Articles: pain-clinics.
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Comparative Study
Feasibility of a rapid diagnostic protocol for an emergency department chest pain unit.
To evaluate the applicability of a short-stay protocol for exclusion of acute ischemic heart disease without hospital admission and to analyze these results in the context of a conceptual model. ⋯ Although most admitted patients with chest pain (53%) were at low probability for AMI, only a minority (14%) were eligible for a short-stay protocol that required patients to be free of known coronary artery disease and able to perform an exercise tolerance test. Factors affecting the operations and efficiency of a CPOU include clinical characteristics of the target patient population, protocol tests used, and hospital occupancy and reimbursement patterns.
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According to WHO guidelines, morphine is the first choice for the treatment of chronic cancer pain, preferably as a controlled-release preparation administered orally. The WHO classifies the quality of pain management of a particular country by its morphine consumption for medical reasons. For this article, data from clinical and market research were collected. ⋯ The report also focuses on physicians' subjective viewpoints and prejudices. When strong opioids are only rarely prescribed, a general practitioner then has difficulties in assessing pain and possible side effects and treatment evaluation. Clinical research, too, is hampered by special regulations concerning controlled opioid administration.
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Comparative Study
Self-reported disability due to headache: a comparison of clinic patients and controls.
To compare the self-reported disability of headache sufferers who seek medical assistance with those who do not seek such help and determine possible relationships between perceived disability and psychological factors. ⋯ Clinic patients reported significantly greater disability on their occupation than controls--a difference emerging after controlling for level of headache pain and personality variables. Patients differed from controls, although not significantly, in the rank order of life activities most affected by headache. Discriminant analysis revealed that self-reported disability for occupation and the Hysteria scale from the MMPI-2 best differentiated the groups.
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Spinal opioids are effective analgesics for surgical and non-surgical pain. Central and systemic side effects are less frequent than with epidural local anaesthetics or parenteral opioids. This review focuses on the analgesic efficacy of spinal opioids and their combination with local anaesthetics for postoperative analgesia, including patient-controlled epidural analgesia. ⋯ However, evidence suggesting that effective postoperative analgesia can significantly improve postoperative morbidity in patients at risk is accumulating. In such patients, combined use of epidural local anaesthetics and opioids may become the technique of choice for postoperative analgesia. However, there is no evidence that this would have any clinically relevant benefit in low-risk patients.