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

The neurosurgeon has many approaches to pain control, depending on the location of the cancer and its tissue characteristics. By far, the most common procedure to be employed is percutaneous chordotomy, which is relatively risk-free and easy for the patient to undergo. It is most important to recognize that pain relief should be effected early in the course of the disease before the ravages of drug addiction and the complications of directed therapy like radiation or chemotherapy have taken their toll. Inanition, under these circumstances, may well be the result of treatment and drugs, rather than the disease itself. We have often seen patients, once given pain relief, make sudden weight gains and go on to a comfortable existence for a surprisingly long period of time thereafter. It is urged that pain relief be considered early, as a major contribution to enhanced quality of living and longevity of survival.
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PMID:Surgical approaches to pain control. 619 74

Transcutaneous stimulation is a proven effective way to relieve pain. Its optimal use requires an accurate patient diagnosis. Treatment of pain as a symptom only is likely to fail. There must be a careful psychosocial evaluation, for the majority of patients who come to the doctor complaining of pain have major psychological, social, or behavioral factors that are most important in the genesis of the complaint. Drug abuse must be corrected. Related symptoms, such as anxiety and depression, must be treated. Then, a thorough trail of transcutaneous stimulation is mandatory. A desultory use will undoubtedly lead to failure. This trial must begin with patient education by experienced personnel. Then the electrodes must be properly applied, and there must be a regular follow-up of stimulation to be certain the patient is utilizing it correctly. The patient must be supported through an adequate trial which should extend over 2-4 weeks before purchase of the device is contemplated. Furthermore, all related nursing and physician personnel must be educated in the proper use of the technique. The uninformed professional who denigrates the therapy is a very effective deterrent to appropriate use. In this situation, transcutaneous electrical stimulation will be of great value in the treatment of acute musculoskeletal injury and acute postoperative pain. It will be effective in the treatment of peripheral nerve injury pain, chronic musculoskeletal abnormalities, chronic pain in the patient who has undergone multiple operations upon the low back and neck, visceral pain, some of the reflex sympathetic dystrophies, and postherpetic neuralgia. Stimulation will not help a complaint which is psychosomatic in origin. It will not influence drug addiction. It is not likely to be useful in any situation where secondary gain is important. The metabolic neuropathies, pain of spinal cord injury, and pain from cerebrovascular accident will not respond frequently enough to warrant more than hopeful trials. The technique is inexpensive, places the patient in control of his own pain, and has no known serious side effects. Its widespread application awaits the development of reasonable systems to provide this service to physicians and patients. Stimulation-induced analgesia deserves a place in the armamentarium of every physician dealing with the complaint of pain.
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PMID:Stimulation of the peripheral nervous system for pain control. 623 44

The benzodiazepine--gamma-aminobutyric acid (GABA) receptor--ionophore system is an oligomeric complex, composed of at least three interacting components. These three components have been well characterized in vitro by radioreceptor binding assays. A variety of centrally acting anxiolytic, depressant, anticonvulsant and convulsant drugs, which affect GABAergic transmission, bind to one of the sites and modulate the binding of ligands at the other sites. Thus, depressant barbiturates, nonbarbiturate hypnotics (like etomidate) and pyrazolopyridines (like etazolate), while inhibiting the binding of alpha-dihydropicrotoxinin (DHP), enhance the binding of GABA and benzodiazepines. These enhancing effects are blocked by convulsant drugs that inhibit the binding of dihydropicrotoxinin and also by bicuculline. These interactions involving barbiturates and other modulatory drugs, exhibit stereoselectivity, anion dependence and brain regional selectivity. Several classes of drugs which facilitate GABAergic transmission appear to interact with the sites for GABA and benzodiazepines allosterically via the dihydropicrotoxinin site of the oligomeric complex. The GABA system has also been implicated in a variety of pathological conditions, including anxiety, seizure activity, movement disorders, cardiovascular control, pain and in drug dependence. Since most of the GABA agonists do not pass the blood-brain barrier, future trends in the pharmacology of GABA may be the development of drugs that will activate the GABA receptor system via picrotoxinin or benzodiazepine sites.
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PMID:Benzodiazepine-GABA receptor-ionophore complex. Current concepts. 632 40

Analgesic drug abuse led to end-stage renal disease in 31% of 122 patients in a cross-sectional investigation at our center. Addiction to analgesics and tranquilizers remained a serious problem in these patients even after they were placed on chronic hemodialysis. There is strong evidence that drug addiction leading to end-stage renal disease and chronic hemodialysis correlates with a special type of personality typified by the 60-year-old depressive woman suffering from chronic headache.
Pain 1983 Sep
PMID:Analgesic dilemma in chronic hemodialysis patients. 663 15

Fifty-three infected aneurysms of the groin in known drug abusers have been treated since 1970. There was a recent history of attempted intravenous drug injection into the femoral vein in 50 patients. Twenty-three patients underwent revascularization immediately preceding or following excision and ligation of the mycotic aneurysm. Five graft infections, resulting in one death and three amputations, occurred in this group. Three grafts became occluded, resulting in one additional instance of an amputation within six months of operation. Thirty patients underwent excision and ligation only. Five extremities were amputated in the immediate postoperative period because of irreversible ischemic changes. Six patients underwent delayed reconstruction five days to two months postoperatively because of rest pain or gangrene limited to the forefoot. No deaths and no graft infections occurred in this group. In infected aneurysms of the groin from drug addiction, we recommend initial excision with ligation and delayed selective revascularization, if indicated.
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PMID:Management of an infected aneurysm of the groin secondary to drug abuse. 668 89

Recent attention to the management of cancer pain in the mass media (TV, books, newspapers) and the medical press provides ample evidence to suggest that many cancer patients are not receiving appropriate therapy for their pain. Since cancer therapy is often not curative, only palliative, specific attention to the management of pain in such patients is essential. However, the management of cancer pain requires a specific approach and expertise. Narcotic analgesics are the mainstay of therapy in the management of such patients, yet physicians lack sufficient knowledge of narcotic pharmacology to use these drugs appropriately. Recent controversy has arisen in 3 specific aspects of narcotic drug therapy: 1) the choice of a narcotic drug and its method of administration; 2) the development of tolerance, and 3) the risk of substance abuse, drug dependence, and addiction.
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PMID:Current issues in the management of cancer pain: Memorial Sloan-Kettering Cancer Center. 679 Oct 24

Ninety-two patients underwent a transduodenal sphincteroplasty and transampullary septectomy (extended papilloplasty) for chronic, incapacitating upper abdominal pain over an 11-year period. Seventy-nine had a prior cholecystectomy; 42 of 56 patients with reported pathology had documented gallstone disease. Serious morbidity included two moderately severe cases of postoperative pancreatitis and a pulmonary embolus. There were no deaths. Operative findings revealed stenosing papillitis (n = 45), transampullary septitis (n = 40), and papillary dysfunction (n = 7). Histologic examination of septal biopsy specimens revealed inflammation in 34 cases and fibrosis in 19 cases. There were no microscopic abnormalities in 39 biopsy specimens. The results at 1 to 10 years in 83 patients is as follows: good in 36 patients (no pain--43%), fair in 27 patients (occasional pain--33%), and poor in 20 patients (unrelieved by the procedure--24%). Patients with prior sphincteroplasty (12 of 15 with a fair to good result) benefitted the most from the procedure. Those who underwent concomitant cholecystectomy responded poorly. Risk factors for failure include alcoholism, drug addiction, mental illness, and duodenal ulcer disease. The finding of papillary cholesterolosis at operation also was accompanied by a less than optimal result. Transduodenal sphincteroplasty with transampullary septectomy provides long-term benefit to carefully selected patients with chronic abdominal pain after cholecystectomy.
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PMID:Transduodenal sphincteroplasty and transampullary septectomy for postcholecystectomy pain. 684 82

The treatment of chronic pain contains several problems such as ineffectiveness, side effects and drug dependence. The concepts of respondent and operant pain are introduced, together with a general operant learning model for analysis and treatment of psychological problems. To make a psychological analysis of pain, evidence for learned pain behaviour must be assessed, reinforcers for treatment revealed, goal behaviours set up, and support in the environment secured. In the further analysis, account must be taken to a) time pattern of pain, b) pain behaviour, c) reactions from the environment, d) pain activators, e) pain reducers, f) the effect of tension versus relaxation on pain, and g) changes in the family structure necessary because of the pain problem. A three-dimensional operant treatment programme for chronic pain is presented. It consists of 1) reduction of medication, 2) increase of activity, and 3) reduction of pain behaviour. Results, supporting the efficacy of the model, are presented.
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PMID:A three-dimensional treatment programme for chronic pain. 685 14

1 In patients with chronic pain, two types of analgesic drug dependence occur, that is, dependence of the barbiturate-type and of the morphine-type. Eighty cases of analgesic drug dependence of the barbiturate-type were examined. All these patients were dependent on drug combinations, not a single patient being on one analgesic alone. 2 Psychotropic agents were found to be the common pharmacological denominator of all abused preparations. These findings confirm the hypothesis that the addition of psychotropic or dependence-producing substances to analgesics is the crucial factor in the complex of mild analgesic drug abuse. 3 One group of patients with chronic pain, who were dependent on analgesic drug mixtures, had both lowered experimental pain thresholds and tolerances. After drug withdrawal, these parameters showed a tendency to increase in some patients.
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PMID:Abuse and paradoxical effects of analgesic drug mixtures. 743 79

The clinical experience of a psychiatrist working in a pain clinic is described. One hundred and seventy two patients were assessed over a 4-year period. The modal age was 45-54 years with a male : female ratio of 7 : 10. The model duration of pain was 1-5 years, the back being the commonest site. Depression was diagnosed in 30% of cases. PErsonality disorder, traumatic neurosis, anxiety, hysteria and drug dependence were the next most common diagnoses. Treatment was instituted in half of the patients seen and half of the treated patients improved or recovered. Drug withdrawal, EMG feedback and brief psychotherapy were associated with more improvement than pharmacotherapy or treatment at a psychiatric unit. The response to antidepressant medication was particularly disappointing and possible reasons for this are discussed.
Pain 1980 Oct
PMID:The psychiatrist and the chronic pain patient: 172 anecdotes. 745 87


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