Articles: pain-management-methods.
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Pain management in the postanesthesia care unit (PACU) is continually evolving, with several new nonopioids expanding the list of available agents. Pain in the PACU is not an inevitable outcome of surgery. ⋯ Accurate assessment of the characteristics of pain will direct rational drug choices while minimizing side effects. Better management of pain in the PACU setting will likely improve patient satisfaction and facilitate shorter PACU stays.
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Review
The efficacy and safety of antidepressants in inflammatory arthritis: a Cochrane systematic review.
To determine the efficacy and safety of antidepressants in pain management in patients with inflammatory arthritis (IA). ⋯ Based upon 9 trials of high or unclear risk of bias, it is not possible to draw firm conclusions about the efficacy of TCA as analgesics for patients with IA. The use of these agents may be associated with adverse events that are generally mild and do not lead to cessation of treatment. High-quality trials are needed in this area.
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Pain represents the most frequent symptom faced by general practitioners and is associated with 60% of neurological troubles. Pain consists in a conscious, subjective, unpleasant and protective sensory experience transmitted by thermoalgic pathways in the central nervous system (nociceptive pain). Lesioning of peripheral or central sensory pathways can also generate pain associated with hypoesthesia (phantom or neuropathic pain). ⋯ However, the technique, when not sufficiently selective, can generate a neuropathic pain and then a short-lating pain relief. Increasing knowledge on pathophysiological mechanisms of pain allowed surgery to interfere with the functioning of the sensory circuits without lesioning and to modulate neuronal activity in order to reduce pain (neuromodulation). Non-lesioning modulating techniques (then reversible) appeared (deep brain stimulation, epidural spinal cord or motor cortex stimulation, intrathecal infusion, radiosurgery) and are currently applied to efficiently alleviate neuropathic pain.
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An epidemic of prescription drug abuse in the United States has increased the burden on clinical toxicology testing laboratories. Urine drug testing provides objective evidence for compliance and aberrant drug behavior in patients on chronic (non-cancer) pain management. This article describes the testing menu, drug testing assays including tandem mass spectrometry and their limitations, interpretation of opiate results and clinical considerations.
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Details of piriformis syndrome, including the proper diagnosis and most effective form of treatment, continue to be controversial. While the cause, diagnosis, and treatment of piriformis syndrome remain elusive, many studies have been conducted to investigate newly developed diagnostic techniques as well as various treatment options for piriformis-induced sciatica. ⋯ Thus, despite the evidence supporting the newer treatment methodologies for piriformis syndrome, research should continue. It is important not only to evaluate treatment outcomes based on associated pain relief, but also to investigate the functional and anatomical return that patients experience from these studied treatments in order to fully explore the most effective form of therapy for piriformis syndrome.