasing numbers of such patients are presenting for surgery. ⋯ Patients treated with opioids have special needs in the perioperative setting and it is the anesthesiologist's responsibility to manage these needs optimally. The aim of the present paper is to briefly orient the reader in the management of postoperative pain in patients chronically treated with licit opioids.
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All generalist and specialist clinicians are likely to encounter torture survivors among refugees and asylum seekers. A minority of people survive torture and a smaller minority reach a developed country; those who do tend to be the more resilient and resourceful. ⋯ Most of the literature on refugee survivors of torture has an exclusive focus on psychological disorders, with particularly poor understanding of pain problems. This article summarizes the current status of assessment and treatment of pain problems in the torture survivor.
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The ActiPatch(®) (BioElectronics Corporation, MD, USA) pulsed shortwave therapy device has been shown to be clinically effective in three double-blind randomized controlled pain studies. However, the effectiveness of this device in a broader population of chronic musculoskeletal pain sufferers, affected by a variety of etiologies in different regions of the body, has not been studied. ⋯ The ActiPatch device appears to provide a clinically meaningful reduction of chronic musculoskeletal pain affecting different locations of the body caused by a variety of etiologies.
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The emergency department serves as the gateway to the acute healthcare system. In the USA and increasingly worldwide, patients view the emergency department as the venue where both diagnostic and therapeutic modalities will be brought to bear regardless of condition or socioeconomic status. At the same time, the emergency department is the canary in the coal mine--the warning location for difficulties in how healthcare is delivered to patients in both the outpatient and inpatient settings. ⋯ Emergency departments are expected to treat patient's pain aggressively, often in the face of incomplete or contradictory histories and the inability to ensure outpatient follow-up. These factors create an ethical challenge for emergency departments in how to approach pain treatment. This paper will provide a framework for how emergency departments can address the ethical challenges posed by pain management.