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

Pain is a complex somato-psychic experience, and all pains do not respond equally to opioid analgesics. Muscle and deafferentation pains are best eased by alternative treatments. Bone pain responds best to the combined use of morphine and an NSAID. Nerve compression often necessitates the concurrent use of a corticosteroid. Few patients need neurolytic or neuro-ablative procedures. Opioid use is governed by three key principles: "By the mouth," "by the clock," and "by the ladder." Morphine remains the strong opioid of choice for most patients. Respiratory depression is not a problem, nor is tolerance. Addiction (psychological dependence) does not occur in patients with opioid responsive pains.
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PMID:The management of pain in cancer: a guide to drugs and dosages. 290 83

Bulimia, a disorder of episodic binging and purging, remains without a known etiology. A case report is presented of a patient who attributed bulimic episodes to efforts at inducing euphoria. Experimental pain tolerance was increased by bulimic vomiting, blocked by naloxone, but not by saline. Vomiting was also associated with falls in depression and anxiety. Plasma ACTH and cortisol, putative markers for beta-endorphin, also rose following vomiting. It is hypothesized that in some bulimics, the disorder arises by virtue of an addiction to one's own internally released endogenous opioid peptides.
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PMID:Bulimic vomiting alters pain tolerance and mood. 303 Sep 47

A 48-year-old woman with a stimulating electrode implanted in the right thalamic nucleus ventralis posterolateralis developed compulsive self-stimulation associated with erotic sensations and changes in autonomic and neurologic function. Stimulation effects were evaluated by neuropsychologic testing, endocrine studies, positron emission tomographic measurements of regional cerebral metabolic rate for glucose, EEG and evoked potentials. During stimulation, vital signs and pupillary diameter increased and a left hemiparesis and left hemisensory loss developed. Verbal functions deteriorated and visuospatial processing improved. Plasma growth hormone concentrations decreased, and adrenocorticotrophic hormone and cortisol levels rose. With stimulation, glucose metabolism increased in both thalami and both hemispheres, reversing baseline right-sided hypometabolism and right-left asymmetries. EEG and both somatosensory and brain-stem auditory evoked potentials remained unchanged during stimulation, while visual evoked potentials revealed evidence of anterior visual pathway dysfunction in the left eye. This case establishes the potential for addiction to deep brain stimulation and demonstrates that widespread behavioral and physiological changes, with concomitant alteration in the regional cerebral metabolic rate for glucose, may accompany unilateral thalamic stimulation.
Pain 1986 Dec
PMID:Compulsive thalamic self-stimulation: a case with metabolic, electrophysiologic and behavioral correlates. 349 99

The observation that the narcotic antagonist naloxone could inhibit analgesia produced by electrical stimulation of the brain indicated the involvement of an endogenous chemical in the relief of pain. Multiple endogenous opioid peptides have been identified that have similar pharmacological properties to known narcotic analgesics. The biosynthesis, release, and degradation of opioid peptides have been studied in order to better understand how the manipulation of endogenous opioid systems can be used to produce or augment analgesia. The results of our studies reveal that various conditions and manipulations, such as electrical brain stimulation, acupuncture, stress, and the administration of opioid analgesics, can cause the release of endogenous opioid peptides and possibly endogenous nonpeptide substances. It has also been discovered that nonopioid peptides, such as cholecystokinin, calcitonin, and angiotensin II, can alter the action of opioid analgesics by antagonizing or potentiating their effects. An understanding of the role of endogenous peptides in endogenous opioid mechanisms is necessary for the development of new ways to treat pain and such other disorders as sleep apnea in children (sudden infant death syndrome), head injury, and opioid addiction that involve the activation or alteration of endogenous opioid systems.
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PMID:The role of endogenous peptides in the action of opioid analgesics. 352 91

Psychiatric problems of patients with head and neck cancer include reactions to disfiguring illness and treatment; adjustment to alterations of speech, eating, and other functions, including sex; changes in body image; alcohol and tobacco addiction; pain; organic brain syndromes; and dealing with terminal illness. Although speech is often compromised, head and neck patients can communicate and psychiatric work is possible. The consultation-liaison psychiatrist can provide considerable assistance by utilizing psychodynamic, behavioral, and pharmacologic modes of treatment and by working with family members and staff.
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PMID:Psychiatric aspects of head and neck cancer surgery. 355 83

One hundred and seventy-six consecutive patients with moderate or severe pain of suspected myocardial infarction were randomized to receive nalbuphine less than or equal to 20 mg or diamorphine less than or equal to 5 mg intravenously with metoclopramide 10 mg and were observed over 2 hours. One hundred and forty-two patients (81%) received the test drug outside hospital. The median time from symptom onset to treatment was 135 minutes for the nalbuphine group and 125 minutes for the diamorphine group. Satisfactory pain relief (grade 0 or 1) was similar for both groups at each time assessment. In particular, within 10 minutes of the drug's administration 77% of those receiving nalbuphine and 68% who received diamorphine had satisfactory pain relief. The number of doses of each drug, the number of patients withdrawn from the trial because of unsatisfactory pain relief or recurrence of chest pain were similar for both groups. For those with myocardial infarction there was similar satisfactory pain relief with nalbuphine as diamorphine. No significant deleterious haemodynamic effects or other side-effects occurred. The noncontrolled classification and low addiction potential of nalbuphine allow for its more widespread use in the control of pain of suspected myocardial infarction.
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PMID:Nalbuphine versus diamorphine early in the course of suspected myocardial infarction. 362 39

Physical and psychosocial risks of running and addiction were compared in a sample of female (n = 112) and male (n = 108) marathon runners. While female runners reported more pain in the knee, shin, hip, and heel, and more stress fractures, than the men, no injuries were significantly higher in women. Over 40% of both male and female subjects reported knee injury, making it the most common running injury reported. There were no significant differences in level of self esteem, anxiety, or running addiction between the two groups. There was, however, a significant relationship between level of negative addiction scores and two injuries: torn ligaments X2 (2,202) = 8.45, p less than .02, and hematuria X2 (2,202) = 11.31, p less than .005.
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PMID:Marathon running: comparison of physical and psychosocial risks for men and women. 364 18

Fifty adult patients with chronic pain and substance dependence were admitted to an inpatient unit for treatment of addiction without primary emphasis on treatment of pain. As a group they had received considerable medical attention for their pain, but relatively little for their addictions. When compared with a group of general medical patients, the study population showed MMPI evidence of considerably more psychopathologic characteristics. MMPI data and family histories of substance dependence did not differentiate the study group from a comparable group in a Pain Management Center.
Pain 1986 Aug
PMID:Substance dependence and chronic pain: profile of 50 patients treated in an alcohol and drug dependence unit. 376 30

Few studies have been published about analgesic management practices during sickle cell pain crisis. Therefore, we reviewed the records of all hospitalized children with this complication during a recent five-year period. The 38 patients (98 painful episodes) who received intravenous narcotic therapy were the subjects of this review. In 76 patients, an initial intravenous bolus injection of morphine sulfate or meperidine hydrochloride was followed by a continuous intravenous infusion of one of these two drugs. To achieve adequate pain control, adjustments in infusion rates were made according to a written protocol. In 22 other patients, subsequent narcotic treatment consisted only of intermittent intravenous bolus injections of meperidine. Satisfactory pain relief was achieved in all 98 episodes. Patients given continuous infusions required more narcotic to control their pain and had more side effects than those treated with bolus injections alone, suggesting a dose-response relationship between narcotic dose and several known side effects. Common side effects included nausea and vomiting, lethargy, and abdominal distention. Although clinically evident respiratory depression was quite uncommon, chest syndrome was a frequent complication, and severe respiratory distress occurred in three patients. Narcotic withdrawal or addiction was not observed. With careful monitoring (including special attention directed to avoiding dosing error), continuous intravenous narcotic infusions are safe and provide effective pain relief for severe sickle cell pain crisis.
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PMID:Intravenous narcotic therapy for children with severe sickle cell pain crisis. 377 42

The propriety of narcotic usage at the Hadassah Hospital has been studied in 35 cancer patients and 70 post-operative patients. Eighty-three per cent of the cancer patients and 66% of the surgical patients remained in moderate to severe distress in spite of the analgesic therapy. Insomnia and anxiety, plus depression in the cancer patients, were the major results of uncontrolled pain. The inadequacy of the treatment was attributed to the incorrect selection of medication, usage "as needed' policy and smaller daily doses than advocated. This resulted mainly because of exaggeration of the risk of tolerance and addiction by both patients and personnel.
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PMID:The propriety of narcotic usage in hospitalized patients. 395 14


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