Oncology
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Ovarian suppression has been used to treat hormone-responsive metastatic breast cancer in premenopausal women for over 100 years and is currently under continued evaluation for treatment in the adjuvant setting. In this article, ovarian suppression by surgery, radiation, and pharmacological therapy is discussed, including the risks, benefits, and efficacy of each strategy. The role of ovarian suppression in premenopausal women with early and advanced stages of breast cancer will be reviewed. It is hoped that this review will assist clinicians and their patients in selecting the appropriate therapy if ovarian suppression is indicated.
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For many patients, neuropathic pain (NeP) is arguably more difficult to control than nociceptive or 'normal' pain. We also now recognise the great burden that NeP has on the lives of patients - it is not only a matter of treating pain in isolation, but managing all of the issues that affect the patient's quality of life. Until relatively recently we have had little understanding of the pathophysiology causing NeP and have relied on the secondary effects of non-analgesic drugs as the mainstays of treatment. ⋯ However, they are now fully established as effective and useful second- or third-line drugs. Many patients in the past have been potentially undertreated as a result of our inertia to use opioids. The case for opioid therapy in NeP has been firmly established.