Search PubMed⌕ Search

Biomedical subjects

S M Weinstein

Publications and source records attributed to S M Weinstein.

At least 19 recordsLinked to original sources

Classification of cancer pain syndromes.

Cancer patients experience pain in multiple sites and from several pathophysiologies of the symptom complex. The fluctuating nature of cancer pain intensity is a relevant clinical feature and depends on disease patterns and pain mechanisms. Breakthrough pain is defined as episodes of pain that "break through" the control of an otherwise effective analgesic therapy. Traditional ways of classifying pain in the cancer population include distinguishing pain associated with the treatments, the tumor, or unrelated to both and between chronic and acute pain. In focusing on the care of the cancer patient with pain, it is useful to be familiar with the characteristics of the typical syndrome found in association with different tumor types and anatomic locations. An understanding of the etiology of pain in relation to the cancer is useful in recognizing these complications and in treating them. This article reviews the methods presently applied to the classification of cancer pain and highlights the need for more research in this area.

Humans↗

Primary T-cell-rich B-cell lymphoma of the ethmoid sinus. A case report with 5 years of follow-up.

T-cell-rich B-cell lymphoma (TCRBCL) is an uncommon and recently recognized variant of B-cell non-Hodgkin lymphoma characterized by a few large neoplastic B cells amid a predominant population of reactive T lymphocytes and variable numbers of histiocytes. Morphologically, TCRBCL resembles a variety of non-Hodgkin lymphomas and Hodgkin disease. Accurate diagnosis and proper treatment are essential to assure a favorable prognosis. To our knowledge, this is the first report of ethmoid sinus presentation of TCRBCL in an Epstein-Barr virus-negative 51-year-old man. Combined chemotherapy and radiotherapy were administered based on the correct diagnosis. The patient has had a complete response with no recurrence during the 5-year follow-up.

Antigens, CD↗

Medical students' attitudes toward pain and the use of opioid analgesics: implications for changing medical school curriculum.

BACKGROUND: Barriers to pain management include physicians' lack of knowledge and attitudes. Our aim was to investigate future physicians' knowledge and attitudes toward pain and the use of opioid analgesics. METHODS: We tested a medical school class during their freshman and senior years. Stepwise regression analysis was used to identify the personal traits that predicted opiophobia. RESULTS: The professionalization process of medical training may reinforce negative attitudes. Psychologic characteristics were associated with reluctance to prescribe opioids, and fears of patient addiction and drug regulatory agency sanctions. CONCLUSIONS: Consistent attitudes were found in senior medical students with preferences for certain specialty areas and the practitioners of their future specialties, suggesting a "preselection" effect. Higher scores on reliance on high technology, external locus of control, and intolerance of clinical uncertainty were associated with higher scores on one or more of the three dimensions of opiophobia. Implications for medical education are discussed.

Acute Disease↗

Physicians' attitudes toward pain and the use of opioid analgesics: results of a survey from the Texas Cancer Pain Initiative.

BACKGROUND: Despite extensive progress in the scientific understanding of pain in humans, serious mismanagement and undermedication in treating acute and chronic pain is a continuing problem. This study was designed to examine the barriers to adequate pain management, especially as they might be associated with community size and medical discipline. METHODS: A 59-item survey was used to measure physicians' attitudes, knowledge, and psychologic factors that contribute to pain management practices. RESULTS: Overall, a significant number of physicians in this survey revealed opiophobia (prejudice against the use of opioid analgesics), displayed lack of knowledge about pain and its treatment, and had negative views about patients with chronic pain. There were significant differences among groups of physicians based on size of geographic practice area and medical discipline. CONCLUSIONS: New educational strategies are needed to overcome these barriers and to improve pain treatment in routine medical practice. The effect of practice milieu must be taken into consideration.

Acute Disease↗

NCCN Practice Guidelines for Cancer Pain.

The overall approach to pain management encompassed in these guidelines is comprehensive. It is based on objective pain assessments, utilizes both pharmacologic and nonpharmacologic interventions, and requires continual reevaluation of the patient. The NCCN Cancer Pain Practice Guidelines Panel believes that cancer pain can be well controlled in the vast majority of patients if the algorithms presented are systematically applied, carefully monitored, and tailored to the needs of the individual patient.

Acetaminophen↗

Transdermal fentanyl in children with cancer pain: feasibility, tolerability, and pharmacokinetic correlates.

OBJECTIVES: (1) To assess the feasibility and tolerability of the therapeutic transdermal fentanyl system (TTS-fentanyl) by using a clinical protocol developed for children with cancer pain. (2) To estimate the pediatric pharmacokinetic parameters of TTS-fentanyl. METHODS: The drug was administered in open-label fashion; and measures of analgesia, side effects, and skin changes were obtained for a minimum of 2 doses (6 treatment days). Blood specimens were analyzed for plasma fentanyl concentrations. The pharmacokinetics of TTS-fentanyl were estimated by using a mixed effect modeling approach. RESULTS: Treatment was well tolerated. Ten of the 11 patients who completed the 2 doses continued treatment with TTS-fentanyl. The duration of treatment ranged from 6 to 275 days. The time to reach peak plasma concentration ranged from 18 hours to >66 hours in patients receiving the 25 microg/h patch. Compared with published pharmacokinetic data from adults, the mean clearance and volume of distribution of transdermal fentanyl were the same, but the variability was less. CONCLUSIONS: Treatment of children with TTS-fentanyl is feasible and well tolerated and yields fentanyl pharmacokinetic parameter estimates similar to those for adults. A larger study is required to confirm these findings and further test the clinical protocol.

Administration, Cutaneous↗

Assessment and rehabilitation of the athlete with a "stinger". A model for the management of noncatastrophic athletic cervical spine injury.

Stingers are the most common athletically induced nerve injury of the cervical spine, but often underdiagnosed or inadequately assessed. In addition to neurologic dysfunction, biomechanical and postural faults are frequently associated with stingers. This article addresses the pathomechanics of the stinger, comprehensive clinical assessment, appropriate diagnostic testing, and a thorough review of rehabilitation techniques to allow return to competition. The principles and practical suggestions can be applied to most cervical spine injuries.

Athletic Injuries↗

Phantom limb pain and related disorders.

Postamputation phenomena, including painful and nonpainful phantom sensations occur following loss of limbs and other body parts. Peripheral and central nervous system mechanisms play a role in persistent phantom pain. Understanding the pathophysiology of this syndrome has improved in recent years. Comprehensive evaluation and a multimodality treatment approach comprise the current standard of care of the patient with phantom pain.

Central Nervous System↗

Industrial rehabilitation medicine. 1. Why is industrial rehabilitation medicine unique?

This self-directed learning module is part of the chapter on industrial rehabilitation medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Industrial rehabilitation medicine encompasses injuries and illnesses that occur in the workplace and are covered under workers' compensation. The central thesis of this article is that industrial rehabilitation medicine is a unique area because the workers' compensation system influences the behavior of injured workers. The article is divided into three sections. The first briefly reviews the history of workers' compensation in the United States, and describes eight key features of compensation systems. The second explores several hypotheses to explain why injured workers frequently have less favorable outcomes than noncompensation patients with similar medical conditions. Some explanations focus on dysfunctional psychologic reactions such as "compensation neurosis" and "disability syndrome." Others focus on contextual factors, including return to work policies by employers and financial incentives or disincentives for return to work. The third section outlines reasons why the physiatrist is often the "preferred provider" in industrial rehabilitation medicine. One crucial consideration is that many of the most important disabling work injuries are those with which physiatrists are familiar. Also, physiatric training and philosophy prepare the physician to focus on function, to work with a rehabilitation team, and to be sensitive to psychologic factors that might impede an injured worker's recovery. All of these skills are important in the treatment of injured workers.

Chronic Disease↗

Industrial rehabilitation medicine. 2. Case studies in occupational low back pain.

This self-directed learning module highlights new advances in this topic area. It is part of the chapter on industrial rehabilitation medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. The evaluation and management of patients presenting with low back pain are skills that practicing physiatrists need to acquire. This chapter gives a step-by-step format, along with the thought processes involved, for managing patients with three types of low back pain presentations.

Absenteeism↗

Industrial rehabilitation medicine. 3. Case studies in upper extremity cumulative trauma disorders.

This self-directed learning module highlights new advances in this topic area. It is part of the chapter on industrial rehabilitation medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This section contains three case studies discussing nerve, joint, and soft tissue pathology and work disability due to upper extremity pain. New areas of interest covered in this section include the controversy regarding the work causality of upper extremity disorders, a detailed review of the impact of upper quadrant postural dysfunction on symptom perpetuation, and the assessment and nonsurgical management of thoracic outlet syndrome.

Adult↗

Industrial rehabilitation medicine. 4. Strategies for disability management.

This self-directed learning module provides a practical overview of the general rehabilitative management of work disability. It is the fourth of four articles on the topic of industrial rehabilitation medicine for the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This section includes an algorithm to highlight strategies for early involvement of the physiatrist in the comprehensive management of injured workers. It also examines the broader role of the physiatrist as independent medical examiner. Finally, it explores the complexities surrounding case closure for the chronically disabled injured worker.

Algorithms↗

Combined administration of opioids with selected drugs to manage pain and other cancer symptoms: initial safety screening for compatibility.

Cancer patients suffer multiple symptoms and require numerous drug therapies. Parenteral administration of multiple medications from a single container can simplify drug regimens for patient self-administration. This simplification reduces drug preparation costs and risk of infection. Therapeutic options are limited by the lack of published information on the compatibility of opioids and adjuvant drugs. We report the results of a study evaluating the physical compatibility of injectable opioids with selected drugs for pain and symptom management. Fentanyl citrate, hydromorphone hydrochloride, methadone hydrochloride, and morphine sulfate solutions were physically compatible with 14 of 15 supportive care drugs tested through visual examination using a high intensity light beam and through measured examination using a turbidimeter over a range of times up to 48 hr. Phenytoin sodium was the only drug found to be incompatible with all opioid solutions tested. This compatibility information will assist clinicians in selecting the most efficient, safe, and cost-effective supportive care drug regimen.

Analgesics, Opioid↗

The Torg ratio.

Explore the source record for details and available documents.

Humans↗

Contemporary concepts in spine care. Epidural steroid injections.

Epidural steroid injections are commonly used for the management of lumbosacral radicular syndromes. The literature is replete with case reports and noncontrolled studies, but relatively few controlled studies exist. The well-designed studies that are available, however, do show a significantly positive pain reducing benefit from lumbar epidural steroid injections. This Contemporary Concepts review summarizes theoretic concepts, clinical applications, and data from the literature regarding the use of lumbar epidural steroid injections and provides current recommendations and suggestions for future research.

Adrenal Cortex Hormones↗