Articles: pain-management.
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An interdisciplinary working group on cancer pain was founded by the German Association for the Study of Pain in 1991. The goal of this group is the development and dissemination of training and information material, guidelines and curricula in the fields of cancer pain, palliative medicine and the legal regulations for the prescription of opioids. ⋯ The results of this survey clarify the need for concrete guidelines in cancer pain management which are at the same time readily understandable. The new edition of 40 000 copies of the "Abbreviated Guidelines for Cancer Pain Management" was published in October 1993. Because of the good response, a further booklet on "Cancer Pain Management in Children" is being planned.
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There have been major advances in knowledge and efficient techniques for pain relief have been developed during recent years. Nevertheless, many patients on surgical wards still suffer from severe pain following surgery or trauma. Therefore, in the University hospital of Kiel (Germany) an anaesthesiology-based acute pain service (APS) was established in 1985 to improve this situation.
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The number of AIDS patients is steadily increasing. According to the literature these patients are often in severe pain. ⋯ The high incidence of complicated neuropathic pain syndromes in AIDS patients requires a sophisticated therapeutic approach. Closer cooperation between AIDS specialists and pain specialists, comparable to that already existing for other patient groups, is therefore desirable.
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Randomized Controlled Trial Clinical Trial
Phentolamine sympathetic block in painful polyneuropathies. II. Further questioning of the concept of 'sympathetically maintained pain'.
To test for the presence of "sympathetically maintained pain" (SMP), we administered placebo-controlled phentolamine sympathetic blocks to 14 patients with painful polyneuropathies. Six received i.v. infusion of saline for 30 minutes, followed by phentolamine (35 mg). In eight patients, the saline phase was followed by double-blind infusion of phentolamine or phenylephrine (500 micrograms), a second saline phase, and then the other active drug. ⋯ Five patients reported significant diminution of pain (> 50%), all in response to placebo. Neither phentolamine nor phenylephrine provided relief, although all patients had signs of physiologic abnormalities reputed to be determinants or predictors of SMP. These results complement previous studies demonstrating the nonexistence of SMP among "reflex sympathetic dystrophy" patients and further question the concept of SMP.
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Comparative Study Clinical Trial Controlled Clinical Trial
The comparative analgesic efficacy of transcutaneous electrical nerve stimulation and a non-steroidal anti-inflammatory drug for painful osteoarthritis.
Thirty-six non-hospitalized subjects with chronic pain from OA of the knee participated in an evaluation of transcutaneous electrical nerve stimulation (TENS) and naproxen, an NSAID. All pre-experiment treatment was withdrawn. Each subject experienced in some order three 3-week treatment phases: NSAID plus placebo TENS; TENS plus placebo drug; and double placebo. ⋯ Broad comparisons across subjects, combining the four main measures of pain, found no significant differences among the three experimental treatments. Analysis of diary and PIPER data for individuals suggested that, in a small minority of subjects, the NSAID plus placebo TENS combination may be more effective than double placebo. The PIPER ratings seemed to tap aspects of the pain experience different from those captured by conventional measures, suggesting the value of very frequent pain assessments, such as those entered by a subject into the PIPER, in the study of chronic pain.