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Query: UMLS:C0344307 (analgesia)
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Angiostrongylus cantonensis is a parasite that causes eosinophilic meningitis and has been reported to be present on most Pacific islands. Rats are the principal host and several species of land snails the intermediate host. Important paratenic hosts are fresh water shrimp and fish. Modes of transmission include ingestion by man of raw fish, snails and fresh leafy vegetables contaminated by snail slime trails containing larvae. The parasitic worms are neurotropic in man, and the diagnosis should be considered in any adult or child, who presents, in endemic areas or areas with suitable intermediate hosts, with severe unrelenting headache, paresthesias, or a cranial nerve palsy. Eosinophils in the cerebral spinal fluid suggest the diagnosis. Simple analgesia is sufficient for mild cases. Treatment of those with severe symptoms remains controversial. Glucocorticoids, lumbar puncture to reduce intercranial pressure and antihelminthic agents have been used.
Pac Health Dialog 2001 Mar
PMID:Human infections with Angiostrongylus cantonensis. 1201 20

The clinical case presented in this article illustrates how many of the more recent advances in the management of critically ill patients apply to current clinical practice. Simple cost-effective general measures (eg, optimal sterile precautions during procedures; hand washing; early goal-directed resuscitation with appropriate fluids, inotropes, and antibiotics; and surgical source control of infected foci) still should form the basis of clinical practice, however. There has been renewed interest in blood transfusion therapy and its associated risks. Lower tidal volume ventilation now is practiced almost universally in patients with ARDS, and several new selective pulmonary vasodilators have extended the armamentarium when taking care of these patients. High-frequency oscillatory ventilation and ECMO remain challenging options in patients with refractory hypoxemia. Appropriate patient selection is important when corticosteroid therapy is considered. Tight blood glucose control and monitoring improve outcome and should be part of ICU care of septic patients. The role of the PAC is controversial. Other techniques to measure cardiac output, hemodynamics, and perfusion are available and should be considered. Sedation and analgesia form an integral part of critical care. Because of its immediate and long-term risks, neuromuscular blockade should be used sparingly and only when all other options have been exhausted. Ongoing education regarding sedation protocols and the effect of sedation on outcome is needed among physicians and nurses caring for these patients.
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PMID:Progress in postoperative ICU management. 1570 53

For centuries, medical and surgical treatment has emphasized saving the life of the patient rather than ameliorating the patient's pain, particularly when there were few options for the latter. Today at the dawn of the 21st century, the best available evidence indicates a major gap between an increasingly understanding of the pathophysiology of pain and widespread inadequacy of its treatment. Epidemiologic evidence has proven that chronic pain is a widespread public health issue. Studies of cancer patients' pain control consistently reveal that up to half of patients receive inadequate analgesia and 30% do not receive appropriate drugs for their pain. Equally, for patients suffering HIV/AIDS, 60%-100% will experience pain at some stage in their illness. In the developed world, this gap has prompted a series of declarations and actions by national and international bodies advocating better pain control. One response to the worldwide undertreatment of pain has been to promote the concept that pain relief is a public health issue of such critical importance as to constitute an international imperative and fundamental human right. The importance of pain relief as the core of the medical ethic is clear. Pain clinicians promote the status of pain management beyond that of appropriate clinical practice or even an ethic of good medicine. They advocate a paradigm shift in the medical professions' perspective on pain management, from simply good practice to an imperative founded on patient rights. There is a need to promote policies which create conditions where human beings can bear even incurable illnesses and death in a dignified manner. This must help health professionals or lay groups to initiate a powerful agenda to reform local statutes. The essential components of such legislation are: 1. Reasonable pain management is a right. 2. Doctors have a duty to listen to and reasonably respond to a patient's report of pain. 3. Provision of necessary pain relief is immune from potential legal liability. 4. Doctors who are notable or willing to ensure adequate analgesia must refer to a colleague who has this expertise. 5. Pain management must be a compulsory component of continuing medical education. For too long, pain and its management have been prisoners of myth, irrationality, ignorance, and cultural bias. We are confident that the Pain Relief and Palliative Care Working Group under the auspices of the Lebanese Cancer Society is the main promoter of Palliative Care in Lebanon whose main goal is to relieve suffering and improve quality of life of the cancer patients, and advocate pain relief as a human right.
Asian Pac J Cancer Prev 2010
PMID:Pain relief is a human right. 2059 Mar 58

Early active mobilization after hand surgery is extremely important for preventing scar tissue and adhesion. We examined four patients for whom continuous peripheral nerve blocks (CPNB) were used during and after hand surgery. This method was used for three median nerves and one ulnar nerve. A 2-cm incision was made at distal one-third of the forearm with local analgesia. The catheter tip was placed in the distal one-fourth of the forearm, and the hand surgery was begun. Early active mobilization and the self-rehabilitation exercise started immediately after the operation. The VAS scores during exercise were 0-2 (mean: 1.3); pain was controlled sufficiently. Regarding ROM, excellent results were obtained for tenolysis, with good results for arthrolysis. No infection or postoperative nerve compression was found. This method, using CPNB with a portable infusion pump, is effective and safe for use at home for postoperative pain control.
J Hand Surg Asian Pac Vol 2018 Sep
PMID:Continuous Peripheral Nerve Blocks for Early Active Mobilization after Hand Surgery: Four Case Reports. 3028 33

Effective pain relief in animals relies on the ability to discern pain and assess its severity. However, few objective measures exist to assess the presence and severity of pain in axolotls, and few resources are available regarding drugs and appropriate doses to provide pain relief in this species. This study evaluated behavioral tools for cageside pain assessment and validated a reproducible and reliable quantitative method to evaluate analgesic efficacy in axolotls. Animals were divided into control and treatment groups (n = 6 per group); treatment groups received buprenorphine through injection (50 mg/kg every 24 h for 48 h intracelomically) or butorphanol immersion (0.50 or 0.75 mg/L every 24 h for 48 h). Qualitative behavioral tests, adapted from other amphibian studies, included tapping on the home tank, directing water jets or physically touching specific anatomic points on the animal, and placing a novel object in the home tank. Quantitative methods used to produce noxious stimuli were the acetic acid test and von Frey aesthesiometers. Animals that were treated with analgesics did not demonstrate a significant difference compared with controls during behavioral assessment at 1, 6, 12, 25, 30, and 48 h after analgesia administration. The acetic acid test revealed a reproducible, concentration-dependent pain response. However, a significant difference in the AAT response was not observed between control and treated groups with the tested analgesics and doses.
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PMID:Quantitative and Qualitative Behavioral Measurements to Assess Pain in Axolotls (Ambystoma mexicanum). 3196 58