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

We present nine patients with necrotizing fasciitis. Two of them had Fourniers gangrene. Predisposing factors included diabetes mellitus, alcohol and drug abuse. Local signs were redness, swelling and pain rapidly followed by fever and deterioration in the patient's general condition. Soft tissue-gas was observed in all patients. It was found either clinically, on roentgenograms or by CT. Bacteria were found in blood cultures and/or necrotic tissues in all patients. The dominating treatment was radical surgical excision and early reexplorations. Antibiotics, intensive care support and early parenteral nutrition were given. Four patients were given hyperbaric oxygen treatment. The overall mortality rate was 11%. Amputation of one lower extremity became necessary in three patients. In these cases 4-8 days had elapsed between the onset and the first surgical excision. We find it important to underline early diagnosis and radical surgical excision in patients with necrotizing fasciitis.
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PMID:[Surgical treatment of necrotizing fasciitis]. 281 6

The incidence of suicide is increasing, the most common form being intoxication by drugs. It is well known that young cocaine abusers, with no cardiovascular disease, may suffer from acute chest pain due to arterial coronary spasm or myocardial infarction. Adrenoceptor stimulating drugs will give the same symptoms and should be considered as a possible cause of the pain in young intoxicated patients with no history of drug abuse or cardiovascular disease. A case is presented.
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PMID:[Poisoning by phenylpropanolamine (Rinexin)--an alpha adrenergic receptor agonist]. 281 44

Three animal models, based on genetic differences in endogenous opioid peptides and opioid receptors, are described. Obese mice and rats, whose pituitary opioid content is elevated, may be used to investigate eating disorders. Recombinant inbred strains of mice, which differ in brain opioid receptors and analgesic responsiveness, can be used for study of opioid- and nonopioid-mediated mechanisms of pain inhibition. Individual reactivity to opioids can be examined in C57BL/6 and DBA/2 inbred strains of mice. A model that combines a variety of opioid effects is offered and suggests the existence of a genetically determined dissociation of opioid effects on locomotor activity and pain inhibition. In addition, stimulatory locomotor responses in the C57BL/6 reaction type are linked to a high risk of drug addiction and facilitatory effects on adaptive processes, while high analgesic potency in the DBA/2 reaction type is accompanied by a low proneness to drug abuse and amnesic properties of opioids.
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PMID:Opioids and behavior: genetic aspects. 283 10

The history of efforts to develop new, safer and less addicting analgesic, antidiarrheal and antitussive drugs and the impact of these efforts on the understanding of the physiology of pain perception and affect, the identification of multiple opioid receptors and the finding of new analgesics has been briefly reviewed. These important findings have major implications concerning the pathology of drug abuse, and the strategies for dealing with it. The importance of these discoveries also have major implications concerning the effectiveness of scheduling of drugs under national laws and international treaties. It is argued that the types of information necessary for scheduling of some of the newer analgesics must differ from data used in previous scheduling efforts and must consider cost-benefits consideration as they relate to public health.
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PMID:Role of agonist-antagonist analgesics in medicine. 285 71

Thirty-eight patients maintained on opioid analgesics for non-malignant pain were retrospectively evaluated to determine the indications, course, safety and efficacy of this therapy. Oxycodone was used by 12 patients, methadone by 7, and levorphanol by 5; others were treated with propoxyphene, meperidine, codeine, pentazocine, or some combination of these drugs. Nineteen patients were treated for four or more years at the time of evaluation, while 6 were maintained for more than 7 years. Two-thirds required less than 20 morphine equivalent mg/day and only 4 took more than 40 mg/day. Patients occasionally required escalation of dose and/or hospitalization for exacerbation of pain; doses usually returned to a stable baseline afterward. Twenty-four patients described partial but acceptable or fully adequate relief of pain, while 14 reported inadequate relief. No patient underwent a surgical procedure for pain management while receiving therapy. Few substantial gains in employment or social function could be attributed to the institution of opioid therapy. No toxicity was reported and management became a problem in only 2 patients, both with a history of prior drug abuse. A critical review of patient characteristics, including data from the 16 Personality Factor Questionnaire in 24 patients, the Minnesota Multiphasic Personality Inventory in 23, and detailed psychiatric evaluation in 6, failed to disclose psychological or social variables capable of explaining the success of long-term management. We conclude that opioid maintenance therapy can be a safe, salutary and more humane alternative to the options of surgery or no treatment in those patients with intractable non-malignant pain and no history of drug abuse.
Pain 1986 May
PMID:Chronic use of opioid analgesics in non-malignant pain: report of 38 cases. 287 50

The agonist-antagonist opioids are clinically effective analgesics with generally low abuse potential. Four agonist-antagonists are currently available for use as analgesics. Pentazocine, butorphanol and nalbuphine produce morphine-like effects in low doses and, to varying degrees, dysphoric effects as the dose is increased. Buprenorphine, an antagonist opioid of slow onset but long duration of action, produces morphine agonist effects at lower doses, and as the dose is increased, antagonist effects with minimal or no dysphoria. Clinical experience with pentazocine indicates that abuse is possible and consists of two main types: misuse (and abuse) of the drug alone by patients during treatment for pain and, abuse of the drug, often taken together with other psychoactive agents, as a substitute for the preferred drug of abuse. Few reports of abuse have appeared for butorphanol, nalbuphine and buprenorphine; however, considerable care is recommended in their use in patients, especially where there is the possibility for abuse as might occur in patients who require long-term treatment, with a history of drug abuse, and where the drug is easily obtained.
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PMID:Clinical observations of agonist-antagonist analgesic dependence. 289 89

The untreatable family is defined as one in which it is unsafe to permit an abused child to live. Despite the fact that many families turn out to be resistive to treatment, they have received very little attention. In the field of physical abuse, 16-60% of parents reabuse their children following the initial incident. Sexual reabuse is estimated to occur in 16% of cases. Treatment of abusive families also aims to alter family functioning. From studies in physical abuse we find 20-87% of families are unchanged or worse at the end of treatment. In sexual abuse the equivalent figures are 16-38%. Parental factors associated with a poor outcome include parental history of severe childhood abuse, persistent denial of abusive behavior, refusal to accept help, severe personality disorder, mental handicap complicated by personality disorder, parental psychosis with delusions involving the child, and alcohol/drug abuse. Parents lack empathy for their child and fail to see the child's needs as separate from their own. Severe forms of abuse (fractures, burns, scalds, premeditated infliction of pain, vaginal intercourse or sexual sadism) are more likely to prove untreatable. Munchausen by proxy, nonaccidental poisoning, and severe forms of nonorganic failure to thrive are similarly resistant. An early recognition of untreatability may help to reduce burnout by diverting precious resources from the untreatable to the families for whom there is relatively more hope.
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PMID:The untreatable family. 331 32

The aim pursued in postoperative analgesia is to mobilize patients, to prevent thrombo-embolism, to improve subjective well-being, and to reduce the stress reaction caused by pain. In sufficiently high doses, metamizol is equally as suitable for the treatment of postoperative traumatic pain as are opioids. Comparative studies provide evidence that metamizol is no less potent in its action than pethidine, and that in cases of pain in the head and neck region it is superior to buprenorphine in its usual dose. It can also be used to supplement opioid medication where this does not produce satisfactory analgesia. In patients with a history of drug abuse, metamizol is in fact the drug of choice for immediate postoperative analgesic treatment.
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PMID:Pyrazolones in the treatment of postoperative pain. 346 86

Treatment dropout is to drug abuse programs as pain is to cancer. Despite the endemic nature of the premature termination phenomenon, we have successfully reduced patient attrition from 50% to 20%. This article describes our clinical and empirical exploration into the dropout process and presents the major administrative and clinical changes that reduced our dropout rate. Once staff decide that patient dropouts are a staff problem rather than a patient problem, effective intervention can begin.
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PMID:Reducing the treatment drop out rate in drug abuse programs. 383 1

There are complications of spinal cord paralysis peculiar to the extended care period. These may be motor skeletal, neurogenic, visceral and psychogenic. If practised regularly, prevention can be very effective in reducing the disability in all groups. Limb oedema, joint contractures, myasthenia and pain can be materially reduced by regular activity, maintaining joint mobility and the use of recreational motor skeletal activities. Urinary tract infection and decubiti can be largely eliminated by careful attention to anti-bacterial suppression and better hygiene, both personal and at home. Decubiti can be eliminated by regular skin care and eliminating friction and pressure. Most episodes of such complications can be effectively prevented and treated by the expert home visiting nurse. Social complications and drug abuse are areas of increasing concern. These can be kept to a minimum by regular assessment and, most importantly, when diagnosed early by the home visiting professional.
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PMID:Preventive measures in the tertiary care of spinal cord injured people. 400 Jun 94


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