Treatment chronic pain

Dosages and routes of administration For acute (postoperative) pain and for anesthesia, fentanyl is given by the intravenous route. For pre-medication in anesthesia and for break-through pain the compound can also been given as an oral-transmucosal formulation (Ashburn and Streisand, 1994). A transdermal patch has been developed for chronic pain treatment (Jeal and Benfield, 1997 O Siordin, 1998). The intravenous doses for premedication are 50-100 pg, oral-transmucosal systems contain 200-400 pg and patch formulations have a delivery rate of 25-100 pg/h. 

Dosages and routes of administration Morphine is available in different salt forms but the hydrochloride and sulfate (Vermeire and Remon, 1999) are used preferentially. The compound can be administered by the oral, parenteral or intraspinal route. Oral application is preferred for chronic pain treatment and various slow release forms have been developed to reduce the administration frequency to 2-3 times per day (Bourke et al., 2000). Parenteral morphine is used in intravenous or intramuscular doses of 10 mg, mostly for postoperative pain and self-administration devices are available for patient-controlled analgesia (PCA). Morphine is additionally used for intraspinal (epidural or intrathecal) administration. Morphine is absorbed reasonably well in the lower gastrointestinal tract and can be given as suppositories. 

SNRI (dual serotonin and norepinephrine reuptake inhibitor) antidepressant chronic pain treatment... 

Horner s syndrome has been reported after lumbar epidural block in two other patients who were having lumbar epidural anesthesia for chronic pain treatment (144). The authors suggested that this complication had probably occurred through anatomical changes in the epidural space, leading to a high degree of sympathetic blockade. 

The primary uses of methadone hydrochloride (Dolo-phine, others) are relief of chronic pain, treatment of opioid abstinence syndromes, and treatment of heroin users. It is not used widely as an antiperistaltic agent. It should not be used in labor. 

Klein E, Uhde TW, Post RM Preliminary evidence for the utility of carbamazepine in alprazolam withdrawal. Am J Psychiatry 143 235—236, 1986 Kouyanou K, Pither CE, Wessely S Medication misuse, abuse and dependence in chronic pain patients. J Psychosom Res 43 497-304, 1997 Kryspin-Exner K [Misuse of bezodiazepine derivatives in alcoholics] (German). Br J Addict Alcohol Other Drugs 61 283-290, 1966 Kryspin-Exner K, Demel 1 The use of tranquilizers in the treatment of mixed drug abuse. Int J Clin Pharmacol Biopharm 12 13-18, 1973... 

In general, treatment of the asthma underlying NSAlDs sensitivity should follow standard asthma guidelines. This type of asthma is often severe and frequently high doses of inhaled corticosteroids and daily doses of oral corticosteroids are necessary. A special treatment option is a chronic desensitization to aspirin [8]. Desensitization and aspirin maintenance is routinely used in some centers for treatment of chronic rhinusinusitis with nasal polyposis. It is the only available procedure which allows AIA patients with ischemic heart disease to use aspirin. During the state of desensitization to aspirin, not only aspirin but almost all strong NSAIDs are tolerated, so desensitization and NSAID maintenance could be used for treatment of rheumatic disease or chronic pain syndromes. 

For some conditions, a large placebo effect can be anticipated. For example, studies of hormone replacement therapies for hot flashes in postmenopausal women consistently show a 50% decline from baseline in the number of daily hot flashes in the placebo group. Therefore, in order to show significance, an active treatment must produce an effect that is substantially larger than 50%. A marked placebo response is commonly observed with any condition that has a subjective component, such as chronic pain (e.g. arthritis), episodic pain (e.g. headaches), psychological states (e.g. anxiety), and certain physiologic measurements (e.g. blood pressure). 

NEW APPROACHES TO TREATMENT OF CHRONIC PAIN A REVIEW OF MULTIDISCIPLINARY PAIN CLINICS AND PAIN CENTERS. Lorenz K.Y. 

Treatment of musculoskeletal disorders involves three phases (1) therapy of an acute injury using the RICE principle, (2) pain relief using oral or topical agents, and (3) lifestyle and behavioral modifications for rehabilitation and to prevent recurrent injury or chronic pain (Fig. 57-3). 

Owing to the lag time between initiation and effect, capsaicin is not used for treatment of acute pain from injury. Instead, topical capsaicin is used for chronic pain from musculoskeletal and neuropathic disorders. Capsaicin preparations have been studied in the treatment of pain from diabetic neuropathy, osteoarthritis, rheumatoid arthritis, postherpetic neuralgia, and other disorders.48 It is often used as an adjuvant to systemic analgesics in these chronic pain conditions. 

Mason L, Moore RA, Derry S, et al. Systematic review of topical capsaicin for the treatment of chronic pain. Br Med J 2004 328 991. 

Buprenorphine is a weak analgesic [91], which precludes its ability to replace morphine in the treatment of chronic pain. However, development of compounds that interact with /u receptors in a similar manner as buprenorphine but that are more effective agonists and analgesics could lead to the development of drugs that can be used for the treatment of chronic pain but which have little or no abuse potential. 

Since 3 agonists have few of the long-term side effects of ft agonists, 3 agonists that could overcome tolerance development may be useful drugs in the treatment of chronic pain. In fact, the non-peptide 3 selective agonist SIOM [100] did not de-... 

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