Articles: pain-management.
-
This article outlines the role of spinal cord stimulation in contemporary chronic pain management. The anatomical and neurophysiological correlates of stimulation of the intraspinal structures are discussed. ⋯ The most common complications are presented, including paralysis, infection, electrode migration, cerebrospinal fluid leak, and pain. Spinal cord stimulation is one of the most effective techniques available in the management of severe chronic pain that has been refractory to other more conservative modalities.
-
(1) To describe a process approach to the improvement of pain management in emergency departments. (2) To compare analgesia ordering and administration practices for patients with acute fractures before and after implementation of a nurse managed, titrated intravenous narcotic policy. ⋯ This study demonstrates that a process approach to improving pain management that resulted in both changes in drug administration and pain assessment and management processes made a significant and sustained change to analgesia ordering and administration practices for patients with long bone fractures in an emergency department.
-
Clinical characteristics of neuropathic pain, i.e. pain after nervous system lesions, are burning spontaneous pain, shooting pain attacks and evoked pains. Partly interacting pathophysiological mechanisms at the peripheral and central nervous system may be responsible for initiation and maintenance of chronic neuropathic pain. (1) Peripheral nociceptive fibers can be abnormally sensitized. (2) Central nociceptive second order neurons in the spinal cord dorsal horn can also be sensitized, i.e. they are hyperexcitable and start responding to non-noxious stimuli. (3) Degeneration of nociceptive neurons may trigger anatomical sprouting of low-threshold mechanosensitive terminals to central nociceptive neurons and may subsequently induce synaptic reorganization in the dorsal horn. By this mechanism activity in mechanosensitive neurons may be perceived as painful. (4) Peripheral nerve injury may induce a pathological interaction of the nociceptive system and the efferent sympathetic system. ⋯ Therefore, a thorough analysis of sensory symptoms may reveal the underlying mechanisms that are mainly active in a particular patient. In the next step novel drugs will be developed that address specifically the relevant mechanism combination. Drug therapies that are available today include NSAIDS, opioids, tricyclic antidepressants, anticonvulsives (carbamazepine, gabapentin), GABA-agonists, Capsaicin and NMDA-antagonists.
-
This clinical policy focuses on critical issues in the evaluation and management of patients with acute myocardial infarction or unstable angina. A MEDLINE search for articles published between January 1993 and December 1998 was performed using combinations of the key words chest pain, acute myocardial infarction, unstable angina, thrombolytics, primary angioplasty, 12-lead ECG, ST-segment monitoring, cardiac serum markers, and chest pain centers. Subcommittee members and expert peer reviewers also supplied articles with direct bearing on the policy. ⋯ Clinical policy: critical issues in the evaluation and management of adult patients presenting with suspected acute myocardial infarction or unstable angina. Ann Emerg Med. May 2000;35:521-544.].
-
Randomized Controlled Trial Multicenter Study Clinical Trial
Pain and suffering in seriously ill hospitalized patients.
Previous studies had suggested a high prevalence of pain in hospitalized patients but had not specifically evaluated pain and other symptoms in seriously ill and older hospitalized patients. ⋯ Control of pain and other symptoms remains an important medical and ethical issue. Routine monitoring of pain and other symptoms should be linked to treatment strategies aimed at combinations of symptoms and tested to assuage concerns about side effects.