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

Physician education in cancer pain management is seriously deficient. Many problems occur with opioids simply because of therapeutic ignorance. Opioid side effects are best prevented by using morphine as the drug of first choice for severe pain. Anticipation and prevention of opioid side effects avoids most problems. Physicians need to be aware of how to transfer patients from one opioid to another or from one route of administration to another. Side effects common in clinical practice are constipation, nausea/vomiting, dry mouth, and sedation. The importance of the issues of tolerance, dependence, and respiratory depression have been exaggerated.
J Pain Symptom Manage 1990 Dec
PMID:Prevention of opioid side effects. 198 Jan 27

One hundred two patients with irritable bowel syndrome were studied in a controlled trial of psychological treatment involving psychotherapy, relaxation, and standard medical treatment compared with standard medical treatment alone. Patients were only selected if their symptoms had not improved with standard medical treatment over the previous 6 months. At 3 months, the treatment group showed significantly greater improvement than the controls on both gastroenterologists' and patients' ratings of diarrhea and abdominal pain, but constipation changed little. Good prognostic factors included overt psychiatric symptoms and intermittent pain exacerbated by stress, whereas those with constant abdominal pain were helped little by this treatment. This study has demonstrated that psychological treatment is feasible and effective in two thirds of those patients with irritable bowel syndrome who do not respond to standard medical treatment.
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PMID:A controlled trial of psychological treatment for the irritable bowel syndrome. 173 48

Since it is not known whether the symptoms and bowel function of patients with the irritable bowel syndrome are truly abnormal we used diaries and frequent telephone interviews over a 31 day period to assess symptoms, defecation, and stool types in 26 unselected female hospital patients with the irritable bowel syndrome, 27 women who admitted to recurrent colonic pain but had not consulted a doctor (non-complainers), and 27 healthy control subjects. Unexpectedly, abdominal pain and bloating occurred in most of the control subjects. Pain, however, was six times more frequent in the patients and was more often considered severe. Bloating occurred three times more often. Defecation was more frequent, more erratic in timing and stool form, and more likely to produce stools of extreme forms, indicating rapid fluctuations in intestinal transit time. Urgency was four times more prevalent in patients than control subjects. Straining to finish defecating was nine times more prevalent and was often accompanied by feelings of incomplete evacuation--a combination which could lead to the misdiagnosis of constipation. The normal relation between stool form and the above symptoms was distorted, possibly due to rectal irritability. Non-complainers were intermediate between patients and control subjects in almost every parameter but were closer to control subjects than to patients. Patients with the irritable bowel syndrome have real cause for complaint and their bowel function is truly abnormal.
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PMID:How bad are the symptoms and bowel dysfunction of patients with the irritable bowel syndrome? A prospective, controlled study with emphasis on stool form. 199 41

A newly identified myopathy of the internal anal sphincter is described. In the affected family, at least one member from each of five generations had severe proctalgia fugax; onset was usually in the third to fifth decades of life. Three members of the family have been studied in detail. Each had severe pain intermittently during the day and hourly during the night. Constipation was an associated symptom, in particular difficulty with rectal evacuation. Clinically the internal anal sphincter was thickened and of decreased compliance. The maximum anal canal pressure was usually increased with marked ultraslow wave activity. Anal endosonography confirmed a grossly thickened internal anal sphincter. Two patients were treated by internal anal sphincter strip myectomy; one showed marked improvement and one was relieved of the constipation but had only slight improvement of the pain. The hypertrophied muscle in two of the patients showed unique myopathic changes, consisting of vacuolar changes with periodic acid-Schiff-positive polyglycosan bodies in the smooth muscle fibers and increased endomysial fibrosis. In vitro organ-bath studies showed insensitivity of the muscle to noradrenaline, isoprenaline, carbachol, dimethylpiperazinium, and electrical-field stimulation. Immunohistochemical studies for substance P, calcitonin gene-related peptide, galanin, neuropeptide Y, and vasoactive intestinal peptide showed staining in a similar distribution to that in control tissue. A specific autosomal-dominant inherited myopathy of the internal anal sphincter that causes anal pain and constipation has been identified and characterized.
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PMID:Hereditary internal anal sphincter myopathy causing proctalgia fugax and constipation. A newly identified condition. 199 4

The study reports the results of a preliminary investigation into the incidence of symptom distress in two cancer patient populations--those receiving chemotherapy and those undergoing radiotherapy--and discusses the further evaluation of a symptom distress scale. The scale is found to be both reliable and valid for use in both patient populations. The results indicate that, although overall symptom distress is similar between chemotherapy and radiotherapy patients, there is considerable individual variation in the extent of that distress and the symptoms causing distress may differ between the groups. As in previous studies, tiredness was the most common complaint. Those patients receiving chemotherapy also complained of an inability to concentrate, mood changes and alterations in appearance. Those undergoing radiotherapy most commonly reported significant distress due to pain, altered appearance, constipation and appetite change. The findings suggest that the Symptom Distress Scale may be a useful addition to the assessment of individual patients and may provide a means by which the effects of interventions, designed to alleviate physical distress, could be evaluated.
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PMID:Preliminary investigations of symptom distress in two cancer patient populations: evaluation of a measurement instrument. 206 7

Surgery for severe constipation is necessary in only a small minority of patients. For those patients with a normal diameter colon, the standard procedure remains a colectomy with ileorectal anastomosis. Although the bowel frequency is usually improved, a third of patients experience post-operative diarrhoea, 10% remain constipated, and two thirds continue to experience some pain. Psychological evaluation is essential preoperatively. In patients with an idiopathic megarectum or megacolon, the best operation is less well defined. In those patients with a moderately dilated rectum or colon, a colonic resection offers the best results with a low morbidity. In those patients with a widely dilated rectum, a Duhamel procedure is reasonable but there is a higher morbidity and the results are less uniformly satisfactory.
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PMID:Role of surgical treatment in patients with severe constipation. 207 76

Results are reported of a two-year rehabilitative treatment of 17 patients with anococcygeal pain syndrome. The I stage of treatment consisted of intrarectal administration of anti-inflammatory reparative anesthetic aerosols "Olasol" and "Cimesol" in association with phonophoresis on the lumbosacral zone. At the 11 stage prophylaxis of recurrences was carried out by dietary and physiotherapeutic correction of constipation as well as short repeat courses of "soft" aerosols "Livian", "Levovinisol" or "Vinisol" in association with phonophoresis every 4-6 months. The medical and economic efficacy of the method is emphasized. Recurrences were 3.5 times less frequent.
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PMID:[The treatment of patients with the anococcygeal pain syndrome]. 208 Jun

The analgesic efficacy of oral controlled-release morphine (MS Contin Tablets; MSC) and its influence on quality of life, including parameters of nighttime sleep and daytime functioning, were evaluated in this open-label, sequential study in cancer patients. Seventy patients completed this multi-investigator study; each patient was assigned to one of two dosing protocols, as determined by their previous analgesic regimen. Evaluations were made at baseline (when patients were receiving their previous analgesic regimen) and again on the second visit, after a dosage level of MSC sufficient to control pain was reached for a minimum of two weeks. There were no significant (p greater than 0.17) differences in incidence of nausea, vomiting, or drowsiness experienced by patients during treatment with MSC and during previous analgesic regimens. A senna and docusate sodium preparation (Senokot-S Tablets; SKS) was used to alleviate opioid-induced constipation; consequently there was a significantly lower (p = 0.02) incidence of constipation during treatment with MSC. A moderate relationship between opioid dose and laxative consumption was observed. Pain intensity was significantly (p = 0.0001) decreased, and quality of nighttime sleep and daytime functioning were significantly (p = 0.0001) increased compared with baseline values. Patients' overall quality of life improved significantly (p = 0.0001) during treatment with MSC when compared to their previous analgesic regimens. In conclusion, the therapeutic merits afforded by MSC coupled with proper dose titration were perceived by the patients to be superior to those provided by their previous medications. The benefits of less frequent dosing combined with potent analgesic effect plus the aggressive use of laxatives resulted in a global improvement in quality of life for the patients involved in this study.
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PMID:A multi-investigator clinical evaluation of oral controlled-release morphine (MS Contin tablets) administered to cancer patients. 208 95

From May 1986 until July 1987, oral morphine hydrochloride in water solution was used in terminal patients, under a strict protocol of administration, and complying with the basic principles of Palliative Care. A retrospective study was carried out on the 40 patients who had received the drug for more than three consecutive days. As shown in Table 1, the average age of the treated patients was 70 years. The ambulatory patients represented 27.5% of the sample. The average initial dose was 60 mg, and the average maintenance dose was 120 mg. The median treatment time was 45 days. "Good" results were achieved in 85% of the patients, and "fairly good" in the remainder ("good" results were defined as "satisfactory symptom control, good life quality"--in this group there were some patients who obtained total suppression of the symptoms and optimal life-quality, i.e. "excellent" results; "bad" results were defined as "total absence of therapeutic effect"; and "fairly good" results, the intermediate cases). The more frequently treated symptoms were: 67.5%, pain due to tumor mass; and 20%, pain due to nerve compression-invasion, bone pain, and dyspnoea due to pulmonary metastases or primary lung cancer: total symptoms was more than a hundred per cent, because a number of patients had more than one symptom. Whenever necessary, adjuvant drugs were employed. Side effects were seen in 37% of the patients (specially nausea, vomiting, constipation, and somnolence for more than four days).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Oral morphine in the treatment of patients with terminal disease]. 213 Feb 44

Conditions in which antidepressants have been used include diabetic neuropathy, postherpetic neuralgia, headaches, arthritis, chronic back pain, cancer, thalamic pain, facial pain, and phantom limb pain. Although much of the available information is derived from inadequately controlled trials, it seems that antidepressants provide analgesia in many of these disorders. The analgesic effects tend to be independent of antidepressant effects, and doses of heterocyclic antidepressants used for analgesia seem to be lower than those considered effective in the treatment of depression. Doses should be started low and gradually increased until the patient reaches the highest tolerable dose. Onset of analgesia is variable, ranging from 1 day to 10 weeks. Common side effects include dry mouth, drowsiness, urinary retention, orthostatic hypotension, and constipation. Optimum dosages and schedules have not been established.
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PMID:Antidepressants in the management of chronic pain syndromes. 214 20


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