Articles: analgesics.
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A central antinociceptive effect of calcitonin has been well established in animal experiments. Owing to the lack of appropriate studies, however, a final judgement cannot be made regarding the value of calcitonin in pain therapy. Positive clinical experiences have been reported in the following cases. (1) In isolated osseous tumor pain and in pain caused by tumorous infiltration of peripheral nerve tissue or acute malignant transverse lesions of the spinal cord (with paraplegia), calcitonin can be a suitable supplement to opiate therapy. (2) In algodystrophy calcitonin can be administered in addition to physical therapy. ⋯ Dangerous side-effects have not been reported to date. However, dose-dependent side-effects occur frequently, which the patients often consider very distressing. The disadvantages and the "escape" phenomenon that occur during longterm use restrict the value of calcitonin as an analgesic.
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We reported the requirement of supplemental analgesics following epidural opioids including Opial 5mg and 10mg, and morphine HCl 2.5mg, for 24 hours in postoperative period after surgery of body surface, and lower and upper abdominal surgeries. Incidence of their side effects was also observed. Opial contains 50% morphine HCl and other opioids such as codeine, thebaine, papaverine, and noscapine etc. ⋯ Kinds and doses of opioids used, suggest that epidural administration of other opioids contained in Opial has some analgesic effect. After the surgery of body surface the opioid requirement may be influenced by the intraoperative anesthetic technics and the state of mind of the patient. Urinary retention was the most interesting side effect observed and our data suggest that papaverine contained in Opial may have favorable effect and morphine HCl may have adverse effects regarding its incidence.
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This review draws on data obtained in the cancer pain, nonmalignant pain, and addict populations to examine critically the major issues raised by the use of chronic opioid therapy in nonmalignant pain. The available evidence suggests that there is probably a selected subpopulation of patients with chronic nonmalignant pain who may obtain sustained partial analgesia without the development of toxicity or the psychologic and behavioral characteristics of addiction. Future discussions of this approach must adequately define the terminology of addiction and strive to distinguish medical considerations from the societal and regulatory influences that may affect prescribing behavior. Those who treat patients with chronic pain must actively participate in these discussions lest decisions with enormous impact on patient care be made solely by those whose primary responsibility is the elimination of substance abuse.
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J Pain Symptom Manage · Feb 1990
Relationship among cultural, educational, and regulatory agency influences on optimum cancer pain treatment.
Evidence is presented that supports the allegation that cancer pain is inadequately treated. This is true despite the existence of more knowledge about the anatomy, physiology, pharmacology, and pathology of pain; more professional organizations dedicated to expanding and disseminating information about pain; and the reputation of physicians as persons of compassion. Not all cancer patients with pain, however, fail to get adequate treatment. ⋯ The reasons these patients have a problem with treatment are, in descending order of influence on physicians' prescribing practices: (a) cultural and societal barriers to the appropriate and adequate use of opioids, (b) real and perceived pressures from government regulatory agencies, and (c) knowledge deficits among health care providers because of newer knowledge gained from pharmacologic studies of cancer pain patients. Factors in each category are discussed. Correction of the problem will require fundamental changes in cultural attitudes, which will distinguish legitimate uses of opioids from drug abuse.
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The treatment of severe pain requires the use of potent opioid analgesic medications. Many patients with opioid sensitive pain are being undermedicated. This results in increased morbidity and needless suffering. ⋯ Dependence and tolerance are virtually inevitable outcomes of long-term opioid use, but they are neither sufficient to cause addiction nor the equivalent of it. Indeed, the evidence shows that only a tiny fraction of patients treated with opioids become addicted. There is little risk of addiction for those patients receiving properly administered opioids for pain.