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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the course of 3 years we observed a considerable improvement of herpes zoster in 44 patients being treated with amantadine. The periods of pain and efflorescence were shortened to 1/3 of the values usually experienced and painful post-zoster complications did not occur. The therapeutic effect depends on a) beginning treatment with high doses as early as possible, b) combination of local and systemic administration of adamantine, c) continuation of treatment for several weeks with gradually reducing doses. Harmless side-effects which are easily controlled are dryness of mouth, slight fall in blood pressure and insignificant general stimulation. In old people half the standard dose should be given in the beginning and particular attention paid to symptoms of restlessness on account of a possible delirium. Severe disorders of renal function are a contraindication.
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PMID:[Improvement of zoster therapy by adamantine]. 30 38

Current trends in the employment of psychotropic medication in somatic illness are considered, and some of the theoretical issues raised by this practice are explored. While much further clinical investigation is needed, a review is made of currently available knowledge regarding psychopharmacotherapy in specific clinical settings: pain, delirium, ischemic heart disease, gastrointestinal disorders, dermatological illness, and in renal, hepatic and pulmonary insufficiency.
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PMID:Psychotropic drugs in somatic disorders. 77 56

In 70 patients (maxillo-facial-, neurosurgical-, abdominal- and gynaecological operations) the technique of "analgetic anaesthesia" using high doses of fentanyl (0.025 mg/kg body weight) and naloxone as its antagonist (0.02 mg/kg body weight) has been employed. All patients were artificially ventilated with N2O/O2 in a 3:1 ratio. Muscle relaxation was achieved with pancuronium-bromide (0.08 mg/kg). The patients had no apparent heart or lung disease. The youngest patient was 4 years of age, the oldest 82 years of age (average age 48.9). The necessity for a reinjection of fentanyl (half the initial dose) was determined by continously monitoring heart rate. This variable appeared to be the most subtle index indicating a reduction in analgesia. Sufficient analgesia was maintained once the heart rate stayed 20% below preanaesthetic levels. At the end of the operation naloxone reversed the respiratory depression. There was no evidence indicating postoperative pain, which may have required administration of additional analgesics. If deep analgesia was maintained up to the last surgical procedures no emesis appeared in the post operative period. The incidence of emesis was higher 10% compared to the classical neuroleptanalgesia with droperidol this was often noted in cases where blood accumulated in the stomach (maxillo-facial operations) (70%). In 3% of all cases psychomotor agitation with delirium appeared right after the injection of naloxone. This lasted for about 15 minutes. We suspect that due to the sudden and powerful effect of naxolone, in replacing fentanyl from its receptor site, acute withdrawal symptoms may be precipitated.
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PMID:[High doses of fentanyl as the sole anaesthetic agent and naloxone as its antagonist (author's transl)]. 113 60

In the dying patient, coma is preceded by either progressive sedation or the development of the organic brain syndrome of delirium. More than one-third of dying patients experience some difficulties during the last 48 hours of life with noisy and moist breathing, pain, and agitation and restlessness the most common. The great majority of these terminal symptoms can be managed by reassurance or drug intervention. Sublingual lorazepam and continuous subcutaneous infusion of midazolam can be effective in controlling terminal restlessness.
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PMID:The last few days. 145 27

Pharmacologic control of the agitated ICU patient requires preliminary assessment of the underlying causes of agitation. Reversal of correctable abnormalities, consideration of drug reaction, withdrawal and pain management should be addressed first. Delirium is the most common cause of agitation in the ICU and often has multiple causes. Pharmacologic management of agitation can be safely accomplished by intravenous haloperidol with or without lorazepam, as outlined above.
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PMID:Managing agitation in the critical care setting. 151 85

In 39 of 100 cancer patients admitted to the palliative care unit at Edmonton General Hospital, the presence of delirium during their last week of life required psychotropic drug treatment. In 10 of the 39 delirious patients, symptoms were only controllable by sedation; this was achieved in 9 patients by a continuous subcutaneous infusion of midazolam. Although haloperidol is considered to be the treatment of choice in agitated, delirious cancer patients, our data suggest that palliative care treatment strategies for these patients may be different.
J Pain Symptom Manage 1992 Feb
PMID:Acute confusional states in patients with advanced cancer. 157 91

The most common psychiatric complications in the cancer population are depression, anxiety, and delirium. All are more likely to occur in the cancer patient who has pain. This review outlines the normal responses to cancer and the psychiatric disorders frequently encountered in clinical practice. The influence of pain on the incidence and presentation of these disorders is described. Multimodal treatment, which includes pharmacologic, psychotherapeutic, and behavioral interventions, is outlined.
J Pain Symptom Manage 1992 Feb
PMID:The cancer patient with pain: psychiatric complications and their management. 157 92

The clinical use of neuroleptics, benzodiazepines, narcotic analgesics, barbiturates, and neuromuscular blockers to manage delirium and agitation in the intensive-care setting is reviewed. Delirium is the most commonly encountered mental disturbance in critically ill patients and may be precipitated by factors such as physical illness, medications, pain, and emotional stress. If agitation cannot be controlled through nonpharmacologic means, pharmacologic intervention may be necessary. Haloperidol is the neuroleptic of choice for rapid control of delirium and agitation in the critically ill patient. It has few adverse effects in most patients, even at high doses, although it can cause extrapyramidal symptoms. Among the benzodiazepines, lorazepam should be considered a first-line agent. It may be used alone or in combination with haloperidol (or another neuroleptic). Midazolam is suitable for administration by continuous i.v. infusion in the intensive-care setting because of its water solubility, short half-life, and short duration of action. The sedative effects of narcotics may be advantageous in patients with both agitation and pain. Barbiturates are not recommended for routine use in the treatment of delirium and agitation. The use of neuromuscular blocking agents such as pancuronium bromide and metocurine iodide may be necessary when other therapies have failed. Haloperidol and the benzodiazepines, alone or in combination, are the drugs of choice for treatment of acute agitation and delirium in critically ill patients.
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PMID:Treatment of delirium in the critically ill patient. 167 22

The lack of control of physical suffering among cancer patients in the last days or hours of life is a common medical problem but it is rarely discussed in an open fashion. We carried out a prospective study of the dying of 120 terminal cancer patients assisted by a home care team. We documented how long it was before death that physical symptoms, unendurable to the patient and controlled only by sedation-inducing sleep, appeared. In 63 patients (52.5%), unendurable symptoms due to tumor progression or irreversible acute organic phenomena appeared, on average two days before death. Of the 63 patients, 47 had only one uncontrollable symptom, 15 had two symptoms and one patient had three symptoms. The most common symptoms included dyspnea (33 patients), pain (31), delirium (11), and vomiting (5). The most frequent symptoms were dyspnea in lung and head and neck disease; pain in breast, gastrointestinal tract, colon-rectum, and male genitourinary tract cancer; and vomiting in female genitourinary tract malignancies. Data reported emphasize the clinical relevance of physical symptoms in the last days of life in terminal cancer patients and how these serve to indicate imminent death. More than 50% of these patients die with physical suffering that is controllable only by means of sedation.
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PMID:Symptom prevalence and control during cancer patients' last days of life. 171

Aside from being hard for physicians and staff to cope with, ICU agitation syndromes result in deterioration of hemodynamics and must be handled effectively. The interaction between pain and delirium is examined, as well as hemodynamic and metabolic syndromes that cause agitation in the ICU setting. The various medications useful in the treatment of pain and delirium are reviewed and new regimens discussed. Comprehensive treatment plans are reviewed for the profoundly agitated patient.
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PMID:The role of sedation in the ICU patient with pain and agitation. 197 21


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