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

This article discusses the roles of the critical care team in providing pain relief. The attitudes of the staff concerning pain relief impact on the delivery of care. Assessment tools, computer systems, and flow sheets to assist in charting are described. Nurses have a role in use of epidural administration of narcotics, and provide relief with the use of patient-controlled analgesia and general pain relief measures. Pain as a nursing diagnosis, substance abuse in the medical profession, and control of narcotics are also issues discussed.
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PMID:Monitoring pain control and charting. 218 6

When seeking medical care, homeless persons often turn to health centers that were designed to treat the poor who have homes. To provide for effective medical care, personnel in such facilities need to know how the health care needs of the homeless are different from those of other clinic users. To compare the physical health of these two groups, we conducted a health survey and screening physical examination of 464 patients who attended the general adult and homeless clinic sessions of one of the main neighborhood health centers in Los Angeles County, California. As compared with the poor who have homes, homeless persons were more likely to have dermatological problems (32% vs 21%), functional limitations (median, 2 vs 0 per person), seizures (14% vs 6%), chronic obstructive pulmonary disease (21% vs 12%), social isolation, serious vision problems (22% vs 12%), foot pain, and grossly decayed teeth (median, 1 vs 0 per person). We conclude that to care more optimally for homeless adults, health centers must pay attention to their functional disabilities, substance abuse, skin abnormalities, vision impairment, dental problems, and foot problems.
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PMID:Health, homelessness, and poverty. A study of clinic users. 206 4

Topical ocular anesthetic abuse is a serious disorder causing keratitis and persistent epithelial defects. It may be the result of either prescription by the patient's eye care practitioner, theft from the practitioner's office, or occult additives in therapeutic medications. The authors report observations of six individuals suffering from this disorder which suggest that persistent epithelial defects, corneal stromal ring infiltrates, disproportionate pain, and prescription or nonprescription substance abuse may be factors involved. Penetrating keratoplasty was required to treat corneal perforation in two patients, and permanent corneal structural damage was noted in two eyes. Two eyes had a relentless downhill course culminating in enucleation. Because five of the six patients were diagnosed and treated as having presumed Acanthamoeba keratitis during the course of their disease, topical ocular anesthetic use should be included in the differential diagnosis of chronic keratitis and may masquerade as Acanthamoeba keratitis. The authors believe that practitioners should not prescribe or dispense topical anesthetics and should avoid clinical settings which provide an opportunity for the theft of topical ocular anesthetics.
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PMID:Topical anesthetic abuse. 194 4

Persistent pain following trauma can lead to long-term disability. This article reviews the pain syndromes most commonly seen following trauma. These include myofascial pain, sympathetically maintained pain, and phantom pain syndromes. Early diagnosis and treatment is emphasized in order to minimize the development of secondary problems of physical dysfunction, emotional deterioration, and substance abuse. Treatment modalities appropriate to these syndromes are reviewed and include medical, anesthesiological, rehabilitative, and behavioral medicine approaches. With prompt diagnosis and referral to a multidisciplinary pain treatment center, most patients will experience significant decreases in their pain, allowing them to return to the workforce and resume a normal life.
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PMID:Persistent pain following trauma. 249 87

A significant percentage of chronic headache sufferers use excessive quantities of substances for relief. Drug dependency is frequent in these patients. Patients have an impaired lifestyle, sustain organ system damage, may suffer a withdrawal syndrome, and continue to have headaches. Drug abuse must cease before a satisfactory remission occurs. Particular attention is directed to ergotamine, butalbital, analgesics, and caffeine. The mechanism of substance abuse may be related to repeated use of substances that reinforce behavior and stimulate brain reward systems. Treatment includes comprehensive diagnostic workup, withdrawal of the agent, and use of headache preventives. beta-Adrenergic blockers, tricyclic antidepressants, monoamine oxidase (MAO) inhibitors, and nonsteroidal anti-inflammatory agents may be of value. Behavior modification and dietary counseling are also helpful.
Clin J Pain 1989
PMID:Drug abuse in headache patients. 252 Mar 77

The treatment of pain in the patient with cancer has focused attention on a series of controversial issues involving medical, social, and moral factors. The medical factors include a lack of knowledge on the part of health care professionals regarding the rational use of opioid drugs. This is coupled with real limitations in the general understanding of the mechanisms of pain and its treatment using pharmacologic, anesthetic, and neurosurgical approaches. Several pharmacologic controversies, including the choice of drug, route and method of administration, and tolerance development and risk of substance abuse, have emerged with the use of opioids on a chronic basis in the cancer population. The social and moral implications involve the issue of who will pay for high technology pain management approaches for patients either at home or in hospice care and the ethical considerations in managing pain with opioid drugs. Carefully designed studies to assess these factors, coupled with broad educational programs, will improve the care of cancer patients in pain and expand our understanding of these important issues.
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PMID:Controversies in cancer pain. Medical perspectives. 256 69

Forty-nine battered women attending a surgical emergency department were studied with regard to prior and current psychiatric morbidity, substance abuse and personality characteristics, and were compared with a control group. More battered women than controls had consulted a psychiatrist and half of them were classified as heavy consumers of alcohol. One third of the assaulted women were found to be depressed, compared to 6% of the controls. The groups also differed in respect of muscular tension, aches and pain, and autonomic disturbances, the battered women having more pronounced symptoms. It is important for psychiatrists to recognize the symptoms that battered women often exhibit. With better early diagnosis, these women could be offered more appropriate psychosocial therapy.
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PMID:Psychiatric morbidity and personality characteristics of battered women. 344 59

The dual diagnosis of AIDS and substance abuse raises serious clinical and ethical issues for health care providers. Often, there are barriers to the diagnosis and referral for substance abuse treatment in people with HIV infection. Countertransference is one such barrier. Important educational needs of patients can be overlooked or not fully addressed. Essential information needs to be conveyed, regardless of whether or not a patient seeks substance abuse treatment. Early intervention and treatment are essential to minimize risk for HIV infection and transmission to others. Specific clinical issues that practitioners often address for patients with AIDS or ARC are appropriate interventions for denial of the HIV-related diagnosis coupled with the denial of substance abuse, difficulties in pain management, the difficulties of family and loved ones, the need for substance abuse relapse prevention, and the need for coordination of care among agencies.
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PMID:Treatment of substance abuse in patients with HIV infection. 348 40

Successful family therapy for drug dependence on the part of an adolescent must include sensitivity to the roles that other siblings play in the family system. Therapists must be aware of the possible infectiousness of substance abuse from an older sibling to a younger sibling. The sabotaging positions and roles that siblings play in relationship to the drug abuser must receive the kind of attention in family therapy that allows a loosening of these roles. What too often happens is a tightening of the grip on these positions when the drug dependent adolescent is identified as the patient, client or the one with the problems as well as the one who is responsible for the family's pain. Without an emphasis on confronting needed changes by others in the sibling subsystem, the recovering adolescent will experience a deep discouragement from a lack of genuine support from brothers and sisters. Feelings of failure and inferiority will point in the direction of rejection and a likely return to an identity as sick, bad and delinquent. Sabotaging siblings understandably fear changes in the familiar family positions and functions. However, in order for these brothers and sisters to welcome the former scapegoat back home, they must make room for the returning member, not as a drug abuser but as a person. They must allow him/her to find a new role of achievement, success identity and inclusion within the total family system, and provide acceptance as a truly valued sibling.
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PMID:Sabotaging siblings: an overlooked aspect of family therapy with drug dependent adolescents. 370 1

Of 225 patients referred to a Veterans Administration pain clinic for treatment of chronic pain, 22 (10%) were later diagnosed as having posttraumatic stress disorder. Many of the 22 also had current or past histories of depression, anxiety, or substance abuse.
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PMID:Preliminary findings on chronic pain and posttraumatic stress disorder. 371 33


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