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

Although a number of randomized controlled trials of treatment for herpes zoster have been performed, there is no consensus on how it should be managed in general practice. A systematic review of existing trials, including meta-analysis, was performed to determine the efficacy of available therapies in reducing the incidence of postherpetic neuralgia. The treatments studied included antiviral agents, corticosteroids and other drugs which had been studied in randomized trials. Trials were included if the subjects were immunocompetent adults and the intervention was feasible in general practice. The main outcome measure was prevalence of pain at one, three and six months after onset of the acute herpetic rash. Data for each time point were not available for all trials. The quality of studies was also assessed. Pooled analyses of trials with acyclovir failed to detect a significant reduction of pain in the treatment group at one or six months, but found a 35% reduction at three months. Confidence limits were wide, and a modest benefit of treatment cannot be ruled out at one and six months. Pooled analyses were not possible for other treatments, either because too few trials had been performed, or because completed trials demonstrated significant heterogeneity. Many clinical trials in this area have been too small to give reliable results. Variations in the definition and reporting of postherpetic neuralgia create difficulties in combining data from different studies. Firm recommendations for clinical practice are not possible because existing evidence neither confirms nor refutes the hypothesis that treatment during the acute phase of herpes zoster reduces pain later.
Br J Gen Pract 1995 Jan
PMID:Primary care management of acute herpes zoster: systematic review of evidence from randomized controlled trials. 777 75

During a 1-year period, neuroleptic drug utilization was assessed in nonpsychiatric departments of a Dutch university hospital in defined daily doses (DDD), DDD per 100 patients and per 100 bed days. Substantial divergence was found among the nonpsychiatric departments with respect to the quantity as well as the types of neuroleptic used, but there was no relationship between psychiatric consultations and neuroleptic use. In semistructured interviews, the senior consultant at each department stated that neuroleptics were used not only for the treatment of behavior disorders but also for nonpsychiatric indications, such as pain, nausea, and hiccups. In addition, specific neuroleptics were considered to be appropriate for the treatment of specific indications, but the doses anticipated to be effective were in many cases well below the DDDs. It is concluded that substantial quantities of neuroleptics are prescribed for nonpsychiatric use. This is remarkable, because very little is known about nonpsychiatric indications and the effects of neuroleptics, including the unwanted side effects, in patients who are somatically ill.
Gen Hosp Psychiatry 1994 Jan
PMID:Neuroleptic drug use in nonpsychiatric departments of a Dutch university hospital. 791 89

Outpatient consultation-liaison (C-L) psychiatry has been beset with problems concerning funding and patient acceptance. Though the consultation, liaison, and referral clinic models for outpatient C-L psychiatry each offer advantages, they have not conquered these fundamental problems. This paper introduces the multidisciplinary pain clinic as an alternative means of addressing somatic symptoms and psychiatric disorders in an ambulatory medical population. The multidisciplinary pain clinic offers advantages in terms of reimbursement, patient acceptance, and opportunities for interdisciplinary research. The pain clinic model has disadvantages that include administration by departments other than psychiatry, traditional location in a tertiary care hospital, and limitations to who can be treated. However, it offers a place where both the physiological and psychological aspects of somatic symptoms may be addressed. The pain clinic nurtures the priorities and goals of primary care for a patient population whose complexities may outstrip the resources of a single primary care physician.
Gen Hosp Psychiatry 1993 Nov
PMID:Psychosomatic clinic or pain clinic. Which is more viable? 811 60

The current conflict theory of emotion states that emotions arise at junctures of plans in which circumstances show the likely attainment or nonattainment of a goal and in which those circumstances include other plans and other goals. But emotions often arise from side goals rather than from the goal being aimed at. This article raises the question of what a goal is and suggests that any goal statement should include goals about a person's identity, self-definition, and cognitive development. This approach questions the sharp distinction usually drawn between goal and cognitive structure and puts forward a broader view of emotion as the awareness of important cognitive change that results from the validation or invalidation of one's cognitive system or a part of it. This view emphasizes the role of having a model of the self and shows how emotions can be defined as beliefs about changes in belief. This approach suggests that, just as pain monitors changes in physical states, so emotions monitor changes in mental states, providing high-level information for the management of cognitions. Another function of emotion is to identify the type and magnitude of inconsistencies between two mental states in a timely manner; such identification avoids the need for logical proof or numerical calculation.
Genet Soc Gen Psychol Monogr 1993 Nov
PMID:There is more to emotion than goal attainment. 815 Feb 71

Fibromyalgia is a chronic illness characterized by widespread pain, fatigue, sleep disturbance, and resistance to treatment. The purpose of this study was to evaluate the effectiveness of a meditation-based stress reduction program on fibromyalgia. Seventy-seven patients meeting the 1990 criteria of the American College of Rheumatology for fibromyalgia took part in a 10-week group outpatient program. Therapists followed a carefully defined treatment approach and met weekly to further promote uniformity. Patients were evaluated before and after the program. Initial evaluation included a psychiatric structured clinical interview (SCID). Outcome measures included visual analog scales to measure global well-being, pain, sleep, fatigue, and feeling refreshed in the morning. Patients also completed a medical symptom checklist, SCL-90-R, Coping Strategies Questionnaire, Fibromyalgia Impact Questionnaire, and the Fibromyalgia Attitude Index. Although the mean scores of all the patients completing the program showed improvement, 51% showed moderate to marked improvement and only they were counted as "responders." These preliminary findings suggest that a meditation-based stress reduction program is effective for patients with fibromyalgia.
Gen Hosp Psychiatry 1993 Sep
PMID:The impact of a meditation-based stress reduction program on fibromyalgia. 830 41

The aim of this prospective longitudinal study was to evaluate an inpatient cognitive behavioural pain management programme for patients with chronic pain. A physical and psychological assessment of patients was carried out before and after treatment, and at one and six months follow up. A total of 212 patients with disabling chronic pain of mean duration 10.5 years, for whom no further medical or psychiatric treatment was appropriate or available, were admitted; their mean age was 50 years and 65% were women. The four week programme was delivered by a multidisciplinary team of two psychologists, a physiotherapist, nurse, occupational therapist and anaesthetist. The main components of therapy included: education, teaching behavioural and cognitive skills, a stretch and exercise programme, medication reduction, goal setting and pacing, and relaxation training. Outcome measures assessed quality of life, physical performance (for example walking speed), pain intensity and distress, depression severity and confidence. Assessment immediately after treatment revealed significant improvements on all measures. Improvements were well maintained at six month follow up. Cognitive behavioural treatment can be of value in improving the day-to-day functioning and quality of life of patients with chronic pain for whom conventional medical treatments have apparently failed.
Br J Gen Pract 1993 Dec
PMID:Evaluation of a cognitive behavioural programme for rehabilitating patients with chronic pain. 831 23

1. Bradykinin and related kinins may act on four types of receptors designated as B1, B2, B3 and B4. It seems that the B2 receptors are most commonly found in various vascular and non-vascular smooth muscles, whereas B1 receptors are formed in vitro during trauma, and injury, and are found in bone tissues. 2. These BK receptors are involved in the regulations of various physiological and pathological processes. 3. The mode of kinin actions are based upon the interactions between the kinin and their specific receptors, which can lead to activation of several second-messenger systems. 4. Recently, numerous BK receptors antagonists have been synthesized with prime aim to treat diseases caused by excessive kinin production. 5. These diseases are RA, inflammatory diseases of the bowel, asthma, rhinitis and sore throat, allergic reactions, pain, inflammatory skin disorders, endotoxin and anaphylactic shock and coronary heart diseases. 6. On the other hand, BK receptor antagonists could be contraindicated in hypertension, since these drugs may antagonize the antihypertensive therapy and/or may trigger the hypertensive crisis. 7. It is worth suggesting that the BK receptor agonists might be useful antihypertensive drugs.
Gen Pharmacol 1993 Mar
PMID:Therapeutic prospects of bradykinin receptor antagonists. 838 49

In order to assure optimal care of patients with chronic medical illnesses it is necessary to take into account the cultural factors that may influence health-related behaviors. By using cancer as a model, this paper discusses the major cultural issues that should be considered in order to increase cultural sensitivity in the medical setting: family function, sex roles, language, disclosure of disease-related information, pain, attitudes towards illness and health practices, immigration, region, autonomy versus dependency, and death and bereavement. Case histories illustrating the relevance of such socio-cultural factors in the cancer setting are reported.
Gen Hosp Psychiatry 1993 Jan
PMID:Cross-cultural differences in the care of patients with cancer. A review. 843 82

1. NS-398 (N-[2-cyclohexyloxy-4-nitrophenyl] methanesulfonamide) is a new non-steroidal anti-inflammatory drug (NSAID) with analgesic and antipyretic effects. 2. The anti-inflammatory potency of NS-398 in rat carrageenin-induced edema was as potent as that of indomethacin and 8 times more potent than diclofenac. In rat adjuvant arthritis, NS-398 showed a therapeutic effect comparable to that seen with loxoprofen but less than that seen with indomethacin and diclofenac. 3. The analgesic potency of NS-398 in rat adjuvant arthritic pain was much the same as that of indomethacin, and was about 3-5 times higher than that of diclofenac and loxoprofen. In the Randall-Selitto method in rats, NS-398 was 2-7 times as potent as loxoprofen, diclofenac and indomethacin. In acetic acid-induced writhing in mice, NS-398 was equipotent to indomethacin and diclofenac. 4. In LPS-induced fever in rats, NS-398 was 1.5-4.5 times as potent as loxoprofen and indomethacin, but less potent than diclofenac. 5. NS-398 produced little gastric ulceration in doses of up to 1000 mg/kg, while reference drugs produced distinct stomach lesions in doses of 10-30 mg/kg. 6. NS-398 inhibited prostaglandin (PG) endoperoxide synthase from sheep seminal vesicle microsomes less potent than that of ibuprofen.
Gen Pharmacol 1993 Jan
PMID:NS-398, a novel non-steroidal anti-inflammatory drug with potent analgesic and antipyretic effects, which causes minimal stomach lesions. 848 83

Outpatient consultation-liaison (C-L) psychiatry clinics are valuable settings for research and teaching endeavors. However, little is known about psychiatric symptoms and health status of persons treated in such settings. In this study, 80 persons seen in an outpatient C-L psychiatry clinic were compared with 100 persons seen in a mood disorder clinic on a variety of self-report instruments. Outpatient C-L clinic patients were found to have significantly poorer health status than mood clinic patients on the following domains as measured by the RAND instrument: general health perception, pain, physical functioning, and role functioning due to physical problems. Both groups had poor role functioning due to emotional problems and poor social functioning. The groups did not differ in depressive symptoms but C-L patients were significantly less anxious. Thus, it appears that patients in an outpatient C-L setting not only have significant medical comorbidity, as expected, but have levels of psychiatric distress comparable to that seen in a traditional psychiatry outpatient setting. These findings indicate that such a clinic is a fertile area for research and training in the diagnosis and treatment of persons with comorbid physical and mental disorders.
Gen Hosp Psychiatry 1996 Jan
PMID:Functioning and well-being of patients in a consultation-liaison psychiatry clinic. 866 11


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