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

The management of the final 24 hours of life of 100 patients, dying in Our Lady's Hospice is reviewed. This review suggests that management might be improved by better contact between general hospitals and hospice/home care teams concerning the timing of patient transfer. The frequency of symptoms in the dying patient, even where many are semi-comatose, is highlighted. The main distressing symptoms are pain, excessive respiratory secretions and agitation. Our review confirms reliance on standard palliative medications such as morphine, however identifies the benefit of such newer preparations as hydromorphone and midazolam. Management might be improved by the earlier usage of hyoscine subcutaneously and stopping the use of intramuscular diazepam. Attention to potential hyoscine toxicity and untreated pyrexia may ease pre-terminal agitation. The dying patient's family also needs attention to complete the optimal management of the final 24 hours.
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PMID:Management of the final 24 hours. 138 75

The signs and symptoms produced by 4 different types of 7F double pigtail catheters, including Cook polyurethane pigtail stent, Surgitek Silitek Uropass, Cook C-Flex and Van-Tec Soft stent, were analyzed prospectively. The stents were placed in 45 men and 28 women ranging in age from 23 to 72 years old. A total of 44 catheters had a suture attached to the bladder end of the catheter, which exited from the urethral meatus to facilitate removal. The remaining 29 catheters had no suture attached. Symptoms were evaluated at 2 and 6 days after insertion and 1 week following removal of the catheter, and included urinary frequency, nocturia, hematuria, flank pain, suprapubic pain, dysuria and pain on removal of the catheter. Frequency and nocturia were evaluated in minutes, pain was graded on a subjective scale of 0 (no pain) to 10 (severe pain), and dysuria and hematuria were assessed qualitatively. There were no significant differences among the 4 types of catheters in terms of frequency, nocturia, hematuria, flank pain, suprapubic pain and dysuria. In addition, there was no significant difference in urinary symptoms between catheters with and without a suture at either 2 or 6 days after insertion nor was there any difference in pain on removal of catheters with (mean 3.9) and without (mean 5.0) suture. We found that catheter composition and use of suture to facilitate removal did not significantly affect patient morbidity.
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PMID:Comparison of symptom characteristics of indwelling ureteral catheters. 200 86

The present work is based on a study of 100 cases of sialolithiasis referred to the Department of Oral Medicine, Dental School, University of Thessaloniki during the period 1963-1986. Among 100 cases sialolithiasis was distributed as following: Submandibular glands 89 cases, parotids 8 cases and minor salivary glands 3 cases. Sialolithiasis of sublingual glands were not found. In most of the cases the calculus was single while on 16 cases calculi were double or even more. Among the cases of sialolithiasis of minor salivary glands we found single in two cases while in the remaining one the calculi were double. There was a slight but not significant prevalence in the male sex (52 male/48 female) and their age varied from 6 to 70 years. In 72% of the cases the patient's age was under 40 with the most common (34%) in the 3rd decade. Inflammatory swelling of the sublingual plica and wharton's duct appeared in 46.4%. Complication of acute sialadenitis was observed in 23.7% of the cases. The first symptom was swelling of the gland during the meals (88.7%) while pain in the gland was followed after different period of time. The duration of symptoms was ranged between 1 to 30 years in 3% of the cases, and in the remaining 61% it ranged from 1 day to 1 year. The calculi were removed surgically in 40 cases and conservatively in 8 cases. All three cases of minor salivary gland sialolithiasis were treated surgically. The remaining 49 patients didn't return for complete treatment.
Hell Stomatol Chron
PMID:[Clinical study of sialolithiasis. Findings from 100 cases]. 248 59

The exposure of dentine has a multifactoral aetiology and pain may frequently be elicited by a number of stimuli. Management of dentinal hypersensitivity tends to be empirical because of the lack of knowledge concerning the mechanism of pain transmission through dentine. Nevertheless, whichever theory proves to be correct, occlusion of dentinal tubules would appear an essential prerequisite for an effective desensitising agent. A large number of compounds as well as iontophoresis have been employed in the management of dentinal hypersensitivity. These desensitising agents are: sodium, fluoride, stannous fluoride, sodium monofluorophosphate, strontium chloride, calcium hydroxide, potassium nitrate, silver nitrate, formalin, corticosteroids, resins, varnishes and glass ionomers. The most effective of the compounds mentioned above, are fluorides used as gels, varnishes, mouthwashes or toothpastes, strontium chloride and potassium nitrate.
Hell Stomatol Chron
PMID:[Dentinal hypersensitivity in periodontal disease. Aetiology Aetiology--management]. 315 91

In 1976 Goldman M. and Kronman J. reported on the effects of a N-monochloro-DL-2 aminobutyrate (NMAB) solution used as a caries removal agent. Since that time various studies demonstrated the safety and clinical acceptability of the solution. No adverse side effects have been reported for NMAB. NMAB is formed in aqueous solution through the reaction of two separate components supplied as Caridex solution I (dilute DL-2-aminobutyric acid) and II (sodium hypochloride in weak alkaline solution). The Caridex delivery system includes a pump, a heater, a solution reservoir and a handpiece to hold the applicator tip. The Caridex is based on the softening effect of NMAB, when it is applied continuously with the applicator tip to carious lesions. In addition to the Caridex rotary instruments and other devices ordinarily used for cavity preparation are used as required Caridex reduce patient pain and anxiety but also has limitations. It cannot totally replace the conventional methods of caries removal and cavity preparation. It can be used on a supplementary method for caries removal, also it is necessary to balance a some what longer treatment time against its advantages.
Hell Stomatol Chron
PMID:[Chemomechanical means of removing caries--Caridex system]. 315 94

This study was conducted to determine the incidence and degree of postobturation pain and to determine whether there is a significant relationship between pain and any clinical factors or conditions existing before, during, or at the completion of the root canal therapy. Of the 239 patients included in the study, 203 (84.9%) had no pain during the first 48 hours, 26 (10.9%) had slight pain, 5 (2.1%) had moderate pain and 5 (2.1%) had severe pain. Thirty days after obturation 3 patients had slight pain, 2 patients moderate pain and only one patient had severe pain. Meanwhile, we had to repeat the root canal therapy in 3 cases. Significant relationships were found between postobturation pain and obturation of the root canal past the apical foramen.
Hell Stomatol Chron
PMID:[Pain after obturation of the root canals]. 315 3

Massive or global tears of the rotator cuff with loss of tendon substance and retracted cuff remnants pose a challenging surgical and rehabilitation problem. In seven patients, global cuff tears were reconstructed with freeze-dried rotator cuff allografts. Five of the seven patients had other significant debilitating medical problems. Three patients had received four steroid injections, one patient had six injections, and the remaining three patients had two injections in or about the affected shoulder. Five of the seven patients had their pain relieved. Only two patients had significant improvement in shoulder function after anterior acromioplasty and allografts. Freeze-dried rotator cuff allografts do not appear to be of significant value in the surgical management of chronic massive rotator cuff tears.
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PMID:The use of freeze-dried allografts in the management of global rotator cuff tears. 334 71

Failure of cemented total hip arthroplasty can emerge from several causes and may be associated with severe bone loss in the proximal femur with a marked diminution in functional capacity of the limb. This is a preliminary report of 14 patients with revision operations for failed total hip arthroplasty. Freeze-dried allograft bone ws implanted for restoration of extensive bone loss in the proximal for restoration of extensive bone loss in the proximal femur. All 14 patients were operated on to salvage failed cemented total hip arthroplasties. Allografts were employed only for large proximal femoral deficiencies. In these patients the alternatives were either an unstable excision arthroplasty or a femoral deficient prosthesis. After revision, all patients had complete bony union and ambulated with the assistance of a cane with greatly increased function and pain relief. There were no infection. Functionally, the patients have shown marked improvement. At this time there is no radiologic evidence of resorption of the graft. The use of bone allografts in this procedure has been encouraging to date; however, the follow-up period has been only 16-30 months. the success or failure of this procedure will be determined in time.
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PMID:Freeze-dried proximal femur allografts in revision total hip arthroplasty. A preliminary report. 380 25

Standard psychological tests generally provide a single global score that reflects multidimensional constructs, such as depression and anxiety. This single score, however, integrates a range of item contents, including cognitive/affective, somatic, and behavioral characteristics of these multidimensional constructs. The present study was designed to compare the pattern of item endorsement among chronic pain patients (N = 50), psychiatric inpatients (N = 50), and hospital employees (N = 50) on the SCL-90-R (Derogatis, Rickels, & Rock, 1976). Pain patients reported the highest SCL-90 scale level of Somatization, while the psychiatric inpatients reported the highest level of Anxiety and Depression. Additionally, the within-scale pattern of item responses on the Anxiety and Depression scales differed among groups. Although psychiatric inpatients endorsed equivalent levels of somatic and cognitive items, the pain patients' reports of psychological distress were limited primarily to somatic signs of anxiety and depression. Thus, the interpretation of pain patients' psychological profiles and subsequent treatment recommendations may be inappropriate if based on normative data obtained from psychiatric and/or normal populations.
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PMID:Cognitive and somatic item response pattern of pain patients, psychiatric patients, and hospital employees. 380 98

Oral morphine sulphate is the strong narcotic of choice at most hospices. Administered in simple aqueous solution (e.g. 10 mg in 10 ml). No advantage in giving as "Brompton Cocktail." Usual starting dose 10 mg every 4 h. If patient has previously only had a weak narcotic analgesic, 5 mg may be adequate. If changing to morphine from alternative strong narcotic, such as dextromoramide, levorphanol, methadone, a considerably higher dose may be needed. With frail elderly patients, it may be wise to start on sub-optimal dose in order to reduce likelihood of initial drowsiness and unsteadiness. Adjust upwards after first dose if not more effective than previous medication. Adjust after 24 h "if pain not 90% controlled." Most patients are satisfactorily controlled on dose of between 5 and 30 mg 4 hourly; however, some patients need higher doses, occasionally up to 500 mg. Giving a larger dose at bedtime (1,5 or 2 x daytime dose) may enable a patient to go through the night without waking in pain. Use co-analgesic medication as appropriate. Eigher prescribe an antiemetic concurrently or supply (in anticipation) for regular use should nausea or vomiting develop. Prescribe laxative. Adjust dose according to response. Suppositories may be necessary. Unless carefully monitored, constipation may be more difficult to control than the pain. Write out regimen in detail with times to be taken, names of drugs and amounts to be taken. Warn patient of possibility of initial drowsiness. Arrange for close liaison and follow up.
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PMID:[Use of oral morphine in incurable pain]. 661 16


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