pain-relief-32.matches: pain relief
Pain and the ethics of pain management.

Edwards RB.

In this article I clarify the concepts of 'pain', 'suffering', 'pains of body', 'pains of soul'. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis, treatment and research. Next, there is the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfilling these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if any, should override the right to refuse treatment where pain relief is of paramount concern.

KIE: After clarifying the concepts of "pain", "suffering", "pain of body", and "pain of soul", the author presents a humanistic ethic of pain management based on the premise that the patient has a strong "prima facie" right to freedom from unnecessary pain. This premise imposes two moral obligations upon medical professionals: (1) the duty not to inflict unnecessary pain and suffering upon the patient, and (2) the duty to do whatever is possible to alleviate pain and suffering. Both the questions of informed consent to treatment of pain and the right to refuse pain relief are addressed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6710192&dopt=Abstract pain, pain medicine, pain relief



pain-relief-32.matches: pain relief
Dorsal root entry zone lesions for the treatment of post-herpetic neuralgia.

Friedman AH, Nashold BS Jr, Ovelmen-Levitt J.

Post-herpetic pain was treated in 12 patients using dorsal root entry zone ( DREZ ) lesions. All patients had failed to receive adequate pain relief from conservative therapy consisting of transcutaneous nerve stimulation, carbamazepine, and/or amitriptyline. Dorsal root entry zone lesions were made to include the involved dermatomes plus one-half of the dermatomes above and below the painful areas. Eight patients reported good pain relief with follow-up periods ranging from 6 to 21 months. A ninth patient obtained satisfactory pain relief, but the superior 1 cm of the original painful area was not included in the distribution of the DREZ lesions. Patients whose lesions were performed using a thermally controlled lesion probe suffered no significant postoperative neurological deficit. Dorsal root entry zone lesions appeared to be a satisfactory treatment for post-herpetic neuralgia in patients who have failed to respond to more conservative modes of therapy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6726370&dopt=Abstract pain, pain medicine, pain relief



pain-relief-33.matches: pain relief
Intracranial stimulation for the control of chronic pain.

Richardson DE.

Long-term stimulation of deep brain structures for pain relief has been efficacious in a significant number of patients who have been total failures at every other means of pain control. Two primary sites are used at this time--the periventricular grey area, which is related to the endogenous opiate system, and the internal capsule system, which is related to the dorsal column projection system. Periventricular sites are more efficacious for externally generated pain, that is, pain with input through the dorsal horn. Internal capsule stimulation is more efficacious for central nervous system-generated pain. While the preoperative preparation and intraoperative testing as well as postoperative testing of these patients requires a great deal of time and tedious attention to detail, our long-term results have been excellent using a combined comprehensive pain unit approach to pain and stress management, plus the stimulation techniques in carefully selected patients. Our results would indicate that initially 80-85% of patients get good pain relief, and then that range decreases to between 50 and 60% over a long period of time. Deep brain stimulation for pain relief is not a technique that should be used on a large number of patients with simple pain problems, but is highly efficacious in a selected group of patients with very specific pain problems that do not respond to usual pain treatment techniques. In patients with pain generated by benign etiologies, it is far superior to destructive procedures and does not have the secondary side effects of sensory loss, postchordotomy dysesthesias, or secondary neurological deficits.(ABSTRACT TRUNCATED AT 250 WORDS)

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6094075&dopt=Abstract pain, pain medicine, pain relief



pain-relief-33.matches: pain relief
Attitudes of patients, housestaff, and nurses toward postoperative analgesic care.

Weis OF, Sriwatanakul K, Alloza JL, Weintraub M, Lasagna L.

A survey was carried out among housestaff and nurses involved with postoperative patient care to assess their knowledge of analgesics and their attitudes toward postoperative analgesic care. Only one-fifth of the respondents prescribed for complete pain relief. There were some misconceptions about adding other drugs to narcotic analgesics as well as fear of the addictive properties of these narcotics. The respondents lacked confidence about their knowledge of narcotic analgesics. Fear of respiratory depression was less prominent. Nine percent of the physicians and 31% of the nurses believed that response to a placebo indicates factitious pain. Fifty-four percent of the physicians and 74% of the nurses believed that patients receive adequate pain relief. Eighty-one patients were questioned on their beliefs about pain and its relief. Sixty-six of these were monitored postoperatively to assess the effectiveness of pain relief, which was judged by the authors to be ineffective (i.e., moderate to severe pain at the peak of analgesia) in 41%. Seventy-five percent of the patients reported that their overall postoperative pain relief had been adequate. There was no correlation between the amount of analgesic required postoperatively and either the degree to which patients believed pain builds character or the degree to which they rated themselves sensitive to pain. This study emphasizes the need for better and more comprehensive training of housestaff and nurses in analgesic care.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6129821&dopt=Abstract pain, pain medicine, pain relief



pain-relief-33.matches: pain relief
[Electroanalgesia by transcutaneous stimulation (TNS). Response to the naloxone test]

[Article in Italian]

Casale R, Zelaschi F, Guarnaschelli C, Bazzini G.

The authors, after a review of the literature about TNS, suggest the comparison between three different TNS techniques from two points of view: A) Pain relief estimate; B) Response to Naloxone Test. To this purpose a impulse generator delivered a biphasic square-wave stimulus with duration of 0.40 msec and amplitude (peak to peak) to 130 mVolt, was used. TNS techniques used are so characterized 1) Frequency 80 Hz; Duration 30'; 2) Frequency 80 Hz; Duration over 120'; 3) Frequency 2/4 Hz; Duration over 120'. Although the techniques used for Group (1) provided the best numerical result in the evaluation of the pain relief, endorphine activity cannot be maintained owing to Naloxone Test negativity. Pain relief of (2) and (3) Group was statistically significant although not numerically at the same level of (1) Group. In the laters, on the contrary, positivity of Naloxone Test seems to hint at the activation of endorphine. This fact suggest to the authors hypothesis in the purpose to spot TNS site of action.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6189000&dopt=Abstract pain, pain medicine, pain relief



pain-relief-12.matches: pain relief
Combined fluphenazine and lidocaine for pain relief in head and neck cancers.

Desai PM, Desai KP.

Savitribai Fule Municipal Hospital, Kolhapur, India.

A successful method of treating intractable neoplastic pain in 12 cases is discussed. A completely new method was tried combining long-acting phenothiazine and lidocaine to achieve long-lasting pain relief. This combination gave pain relief which lasted for weeks. A possible explanation of the mechanism is offered.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10842546&dopt=Abstract pain, pain medicine, pain relief



pain-relief-33.matches: pain relief
Surgical approaches to pain control.

Rosomoff HL.

The neurosurgeon has many approaches to pain control, depending on the location of the cancer and its tissue characteristics. By far, the most common procedure to be employed is percutaneous chordotomy, which is relatively risk-free and easy for the patient to undergo. It is most important to recognize that pain relief should be effected early in the course of the disease before the ravages of drug addiction and the complications of directed therapy like radiation or chemotherapy have taken their toll. Inanition, under these circumstances, may well be the result of treatment and drugs, rather than the disease itself. We have often seen patients, once given pain relief, make sudden weight gains and go on to a comfortable existence for a surprisingly long period of time thereafter. It is urged that pain relief be considered early, as a major contribution to enhanced quality of living and longevity of survival.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6195674&dopt=Abstract pain, pain medicine, pain relief