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Query: UMLS:C0184567 (acute pain)
 3,962 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Numerous publications devoted to the topic of transcutaneous electrical nerve stimulation (TENS) have appeared since the presentation of a special issue of Physical Therapy (December, 1978). This update article addresses contemporary information on efficacy, mode of application, treatment outcomes, and neurophysiological mechanisms relevant to this modality. Investigators have become far more specific when presenting this information in the current literature on treating acute pain conditions with TENS than they were in the literature for the 1978 special issue. Improvement has been made in providing specific details to enable replication of TENS stimulating characteristics among patients with chronic pain; yet several clinical researchers still fail to evaluate treatment outcomes adequately. Perhaps the greatest advances in our understanding of TENS involve the recent development of mechanisms that might account for how different types of TENS work. Suggestions for predicting patient responses to TENS and for avenues of future inquiry are offered.
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PMID:Applications of transcutaneous electrical nerve stimulation in the management of patients with pain. State-of-the-art update. 387 54

Suprofen (sutoprofen) is a non-steroidal anti-inflammatory analgesic, closely related structurally to drugs such as ibuprofen, ketoprofen and naproxen. In patients with acute pain, single oral doses of suprofen are at least as effective as: usual therapeutic doses of aspirin; codeine alone or combined with aspirin; dextropropoxyphene alone or in various combinations; oxycodone combined with aspirin; dipyrone; pentazocine; paracetamol (acetaminophen); diflunisal; ibuprofen; indomethacin; or mefenamic acid. In chronic pain due to osteoarthritis, suprofen is as effective as usual dosages of aspirin or dextropropoxyphene during long term therapy, and as effective as diclofenac, ibuprofen, indomethacin and naproxen during short term treatment. As with other non-steroidal anti-inflammatory drugs, gastrointestinal complaints are the most frequently reported side effects, although discontinuation due to gastrointestinal effects may be necessary less frequently with suprofen than with aspirin, dextropropoxyphene or combinations of the two. Suprofen appears to be a useful alternative to mild analgesics, analgesic combinations or the older more established non-steroidal anti-inflammatory drugs in the treatment of patients with acute or chronic pain. However, further definition of its efficacy and tolerability is required, especially in comparison with newer non-steroidal anti-inflammatory analgesics.
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PMID:Suprofen. A review of its pharmacodynamic and pharmacokinetic properties, and analgesic efficacy. 390 75

Common criticisms of behavioral treatment programs for chronic pain are summarized. Some criticisms are based on conceptual misunderstandings; therefore, basic concepts and goals of behavioral programs are presented. Other criticisms question the effectiveness of these programs; therefore, the role of social reinforcers in maintaining or reducing pain behaviors is reviewed. The failure to isolate specific treatment variables is alleged; this is acknowledged, along with the practical and ethical questions making this virtually impossible. Finally we describe the need to change the thinking about 'pain' from the pathological or disease model, appropriate to acute pain, to a learning model when discussing the excess disability and suffering of chronic pain patients.
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PMID:The behavioral management of chronic pain: a response to critics. 404 98

Due to recent interest in the development of drug assay techniques, the pharmacokinetics of many analgesics have been defined. In addition, mechanisms of action of the commonly used analgesics have been partly delineated, and currently accepted analgesic regimens and usages are being questioned. By considering both the pharmacokinetics and the mechanism of action of each of these analgesics, it would appear that only a few of the currently available agents are needed for the treatment of acute and chronic pain. Newer agents with reduced toxicity have been introduced but have resulted in little expansion of novel ways to interfere with pain. The recent discovery of the beta-endorphin system, the reevaluation of older agents, and the development of new agents that work at pain pathways other than the classical sites hold out the promise of alternative means of control of certain types of pain. An agent that has analgesic efficacy equivalent to morphine but with reduced toxicity is especially exciting in the development of new analgesics. An agent that, in addition, does not lead to intolerable psychomimetic reactions but instead addresses multiple aspects of treating the fear, pain, and tension triad of pain will be beneficial in acute pain but will especially enhance the spectrum of the control of chronic pain such as cancer, neuralgia and arthralgia.
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PMID:Pharmacokinetics and mechanisms of action of analgesics in clinical pain. 611 74

Chronic pain syndrome must be considered as a psychologic-physiologic disability. The understanding and treatment of chronic pain syndrome comprises a new medical disease model; however, some of the original symptoms are considered to have an underlying organic pathology. Recognition of the need for differentiation between the various forms of pain is paramount to the success of the treatment process. By applying different treatment modalities, we can best prevent acute pain from becoming chronic pain syndrome. Chronic pain syndrome must be treated differently from acute pain; To persist in treating chronic pain syndrome as an acute problem very often leads to unsuccessful treatment results. The appropriate use of medication is an important component in the multidisciplinary approach to chronic pain syndrome. Treatment of chronic pain syndrome has been most successful when a combination of all legitimate treatment modalities available were utilized.
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PMID:Chronic pain syndrome. 614 87

Narcotics have been shown to act selectively upon nociceptive synaptic junctions in laminae 1 and 2 of the dorsal horn of the spinal cord. Subarachnoid or epidural injection of narcotics can produce selective segmental analgesia of great intensity and prolonged duration that is free of motor or sympathetic blockade. However, poorly lipid-soluble drugs, such as morphine, that tend to linger in the water phase of the CSF may spread rostrally to involve opiate receptors in brain stem nuclei. Delayed respiratory depression and lifethreatening apnoea is therefore the greatest danger. Other undesirable side effects include itching, nausea and vomiting and urinary retention. All side-effects are antagonized by naloxone. Intraspinal narcotic analgesia has many useful applications for the relief of acute or chronic pain. Obstetrical pain is less amenable to this approach. Effective and safe management of acute pain requires that the patients be under adequate surveillance to avoid the danger of insidious respiratory depression. Chronic malignant pain is well controlled by relatively small doses of narcotic, and these patients can be managed at home on a long-term basis.
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PMID:Spinal opiate analgesia: its present role and future in pain relief. 614 23

Control of pain and the suffering that it causes still eludes us. Despite impressive progress in the prevention and cure of disease and in care of the trauma victim, pain is still a frontier in medical research. It accompanies surgery, various diagnostic procedures and dental care as well as acute injury and disease. For a significant number of patients it persists after injury or illness into a chronic state. Chronic pain is recognized to be the most frequent cause of disability in the United States and many industrialized nations today, and is a major cost to society in both work hours lost and medical expenses. In addition to its social importance, pain is an intimate cause of personal concern for every human being throughout life. The progress, or lack of progress, achieved by medical research in pain control is of interest to us all. Pain disorders may be usefully classified in two categories: acute and chronic. The etiology, physiopathology, symptomatology, diagnosis and therapy of these two types of pain are quite different and require separate consideration. Acute pain is that which arises from an acute injury or disease process and persists only as long as the tissue pathology itself. If acute pain problems are not effectively treated, they may progress to chronic states. Chronic pain is that: (1) associated with chronic tissue pathology; or (2) which persists beyond the normal healing period for an acute injury or disease. There are unique challenges for health care providers associated with each of these two categories of problems, and failure to distinguish between these types of pain has led to a widespread, ongoing mismanagement of patients that can be prevented if strong efforts are made to better educate health care professionals about pain and its therapy. This paper presents an overview of current understanding about the nature of pain and its management. The physiology and psychology of pain are reviewed against a background of the concepts and information taught 25 years ago. Some common acute and chronic pain problems are reviewed and discussed. Finally, several new directions in pain control are described.
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PMID:New directions in the understanding and management of pain. 615 60

Lumbar cerebrospinal fluid levels of 5-hydroxyindoleacetic acid, which are used as indicators of central nervous system serotonergic neuronal activity, were significantly higher in 67 patients with chronic pain and in 32 patients with acute pain (23.6 +/- 3.3 and 23.1 +/- 3.8, respectively) than in 30 patients (8.8 +/- 1.7) who had no pain. However, there was no correlation between levels of 5-hydroxyindoleacetic acid in patients with chronic or acute pain, nor between groups of patients with chronic pain whose pain mechanisms were of psychogenic, sympathetic, somatic, or central origin, based on their responses to differential spinal block; there was also no correlation between levels of depression, as evaluated by the Zung scale, in patients with different types of chronic pain, even though all of these patients were depressed. The elevated levels of 5-hydroxyindoleacetic acid in the depressed patients with chronic pain are not consistent with previous studies on the etiology and types of chronic pain. As recent research indicates that the perception of pain may be modulated by endogenous analgesic systems involving enkephalin and serotonin (5-HT), this study was undertaken to clarify the association between 5-HT activity and nociception. Our findings did show a link between acute noxious stimulation and central increases in serotonergic activity. However, we could not differentiate between pain mechanisms and degree of depression. Our studies did indicate that, because of both the persistence of pain complaints and the increased levels of brain 5-HT activity, the endogenous analgesic systems are not totally effective as natural inhibitors of pain. Furthermore, the increased depression and continued pain in the presence of elevated 5-HT activity in patients with chronic pain may represent a tolerance or decreased responsiveness to 5-HT.
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PMID:Serotonergic activity in man as a function of pain, pain mechanisms, and depression. 617 60

Chronic pain can be treated by combining hypnosis with brief psychotherapy. Hypnosis alone, though useful for acute pain, is seldom effective in relieving chronic pain because it does not address the significant psychologic components in the patient's illness. Treatment using self-hypnosis in conjunction with brief psychotherapy, however, can enable the patient to recognize these components, to change from a passive to an active role in achieving relief, and to modify his attitude toward the pain. This procedure can both reduce suffering and lead the patient to deemphasize pain in his life.
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PMID:Hypnosis in the treatment of chronic pain. 618 70

Workers' compensation laws influence recovery from injury. They affect the "cause" of disease, access to care, diagnostic evaluation, treatment, response to treatment and residual disability. Paradoxically, financial compensation may discourage return to work, the appeal process may increase disability, an open claim may inhibit return to work and recovering patients may be unable to return to work. Physicians may help improve the prospects of returning patients to work by providing care that is medical, caring and independent. It is essential that the treatment of back pain be based on the known natural history and on the understanding that the management of acute pain differs from that of chronic pain. Increased awareness of the factors controlling return to work should motivate legislative bodies, labor and industry to alter those features of the compensation system that interfere with the return to work of injured workers.
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PMID:Compensation and recovery from injury. 623 94


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