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

In the runner study, as measured by tourniquet ischemic pain, exercise stress produced hypoalgesia 20 minutes post-run, followed by hyperalgesia and euphoria at 30 minutes. The hypoalgesia and euphoria were reversed by naloxone. Exercise stress also produced a decrease in P(A), suggesting hypoalgesia to the thermal cutaneous stimulation. However, this analgesia was not naloxone reversible. Nor did exercise stress produce analgesia to cold-pressor pain. In the acupuncture study, noxious electrical stimulation of classical acupuncture sites failed to produce analgesia either during or after stimulation. However, expectation did produce a change in the pain report criterion, but only in the acupunctured arm. Noxious electrical stimulation (TENS) of the median nerve produced no analgesia outside of the related segmental area, that is, acute electrical pain did not produce generalized hypoalgesia. Thus, the effects of the stress produced by noxious electrical stimulation differ from that produced by exercise. In contrast to the results of the acute pain studies, chronic clinical pain, which combines mental stress and pain stress, produced strong hypoalgesia and anesthesia. Again, in contrast to the acute experimental pain studies, the emotional stress of mental illness produces hypoalgesia, but not anesthesia. Finally, the somatosensory system is not the only the sensory system affected by stress. Cold-pressor pain decreases visual sensitivity both during and for a few minutes following stimulation, and does not interfere with short-term (supra-digit span) memory.
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PMID:Altered pain and visual sensitivity in humans: the effects of acute and chronic stress. 294 86

The oral surgeon's role in the management of the very apprehensive and/or phobic patient presents multiple challenges. It is important for the surgeon to recognize and even analyze some of the subtle changes that he and members of his staff feel when presented with these special patients. In general, they tend to disrupt the usual flow of practice and elicit behavior that may be defensive and threatening. Surgeons are temperamentally task oriented and may not be able to effectively manage such patients short of resorting to full general anesthesia. Appropriately administered and monitored, it may answer the acute surgical need while bypassing the underlying emotional situation. Referral of the patient to a special "dental phobia clinic" for follow-up care is definitely indicated, once the acute pain, swelling, or traumatic injury has been treated.
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PMID:An oral surgeon's approach to the fearful patient. Intravenous sedation and general anesthesia. 318 63

The purpose of this study was to investigate whether regression of sensory analgesia during constant epidural bupivacaine infusion was different in postoperative patients with acute pain than in patients with chronic nonsurgical pain. Sensory levels of analgesia (to pinprick) and pain (on a five-point scale) were assessed hourly for 16 hours during continuous epidural infusion of 0.5% plain bupivacaine (8 ml/hr) in 12 patients with chronic nonsurgical pain and in 30 patients after major abdominal surgery performed under combined bupivacaine and halothane--N2O general anesthesia. No opiates were given. If sensory analgesia decreased more than five segments from the initial level or if the pain score reached 2 (moderate pain), the patient was removed from the study. Initial levels of sensory analgesia after loading doses of 21.8 +/- 0.5 and 19.3 +/- 0.8 ml bupivacaine 0.5% were similar (T3.8 +/- 0.3 and T3.8 +/- 0.5) in the surgical and chronic pain patients, respectively (mean +/- SEM). Of the surgical patients, only 4 of the 30 (13%) maintained the initial level of sensory analgesia, and a pain score below 2 throughout the study compared with 7 of the 12 patients with chronic pain (58%) (P less than 0.01). Mean duration of sensory blockade was significantly longer (P less than 0.005) in the patients with chronic pain than in surgical patients (13.1 +/- 1.2 and 8.5 +/- 0.7 hours, respectively). Thus, surgical injury hastens regression of sensory analgesia during continuous epidural bupivacaine infusion. The underlying mechanism remains to be determined.
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PMID:The roles of acute and chronic pain in regression of sensory analgesia during continuous epidural bupivacaine infusion. 339 60

Pain in pediatric oncology must be taken care of after years of neglection. On an average of 62% of tumours pain is of therapeutic relevance. In cancer relapse and final states incidence of pain increases up to 90%. Treatment of acute pain is not difficult, chronic pain however affords a special procedure: individual dosage with optimal suppression of pain whole day long, often combination of different methods, will give sufficient longtime results. Around 4/5 of pediatric cancer pain can be treated by pharmacological regime using central and antiphlogistic analgesics. Additional methods are local anesthesia, transcutaneous nerve stimulation, physiotherapy, psychotherapy and seldom neurosurgical intervention. The optimal treatment of cancer pain is part of a consequent oncological procedure. Some more effort is necessary to reach the most possible quality of life in these children.
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PMID:[Diagnosis and therapy of pain in pediatric oncology]. 349 28

Patient-controlled analgesia (PCA, intravenous self-application of narcotics) was studied during the early postoperative period. Subjects were 40 ASA I-III patients recovering from elective major and minor surgery (each 20 having undergone abdominal or orthopaedic operations). Pentazocine bolusses of each 8 mg were available via a hand-button whenever the patients felt pain relief necessary, and delivered by a microprocessor-controlled injection pump (On-Demand Analgesia Computer, ODAC). Hourly maximum dose was set to 60 mg with a pump refractory time of 1 min between valid demands. A continuous low-dose pentazocine infusion (1 mg/h) was additionally administered in order to prevent catheter obstruction. Duration of the PCA period was 20.3 +/- 5.9 h (mean, standard deviation). During this time, 20.0 +/- 12.7 demands per patient were recorded resulting in mean pentazocine consumption of 135.6 +/- 81.4 micrograms/kg/h. Self-administration was characterized by considerable intra- and interindividual variability. There were no statistically significant differences with regard of pentazocine consumption or pain relief between abdominal and orthopaedic patients, nor could any be demonstrated between the sexes. Similarly, no clear differences were found after various anaesthetic techniques (neuroleptanalgesia, halothane or spinal anaesthesia). Over-all efficacy and patient acceptance proved to be excellent. Effectiveness of PCA was judged superior by about 68% of patients when compared with previously experienced conventional postoperative analgesia. Side effects (nausea, emesis, sweating) occurred in about 10-18% but were usually of minor intensity. Circulatory or respiratory problems were not observed during the PCA period. Patient-controlled analgesia is discussed as a promising concept for the treatment of acute pain and clinical pain research.
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PMID:[Postoperative on-demand analgesia with pentazocine (Fortral)]. 409 11

Contralateral local anaesthesia was employed in patients with chronic (n = 42) and acute (n = 8) pain syndromes (see Table 1). I. Phantom limb and stump pain: n = 10; II. Pain of face and ear: n = 10; III. Pain of neck and trunk: n = 14; IV. Pain of the hip joint: n = 6; V. Pain of the extremities: n = 10: Sa. = 50 patients. Among these were n acute pain syndromes: I.: n = 0; II.: n = 1; III.: n = 1; IV.: n = 1; V.: n = 5 (Sa.: n = 8). 42 patients with chronic pain syndromes were treated with contralateral local anaesthesia (CLA). In 27 patients CLA displayed a clear effect upon the chronic pain; in 8 patients pain release was more than 50%, in 15 patients pain release was less than 50%. 3 patients relapsed into their former condition of pain. CLA was without any positive influence in 12 cases. The medium frequency of treatments was between 5 and 6 in both groups. The average time of treatment amounted to 6 and 7 months respectively. In 8 patients with acute pain syndromes contralateral local anaesthesia produced the following results: 6 patients were permanently released from their pain; in 2 patients CLA remained without any success. The average frequency of treatment was 1.25; the average time of observation was 2.3 months. Hence we suggest that CLA should be employed as early as possible in acute or chronic posttraumatic or postoperative pain syndromes. The influence of contralateral pain therapy on acute and chronic pain conditions of the opposite side can be affirmed; its mechanism remains to be clarified. Obviously it is possible to exert an inhibitory influence from the contralateral side upon peripheral, spinal, reticular and thalamic regions, which can lead to the extinction of acute and chronic pain conditions on the opposite side. According to our experiences it is necessary that the cerebro-spinal nerve system - apart from the traumatic lesion - is intact and that the pain syndrome is not maintained by a psychic disturbance.
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PMID:[Contralateral local anesthesia in stump, phantom and post-traumatic pain]. 672 57

This paper reviews the use of tramadol in the management of acute pain. Tramadol is a weak opioid analgesic with a potency comparable to that of pethidine. While it is not recommended as a supplement to general anaesthesia because of its insufficient sedative activity, tramadol has been successful in the treatment of postoperative pain. Several studies have demonstrated its analgesic efficacy after intramuscular and intravenous application, both in adults and children. Moreover, negligible respiratory depressant activity and only minor side effects have consistently been shown. Patient-controlled analgesia with tramadol has been frequently employed and was well accepted by the patients. There have been only a few studies of oral or spinal application of tramadol in acute pain states. Tramadol has also been used for the control of pain associated with labour and acute myocardial infarction, as well as for the management of trauma pain. In summary, tramadol can be recommended as a basic analgesic for the treatment of patients with moderate to severe pain.
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PMID:Tramadol for the management of acute pain. 751 22

Local anesthetics administered to block nerve conduction for surgical anesthesia and to provide analgesia in management of acute pain have become a standard of anesthesiology practice. These drugs have had an important role in the multimodality management of chronic pain as well, and this role is expanding since the revival of systemic administration. Local anesthetics are analgesics, albeit not in the traditional clinical and pharmacologic sense. Evidence suggests that intravenous administration is an effective treatment in chronic neuropathic pain syndromes. There is also evidence that intravenous local anesthetics can relieve acute pain. Furthermore, the novel idea that acute procedural and postprocedural pain control with local anesthetics could prevent the development of chronic pain syndromes, including chronic neuropathic pain syndromes, adds another important potential dimension to the role of local anesthetics in pain management.
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PMID:Local anesthetics as adjuvant analgesics. 753 34

Diagnostic laparoscopy under local anaesthesia for acute pain in the right iliac fossa in an old man is reported. Exploring the abdominal cavity under local anaesthesia is an excellent method for establishing a diagnosis in doubtful abdominal pain presentation. This technically easy procedure may avoid up to 45% of unnecessary laparotomies and related complications.
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PMID:[Exploratory laparotomy under local anesthesia]. 778 39

Inadequately treated pain is a major cause of unanticipated hospital admissions after ambulatory surgery. The ability to provide adequate pain relief by simple methods that are readily available to the day-care patient in his or her home environment is one of the major challenges for providers of ambulatory surgery and anesthesia. The increasing number of extensive and painful surgical procedures (e.g., laparoscopic cholecystectomy, laminectomy, knee construction, hysterectomies) being undertaken on an ambulatory basis presents new challenges with respect to acute postoperative pain. Hence the availability of more sophisticated and effective treatment modalities, such as ambulatory PCA and continuous local and regional anesthetic blocks, with minimal side effects, are necessary to optimize the benefits of ambulatory surgery for both patient and health care provider. However, outcome studies are needed to evaluate the effect of these newer therapeutic approaches with respect to postoperative side effects and other important recovery parameters. Recent studies suggest that factors other than pain per se must be controlled to reduce postoperative morbidity and facilitate the recovery process. Not surprisingly, the anesthetic technique can influence analgesic requirement in the early postoperative period. Although oral analgesic agents will continue to play an important role, the adjunctive use of local anesthetic agents is likely to assume an even greater role in the future. Use of drug combinations (e.g., opiates and local anesthetics, opiates and NSAIDs) may provide improved analgesia with fewer side effects. Finally, safer and simpler analgesic delivery systems are needed to improve our ability to provide cost-effective pain relief after ambulatory surgery. In conclusion, as a result of our enhanced understanding of the mechanisms of acute pain and the physiological basis of nociception, the provision of "stress-free" anesthesia with minimal postoperative discomfort is now possible for most patients undergoing elective surgical procedures. The aim of an analgesic technique should be not only to lower the pain scores but also to facilitate earlier mobilization and reduce perioperative complications. If future clinical investigations clarify the issues that have been raised by laboratory studies, clinicians may be able to effectively treat postoperative pain using combinations of "balanced," "preemptive," and "peripheral" analgesia. More important, improved analgesic techniques will increase patient satisfaction and enhance their perception of ambulatory anesthesia and surgery.
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PMID:Postoperative pain management. 796 Jan 70


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