Articles: opioid-analgesics.
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Patient-controlled analgesia (PCA) is a newer technique for pain management. Patients are allowed to self-administer small analgesic bolus doses into a running intravenous infusion, intramuscularly, subcutaneously or even into the epidural space. Demands are usually controlled by computer-driven infusion pumps, but can also be delivered by disposable devices. ⋯ PCA has proved its importance for pain studies, e.g. for algesimetry, to determine predictors of postoperative pain, to describe drug interactions, to evaluate the concept of pre-emptive analgesia or for pharmacokinetic designs. It is concluded that PCA results have been urgently required in order to change the mind of physicians and nursing staff with respect to individual pain management strategies. Once this goal is achieved, PCA concepts should also be used for the improvement of more conventional techniques.
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J Pain Symptom Manage · Apr 1995
Severe undertreatment of cancer pain: a 3-year survey of the German situation.
The aim of this survey was to determine the prescribing patterns of German physicians in the treatment of cancer pain. The computerized patient records of 330 practices, which treated a total number of 1,104,435 patients over a 3-year period, were analyzed. "Strong" opioids, widely accepted in the management of severe cancer pain, were prescribed to just 322 of 16,630 cancer patients (1.9%). ⋯ Germany is still a developing country in terms of pain therapy. This situation is symptomatic of many countries and reflects the continuing prejudice against opioids.
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Adjuvant analgesics are drugs that are not primarily used as analgesics but can produce analgesia in certain types of pain. Adjuvant analgesics can be administered together with non-opioid and opioid analgesics on each step of the WHO analgesic ladder. They should be given when an additional or specific indication exists, but should not be used as a substitute for a thorough treatment with opioids and nonopioids. ⋯ Biphosphonates (etidronate, clodronate, pamidronate derivates) also produce analgesic effects in patients with bone metastases. However, differences among the various compounds have not been clearly evaluated yet. Potent and specific radioisotopes are still under development and the use of calcitonin in bone pain is considered controversial.