Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Advances in physiological psychology and neuroendocrinology, together with epidemiological studies, have added new dimensions to psychosomatic research. Psychological influences still are accepted as exacerbators or trigger mechanisms, if less often as causes. Theories of psychosomatics which connected specific personality profiles with specific psychosomatic illnesses have lost favor, and multifactorial explanations, which include heredity, environment, social class, life stress, endocrines, brain areas, neurohormones, and immunological mechanisms, are new areas of research. Research methods have become more sophisticated scientifically, particularly in the selection and size of samples tested, and the variety of situations investigated. Psychological reactions to illness in general, terminal disease, and death, and psychological experiences of pain, in addition to variable effects of psychotherapeutic methods and psychotherapists' personality, are identifiable but unquantified influences which seem acceptable as contributors to, if not causes of, psychophysiological disorders.
 ...
PMID:New trends in psychosomatic research. 56 3

Today's technology provides portable pumps which facilitate continuous infusion of drugs to relieve suffering in terminal disease. Subcutaneous and epidural infusion is now frequently used in our hospital. The most common indications are gastrointestinal obstruction, impaired absorption of drugs, refractory side effects of oral medication or poor compliance because good pain relief is no longer possible orally. During the last days of life, this method may be the only possible approach to good comfort and relief from terminal agitation and anxiety. Of the patients referred to the advisory group for seriously ill and dying in 1990, 64% received subcutaneous infusions and 15% epidural infusions during the last days or weeks of life. Continuous infusion of drugs from portable pumps has become an almost indispensible method of treatment in an ordinary clinic.
 ...
PMID:[Continuous drug infusion in terminal cancer]. 137 57

Although spiritual pain has achieved comparable recognition to physical and emotional pain in the care of patients with terminal disease, it is less well recognised in those who are not terminally ill. This article describes the signs of spiritual pain in hospital patients and emphasises the crucial role of nurses in diagnosing and alleviating it.
 ...
PMID:Spiritual care: diagnosing spiritual pain in patients. 155 Jul 47

We surveyed 550 cancer patients who experienced pain and were treated with morphine for a total of 22,525 treatment days. Sufficient pain relief was achieved during more than 80% of this time using an average oral morphine dose of 82.4 mg--significantly lower than other studies. The use of this low dose, which was possible due to the concomitant administration of nonopioids and specific coanalgesics in most patients, resulted in a low incidence of side effects. Constipation and nausea/vomiting were the most common of these side effects. Physical dependence posed no practical problem in discontinuation of morphine treatment. Long-term opioid intake and development of tolerance did not appear to be linked; an increase in morphine dosage was most often explained by progression of the terminal disease. Addiction was a negligible problem, with only one observed case.
J Pain Symptom Manage 1992 Jul
PMID:A long-term survey of morphine in cancer pain patients. 162 12

On admission to a pain management unit, 92.5% of 174 cancer patients suffered from more than moderate pain despite prior treatment. This inefficacy was mainly due to underdosage of drugs, inadequate intake schedule, and hesitation to use strong opioids. Following introduction of an oral drug therapy based on World Health Organization (WHO) guidelines, more than 80% of all patients described their pain as ranging between "none" and "moderate" on a six-step verbal rating scale at all times. To obtain these results, it was necessary to adapt the therapy to increasing pain in the course of terminal disease. Step III (strong opioids) gained more and more importance with time, and step I (nonopioids) was finally useful only in a minority of patients. Side effects played a minor role as a reason to change therapy. Oral drug therapy following these guidelines led to sufficient pain control in most patients over the whole study period (7,400 days); only 11% of the patients required other methods of pain management.
J Pain Symptom Manage 1990 Feb
PMID:Cancer pain management according to WHO analgesic guidelines. 232 58

Pain control is recognised as perhaps the most important single objective in the patient with terminal disease. Cancer, cardiovascular disease and obstructive airways disease are foremost among many causes of pain requiring control in the terminal phase. Spiritual, emotional, religious and socio-economic factors are important in raising or lowering the pain threshold. Analgesic strategies include use of drugs, neurosurgery, radiotherapy and supportive measures which may be brought to bear singly or in combination as required. Pain is clinically classified as being acute or chronic, by the type of patient, and by a series of common pain syndromes and their pathological mechanisms. General concepts of control of pain and discomfort in disease are discussed, together with a brief comment on epidemiology, in the first part of the article. Rationale is then discussed under the following headings: (i) principles of pain control; (ii) causes of pain; and (iii) analgesic modalities and factors impinging on their efficacy.
 ...
PMID:Pain control in terminal disease. 244 40

The World Health Organization estimates that approximately 3.5 million people suffer daily from cancer pain. Approximately 30% to 40% of people with intermediate stages of cancer and 55% to 90% of patients with advanced or terminal disease have pain. A multidisciplinary effort is under way in Wisconsin to improve cancer pain management. In recognition of the state's initiative, the World Health Organization has designated Wisconsin a demonstration state for cancer pain management. Support for staffing is provided by the United States Public Health Service Interagency Committee on Pain and Analgesia. In December 1986, 65 people representing 50 health organizations met to develop a comprehensive plan of action to improve pain management in people with cancer. In this article the various statewide activities focused at improving cancer pain management are discussed.
 ...
PMID:Cancer pain control: one state's experience. 256 72

Fentanyl (1 microgram/kg body weight) was administered intravenously and via a lumbar epidural catheter (in random order) on 2 separate occasions to 6 patients with chronic pain associated with non-terminal disease states. Frequent blood samples were collected from an indwelling intravenous catheter and CSF samples were collected via spinal needles inserted in the cervical (C7-T1 interspace) and lumbar (L3.4 interspace) regions at 0, 5, 10, 20, 30 and 45 min after fentanyl administration. The concentration of fentanyl in blood and CSF samples were quantified by a sensitive and selective gas-liquid chromatography assay. Visual analogue pain scores (VAPS) were recorded every 5 min for the first hour. Coded syringes (one containing the appropriate fentanyl dose while the other contained an equivalent volume of saline) allowed the investigator administering the fentanyl and assessing VAPS to remain blinded as to which route of administration actually contained the fentanyl. There was minimal vascular uptake of fentanyl following epidural administration. Similarly, the permeation of fentanyl into cervical and lumbar CSF following intravenous administration was minimal and erratic such that only 4 of the 60 CSF samples had detectable fentanyl concentrations. In contrast, there was a rapid penetration of fentanyl across the dura mater following lumbar epidural administration. There was significantly fentanyl in lumbar CSF samples by 10 min in 5 patients, and by 20 min in all 6 patients. The mean maximum lumbar CSF concentration was 19.1 ng/ml, while the time associated with these maximum concentrations was 22.5 min. The mean maximum cervical CSF fentanyl concentrations were 10% of the lumbar CSF concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)
Pain 1989 Sep
PMID:Pharmacokinetics of fentanyl in lumbar and cervical CSF following lumbar epidural and intravenous administration. 281 36

This is a report of the discussions and recommendations of the "Conference on the Care of Patients With Severe Chronic Pain in Terminal Illness," sponsored by the American Medical Association and the Public Health Service, held on 28 January 1983 in Washington, D.C. Despite the availability of effective analgesic drugs, insufficient and improper medication has resulted in suffering and diminished quality of life for many terminally ill patients. This review describes the dynamics of pain, evaluates the pharmacologic activity of analgesics, and maintains that it is incumbent on physicians to understand these mechanisms as well as the needs of the patient and family in providing optimum terminal care.
 ...
PMID:The care of patients with severe chronic pain in terminal illness. 614 2

In patients suffering from advanced or recurrent cancers that are no longer amenable to curative treatment, palliation and symptomatic care have to take the place of cure. In such cases, palliation aims at relief of pain, alleviation of functional disabilities and restoration of mental and social balance. Since the clinicians effort is concentrated on the control of symptoms of uncontrollable disease, decisions have to be made concerning the relative value of the various methods available for treatment and support in the individual patient. Criteria for the physician's decision-making are important parameters in any approach to the patient with incurable cancer and have particular significance in caring for terminal disease.
 ...
PMID:[The incurable tumor patient]. 752 Aug 94


1 2 3 4 5 Next >>