Articles: patients.
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In the Federal Republic of Germany, strict regulations complicate the prescription of strong opioids to patients suffering from severe pain. In summer 1991 the German Association for the Study of Pain launched an initiative directed at simplification of the prescription requirements for such analgesics and submitted the suggestions to the ministries responsible. ⋯ Moreover, the prescriptions are to be simpler to make out and certain exemptions have been specified by law. Acceptance of the bill by the political committees and its realization are expected in autumn 1992.
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Journal of anesthesia · Jul 1992
Cardiovascular responses to fiberoptic intubation: a comparison of orotracheal and nasotracheal intubation.
We compared the cardiovascular responses between nasal and oral intubation with a fiberoptic bronchoscope under the combination of neuroleptic analgesia (NLA) and topical anesthesia. The 16 patients studied were divided into 2 groups: the nasal intubation group (N group: 8 patients) and the oral intubation group (O group: 8 patients). There were significant changes in systolic, diastolic and mean arterial pressures in the N group and in the pressure rate quotient in the O group. ⋯ The individual RPP in both groups was relatively stable except for one patient in the N group, who had a marked increase in RPP during the procedure. We conclude that, under the combination of NLA and topical anesthesia, the cardiovascular responses to oral fiberoptic intubation are less severe than those to the nasal approach. The oral approach is recommended, especially in patients with coronary artery disease, taking into consideration of the cardiovascular responses to fiberoptic intubation.
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Epidural steroid injections are frequently used in the conservative treatment of backache, although they are still subject to critical discussion. Relief of pain is attributed to the anti-inflammatory effect of the steroid. During a 3-year period, 53 patients with back pain or differing aetiology were treated with one or more epidural injections of 14 mg betamethasone (2 ml Celestan) in a prospective and retrospective fashion. ⋯ Patients with acute pain (up to 6 months) responded better than patients with chronic symptoms. No significant correlations were detected between response and other characteristics, e.g. age, sex, number of injections, type of pain, intensity of pain, or psychological overlay. For patients with acute pain epidural steroid injections seem to be a safe, appropriate and promising procedure.
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In a retrospective, controlled clinical study the life events of 35 patients suffering from chronic low back pain (LBP) and a matched sample of 23 patients with neurotic depression (ICD 300.4) were investigated. The pain patients formed two groups: 19 patients with definite organic diagnosis (IASP code 530.96) and 16 without (adequate) organic lesion (IASP code 510.99). Somatic diseases (other than LBP), injuries and operations, as well as psychic trauma (feelings of shame, narcissistic traumatisations and object losses) were defined and counted as documented in the patient's histories. ⋯ Object losses occur equally often in all groups, apart from the initial year, when depressive patients have to cope with even more losses than the others. These results are discussed considering the development of chronic pain syndromes, the influence of age and their consequences for models of illness. There is convincing evidence, that physical injury is neither a necessary nor a sufficient condition for the development of chronic pain and that chronic pain is in essence an emotional disease based on unresolved unconscious conflicts requiring psychotherapy.
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The efficacy of classic homeopathic therapy is scientifically not well proven. Few of the studies available are acceptable from a scientific point of view. In this paper we will describe a study protocol for a trial of classic homeopathy in chronic headache, which not only is in accordance with currently accepted scientific research standards but also accounts for the special needs of homeopathic therapy. ⋯ The study started in the later part of 1991, and is scheduled to last for 2 1/2 years. We expect a critical discussion of the results from conventional medicine or from homeopathy, depending on the outcome of the study. The study protocol is being published in advance to enable the reviewers of the study to check the original study design and the a priori hypotheses adopted.