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Biomedical subjects

C A Warfield

Publications and source records attributed to C A Warfield.

At least 19 recordsLinked to original sources
PubMed2001

Pain management in polycystic kidney disease.

Pain is a common complaint in patients with autosomal-dominant polycystic kidney disease, and a systematic approach is needed to differentiate the etiology of the pain and define an approach to management. A thorough history is the best clue to the multifactorial causes of the pain, superimposed upon an understanding of the complex innervation network that supplies the kidneys. The appropriate use of diagnostic radiology (especially MRI) will assist in differentiating the mechanical low back pain caused by cyst enlargement, cyst rupture and cyst infection. Also, the increased incidence of uric acid nephrolithiasis as a factor in producing renal colic must be considered when evaluating acute pain in the population at risk. MRI is not a good technique to detect renal calculi, a frequent cause of pain in polycystic kidney disease. If stone disease is a possibility, then abdominal CT scan and/or ultrasound should be the method of radiologic investigation. Pain management is generally not approached in a systematic way in clinical practice because most physicians lack training in the principles of pain management. The first impulse to give narcotics for pain relief must be avoided. Since chronic pain cannot be "cured," an approach must include techniques that allow the patient to adapt to chronic pain so as to limit interference with their life style. A detailed stepwise approach for acute and chronic pain strategies for the patient with autosomal dominant polycystic kidney disease is outlined.

Acupuncture Therapy↗
PubMed1998

Controlled-release morphine tablets in patients with chronic cancer pain: a narrative review of controlled clinical trials.

BACKGROUND: Controlled-release (CR) morphine tablets have become routine therapy in the management of cancer pain. Compared with immediate-release (IR) morphine, this formulation provides the benefit of dosing every 12 hours. METHODS: This study reviewed the 10 published, well controlled, repeated-dose, comparative studies with CR morphine tablets administered every 12 hours to patients with cancer pain. RESULTS: CR morphine tablets were uniformly effective; 98% of patients completed a treatment course of every-12-hours therapy. Although the effective analgesic dose varied considerably from study to study (range, 90-330 mg per day), pain was well controlled with CR morphine tablets as the primary analgesic. Mean pain scores, converted to a common 10-point scale, ranged from 1.1-2.9 across all studies. There was only occasional need for IR morphine rescue medication (range, 2-39 mg per day). The mean discontinuation rate because of side effects or lack of every-12-hours efficacy was 2%. In seven studies that used IR morphine as the comparative agent, CR morphine tablets were found to be equally effective as IR morphine. CONCLUSIONS: Twice-daily dosing of CR morphine provides convenient, safe, and effective relief of cancer pain.

Administration, Oral↗
PubMed1997

Utilization patterns of tricyclic antidepressants in a multidisciplinary pain clinic: a survey.

OBJECTIVES: Tricyclic antidepressants (TCA) have been shown to provide analgesia for a variety of neuropathic and headache pain syndromes regardless of the presence of depression. There is a high incidence of depression in patients with chronic pain, thereby making tricyclic antidepressants particularly suitable for chronic pain patients. We wanted to study patterns of use of tricyclic antidepressants in our Pain Management Center (Beth Israel Hospital, Boston, MA, U.S.A.) primarily to answer four questions: (1) What percentage of all patients were treated with tricyclic antidepressants? (2) How many patients were treated with each antidepressant, and what was the dose range used for individual antidepressants? (3) Were tricyclic antidepressants beneficial for chronic pain, and was that response dependent on a particular dose? (4) Did patients receive an adequate TCA trial, and what factors led to the discontinuation of a TCA trial? METHODS: A total of 1,145 pain clinic patient charts were reviewed in alphabetical sequence. A total of 282 patients were identified as being treated with tricyclic antidepressants. Data were obtained from these 282 charts regarding the patient's age, diagnosis, tricyclic antidepressant use and dose, other pain treatments, response to treatment, and side effects. The existing diagnosis of depression was documented if possible. Tricyclic antidepressant doses were defined as low doses when the equivalent of 50 mg or less of amitriptyline was used, and as full doses when the equivalent of at least 150 mg of amitriptyline was used. Response to treatment was noted as mild, moderate, or marked improvement. Patients reporting mild improvement were considered nonresponders. RESULTS: Of 1,145 patients, 282 were treated with tricyclic antidepressants. A total of 205 (73%) of the patients were treated with low doses and only 34 (12%) with full doses. The remaining 43 (15%) received intermediate doses. Amitriptyline was the most commonly used drug (58%). Amitriptyline and doxepin appeared to be more effective than other tricyclic antidepressants. The rate of response to our treatment among the 31 patients with a coexisting diagnosis of depression was similar to the patients without documented depression. In patients with tricyclic antidepressants as the only treatment, there was only a trend toward greater response with full dose. In terms of side effects causing dose limitation or discontinuation of the drug, clomipramine, amitriptyline, and doxepin appeared to be worse than imipramine, desipramine, and nortriptyline. CONCLUSION: Tricyclic antidepressants were used in 25% of patients referred to a multidisciplinary pain center and were commonly used in low to intermediate doses, even in situations in which there were neither side effects nor optimal clinical response.

Aged↗
PubMed1996

Migraine headache following stellate ganglion block for reflex sympathetic dystrophy.

The alteration of extracranial blood flow in conjunction with clinical signs of autonomic nervous system dysfunction have led to various explanations concerning the pathophysiology of migraine headache. Reflex sympathetic dystrophy, a painful disorder of the sympathetic nervous system, can be treated by blocking the sympathetic nerves located in the stellate ganglion, resulting in vasodilation, ptosis, miosis, and anhydrosis. In theory, these changes could trigger a migraine headache attack secondary to autonomic dysfunction reflecting an imbalance between sympathetic and parasympathetic nervous systems. This may be especially true in a patient with a previous history of meningitis that may have resulted in a disorder of cerebrovascular regulation. We report a 56-year-old man with no previous history of migraine who developed migraine with aura after a stellate ganglion block. These episodic headaches occurred with decreasing frequency and severity for over 6 months, with eventual complete resolution. This interesting phenomenon has not been reported in the English literature and may help to better understand the pathophysiology of migraine.

Humans↗
PubMed1996

Consensus radiation protection practices for academic research institutions.

Under the auspices of the Howard Hughes Medical Institute, a set of consensus guidelines for Radiation Protection Practices has been developed for biomedical research using radioactive materials. The purposes of the guidelines are (1) to promote good radiation protection practices consistent with the needs of biomedical research, the ALARA principle, and regulatory requirements; (2) to establish common goals and consistent practices within radiation safety programs; and (3) to build a meaningful partnership between radiation safety professionals and the biomedical research community. These practices are intended to enhance radiation protection and the efficiency of the research staff. The consensus guidelines will lessen the variability in radiation safety practices that is evident among many academic research institutions and will encourage better acceptance and regulatory compliance by users of radioactive materials in biomedical research.

Academies and Institutes↗
PubMed1995

Acute pain management. Programs in U.S. hospitals and experiences and attitudes among U.S. adults.

BACKGROUND: The objective of the survey was to assess the status of acute pain management in U.S. hospitals and attitudes of adults in the U.S. toward postoperative pain management, information that has not been previously available. METHODS: Two telephone questionnaire surveys were conducted U.S. hospital participants, including 100 teaching hospitals (acute care hospitals with a residency program and/or university affiliation), 100 nonteaching (community) hospitals with fewer than 200 beds, and 100 nonteaching (community) hospitals with 200 beds or more were interviewed regarding current and future pain management programs and related topics. Adult participants in 500 U.S. households were interviewed on attitudes and experiences with postoperative pain and its management. RESULTS: Forty-two percent of the hospitals have acute pain management programs, and an additional 13% have plans to establish an acute pain management program. Seventy-seven percent of adults believe that it is necessary to experience some pain after surgery. Fifty-seven percent of those who had surgery cited concern about pain after surgery as their primary fear experienced before surgery. Seventy-seven percent of adults reported pain after surgery, with 80% of these experiencing moderate to extreme pain. CONCLUSIONS: Despite a growing trend in pain management, increased professional and public awareness including the establishment of pain management programs and public and patient education is needed to reduce the incidence and severity of postoperative pain.

Acute Disease↗
PubMed1993

Laminectomy and the treatment of lower-back pain in Massachusetts.

During 1984-85, laminectomy rates in Massachusetts demonstrated a 2.2-fold variation among districts. Thirty-five percent of laminectomies occurred in 7 of the 108 hospitals studied. Approximately 81% of laminectomies were performed by neurosurgeons. Rates of laminectomy decline with increasing age after 65, while rates of hospitalization for lower-back pain rise.

Adolescent↗
PubMed1992

Lower back pain. Laminectomies, spinal fusions, demographics, and socioeconomics.

The models and analyses used in this study represent an important step in the continued search for the optimum use of surgery for the treatment of lower back pain. The likelihood of patients who are hospitalized with lower back pain in Massachusetts receiving either laminectomies or spinal fusions or both was increased when any of the following demographic, socioeconomic, or medical characteristics were present: white, male, well insured, young, routine admission, admitted to a medium-sized hospital, admitted to a teaching hospital, admitted to a hospital with a high occupancy rate, and discharged home.

Back Pain↗
PubMed1991

Guidelines for the use of MS Contin tablets in the management of cancer pain.

MS Contin (controlled-release oral morphine) has been successfully used to treat moderate to severe pain associated with cancer. The indication for administering MS Contin is not a poor prognosis, but rather pain requiring repeated dosing with potent opioids over periods of more than a few days. Individualization of analgesic dosage to each patient's needs can provide excellent relief of pain in most patients but require selection of the right analgesic in the right dose at the right intervals.

Administration, Oral↗