Articles: pain.
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Ann. N. Y. Acad. Sci. · Mar 2001
ReviewRepresentation of acute and persistent pain in the human CNS: potential implications for chemical intolerance.
The study of pain may be relevant to the study of chemical intolerance (CI) in many ways. Pain is often reported as a symptom of CI and it is defined as a subjective experience similar to many other symptoms of CI, making its objectification difficult. Furthermore, the CNS plastic changes that underlie the development of persistent pain states and abnormal pain responses may share some similarities with those involved in the sensitization to environmental chemicals. ⋯ These psychological processes can be solicited to reduce clinical pain and we speculate that they may further attenuate or promote central mechanisms involved in the transition from acute to persistent pain states. The investigation of central determinants of subjective experience is essential to assess the possibility that higher-order brain/psychological processes modulate and/or mediate the development of persistent pain states. These factors may contribute to the development of symptoms in CI.
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Support Care Cancer · Mar 2001
ReviewMethadone for relief of cancer pain: a review of pharmacokinetics, pharmacodynamics, drug interactions and protocols of administration.
Methadone, a synthetic opioid, has unique pharmacodynamics and pharmacokinetics, which contribute to its unique ability to relieve pain unresponsive to other potent opiates and its unique dosing and drug interactions. Several guidelines of administration have been established. Physicians who are involved in pain management should have a fundamental understanding of methadone's unique properties.
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Pain is a feature of many cancers, particularly in the advanced stages at which the palliative care approach to symptom control achieves the best outcomes. The holistic approach generally dictates that any treatment of the cancer per se has symptom control as the primary objective at this advanced stage. Pain, which invariably increases with disease progression, is treated with opioids and adjuvant analgesic drugs together with physical therapies. ⋯ The extent of pain relief provided by transdermal fentanyl and sustained release morphine formulations is similar, with quality-of-life instruments showing no consistent preference for either formulation. Open studies have suggested a lower risk of constipation. Transdermal fentanyl is effective in the treatment of severe cancer pain, particularly when the oral route is unavailable.
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Review
New approaches for evaluating the quality of cancer pain management in the outpatient setting.
Both retrospective and prospective methods can be used to evaluate the quality of cancer pain management in the outpatient setting. Retrospective evaluations of the quality of cancer pain management in the outpatient setting provide benchmark data that can be used to change clinical practice for groups of patients or for specific types of cancer pain problems. Prospective evaluations of the quality of cancer pain management with patient diaries in the outpatient/home care setting can help clinicians do "real-time" evaluations and modify the pain management plan for individual patients. This report provides practical suggestions for evaluating the quality of cancer pain management in the outpatient setting.
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Review Comparative Study
Cyclo-oxygenase 2 inhibitors: an important new drug classification.
The pharmacologic treatment of acute and chronic pain has evolved greatly over the last several decades. Notably, several new classifications of drugs have emerged to meet the growing demand of patients in pain and health care providers who attempt to assist them. This article describes 1 new classification, cyclo-oxygenase 2 inhibitors, and provides specifics about the 2 agents currently available via prescription.