Cancer: Palliative Care examines the nature of the care and support that can be provided to those in need of palliative care and their families. This covers not only the physical treatment, such as pain management, but also the psychological well-being of patients. Health workers, clinicians, specialist nurses and medical students will find a balanced and thoughtful overview of the subject which will be of value in managing patients and helping them to come to terms with their condition.

Dipyrone is widely acknowledged to be an effective antipyretic analgesic with an additional intrinsic spasmolytic activity. It has stood the test of time over the last 75 years in many clinical settings throughout the world. Some 20 years ago, however, concern arose over the implications of isolat ed reports of agranulocytosis following use of dipyrone. Based on these initial cases the Swedish authorities ordered the withdrawal of the drug from the market. Subsequently, dipyrone has been subjected to extensive comparative epidemiological and clinical studies. The results of these in vestigations have allayed the earlier concerns and have shown dipyrone to be a versatile analgesic drug with an overall risk of serious adverse events lower than most other non-opioid analgesics. Based on these results, the Swedish authorities (Lakemedelsverket) have approved the reintroduc tion of dipyrone to clinical use as a valuable contribution to pain treat ment. In connection with this further milestone in the story of the drug, a symposium was held in Stockholm on March 14, 1996, under the chairman ship of Professor N. Rawal to review the current understanding of the ac tion, efficacy and safety of dipyrone. The highlights of this Hoechst symposium emphasize particularly the therapeutic basis for the use of dipyrone in the modern treatment of acute post-operative pain. 9 Mode of action of dipyrone Professor K. Brune, M. D. Erlangen, Germany Most non-opioid analgesic drugs are inhibitors of cydo-oxygenase, the en zyme catalysing the formation of prostaglandins (PGs).

There is no ideal analgesic and the most potent drug is not always the best because of its side-effects. Non-opioid analgesics, including the non-steroi- dal anti-inflammatory drugs and the non-narcotic analgesics, play an im- portant role in the relief of a wide spectrum of painful conditions, though they vary in efficacy and safety. This book reviews the role which non-opi- oid analgesics play in the relitff of pain, particularly with regard to post- operative and cancer pain. Emphasis is placed on the clinical indications for the non-acidic analgesic, dipyrone, and its relative safety in comparison to other non-opioid anlgesics. Michael J. Parnham 9 Introductory remarks Klaus A. Lehmann, Department of Anaesthesiology and Operative Intensive Care, University of Cologne, J osef-Stelzmann-Str. 9, D-50924 Cologne, Germany Opioids are considered to be the most potent analgesics for the manage- ment of acute and chronic pain. Much progress has been achieved with respect to their general availability in most countries, and health care per- sonnel have been encouraged to use these drugs more generously in a vari- ety of pain syndromes, including post-operative or cancer pain. The intro- duction of new techniques such as Patient-Controlled Analgesia (PCA) or guidelines such as the WHO ladder concept for cancer pain mangement have considerably increased our knowledge of their benefits and prob- lems.

INTRATHECAL DRUG THERAPY FOR SPASTICITY AND PAIN is a practical manual for nurses and physician assistants who use Intrathecal Drug Infusion for treating patients suffering from spasticity and chronic pain. This book supplies users of this new technology with the information they need to utilize it effectively, including pump mechanics and the pharmacology of drug delivery. No other book of its kind exists, and its users at the over 100 facilities that use implanted drug delivery have relied solely on the pump manufacturer's manuals. The authors are from a leading center for research and applied use of these pumps and, working with Dr. Richard Penn, have spent years developing the skills necessary to utilize this system efficiently. Dr. Penn, who writes the Foreword, has personally implanted over 3000 pumps.

Pain in oncology, and especially in patients with advanced disease, is an essential issue which cannot be overlooked. Today, pain is worldwide recognised as a very complex symptom which includes different aspects such as somatic, spiritual, social and psychological pain. Practical and scientific knowledge of pain in cancer should be part of the pre and post training of general practioners and oncologists. This manual reflects the opinion of different authors, contributors to pain clinic. These guidelines cover all different aspects of cancer pain. It responds to a need for information, education and training in the field of diagnosis and treatment of cancer pain. The reader will find useful information and suggestions as how to diagnose and treat pain from a pharmacological, surgical and psychosocial point of vIew. Pain therapy is a very important part of quality of life; due to its relevance, we think that this manual will be a useful tool for all health professionals, and we are grateful to Drs. K. Foley and F. De Conno for their generous contribution in making this effort successful. Alberto Costa Director European School of Oncology Vlll Acknowledgements The European School of Oncology wishes to acknowledge Janssen Pharmaceutica for an educational grant for the sponsorship of this manual. Pain - definitions, classification and pain. Patients who are aware that their causes pain is temporary have a more positive attitude.

While recognizing the multidisciplinary nature of pain management, the Clinical Manual of Pain Management in Psychiatry focuses on the role of mental health practitioners in evaluation and assessment, pharmacological management, psychotherapeutic interventions, and comprehensive treatment planning. It balances theoretical foundations of pain pathophysiology with applied clinical information, providing guidelines to psychiatric differential diagnosis of pain states and psychiatric comorbidities associated with pain and integrating diagnostic and treatment approaches. Because proper treatment requires understanding the whole person, the book views the patient from biological, psychological, and social perspectives. It stresses the importance of examining psychological variables that can limit outcomes and even preclude aggressive interventional approaches. The manual also includes considerations pertinent to the elderly, children, and cultural groups.

This manual expands on the author's previous Concise Guide to Pain Management for Psychiatrists to reflect significant advances in the field of pain medicine. It updates trends in treatment approaches along with our understanding of chronic pain conditions, and presents new knowledge of the biological substrates underlying both pain and psychiatric comorbidities. The manual features particularly extensive revisions regarding the use of psychiatric and other adjunctive medications in pain management, including expanded discussion of long-term adverse effects, dependence, and pseudoaddictive behaviors involving opiates and weak analgesics. It also delineates the use of adjunctive treatments, including evolving data on the use of antidepressants and related medications for patients with chronic pain. Among the its practical benefits, the book - Features updated coverage of common psychiatric comorbidities such as depression, anxiety, and personality disorders- Addresses common pain disorders ranging from headache and back pain to pain related to cancer and HIV- Includes an extensively revised chapter on pharmacology, familiarizing readers with the range of pain medications and providing information on dosages and side effects- Fully discusses psychotherapeutic approaches, plus adjunctive interventions such as biofeedback and hypnosis - Covers special techniques such as acupuncture and regional neural blockade- Offers updated advice on emerging forensic issues, from disability claims to controlled substance diversion

With pain management issues so common in daily practice, this handy portable guide is designed for quick reference, features numerous tables and illustrations, and is easily understandable by less experienced clinicians or non-pain specialists. While written expressly for busy psychiatrists, it is also useful to psychologists, social workers, and other physicians.

This monograph presents electric therapy for the reduction of pain in a different way than the classical well known manner to use electric currents of various kinds for this purpose. It started when Melzack and Wall published their theory of pain. But contrary to most researchers, the author looked for a proof which objectively could demonstrate, that electric current would have an influence on nerve fibers conducting pain. Starting from this model of demonstration, an optimal type of current could be selected as well as optimal electrode positions and sizes of electrodes. It is an absolute new approach presenting the results of applying the type of current to more than 17.000 patients suffering from any kind of pain. Anatomic sketches and photo-documentation of electrode positions for many conditions allow the reader to obtain identical degree of pain reduction as the author describes from his great experience. In addition, a brief theoretical introduction and discussion of the influence of weather on pain is given. Practical forms for the management of pain are presented in an appendix. 256 references and a table of suitable apparatus with their essential technical characteristics facilitates correct application of this new principle.

Largely reorganised and much expanded in this second edition, Practice and Procedures brings together in a single volume general methods of pain assessment and presents the wide range of therapies that can be provided by a range of health care disciplines. Authored by a multidisciplinary team of experts, chapters can stand alone for readers looking for a general overview of the methods of techniques for pain management available to them or work to complement chapters in the preceeding three volumes, providing practical procedures and applications in the management of acute, chronic and cancer pain. The book is divided into three parts. Part One covers the principles of measurement and diagnosis, including history taking and examination, the selection of pain measures, diagnostic tests and novel imaging techniques. Part Two discusses the full range of therapeutic protocols available, from pharmacological therapies, through psychological techniques, physical therapy and international procedures, to techniques specific to pain assessment and management in paediatric patients. Part Three provides information on planning, conducting, analysing and publishing clinical trials, with invaluable guidance on the techniques of systematic review and meta-analysis in pain research. Part Four considers the role of multidisciplinary pain management teams, their organization, their place within different health care systems, and how best to manage change when implementing such a service. Part Five concludes the volume, investigating the use of guidelines, standards and quality improvement initiatives in the management of post-operative pain, and discussing the expert medicolegal report.

Epidural opioids are widely used in the management of post- operative pain. On the basis of an extensive review of the literature the authors here present their own interpretation of current knowledge of how the distribution and effectiveness of epidurally administered opiods are fundamentally determined. They conclude that all opioids that are currently being used to treat postoperative epidural pain carry the potential risk of severe side effects if the dose regimens are not tailored to the patients individual analgesic need. This book will serve to stimulate new ideas among pain specialistst.

E.MARTIN Acute pain services are now established worldwide and guidelines have been drawn for the management of acute pain resulting from surgical or medical procedures and trauma. However, the treatment of pain after surgery is still inadequate and no progress has been made in recent years in several coun tries, including Germany. There are still innumerable patients who find the is also no early postoperative period to be an unpleasant experience. There doubt that pain plays a role in the pathogenesis of postoperative complica tions that could be avoided with effective pain management. However, concern about side effects and inadequate knowledge of the pharmacokinet ics and -dynamics of drugs is still putting constraints on treatment. An acute pain service should be responsible for adequately treating pain, training medical and nursing staff, and evaluating new and existing methods of treatment. As anesthesiologists deal with pain in the operating theater, it is not surprising that they claim a leading role for themselves in acute pain services choosing from the various postoperative pain treatment options."

This book is a critical response to a range of problems - some theoretical, others empirical - that shape questions surrounding the lived experience of suffering. It explores how moral and ethical questions of personal suffering are experienced, contested, negotiated and institutionalised. Bodies and Suffering investigates the moral labour and significance invested in actions to care for others, or in failing to do so. It also explores circumstances - personal, political and social - under which that which is perceived as non-moral becomes moral. Drawing on case studies and empirical research, Bodies and Suffering examines the idea of the suffering body across different cultures and contexts and the experience and treatment of these suffering bodies. The book draws on theories of affect, embodiment, the phenomenology of illness and moralities of care, to produce a nuanced understanding of suffering as being located across the assumed borders of time, space, bodies, persons and things. Suitable for bioethicists, medical anthropologists, health sociologists and body studies scholars, Bodies and Suffering will also be of use on health science courses as essential reading on suffering bodies, mental health and morality and ethics issues.

Since 1961, when pain therapy was introduced by Bonica, the- re have been world-wide efforts to establish basic regimens for the treatment of chronic pain. Yet many patients still continue to suffer from intractable pain despite the availa- bility of effective treatment that would greatly improve their quality of life. The lack of specialists familiar with recent developments is one of the causes. There is con- sequently a great demand for interdisciplinary pain clinics and specialist training programs. This book constitutes both a valuable introduction and an overview of current basic regimens and the latest sophisticated techniques in pain therapy.

Aimed at health care professionals and their colleagues, ministers of religion and funeral directors, this comprehensive work of reference describes the complex procedures required when someone dies. The information should be of value to all those who are concerned with the correct handling of situations as diverse as fatal mass disasters and the rites that are associated with those who hold unfamiliar religious beliefs. The guide is in three parts: legal and technical aspects; considerations for the living, care of the dying, and death with dignity; and religious, ethnic and cultural aspects of dying and death. The author combines medico-legal facts and practical, sensitive advice.

Abundant evidence indicates that TENS can be used effectively to alleviate certain pain syndromes. For patients suffering from chronic musculo-skeletal pain in particular, TENS offers an alternative means of pain management. This book addresses the need among physiotherapists for a practical manual on the application of this relatively new technique. Numerous illustrations provide guidelines for the choice of stimulation parameters, the selection of electrode positions, as well as other aspects related to technique. A brief introduction to the neurophysiological mechanisms of pain and the pain-relieving effects of TENS is also given. These special features make this comprehensive presentation of particular interest to physiotherapists and clinicians actively engaged in the management of patients suffering from pain.

This volume reviews the state-of-the-art in osteoarthritis. The pathogenetic roles of mechanical, systemic and inflammatory factors and the importance of neurogenic factors in pain management and in the causes of disease are considered. Of particular value is the review of the implications of pathogenetic mechanisms in future modes of management. The concept of "activated arthrosis" is given special attention. Finally, controversial issues and new areas for investigation are discussed. The book will help the clinician and the investigator consider the importance of addressing different phases and subtypes of osteoarthritis in planning treatment.

Sportliche HAchstleistungen werden heute oft nur noch unter Schmerzen erbracht und viele Sporttreibende leiden unter schmerzhaften Bewegungs- und LeistungseinschrAnkungen. Der mit groAen Schmerzen verbundene Tod einer begabten Hochleistungssportlerin ging in jA1/4ngster Vergangenheit durch alle Medien. In diesem Buch wird erstmals der aktuelle Themenbereich Schmerz und Sport aus interdisziplinArer Sicht umfassend abgehandelt. Sportmediziner, OrthopAden, Physiologen, Schmerz- und Physiotherapeuten, Psychologen, Trainer und Sportler vermitteln in ihren BeitrAgen wichtige Hinweise fA1/4r eine richtige und schmerzfreie SportausA1/4bung und eine interdisziplinAre schmerztherapeutische Versorgung der sporttreibenden BevAlkerung. AuAerdem wird die Frage angesprochen, inwieweit es vertretbar ist, das physiologische Warnsignal Schmerz durch Arztliche und andere MaAnahmen auszuschalten. Ein aktuelles Buch zu einem aktuellen Thema.

The existence of a differential block is still part of the theory of regional anaesthesia. In 1980 it was described in detail by Cousins and Bridenbough in their standard work Neural Blockade. The theory of differential sensitivity of fibres in the peripheral nervous system essentially goes back to Gasser and Erlanger, who in 1929 established that when isolated peripheral nerves are electri- cally stimulated in the presence of increasing concentrations of co- caine, the compound action potentials of slow-conducting fibres are blocked before those of fast-conducting fibres show any measur- able changes. In man, regional anaesthesia begins subjectively with a feeling of warmth, objectively with a corresponding increase in skin tem- perature. There is then, in order of occurence, loss of sensation of cold, heat and pain, and pressure and touch, and fmally loss of voluntary motoricity. In recovery from anaesthesia, these return in the reverse order. The theory of differential block is by no means undisputed. In 1981, de Jong, commenting in Anesthesiology on the work pub- lished in that journal by Gissen et al. which showed a new sequence of differential sensitivity in the rabbit, wrote, "There remains plen- ty to be done yet before the book on differential nerve block can be closed".

In September 1983 the First International Headache Congress took place, the founding congress of the International Headache Society (lHS). This meeting was attended by around 200 headache specialists from some 20 countries. One of the principal goals of the IHS, which was formed in London in 1982, is to promote and stimulate interest and research in the headache field. In addition to the sponsorship of continued-education events, this also involves the coordination of scientific pro jects and the organization of future conferences. There is no doubt that headaches represent an everyday problem in medical practice. When the first headache clinics were established some years ago, they were regarded as very progressive. Today there are special outpatient centers and clinics for headache patients. However, this specialization has certainly not progressed very far. The fact is that differential diagnosis and treatment of recurrent and chron ic headaches represents a broad field that cuts across many disciplines. Headaches are thus relevant not only to the neurologist, but also to the psychiatrist, the neuro surgeon, the internist, the endocrinologist, the psychologist, the pharmacologist, and the biochemist. Despite intensive research in numerous and very disparate medical disciplines there are still no generally accepted pathophysiologic concepts for many headache syndromes. Realizing the importance of a multidisciplinary fo rum, the IHS assumed the organization of this congress in collaboration with the German Migraine Society."

The phenomenon of phantom limb was described in medical literature at least as early as 1545 by Ambroise Pare, according to the notes in the translation of Lemos' dissertation, "On the Continuing Pain of an Amputated Limb", by Price and Twombly [9]. This strange experience was brought to public attention by a popular essay anonymously published 1866 by Mitchell concerning the story of George Dedlow, a quadriamputee who described his invisible limbs [7]. In 1871 Mitchell wrote under his own name, and was the. first to use the term "phantom limb" [8]. In this work, he also corrected some erroneous beliefs that had arisen from his 1866 essay [13]. Most amputees report feeling a phantom limb almost immediately after amputation of an arm or a leg [11]. It is a positive sensation, usually described as tingling or numbness, which is not painful. The most distal parts of the limb, particulary the digits, thumb, and index, are the strongest and most persisting phantom sites, and may be the only parts to appear even after removal of a whole limb. The elbow or knee is sometimes involved, the forearm or lower leg rarely, and the upper arm and thigh almost never [5]. The phantom thus appears to consist predominantly of those parts which have the most extensive representa tion in the thalamus and in the cerebral cortex.

Up to 35% of adults suffer from chronic pain, and a substantial number of these patients are admitted to hospitals every year. A major concern of these patients is whether the pain will be adequately controlled during hospitalization. these patients are more likely to have poor pain control and may experience an exacerbation of their co-exisitng chronic pain condition during hospital admission. Adequate pain control is directly related to clinical outcomes, length of hospital stay, and patient satisfaction. A considerable body of evidence demonstrates the medical, social, and economic benefits of satisfactory inpatient pain control. Currently, there are limited pain control guidelines to address this challenging inpatient population. In fact, there are no guidelines outlinign best practices for postoperative pain control in patients with chronic pain. The complex nature of chronic pain and a dearth of publications addressing the concerns of these patients make the creation of relevant guidelines difficult. The goal of this book is to equip clinicians to provide safe and effective management of hospitalized patients with co-existing chronic pain. Each chapter addresses a particular clinical question and is written by an expert in the field. Chapters describe basic principles and specific clinical situations commonly encountered during the care of patients with co-existing chronic pain in hospital settings.

Everyone experiences pain, whether it's emotional or physical, chronic or acute. Pain is part of what it means to be human, and so an understanding of how we relate to it as individuals - as well as cultures and societies - is fundamental to who we are. In this important new book, the first in Routledge's new Critical Approaches to Health series, Robert Kugelmann provides an accessible and insightful overview of how the concept of pain has been understood historically, psychologically, and anthropologically. Charting changes in how, after the development of modern painkillers, pain became a problem that could be solved, the book articulates how the possibilities for living with pain have changed over the last two hundred years. Incorporating research conducted by the author himself, the book provides both a holistic conception of pain and an understanding of what it means to people experiencing it today. Including critical reflections in each chapter, Constructing Pain offers a comprehensive and enlightening treatment of an important issue to us all and will be fascinating reading for students and researchers within health psychology, healthcare, and nursing.

Understanding Low Back Pain chart uses low back pain guidelines from the American Pain Society (APS) and the American College of Physicians (ACP) as a key reference, this visual and textual overview of the condition explains: Types of low back pain Causes and risk factors Signs and symptoms Treatment and management Prevention techniques This chart illustrates: A human figure (posterior view) with pain radiating into the leg and numbness and tingling in the leg Sagittal view of lower spine with: tumor of the spinal cord, bone spur impinging on spinal nerves, compression fractures and herniated disc impinging on spinal nerve Anterior view of the lower spine and pelvis showing tumors, infections, degenerative diseases, ankylosing spondylitis, sacroiliitis, arthritis, and intrapelvic mass Correct postures and techniques to avoid low back pain Made in USA Available in the following versions: 20" x 26" heavy weight paper laminated with grommets at top corners ISBN 9780781782432 20" x 26" heavy weight paper ISBN 9780781782425

Epidural Anaesthesia: Images, Problems and Solutions brings together the most comprehensive collection of post-block epidurograms in the world into a single volume. With accompanying X-rays and contrast injection images, it clearly explains why an epidural block has failed and provides practical advice on how to avoid complications in the future. Key featuers: Contains over 180 clearly labelled X-rays and contrast injection images to help you learn using these examples. Uses X-rays and contrast injection images rather than more complext imaging technologies, to allow quick assessment of blocks in the most basic radiology department. Written by a world-renowned expert, providing consistency of style and approach throughout. Companion website contains downloadable images as well as moving X-rays of contrast injection, 3D reconstructions and explanatory cartoons. This unique book for specialist and trainee anaesthetists demonstrates, with simple X-rays and contrast injection, why epidurals are occasionally imperfect. Epidural Anaesthesia: Images, Problems and Solutions will enable you to refine your technique and avoid adverse outcomes in practice.