Articles: analgesics.
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This study was designed to evaluate the efficacy of different strategies for migraine prophylaxis over a fairly long period. Metoprolol alone was compared with psychotherapy alone and with a combination of metoprolol and psychotherapy. The psychological programme was planned for future use in preventive treatment. In this paper only the results of the psychological therapy are described. ⋯ According to the results, the efficacy of the psychological treatment increases only gradually, as it has also been demonstrated for biofeedback and relaxation training [9]. Subjectively, patients rate the results of psychotherapy higher than those demonstrated by statistics. This may depend on the selection of patients, but also on the fact that subjective criteria of improvement are not contained in statistical evaluation. Responders and non-responders had initial differences regarding vegetative, hormonal and psychological factors. Responders had a more stable circulatory status, suffered more rarely from menstrual migraine and normally took significantly fewer analgesic drugs. On the whole, this psychological programme has proved quite effective.
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Randomized Controlled Trial Clinical Trial
Epidural clonidine treatment for refractory reflex sympathetic dystrophy.
Intraspinally administered alpha 2-adrenergic agonists may relieve pain in sympathetically maintained pain (SMP) syndromes, such as reflex sympathetically dystrophy (RSD), by spinal, peripheral, and central nervous system actions. This study examined analgesic efficacy and side effects of epidurally administered clonidine in patients with severe, refractory RSD. ⋯ Transdermal clonidine has been demonstrated to produce analgesia in the area surrounding its application site in patients with SMP. The current study indicates that extensive analgesia may be obtained by epidural administration. Sedation and hypotension may limit bolus epidural clonidine administration for RSD. The role for chronic epidural infusion of clonidine has not yet been established.
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Intraspinal drug delivery is one of several important pain management therapies. Numerous delivery methods and drugs are available for administration into the epidural or intrathecal space. ⋯ Nurses can assist in this screening and perform preoperative teaching, postoperative care, and long-term follow-up. Essential knowledge includes general pain management principles as well as principles of intraspinal drug delivery.
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Pain is among the most prevalent symptoms experienced by cancer patients. A strategy for the management of cancer pain is now widely accepted, and when well implemented, is usually effective. Unfortunately, many oncologists are ill-prepared for the task of pain assessment and management, and the outcomes achieved in clinical practice are often suboptimal. ⋯ Finally, the use of sedation in the treatment of patients with pain that is refractory to other interventions is addressed. The skilled application of this strategy can provide adequate relief to the vast majority of patients, most of whom will respond to systemic pharmacotherapy alone. Patients with refractory pain should see specialists in pain management or palliative medicine who can address these difficult problems.
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Intractable metastatic cancer pain can be controlled in the majority of cases with narcotic drugs. This review focuses on parenteral analgesic therapy; the available drugs, administration systems, and electronic infusion devices. ⋯ This enables patient care to move from a bed-bound hospital therapy to ambulation in the hospital or home. The safeguards, features, and modes of operation of these pump-port-catheter-drug systems are described.