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

Careful assessment is a necessary preliminary to treatment; pain may be caused by a variety of mechanisms or associated with a non-malignant condition. In the majority of patients treatment should be planned on a multimodality basis. The fact that pain is a somato-psychic phenomenon must not be forgotten. Analgesics should be gives regularly, usually every four hours. Whereas the optimal dose of non-narcotic and weak narcotic drugs vary little the optimal dose for the stronger narcotic analgesics varies considerably. Aspirin or other non-steroidal anti-inflammatory drugs should always be used in metastatic bone pain, usually with a narcotic. Morphine sulphate in solution administered by mouth is the narcotic analgesic of choice in far-advanced cancer. When used as described, escalation of dose (tolerance) is not a practical problem. Physical dependence does not prevent the downward adjustment of dose should this become feasible as a result of non-drug intervention. Psychological dependence (addiction) does not occur if the patient is closely supervised and given adequate emotional support.
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PMID:Medical treatment of chronic cancer pain. 744 45

Forty-eight patients with noncancer neuropathic pain who had participated in a randomized controlled trial with intravenous fentanyl (FENiv) infusions received prolonged transdermal fentanyl (FENtd) in an open prospective study. Pain relief, side effects, tolerance, psychological dependence, mood changes, and quality of life were evaluated. The value of clinical baseline characteristics and the response to FENiv also was evaluated in terms of the outcome with long-term FENtd. Eighteen patients stopped prematurely because of insufficient pain relief, side effects, or both. Among the remaining 30 patients completing the 12-week dose titration protocol, pain relief was substantial in 13 and moderate in five. Quality of life improved (23%, P < 0.01). Psychological dependence or the induction of depression was not observed. In only one patient did tolerance emerge. There was a significant positive correlation between the pain relief obtained with FENiv and that with prolonged FENtd (r = 0.59, P < 0.0001). We conclude that (1) long-term transdermal fentanyl may be effective in noncancer neuropathic pain without clinically significant management problems and (2) A FENiv-test may assist in selecting neuropathic pain patients who might benefit from prolonged treatment with FENtd.
J Pain Symptom Manage 1998 Oct
PMID:Prolonged treatment with transdermal fentanyl in neuropathic pain. 980 49

Freedom from cancer pain is one of the four priorities of the WHO Cancer Control Programme. Every day 3.5 million people are suffering from cancer pain, and most do not receive adequate relief. A lack of training in cancer pain management at most nursing and medical schools is the principal reason for this, coupled with limited availability of oral strong opioids in many countries. Education is the key to progress in cancer pain management. Health workers must appreciate that: 1. Attention must be paid to all aspects of suffering -physical, psychological, social and spiritual. 2. In advanced cancer, most patients with pain have multiple pain. 3. Pain experienced in carcinoma is not always caused by the tumour. 4. There is more to pain management than the use of analgesics. 5. In the case of opioid-responsive pains, analgesics should be administered by mouth according to a regular time-schedule and with dose increments. 6. Adjuvant medication is generally necessary. 7. Opioid-resistant pains require other forms of treatment. 8. Pain is the physiological antagonist to the central depressant effects of opioids. 9. Opioid tolerance is not a problem in practice. 10. Psychological dependence does not occur in patients receiving opioids for pain relief. 11. Patients receiving analgesics must be carefully monitored. 12. Teamwork is necessary for good results.
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PMID:[Pain treatment in cancer patients.]. 1841 21