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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Management of the chronic pain of cancer is a common and difficult problem. In addition to a medical examination of the patient, it is necessary to perform a psychological assessment of his premorbid personality, current mental status, and coping mechanisms to devise an individualized approach to his pain. The mainstay of cancer pain control are the narcotics, which differ primarily in potency and duration of action. Nonnarcotic analgesics are equianalgesic with the less potent narcotics. Antipsychotic drugs are useful as tranquilizers, antiemetics, and analgesic potentiators. Antidepressants and hypnotics permit the patient a more normal life-style. Stimulants such as cocaine and amphetamines both potentiate narcotic analgesia and reduce narcotic-induced somnolence and respiratory depression. Tetrahydrocannabinol offers no advantage over traditional analgesics. With care and patience, the physician can render practically any cancer patient pain-free.
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PMID:Medical management of chronic cancer pain. 3 26

The present study was undertaken in order to investigate the analgesic effect of needle puncture in a small self-selected group of patients with chronic or acute pain, and to examine the factors which determine success or failure of this treatment modality. We have found that in chronic painful conditions, needle puncture may be very effective in producing at least transient analgesia. It also can produce permanent relief of acute (self-limited) pains. Needle puncture was not helpful in the management of pain resulting from nerve damage. High score on psychometric indicators of anxiety and depression is a significant predictor os successful needle puncture analgesia in patients with chronic pain. Comparison of our results to studies of counterirritation indicate that the analgesia produced by needle puncture involves a mechanism similar to that of counterirritation-induced analgesia.
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PMID:Observations on the analgesic effects of needle puncture (acupuncture). 14 Oct 19

A fundamental aim of the Neurosurgical Unit at Georgia Baptist Medical Center is to enable each individual to return to normal and meaningful functioning. The problem of chronic pain almost always results in a steady decrease in those activities, interests, and concerns which are essential to the normal process of living. When the process is disrupted, the result is usually a feeling of despair and uselessness. These problems will almost inevitably complicate the pain experience. In addition, the ever present stress that accompanies severe and chronic problems of any sort tends to result in related psychological difficulties such as depression, anxiety, feelings of inadequacy and a multitude of other family and personal problems. These difficulties often become major features of an individual's pain problem. A holistic approach to patient care is based on the concept that each individual needs to be considered physically, psychologically and spiritually. The active participation of the psychiatric liaison nurse as a member of the neurosurgical team helps integrate the forces that enable such an approach. By focusing on a thorough patient assessment, improved staff morale and improved well being of patients, the psychiatric liaison nurse assists the team in focusing its energy on total comprehensive patient care. The combination of clinical neurosurgical treatment and psychological care has proven effective in helping our neurosurgical team achieve the fundamental goal toward which we all work.
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PMID:Psychiatric liaison nurse for neurosurgery: an innovative approach to management of chronic pain. 16 40

The contribution of psychiatry to the evaluation and treatment of chronic pain is described. Psychological profiles may predict the outcome of surgery, while the psychiatric interview enhances understanding and may disclose formal psychiatric disorder. The measurement of pain is dependent on factors affecting pain complaint, and the psychiatrist can only accept the patient's experience. The reaction inhibition test and Chapman's Somatic, Anxiety, Depression (SAD) index provide ways of elucidating the functional versus organic dilemma. This is further understood by attention to the concepts of operant pain, the sick role, and illness behaviour. Psychotropic medications, psychotherapy, behaviour therapy, biofeedback, and distractional methods are the tools available to the psychiatrist. The patient's attitude and a combined physical and psychiatric approach are important for successful therapy.
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PMID:Chronic pain and the psychiatrist. 27 40

The efficacy of nefopam, a novel analgesic agent, was compared to pentazocine in a double blind study in 40 cancer patients with chronic pain. Both drugs were administered orally for 10 days. Pain relief after nefopam was at least as good as after pentazocine. Side efftects after nefopam were different in nature and less frequent than after pentazocine; respiratory depression or sedation were no observed.
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PMID:[Analgesia with mild side effects]. 33 98

Of 6 outpatients with chronic pain, 5 completed therapy based on a 3-part treatment package designed to provide symptom control, stimulus control and social system modification. Each of the components of the treatment package resulted in therapeutic change. A mean of 35.8 weekly hour long therapy sessions resulted in statistically significant decreases in pain, hopelessness, depression and analgesic medication intake. Generally, these improvements were maintained at 6 months and 1 year follow-up. This study is consistent with the notion that chronic pain is maintained by a combination of inter- and intrapersonal factors. A controlled comparison of this treatment program with other treatments for chronic pain is indicated.
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PMID:A pilot study of the treatment of outpatients with chronic pain: symptom control, stimulus control and social system intervention. 35 68

Buprenorphine, a derivative of the morphine alkaloid thebaine, is a strong analgesic with marked narcotic antagonist activity. In studies in relatively small groups of postoperative patients with moderate to severe pain, one or a few doses of buprenorphine parenterally (by intramuscular or slow intravenous injection) or sublingually were at least as effective as standard doses of other strong analgesics such as morphine, pethidine or pentazocine, and buprenorphine was longer acting than these agents. Only a small number of patients with chronic pain have received repeated doses, but in such patients there was no need for increased doses during several weeks to months of treatment. Buprenorphine appears to produce side effects which are similar to those seen with other morphine-like compounds, including respiratory depression. There is apparently no completely reliable specific antagonist for buprenorphine's respiratory depressant effect, since even very high doses of the antagonist drug naloxone may produce only a partial reversal. The respiratory stimulant drug doxapram has overcome respiratory depression in volunteers and in a few patients in a clinical setting, but such studies have not been done in an overdose situation. Animal studies and a direct addiction study in a few volunteers suggest that the dependence liability of buprenorphine may be lower than that of other older morphine-like drugs. However, a slowly emerging abstinence syndrome did occur on withdrawal after very high doses administered for 1 to 2 months. A definitive statement on the drug's dependence liability and abuse potential cannot be made until it has had much wider use for a longer period of time.
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PMID:Buprenorphine: a review of its pharmacological properties and therapeutic efficacy. 37 45

Recent descriptions of illness behavior and personality factors in chronic pain patients reflect patient populations at clinics dealing with refractory, multiple referral pain problems. Pain patients from the University of Washington Pain Center were compared with patients from a private practice clinic with regard to illness behavior and depression. Private practice patients were significantly less depressed, showed less conviction of disease, general hypochondriasis, affect disturbance and were less somatically focussed than the Pain Center patients. Physicians in general practice treating pain patients should avoid forming stereotypes of chronic pain patients based on the experiences of referral clinics, for such characterizations may lead them to weigh psychologic factors too heavily in diagnosis.
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PMID:Illness behavior and depression compared in pain center and private practice patients. 42 32

A group of moderately to severely depressed individuals with moderate anxiety were studied to determine the frequency and nature of pain complaints and their response to doxepin. It was discovered that 100% of these subjects had chronic pain complaints, most of which paralleled the course of depression. Headache was most commonly noted. Doxepin's analgesic effects were intimately associated with its antidepressant effects. There was a highly significant relationship between improvement of depression and reduction of pain on doxepin (P less than 0.005). Conversely, patients who obtained minimal antidepressant effect also obtained minimal analgesic effect. Psychophysiologic and biochemical hypotheses of this association of pain and depression are discussed.
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PMID:The effectiveness of tricyclic antidepressants in the treatment of coexisting pain and depression. 53 Jul 39

Forty patients with chronic pain below the waist level were evaluated in a multidisciplinary pain clinic using a refined differential spinal block (DSB) technique. The refinements consisted of verbal instructions to prevent biasing the patients, coupled with a thorough evaluation of verbal and physiologic responses to the block. When demographic and psychologic data were assessed according to pain mechanisms, a pattern of patient groups emerged along a chronic pain continuum. Stress, anxiety, depression, and hysteria, as well as the neurophysiologic and demographic factors, modified the responses to the block. Long-term follow-up of these patients, including repeat DSB procedures and confirmatory anatomic blocks of sympathetic and somatic nerves, validated these impressions. The findings indicate a link between pain mechanisms and psychosocial factors that may directly influence responses to DSB.
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PMID:Towards an understanding of chronic pain mechanisms: the use of psychologic tests and a refined differential spinal block. 76 May 99


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