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At least 19 recordsLinked to original sources
PubMed1991

Toxic epidermal necrolysis.

To improve the past statistics of high mortality and morbidity in patients with TEN, definitive measures are required. Early referral and transfer to a burn center and withholding or withdrawing steroid therapy are two crucial factors. Therapeutic goals must be directed toward promotion of wound healing; correction of fluid and electrolyte abnormalities; provision of pulmonary care; prevention or correction of thermal disturbances; control of pain; prevention of physiologic and psychologic disabilities, which may hamper the return to activities of daily living; and above all, prevention of sepsis through protective isolation and refraining from use of invasive lines and catheters. Wound healing is best supported through gentle cleansing with physiologic saline; application of biologic or synthetic skin dressings or silver nitrate dressings; hourly eye care; nutritional support; and avoidance of infection or further injury of the dermis. Collaboration and teamwork by all health care providers are essential, and the quality of intensive nursing care makes the critical difference.

Clinical Protocols↗
PubMed1979

Hemodynamic monitoring and care of the patient of high risk for anesthesia.

Hemodynamic monitoring and care of the patient at high risk for anesthesia require a careful and systematic approach. During preoperative evaluation the patient at increased risk must be identified and correctable problems must be solved. The patient's current medications must be reviewed because they may influence the choice of anesthetic approach and may alter the physiologic response to the stresses commonly associated with anesthesia. In addition to conventional clinical and electrocardiographic monitoring, perioperative hemodynamic monitoring may be desirable for patients at special risk, who are likely to have significant associated medical problems or to undergo complicated surgical procedures. No ideal induction agent exists, and hypotension secondary to peripheral vasodilation or myocardial depression, or both, is a potential problem. Patients with an inordinately high risk may benefit from mechanical circulatory assistance prior to induction of anesthesia. Attention to oxygenation, blood volume replacement and the prevention of hypertensive episodes are particularly important during anesthesia so that optimal cardiac performance is ensured and ischemia avoided. The stresses during emergence from anesthesia contribute to lability of the cardiovascular status and hypoxemia. The period of risk does not conclude with immediate recovery from anesthesia but extends through the postoperative phase. Careful monitoring and attention to the control of pain, prevention of hypotension and hypertension, adequate oxygenation, early mobilization and resumption of the administration of cardiac medications are important factors in a successful outcome.

Aged↗
PubMed1990

Intraoperative topical etidocaine for reducing postoperative pain after laparoscopic tubal ligation.

Self-reported postoperative pain was reduced significantly (P less than .05) for up to six hours in a group of ambulatory surgical patients with the application of 5 mL of 1% etidocaine to the banded portion of each fallopian tube after laparoscopic tubal ligation with Falope Rings in comparison to a control group receiving normal saline. The etidocaine group had less nausea and vomiting and smaller antiemetic and analgesic requirements than did the control group, though those results were not statistically significant.

Acetanilides↗
PubMed1992

Behavior of patients with lung cancer: description and associations with oncologic and pain variables.

Although reflexes are recognized as protective responses to noxious stimuli, less is known about voluntary behavioral responses to cancer pain, which could provide clinicians with important diagnostic and therapeutic information. Forty-five patients with lung cancer were studied in their homes on 2 occasions to identify pain behaviors and to examine relationships between behaviors and selected variables. Patients completed the McGill Pain Questionnaire (MPQ) and Visual Analogue scale (VAS). Using a videotape observation method, patients sat, stood, walked, and reclined for 10 min. Videotapes were scored using 5 position-related and 31 pain-related behavior definitions. Within 3 days scored behaviors were described to patients who reported whether each scored behavior was performed: to express pain; because pain prevented usual behavior; to control pain; or as a habit. Patients reported that pain was controlled by 42 different behaviors; the number of different pain-reduction behaviors was correlated with pain intensity (r = 0.44) and pain quality (r = 0.64). Simultaneous multiple regression indicated that length of time pain was experienced, number of pain sites, pain quality, and pain intensity accounted for 41% of the variance in the number of pain control behaviors. None of the taped behaviors was reported as performed to express pain, and few of the patients reported that pain prevented behavior during the video session. Results clarify the pain-behavior construct, provide insight about the multidimensional nature of lung cancer pain, and suggest directions for behavioral interventions to augment pharmacological therapy for lung cancer pain.

Adult↗
PubMed1989

The influence of a combined oral contraceptive on uterine activity and reactivity to agonists in primary dysmenorrhea.

The mechanisms underlying the therapeutic effect of an oral contraceptive (150 micrograms levonorgestrel and 30 micrograms ethinyl estradiol daily for 21 days) in primary dysmenorrhea were studied by recordings of uterine activity and reactivity to lysine (L) vasopressin (VP) and prostaglandin (PG) F2 alpha on the first day of menstruation in 14 women before and after one period of oral contraceptive treatment. During the first session, when all women had moderate to severe dysmenorrhea, intra-uterine pressure recording showed an intensive uterine activity, and bolus injections of LVP (6 pmol/kg body weight; 6 subjects) or PGF2 alpha (6 or 12 nmol/kg body weight; 4 subjects in each group) increased contractile activity and discomfort. After oral contraceptive treatment, spontaneous uterine activity, measured as total pressure area, decreased significantly (p = 0.02 and p = 0.03 in the VP and PG groups, respectively). The mean uterine responses to LVP and PGF2 alpha were on average smaller after oral contraceptive treatment and the women experienced minimal discomfort after this injection. It is suggested that inhibition of uterine activity could be an important mechanism for the therapeutic effect of gestagen-dominated oral contraceptives in primary dysmenorrhea and that reduced uterine reactivity to agonists might contribute to this effect.

Adolescent↗
PubMedDate not supplied

Naproxen sodium for OB/GYN use, with special reference to pain states: a review.

The effectiveness of naproxen sodium and its parent compound, naproxen, has been assessed in the treatment of a variety of obstetric and gynecologic problems, particularly pain states. This article summarizes the literature on the efficacy of the naproxen compounds in treatment of the following conditions: primary and secondary dysmenorrhea, insertion of a contraceptive intrauterine device, suction curettage, postpartum pain, pelvic inflammatory disease, gynecologic surgery, menorrhagia, premature labor and menopause. The data from the studies compiled demonstrate the usefulness of naproxen sodium or naproxen as an effective analgesic in treating pain and inflammation associated with these conditions.

Clinical Trials as Topic↗
PubMed1987

Infiltration of the mesosalpinx for pain relief after laparoscopic tubal sterilization with Yoon rings.

Approximately 200 women of American Society of Anesthesiologists class I and II physical status electing outpatient laparoscopic tubal sterilization with Yoon rings were involved in a double-blind study to evaluate postoperative pain relief after intraoperative suprapubic infiltration of the fallopian mesosalpinx. The postoperative pain levels were lower after bilateral infiltration of 0.5% bupivacaine beneath the site of ring application. Postoperative, suprapubic infiltration provided safe, prolonged and effective pain relief, allowed prompt ambulation and early discharge, and reduced the need for narcotic analgesics and postoperative analgesia.

Adnexa Uteri↗
PubMed1978

Rheumatic disease: exercise or immobilization?

Though it may be true that, in the absence of a dependable cause, there is no single cure for inflammatory diseases of the locomotor system, nevertheless there is no reason for therapeutic nihilism. Much can be done to induce a remission in the disease while at the same time suppressing inflammation, relieving pain, preventing or correcting deformities, easing stiffness and increasing muscular control of the joints. However, no drug regime can be expected to achieve this, and reliance on drugs alone invariably leads to disappointing results, both for the doctor and patient. Hence every patient also should have a properly organized and supervised regime of physical methods of treatment. The relative value of rest or exercise remains controversial, and different considerations play a role in some of the disease processes. Thus in patients with active rheumatoid synovitis there seems no doubt that at first, extra rest to the inflamed joints is essential, but as the disease process is brought under control, the patient can be mobilized and made more active. In patients with ankylosing spondylitis, the emphasis should be placed on activity and exercise.

Arthritis, Rheumatoid↗
PubMed1989

Lifestyle and low-back pain. The influence of smoking and obesity.

The authors examined associations between back pain prevalence and lifestyle factors (smoking and obesity) using national survey data. Back pain prevalence rose with increasing levels of smoking, with a relative risk of 1.47 for persons reporting 50 or more pack-years of smoking. This association was strongest in persons under the age of 45 years, however, for whom the corresponding relative risk was 2.33. There were similar trends toward greater prevalence with increasing body mass index, but prevalence rose substantially only in the most obese 20% of subjects (1.7 times higher than the lowest 20%). In a logistic regression, smoking and obesity contributed independent risk, even after controlling for age, education, exercise level, and employment status. Programs for back pain prevention may wish to test interventions for these lifestyle-related factors.

Adult↗
PubMed1989

Experimental studies on the prevention and treatment of chickenpox and herpes zoster with measles vaccine.

In 151 chickenpox patients treated with live attenuated measles vaccine, the cure rate was 100%. In 145 cases of herpes zoster, the effective rate was 100% (completely cured in 91.7% and improved in 8.3%). In the treated group, the time needed for the subsidence of fever and skin rash and the duration of the disease were markedly shorter than those in the control group (P less than 0.01). It is particularly effective for alleviating pain, preventing and relieving postherpetic neuralgia in patients with zoster. The application of measles vaccine to the patients in the chickenpox incubation period might prevent the development of the disease, and decrease the incidence and death rate of varicella zoster virus infection in highly susceptible patients. The mechanism of its anti-viral action and production of interferon in the body is discussed.

Chickenpox↗
PubMed1987

Advances in orthotics for the patient with rheumatoid arthritis.

Orthotics are externally applied devices which support a joint or enhance its function. In arthritis orthotics are prescribed to stabilize joints, provide better positioning, reduce pain, prevent deformity and improve function. Splints are used primarily for the upper extremity. Specially designed shoes can control foot and ankle pain and instability. Continuous passive motion devices are becoming widely used for early postoperative rehabilitation after arthroplasty. Unfortunately, few controlled studies have been performed to determine the utility of orthoses in patients with arthritis. Some of the most important questions on this subject are posed and available data discussed as well as the need for additional information.

Arthritis, Rheumatoid↗
PubMed1992

The role of patient education in cancer pain control.

Patient education should be a central component of pain control regimens for cancer patients. Few systematically developed and carefully evaluated pain control patient education programs have been reported. Patient education for cancer pain control should include five phases: assessment, goal setting, selection of educational strategies, implementation and reassessment. Each of these phases should be included to maximize the goals of pain prevention and pain relief.

Humans↗
PubMed1984

[Postoperative pulmonary function following abdominal surgery. Comparison of continuous, segmental thoracic peridural anesthesia and intramuscular piritramide injections].

Respiratory function was studied in 35 patients after upper abdominal surgery, who had been randomized into two groups. 15 patients (median age: 59 years) were operated on using neuroleptanalgesia and received intramuscular piritramide as postoperative analgesic. A continuous thoracic epidural was placed prior to surgery in 20 patients (median age 52 years). A light general anaesthesia was additionally given when these patients were operated on. Postoperatively, epidural analgesia was continued by infusion of 0.25-0.3 ml/kg X h 0.125% bupivacaine via epidural catheter over a period of 4 days. If pain prevention during coughing and getting up was not complete, top-ups of 6-10 ml 0.25% bupivacaine were given additionally. Respiratory function (FVC, peak expiratory flow, VT, VD/VT, RR, MV, VA, AaDO2(0.21), PaO2 and PaCO2) was investigated before surgery, and on the 1st, 3rd and 5th postoperative day, the patients breathing room air. Results (the median of each groups is plotted, the values of the epidural group being in brackets. 0: preop., 1: first, 3: third, 5: fifth postop. day): FVC 0: 3.05 (3.16) 1: 1.42 (1.40) 3: 1.64 (1.42) 5: 1.39 (2.27) 1. Peak expiratory flow 0: 310 (287) 1: 118 (113) 3: 130 (127) 5: 153 (194) 1/min. Respiratory rate 0: 16 (14.5) 1: 20 (18.5) 3: 16 (18.5) 5: 17 (17) min-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1990

Effect of repetitive electroconvulsive treatment on sensitivity to pain and on [3H]nitrendipine binding sites in cortical and hippocampal membranes.

The effect of electroconvulsive shock (ECS) on the responsiveness to pain (measured by the hot-plate test) and on the characteristics of L-type calcium channels (measured as [3H]nitrendipine binding sites) in the cortex and hippocampus was tested on the Wistar rat. In animals receiving a single ECS, the calcium channel density and affinity 24 h after treatment did not differ from the controls; the response to pain was also at the control level. Repeated ECS (eight once-daily shocks) resulted in an increased responsiveness to pain (shortening of response latency) and in an increase in the density of cortical, but not hippocampal, calcium channels. The KD value for [3H]nitrendipine binding sites in either brain region remained unaltered by ECS. The calcium channel antagonist nifedipine, which by itself did not significantly alter the response to pain, prevented the enhancement of pain sensitivity brought about by ECS. The results suggest activation of calcium-dependent mechanisms by repeated ECS and confirm the involvement of calcium channels in pain mechanisms.

Animals↗
PubMedDate not supplied

Supportive care in oncology.

Pain management, nutritional support, and psychosocial support are fundamental services that enhance patients' ability to cope with their cancer and its therapy. The common goal of symptom prevention mandates that each of these supportive services be provided to all patients throughout their cancer experience. Comprehensive cancer pain management begins with identifying the origin of all of the patient's pains and treating each one specifically. Pain prevention can be achieved through around-the-clock opioid administration with as-needed supplements for breakthrough pain and dose titration. Common narcotic side effects such as constipation and nausea also must be prevented. Successful opioid analgesia requires that patient and family concerns regarding addiction and tolerance be dispelled at the outset. Cancer pain prevention can be further optimized with the use of appropriate coanalgesics in response to the pathophysiology of the patient's pains. Cognitive and behavioral therapies may also be useful adjuncts to reduce both pain and suffering. Procedure-oriented pain control should be considered when systemic pharmacologic therapy does not provide adequate pain relief or is associated with intolerable side effects. The only absolute contraindications for pain-relieving procedures are untreatable coagulopathy and a decrease in mental status not related to medical pain management. Useful neurodestructive techniques include radiofrequency lesioning, cryoanalgesia, and chemical neurolysis with agents such as phenol, alcohol, and hypertonic saline. The most beneficial pain-relieving procedures and percutaneous cordotomy, spinal narcotics, celiac and hypogastric plexus ablation, spinal neurolysis, and epidural injection of steroids and hypertonic saline. Procedure selection depends on the cause of the pain and the patient's prognosis. Common indications for pain-relieving procedures include unilateral pain below the shoulder, upper abdominal visceral pains, pelvic visceral pain, perineal pain, vertebral body metastasis, discogenic pain, and spinal stenosis. As results of well-conducted scientific trials begin to appear in the literature, the indications for these procedures will be better understood, resulting in their more appropriate use. Principles of nutritional support in patients with cancer include an awareness of the problem of malnutrition and its impact on performance status, quality of life, prognosis, and treatment; identification of those patients at risk; prophylactic versus therapeutic intervention; and analysis and management of the specific impediment(s) to adequate nutrient intake and absorption. The primary goals for nutritional support in cancer patients are prevention of weight loss and maintenance of adequate protein status. Appreciation of practical issues of nutritional support will enable the practicing physician to achieve these goals using primarily oral nutrition options.(ABSTRACT TRUNCATED AT 400 WORDS)

Analgesics, Opioid↗
PubMed1992

[Prevention and control of pain in (adeno)tonsillectomy].

Pain prevention and analgesia in (adeno)tonsillectomy OBJECTIVE. To study the efficacy of three analgesia protocols in children subjected to (adeno)tonsillectomy. SETTING. Twenteborg District Hospital, Almelo, the Netherlands. PATIENTS AND METHODS. In 64 children with body weights ranging from 15 to 25 kg (mean 20.4 kg) subjected to (adeno) tonsillectomy according to the procedure most current in the Netherlands (according to Sluder with administration of a volatile anaesthetic without intubation in day treatment), three protocols for preventing and treating postoperative pain were applied, with the analgetics most current in the Netherlands. Permission from the Medical Ethical Committee and written informed consent from the parents were obtained. According to protocol I 240 mg paracetamol was given, according to protocol II, 500 mg paracetamol and according to protocol III, 500 mg paracetamol plus 10 mg codeine, in suppository form, every 4 hours always starting 60 minutes before operation. Initially, protocol I was carried out, subsequently randomization of protocols II and III. After a pilot study use of a control group was omitted for ethical reasons because of the severe pain in a placebo group. MEASUREMENTS. The efficacy of the analgesia was evaluated by means of pain assessments by the children themselves using the Oucher test, 1, 3 and 6 hours after operation. The statistical processing of the children's pain scores was performed primarily in a descriptive sense, with simultaneous comparison of the three groups using a single variance analysis for comparison of several groups. Multiple comparisons were carried out according to Ducans' multiple range test. The level of significance was put at p less than or equal to 0.05. RESULTS. One hour postoperatively there was no significant difference among the mean pain scores (0: no pain and 10: very bad pain) of the three groups, viz. 5.2 (SD 3.0), 4.7 (SD 2.9) and 4.7 (SD 2.3), respectively; three hours postoperatively there was a significant difference between the mean pain scores of group I (4.5; SD 2.4) and group II (2.7; SD 2.4) but not between group I and group III (3.3; SD 1.5); six hours postoperatively there was a significant difference between the mean pain scores of group I (4.1; SD 2.1) on the one hand and of groups II (2.1; SD 1.5) and III (2.6; SD 1.6) on the other. CONCLUSION. The findings indicate existence of violent pain immediately after recovery from anaesthesia after (adeno)tonsillectomy as shown by the pain assessments by the children themselves one hour postoperatively, in spite of preventive administration of a high dose of a 'minor' analgetic according to each of the three protocols. Modification of the anaesthetic technique should be considered to effect adequate prevention or suppression of pain.

Acetaminophen↗