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

A prospective, randomized, double-blind trial was designed to compare the duration of analgesia produced by intravenous morphine and methadone. Patients with intractable cancer-related pain were studied for 5-6 days. One-eighth of the patient's daily opiate requirement was supplied as an i.v. infusion of either morphine or methadone over a period of 15 min. when initiated by the patient using a patient-controlled analgesia device. Dosing intervals, pain intensity assessments and toxicity were evaluated. Twenty-three patients were randomized; 18 were fully evaluable. Ten of the evaluable patients received morphine, 8 received methadone. Dosing intervals did not change over the 5 days for either group. The mean dosing interval for the last 10 doses was 3.9 +/- 0.85 h for patients receiving morphine and 3.9 +/- 1.6 h for patients receiving methadone (P = NS). One patient receiving morphine and one taking methadone required only 2-3 doses/day for pain control. Pain intensity and relief were similar for both groups. All patients had adequate analgesia as determined by at least a 50% difference in pain intensity at peak relief. The duration of pain relief when repeated intravenous doses of these analgesics were given was similar throughout the entire study period although morphine and methadone have different serum half-lives (3 vs. 25 h). Parenteral methadone does not offer a clinically significant increase in the duration of analgesia in patients with severe pain secondary to cancer.
Pain 1989 Aug
PMID:Does intravenous methadone provide longer lasting analgesia than intravenous morphine? A randomized, double-blind study. 225 Sep 26

The three general methods of treating pain are pharmacologic, physical and psychological. The goal of medical management of the patient with pain and inflammation is to relieve these symptoms with minimal side effects and inconvenience. Pain associated with inflammation may be relieved with nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin. All NSAIDs relieve pain and stiffness in a similar manner; their primary action appears to be the inhibition of the cyclo-oxygenase system in the arachidonic acid cascade. When prescribing NSAIDs for orthopaedic pain and inflammation, it seems sensible to start with aspirin because of its low cost and safety at analgesic doses. However, if safety and low incidence of side effects are the most important factors in determining appropriate therapy, newer NSAIDs such as ketoprofen will be preferred. The relief of pain is an important aspect of postoperative care. Parenteral and oral opiates serve as the standard against which other therapies for severe pain are compared. When pain cannot be adequately controlled with intramuscular or subcutaneous opiates, intravenous opiates controlled by the patient (patient-controlled analgesia) are often useful. Relatively small doses of epidural or intrathecal opiates can also be used to achieve postoperative pain relief. Thus, treatment for orthopaedic pain begins with NSAIDs, followed by an oral opiate combined with acetaminophen, aspirin, or another NSAID. If these regimens are ineffective, oral opiates followed by parenteral opiates may be tried.
Clin J Pain 1989
PMID:The management of pain in orthopaedics. 252 Apr 38

There is accumulating evidence that selenium plays an important role in human nutrition. We have seen an increasing number of reports of selenium deficiency in patients after long-term Total Parenteral Nutrition (TPN) support, such as Home Parenteral Nutrition support. There had been no such patient reported in China until now. A sever multiple gastro-intestinal external fistulae patient was admitted in early Oct. 1985. His intestinal fluid loss was about 4-6 liters/day and he was a resident of a town where many people have low serum selenium levels. After two weeks of high calorie, high nitrogen TPN support, his serum selenium levels were 7.14, 6.25, and 7.97 micrograms/L (around the 3rd and 4th weeks of such TPN support). The patient also showed a higher heart rate and pain in the thigh muscle. After 4 weeks of selenium supplement, his serum selenium levels and heart rate were back to normal and the muscle pain disappeared.
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PMID:[Human selenium deficiency during total parenteral nutrition support (a case report)]. 252 33

This prospective study assessed 54 consecutive arthroscopically assisted ACL reconstructions for the amount of postoperative pain relief provided by cold therapy, using the Hot/Ice Thermal Blanket. Twenty-six randomly selected patients undergoing this procedure were compared to a control group consisting of 28 patients having the identical procedure in which the Hot/Ice unit was not used postoperatively. The initial ACL injury in both groups was sports related with the exception of three patients whose injury occurred while on the job. The Hot/Ice Thermal Blanket consists of two rubber pads (blankets) connected by a hose to the main cooling unit. The pads were applied to either side of the operated knee in the operative suite. The pads received fluid which was circulated from the main unit. The temperature of the fluid was set at 50 degrees in the recovery room and the unit was run continuously until the time of discharge, which was approximately 4 days. Hot/Ice patients required 53% less injectable Demerol and 67% less oral Vistaril than patients in the control group. Hot/Ice patients had made the conversion from injectable to oral pain medication an average of 1.2 days sooner than did their non-Hot/Ice counterparts. There was no appreciable difference in length of hospital stay. Physical therapy and nursing records documented a greater percentage of compliant patients in the Hot/Ice group. According to these records the Hot/Ice patients were more helpful in self-assistance, were out of bed and ambulating in the halls more quickly, and did their range of motion exercises with greater ease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The effects of cold therapy in the postoperative management of pain in patients undergoing anterior cruciate ligament reconstruction. 272 84

Twenty patients were studied in the early post-operative period after cardiac surgery with sternotomy. Buprenorphine was prescribed: 0.3 mg intra-muscularly after total recovery from anaesthesia (8th hour) then every 8 hours if requested during 72 hours. The patients auto-estimated their level of analgesia, the clinical effects were measured with regard to heart rate, systolic and diastolic arterial pressure, and respiratory rate, before, 2 and 4 hours after each injection. Buprenorphine administration produces an effective, long lasting (8 to 12 hours) analgesia. No significant changes in haemodynamic or respiratory parameters were noticed. Side effects occurred rarely: 5 cases of drowsiness, reversible by verbal stimulation, 2 of nausea and sweats, 2 retentions of urine (after vesical catheter withdrawal). Parenteral buprenorphine is satisfactory for treatment of severe thoracic pain due to sternotomy, although the oral route would be safer during effective anticoagulant treatment.
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PMID:[The use of buprenorphine in the postoperative period in heart surgery. Evaluation of its efficacy and tolerance]. 273 Oct 59

To assess the influence of a pain and symptom control team on the pattern of prescription of pharmacologic and nonpharmacologic treatments for cancer pain, we reviewed the charts of 100 consecutive patients admitted to the Cross Cancer Institute during 1987 and 100 patients admitted during 1984. The average daily dose of parenteral morphine per patient was 44 +/- 26 mg in 1987 versus 34 +/- 38 mg in 1984 (p less than 0.05). In 1987 and 1984, only 31 and 22% of the analgesics were ordered around the clock respectively (P:NS). Approximately half of the patients in 1987 and 1984 were prescribed antiemetics and two-thirds of the patients were prescribed laxatives. Parenteral narcotics were prescribed subcutaneously in 0/52 cases in 1984 versus 21/63 cases in 1987 (33%, p less than 0.01). The pattern of prescription of narcotics by residents changed significantly during the last four weeks of rotation as compared to the first four weeks. We conclude that there have been some changes in the modality of treatment of pain that are probably due to changes in the pattern of prescription by the residents and continued improvement in assessment of pain by nurses. However, in several areas of treatment the impact of a pain and symptom control team remains minimal.
J Pain Symptom Manage 1989 Sep
PMID:Influence of the pain and symptom control team (PSCT) on the patterns of treatment of pain and other symptoms in a cancer center. 277 58

Of 73 infected total knee arthroplasties treated from 1973 through 1984, the outcome of various management options revealed that solid arthrodesis was obtained in 70%. Fifteen percent of those with a solid fusion had residual pain or even recurrence of infection. Aggressive debridement was successful in eight of ten (80%). Long-term follow-up results show reimplantations were successful in eight of 15 (53%) but were functionally successful in only five of 15 (33%). A treatment plan based on functional considerations follows. For acute infections a very aggressive initial debridement followed by primary closure over an antibiotic-soaked pack is carried out. The prosthesis is left in place if at all possible and if the bone-cement interface has not demonstrated loosening. The knee is debrided every two or three days until negative cultures are obtained. Antibiotic beads are then inserted, with reexploration at three weeks with new cultures. Parenteral antibiotics are given for a three-week period initially. If two successive surgical debridements fail to reveal a positive culture, the knee is closed and rehabilitation is begun. For chronic infections, the recommendations of Wilde and Ruth are followed, employing antibiotic-impregnated beads and spacers with staged debridements similar to the method described above. Finally, an accurate definition of the true value of any of these options is predicated on long-term follow-up studies, since options that seemed promising as an initial procedure have proved disappointing as more experienced and longer follow-up study is obtained.
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PMID:Long-term results of various treatment options for infected total knee arthroplasty. 280 68

Effective pain control following surgery is a concern. Oral narcotic agents may be effective yet have many side effects. Parenteral agents are impractical in outpatient procedures. Local blocks may distort tissue planes and require additional time and technical skill to administer. We have found that instillation of local anesthetic (0.5% bupivacaine [Marcaine, Sensorcaine]) into the wound prior to closure is a safe and effective means of providing significant reduction in postoperative foot pain.
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PMID:Postoperative pain relief using local anesthetic instillation. 340 55

The present treatment for acute attacks of headache is empiric. Intramuscular nalbuphine (Nubain) and hydroxyzine (Vistaril) were assessed for pain relief in a prospective, double-blind clinical trial. Ninety-four patients were assigned randomly to treatment groups receiving nalbuphine 10 mg, nalbuphine 10 mg plus hydroxyzine 50 mg, hydroxyzine 50 mg, or placebo. The treatment groups were found to be adequately homogenous with regard to age, sex, type and duration of headaches, and history of prior narcotic use. All data were analyzed by one-way analysis of variance. Patients who had headaches diagnosed as other than classic migraine had significantly greater pain relief with nalbuphine compared to placebo (P less than .01). The combination of nalbuphine and hydroxyzine was not significantly more effective than other treatment groups. In 20 patients with classic migraine, none of the treatment regimens significantly outperformed placebo. There were no clinically significant adverse effects attributed to the study drugs. These findings are similar to others that showed a lack of efficacy of kappa receptor agonists in classic migraineurs. Nalbuphine appears to be clinically useful in other types of severe headache. This study does not support the routine addition of hydroxyzine for presumed synergistic effect.
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PMID:The effectiveness of nalbuphine and hydroxyzine for the emergency treatment of severe headache. 354 82

Palliative terminal care of patients with malignant bowel obstruction is a major clinical and ethical challenge. These patients are often mentally alert and ambulatory, but are kept in the hospital for hydration, nasogastric suction, and pain control. Parenteral nutrition requires frequent metabolic monitoring, is expensive, and is ethically questionable. We have used an alternative method of home management for 27 patients who met the following criteria: inoperable bowel obstruction due to untreatable cancer, an estimated life expectancy of between 2 weeks and 3 months, and understanding of the goals and limits of therapy. Hydration was provided by 10 percent dextrose and electrolyte solutions administered as overnight infusions through long-term central venous catheters. Thirteen patients with complete bowel obstruction required a venting gastrostomy which, when connected to passive drainage, relieved nausea and vomiting. The mean duration of survival was 64 days (range 9 to 223 days). Acceptance by patients and families was excellent, although most acknowledged increased costs due to limited insurance coverage for outpatient care. Seven patients returned to the hospital for terminal care (average stay 3.2 days), and 20 chose to die at home. The mean daily expense for fluids and supplies was +73.50, with an overall cost decrease of $900,000 compared with inpatient care. Home support with fluids and gastric venting is a humane, cost-effective alternative to in-hospital care for selected patients.
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PMID:Home support of patients with end-stage malignant bowel obstruction using hydration and venting gastrostomy. 372 1


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