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

The recent literature on pain states shows: pain thresholds are relatively constant for an individual, but pain tolerance is influenced by psychological state; the expression of pain is a function partly of ethnic membership and degree of extroversion; pain complaints are determined as well by cultural and extroversive factors, and also degree of neuroticism. Studies of pain patients reveals that those with acute pain tend to show normal personality profiles, but the degree of pain experienced is related to the degree of anxiety present. Most chronic pain patients, like those with psychogenic pain, show somatic preoccupations and reactive depression. The treatment and/or rehabilitation of pain patients has developed in three areas. In cases of peripheral neuropathy and some spinal cord lesions, electrical stimulation with "neural pacemakers" can often "close the gate" to pain signals and provide significant reduction or abolition of pain. Psychotropic medications, particularly the tricyclic antidepressants, sometimes in combination with phenothiazines and antihistamines, are effective in many instances of central pain, and help increase the pain tolerance and decrease the need for narcotics in other pain states. Operant conditioning, including the use of biofeedback, extinguishes pain behavior and increases pain-incompatible behaviors, with good long-term results.
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PMID:Psychophysiology of pain. 0 84

Acute pain produced by disease or injury is the net effect of highly complex interactions of various neural systems and psychological factors. Through the interaction of the afferent systems and neocortical processes, the individual is provided perceptual information regarding location, magnitude, and spatial and temporal properties of the noxious stimulus that activates motivational tendencies toward escape or attack and permits analysis of multimodal information, past experience, and probability of outcome of different response strategies. In contrast, chronic pain is a malefic force that taxes the physical, emotional, and economic resources of the patient, his famiily, and society. Moreover, chronic pain is characterized by physiological affective and behavioral responses that are quite different than those of acute pain. The clinician must keep these differences in mind in order to provide patients with optimal relief of their pain.
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PMID:Neurophysiologic and pathologic aspects of acute and chronic pain. 1 80

The use of potent narcotics to control severe pain should be of short duration and limited to patients with acute diseases or inoperable or metastatic cancer who require long-term relief. Continued and prolonged use of narcotics in patients with chronic benign pain is not recommended because of serious behavioral consequences, the development of tolerance, and addiction liability. Long-term use of analgesic drugs in chronic pain usually produces negative behavioral complications that are more difficult to manage than the pain it was desired to eliminate. The use of antidepressant drugs in the pain regimen has been found to provide increased relief of pain and often allows the dose of narcotic analgesic to be reduced or totally eliminated.
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PMID:Analgesic drugs in the management of pain. 1 28

Although the four-point relative potency assay using crossover design has proven a powerful technique for the clinical evaluation of analgesics in patients with chronic pain, excessive dropouts have made this design impractical in postoperative pain. In a relative potency assay comparing single graded intramuscular doses of morphine standard and morphine test in postoperative patients, we have managed to circumvent this difficulty while preserving many of the advantages of a complete crossover by using the "twin-crossover" balanced incomplete block design, which requires that each subject receive only two of the four possible treatments. The "twin crossover" design, coupled with a sequential decision-making process that expedites choosing the doses of the test medication which are most closely equianalgesic with the standard, yielded excellent analgesic assay sensitivity and made efficient use of our population of postoperative patients.
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PMID:Twin crossover relative potency analgesic assays in man. I. Morphine vs. morphine. 1 6

Except in emergencies, the physician's obligation is not to relieve pain, but to diagnose and treat pathology. Psychological factors complicate organic pain, and make the diagnosis of "psychogenic" pain virtually impossible on the basis of psychological tests alone. In acute (short-term) pain, anti-anxiety agents are useful, but in chronic pain antidepressants are usually more appropriate. Continuing anxiolytic drugs past the acute stage tends to potentiate depressions. In addition to antidepressants, modalities which help in the management of chronic pain are physical therapy, transcutaneous electrical neurostimulation, use of weak analgesics on a "clock" rather than an "as needed" basis, and behavior modification. Explicit agreement on the features of the doctor--patient relationship is almost always essential for successfully managing these difficult and demanding patients.
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PMID:Psychological aspects of chronic pain. 2 10

30 patients suffering from therapy-resistant chronic pain were divided into three groups according to drive and mood: I. psychomotor inhibition combined with depressive mood, II. agitation and depressive mood, III. agitation combined normal mood. The psychopharmacological treatment of pain showed sufficient results, when the drugs were directed to the target symptoms "agitation", "lack of drive", and "depression". The differentiated administration of activating or sedative antidepressants and neuroleptics caused reduction or absence of pain while the routine administration of neuroleptics (i.e. chlorpromazine) was less effective.
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PMID:[Treatment of pain with psychotropic drugs (author's transl)]. 2 29

This report concerns the current status of the results of intraencephalic implantations carried out up to the present time in man with the aim of relieving certain forms of chronic pain. It places little emphasis upon the neuro-physiological basis of these implantations, which have been studied at length during previous reports. After presenting the overall results of operations carried out in the world up until September 1967, a critical study is undertaken: 1--In relation to the targets (Postero-Lateral Ventral Nucleus, posterior arm of the internal capsule, para-ventricular thalamic grey matter). 2--In relation to etiologies, both analytically (syndrome) by syndrome as well as in terms of synthesis (excess of pain perception-deafferentation). 3--In terms of various factors, such as: --technical requirements; --side ffects; --duration of "post effect" (residual analgesia after stimulation); --parallel action of drugs. Conclusions are drawn concerning future perspectives of this technique.
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PMID:[Chronic intracerebral electric stimulation for analgesia in man]. 2 42

The clinical results obtained with phloctaphenin in an "open" study comprising cases of real neuralgia and spinal radicular pain syndromes and in a "double-blind" study comparing the preparation with a placebo, and involving algico-vasomotor syndromes of the face, are reported. The results obtained confirm the antalgic power of phloctaphenin for by the third day, subacute or chronic pain syndromes already presented a significant improvement in simptomatology, while in algico-vasomotor syndromes of the face, the treatment proved effective in eliminating pain attacks.
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PMID:[Floctafenine in the treatment of painful syndromes of neurologic interest]. 3 14

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

Physical, psychological, financial, interpersonal and spiritual factors all modify the appreciation of chronic pain. The Brompton mixture is a highly effective, flexible, safe and convenient means of controlling the chronic pain of malignant disease. The mixture is a solution containing morphine; the dose of narcotic can be varied with the need for analgesia. It is given regularly, usually every 4 hours, with a phenothiazine, the main aims of therapy being prevention of pain rather than treatment, an unclouded sensorium and a normal affect.
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PMID:Use of the Brompton mixture in treating the chronic pain of malignant disease. 5 9


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