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)

Despite the vast literature on drug dependence, little has been written about patients who become addicted while taking medically prescribed drugs for organic pathology. Observations from a psychiatric consultation-liaison service reveal that these patients are frequently middle-aged with no history of drug abuse before the onset of a chronic medical condition. Associated with their medical condition is a dependence on narcotics and/or psychotropic medications for such complaints as pain, headache, insomnia, and anxiety. Thea addiction may persist for years without acknowledgement by a patient, doctor, or family, although there is usually a progressive constriction of social and occupational functioning. The primary physician is highly valued by the patient; this manifest appreciation trends to facilitate the primary physician's continued prescription of large doses of addicting drugs. Treatment involving detoxification typically goes through a series of stages, each of which has characteristic hazards and pitfalls that can lead to failure of treatment.
 ...
PMID:Treatment of iatrogenic drug dependence in the general hospital. 746 45

This survey aimed to determine what type of information patients want about the risks of postoperative pain management and whether this corresponded to the information that doctors and nurses wished to provide. Seventy-four patients scheduled for elective surgery, 50 nurses and 48 doctors completed a questionnaire asking about perceived risks of analgesia, level of acceptable risk and information that should be provided to patients. Compared to doctors and nurses, patients underestimated the risks associated with postoperative pain relief, except for the risk of drug addiction, which they rated higher. Ninety-one per cent of patients wanted information about the side effects of analgesia. The preferred means of obtaining this information was by discussion with their surgeon or anaesthetist. Doctors were willing to accept a greater risk of minor side effects to achieve excellent pain relief than were patients. In contrast, patients were willing to accept a greater risk of serious side effects. The results obtained in this survey will facilitate the preparation of guidelines for obtaining informed consent from patients to receive postoperative analgesia.
 ...
PMID:Perceived risks of postoperative analgesia. 790 52

The health care system has moved towards home care, early discharge, and day procedures. Parents in the home are, therefore, far more likely to be managing their children's postoperative pain than health professionals. The purpose of this study was to describe mothers' experiences in identifying and managing their children's acute pain associated with surgery. Because little is known about family's perceptions and management of a child's pain in the home, a qualitative design and grounded theory method were used. A purposive, convenience sample of 7 mothers whose children were 4-8 years old and who had a day-surgery adenoid-tonsillectomy were interviewed in depth (2-3 interviews per mother). Four themes were found in the data: (1) mothers' descriptions of their children's overall pattern of postoperative pain indicated that pain was minimal or absent before surgery, increased following surgery, and decreased with medicine and healing; (2) mothers' assessment and evaluation of their children's pain used pain cues similar to those used by nurses and physicians; (3) all the mothers worried about drug addiction; and 4) mothers learned to manage their children's pain through 'trial and error'. This study provides beginning data for understanding family management of children's pain.
Pain 1994 Jun
PMID:Mothers' management of adenoid-tonsillectomy pain in 4- to 8-year-olds: a preliminary study. 752 9

Postoperative pain relief is often inadequate. Ignorance and misconceptions about opioids by ward staff contribute to this poor management. The introduction of acute pain teams has done much to improve pain relief for patients. It may also have contributed to changes in attitudes and knowledge of medical and nursing staff. We questioned 48 doctors and nurses on their knowledge and beliefs about postoperative pain relief. Staff members were questioned on two units, one with access to an acute pain team and one without. Over half those on the unit using traditional postoperative care thought patients did not receive adequate pain relief (58%). In comparison, only one respondent from the unit with the pain team thought this was the case (P < 0.001). More staff members that had experience of patient-controlled analgesia (PCA) were optimistic about its benefits than those in the unit with no experience; they were also less concerned about possible side effects. Only one respondent on the unit using PCA thought it carried a risk of drug dependence, compared to over half (55%) of those on the unit with no experience in this technique (P < 0.001). Over two-thirds of staff familiar with PCA thought nursing workload had decreased. Acute pain teams have an important role in educating ward staff. The impact of establishing such teams on staff knowledge and attitudes needs further study to ensure that they can carry out this role most effectively.
J Pain Symptom Manage 1995 Jan
PMID:Shaping attitudes to postoperative pain relief: the role of the acute pain team. 753 28

We report a case that illustrates methylphenidate's (MP) usefulness in the management of psychological distress and associated somatization in the palliative-care setting. A 60-year-old man affected by terminal cancer of the prostate had been complaining of increasing physical pain, without any evidence of significant disease progression, opioid toxicity, or previous history of drug addiction. Because of patient's denial, the team had been unsuccessful in identifying any potential emotional factors affecting his physical suffering. MP could both counteract opioid-induced sedation and improve pain control through a positive action on patient's mood. In spite of a rapid development of tolerance, which required a subsequent escalation in MP daily doses, the drug was well tolerated and the patient could die in good physical comfort 2 weeks later.
J Pain Symptom Manage 1995 Feb
PMID:Methylphenidate for the management of somatization in terminal cancer patients. 773 Jun 89

Optimal pain control in the dying child often requires aggressive opioid therapy that exceeds recommended parameters and may hasten death caused by respiratory depression. For pediatric nurses caring for the dying child, the administration of potentially life-shortening analgesia gives rise to a number of ethical issues. Pediatric nurses often express concern that aggressive pain control is a form of euthanasia or fear the child will develop a drug dependence. Lack of clarity about the ethical obligations and professional responsibilities of nurses who administer potentially life-shortening analgesia may also contribute to the dilemmas surrounding such situations. If left unresolved, these issues can interfere with the nurse's ability to implement an appropriate pain regimen. To provide adequate pain control, pediatric nurses who care for dying children must accomplish the following: critically examine ethical issues and underlying principles; understand the phenomena of addiction, tolerance, and physical dependence; and identify the boundaries of acceptable nursing practice when administering potentially life-shortening analgesia to terminally ill children.
 ...
PMID:Pain management and potentially life-shortening analgesia in the terminally ill child: the ethical implications for pediatric nurses. 781 90

The objective of this study was to describe pain tolerance in drug abusers. Research suggests that drug dependence and pain perception share common neuroanatomical and neurophysiological substrates; thus the abuse of psychoactive drugs was hypothesized to relate to pain tolerance. We examined cold-pressor pain tolerance in 122 male, current and former opioid and cocaine abusers, across use status and primary drug of abuse. Descriptive analyses showed that the ratio of pain-sensitive to pain-tolerant persons was considerably higher than that described in the normative cold-pressor pain literature. Two-way analysis of variance revealed a significant main effect for using status, indicating that current drug use is associated with decreased pain tolerance. The main effect for drug type approached significance, implying that persons who abuse opioids manifest less pain tolerance than cocaine users. The findings emphasize the importance of studying pain tolerance and drug abuse as interrelated phenomena.
J Pain Symptom Manage 1994 Oct
PMID:Cold-pressor pain tolerance in opiate and cocaine abusers: correlates of drug type and use status. 782 86

A questionnaire study was performed in order to clarify knowledge and practice of cancer pain treatment in Norway: a 10% random sample of Norwegian physicians received a questionnaire. Of 800 correctly addressed questionnaires, 549 were returned and 306 were analyzed after exclusion of those doctors who never treated cancer patients. Their knowledge of the principles and methods of cancer pain treatment were evaluated with 8 multiple-choice and 13 open questions. Their ability to apply their knowledge in practice was evaluated by analyzing their suggested treatment of 3 illustrative case histories. The results show that only 25% of Norwegian physicians treating cancer patients appear to have knowledge of the principles of the World Health Organization analgesic ladder strategy. However, the majority (86%) of the physicians were prepared to prescribe strong opioid analgesics, but in the illustrative cases where strong opioids were appropriate, 44% prescribed too small doses and often preferred neuroleptic drugs instead of increasing the analgesic to a sufficiently large dose. Patients needing step two on the analgesic ladder, in Norway often (49%) are treated with a standard combination of paracetamol and codeine. However, when a strong opioid is required, 50% of Norwegian physicians forget to continue the paracetamol or NSAID component. Two hundred seventy-four (97%) of the physicians said they experienced problems when treating cancer pain, ranging from inefficient pain relief (52%) to side effects of opioid analgesics (32%), most often sedation, in combination with nausea and constipation. Only 13% of the physicians had a correct understanding of opioid drug dependence. As many as 72% of Norwegian physicians thought their education in cancer pain treatment was insufficient.
Pain 1994 Apr
PMID:Treatment of cancer pain in Norway. A questionnaire study. 806 87

A sample of persons with AIDS (N = 71) was drawn from two tertiary care centers and one group residence. Chemical dependence was measured by the Michigan Alcoholism Screening Test (MAST) and the Drug and Alcohol Screening Test (DAST), and the perception of pain was then measured with the Wisconsin Brief Pain Inventory. The hypothesis that the groups would demonstrate a significantly different perception of pain was not supported. Self-report of drug and alcohol use did not correlate well with scores on the MAST and DAST, indicating that these instruments may not measure chemical dependence in persons with AIDS. On scales of zero to 10, mean scores reflecting pain intensity averaged 5.1 and scores reflecting pain's interference with seven aspects of daily life averaged 5.98.
 ...
PMID:The effect of chemical dependency on pain perception in persons with AIDS. 806 91

Drug dependence in "pain patients" usually involves primary headache syndromes with chronicity resulting from the use of analgesic-psychotropic or ergotamine-containing combination preparations. Since, during the withdrawal phase, enhancement of pain intensity together with other abstinence phenomena are to be expected, hospitalization is usually indicated. Psychosomatic pain syndromes with dependence on benzodiazepine derivatives represent the second largest group. In these patients, withdrawal is effected stepwise, usually on an outpatient basis. Opioid analgesics administered to patients to treat chronic pain do not necessarily lead to the development of tolerance. Occasionally, dependency is observed in organic or psychosomatic pain states. In all three groups, typical addition behavior is rare.
 ...
PMID:[Drug dependence and withdrawal in chronic pain patients]. 807 Jul 45


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>