Articles: pain-management-methods.
-
Drug addicts often seek medical help for pain. Numerous fears and beliefs may hinder the recognition, evaluation, and management of pain in addicts. Nevertheless, the same fundamental principles apply to these patients as to other patients in terms of pain evaluation, analgesic selection, and dosage adjustment. ⋯ The use of strong opioids should be kept to a minimum (although this important rule may be difficult to follow, for instance in surgical emergencies). The best route of administration and galenic formulation vary with each individual situation but, in general, intravenous administration of strong opioids is highly undesirable. A treatment contract established with the patient is crucial and must indicate the nature of the drug or replacement agent used and the treatments given for pain control.
-
Approximately 100 million people suffer from chronic pain in the USA. Opioid medications are commonly prescribed to treat pain, but are becoming the most widely misused controlled substance nationally. Physicians who treat patients with chronic pain must be cognizant of the federal and state policies that govern the distribution of opioid medications as well as the current standards of medical practice for opioid prescribing. ⋯ The problems of undertreated pain and the epidemic of prescription drug abuse have coincided, creating a need for medical and social policy that protects society and access to appropriate care for those in pain. Federal and state laws are in evolution, and clinicians must remain aware of these changes as well as the issues behind them that will impact safe and appropriate care of patients in pain.
-
Chronic postsurgical pain (CPSP) is the consequence of acute postoperative pain. Unfortunately, despite many attempts of improvement, the treatment of acute postoperative pain remains unsatisfactory. In the present review, the probable reasons for this will be reviewed. ⋯ A single treatment approach is almost unlikely to solve the problem of CPSP. Consequently, the management of postoperative pain has to become more patients' specific and etiologies sensitive.
-
Substance use disorders are a large public health problem in the United States. Over the past decade, there has been a trend of increased prescription drug misuse, morbidity, and mortality related to prescription opioids. ⋯ Acute, chronic, and palliative each present distinct issues in pain treatment. A best practices model of pain treatment, including risk stratification and integrative treatment, may provide the best prospect for safe and effective treatment.
-
Although chronic opioid therapy is usually initiated using short-acting opioids, many patients with chronic pain are subsequently converted to long-acting and extended-release preparations. In clinical practice, optimal management requires careful individualization of dosage in order to achieve an appropriate balance of efficacy and adverse effects. After successful initiation and stabilization of opioid treatment, subsequent changes in regimen may still be required to maintain efficacy with an acceptable adverse effect profile. ⋯ Although continued research is needed to refine equianalgesic doses further, opioid rotation is an important and necessary practice in patients with chronic cancer or noncancer pain that is refractory to the initially used opioid.