Articles: pain.
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The physiology and pharmacological management of postoperative pain are briefly discussed. Although narcotic analgesics are still the mainstay in the management of postoperative pain the judicious use of non-narcotic analgesics, anticholinergics, tranquillizers and soporifics as well as the administration of local anaesthetic agents could contribute greatly to the alleviation of postoperative pain and discomfort. Certain regimens for intravenous medication are outlined and strong emphasis is placed on the fact that postoperative pain relief is the duty of the doctor and not that of unskilled nursing staff.
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The individual who complains of pain often has a combined emotional and organic experience. Pain is the resultant symptom of organic factors, personal and developmental phenomena, as well as social and cultural characteristics of the individual. The individuals who complain of pain often have chronic histories of difficulty and disability thus creating a difficult treatment problem. The physician who faces such individuals must attend the psychological, social, and organic entities in order to adequately manage and help rehabilitate these distressed individuals.
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Der Urologe. Ausg. A · Jul 1977
[Pain relief by means of continuous epidural analgesia after retroperitoneal lymph node dissection (author's transl)].
A retrospective study compares the effectiveness of postoperative epidural analgesia with conventional analgetic medication in cases of retroperitoneal lymph node dissection. Epidural analgesia is noted for its reduced need for additional medication and for its lower incidence of complications.
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The neurosurgeon can play a significant role in the management of chronic pain. This potential is all to often unrealized or distorted by a lack of knowledge about patients who are suffering from chronic pain. Patient selection is the most important determinant of successful surgical therapy. ⋯ Neurosurgical therapy is less likely to be successful if the pain is secondary to benign disease; tic douloureux is an exception to this rule. If chronic pain behavior is not primarily due to noxious peripheral input, surgery is unlikely to yield any long-term benefit. Augmentation of input by skin stimulation or electrical stimulation of various regions in the peripheral and central nervous system may become important therapeutic procedures for the neurosurgeon.
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Electrical stimulation for the control of pain is now a well accepted therapeutic modality. Transcutaneous application of electrical stimulation is the most common technique employed and has been used to treat chronic pain, acute surgical pain, and acute pain of other origins. Percutaneous application of electricity to the nervous system through needles electrodes is useful in predicting the efficacy of implantable stimulators and has served the same function as diagnostic nerve block. ⋯ Peripheral nerve stimulators are the most efficacious of the implantable devices. They are used specifically for pain of peripheral nerve injury origin. Their use for pain outside the distribution of the nerve stimulated is not yet proved.