Articles: pain-management.
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The use of transdermal fentanyl is gaining in importance in the management of cancer pain. We describe the reasons for switching opioid medication to transdermal fentanyl in a pain management unit. ⋯ Conversion to transdermal therapy may readjust the balance between opioid analgesia and side effects. The opioid switch resulted in more pain relief or fewer side effects in half of the patients. A proposed equianalgesic conversion ratio between 70:1 and 100:1 from oral slow-release morphine to transdermal fentanyl can be confirmed by our data. Conversion rates from other opioids to transdermal fentanyl are suggested.
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Clinical Trial Controlled Clinical Trial
Dissociation of sensory and affective dimensions of pain using hypnotic modulation.
Understanding the complex nature of pain perception requires the ability to separately analyze its psychological dimensions and their interaction, and relate them to specific variables and responses. The present study, therefore, attempted to selectively modulate the sensory and affective dimensions of pain, using a cognitive intervention, and to assess the possible relationship between these psychological dimensions of pain and changes in physiological responses to the noxious stimuli. In three experiments, normal subjects trained in hypnosis rated pain intensity and pain unpleasantness produced by a tonic heat-pain stimulus (1-min immersion of the hand in 45.0-47.5 degrees C water). ⋯ Wade JB, Dougherty LM, Archer CR, Price DD. Assessing the stages of pain processing: a multivariate analytical approach. Pain 1996;68:157-167) which provides a conceptual framework necessary to study the cerebral representation of pain perception.
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The diagnosis and therapy of pain is routine in common practice of almost all clinical fields. Whilst acute pain may be controlled fairly easily, the treatment of chronic pain patients may be frustrating if conventional approaches for analgesia are chosen. Only a specialized and multidisciplinary procedure is beneficial for advanced stages of pain chronification. Precisely, an adequate treatment program has to consider biological, psychological and social aspects of chronic pain.
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Approximately 80% of all patients with chronic pain report current or past psychological impairment. That is why psychologists or psychosomatic specialists necessarily have to play a role in pain management. ⋯ A lot of different therapeutic approaches are used in clinical practice. Today the best evidence exists for relaxation techniques, behavioural therapy and analytical psychotherapy.