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Pain and K. Laurent biography, Pain and K. Laurent discography
Welcome at the Djshop a Online Shop for Vinyl and mp3 Downloads.Du nouveau sur le myspace(photos,visuel...Au fait je t'en commande d'autres pour ma page...This is not a MySpace login page, please do not enter your MySpace login information (email address or password).Id + " Link: " + targetLink.Id + " Text: " + targetLink.Departments of Anesthesiology, Neurology, and Epidemiology, the Center for Clinical Epidemiology and Biostatistics, the University of Pennsylvania Cancer Center, Philadelphia, Pennsylvania.The neurologist's unique understanding of the complex interactions that occur in the nervous system can provide a significant contribution to the care of patients with pain.An equally important role of the practicing neurologist, therefore, is to acknowledge the patient's experience of pain without attempting to validate its source.This article includes strategies for approaching a neuropathic pain patient, useful methods to treat the whole patient, and a discussion of why a holistic approach is important.Copyright 2001 Galen Publishing, LLC.Treating neuropathic pain means treating the neuropathic pain patient by first understanding what the patient is experiencing.Yet, the pain is completely real to the patient, and may even be incapacitating.The primary role of the physician is to make the appropriate diagnosis and focus treatment on the most important features of the patient's pain as reported by the patient.The International Association for the Study of Pain (IASP) defines pain as: "The unpleasant sensory and emotional experience of actual or potential tissue damage or an experience expressed in such terms."Despite the exponential growth of our knowledge about the brain in recent years, we do not yet understand the intricate pathophysiological mechanisms of neuropathic pain.Similarly, the success of treatment can be assessed only by individual patients reporting on changes in their symptoms.Neuropathic pain is caused by nerve damage proximal to the sensory nerve endings in the skin.Neuropathic pain has no protective or predictive value, because it persists long after tissue (i.In essence, the lack of a specific measure of tissue damage does not preclude the sensation of pain.Patients with neuropathic pain may also report fatigue, difficulty in concentrating, depression, and insomnia, and the severity of these symptoms may seem disproportionately high relative to the initial injury.Again, the most effective approach is to acknowledge the patient's discomfort and make a commitment to treat the pain.The hope gained from knowing that the physician will attempt to treat one's pain provides an effective distraction.Most pain patients, especially those with chronic pain, have a mixed syndrome (neuropathic and somatic pain).It is important for physicians to explain this distinction to patients, who will be reassured when they learn that their pain does not signal continuous damage and may not be the harbinger of a more serious illness.The body responds to the pain of compression by protecting the area through spasms, which create muscle pain in the area as well as other inflammatory responses.There are several neuropathic pain syndromes, outlined in Table 1, that are the result of ectopic generators, nerve trunk pain, microenvironmental changes, central alterations, and changes in the balance of nociceptor and nonnociceptor fibers.At this time, it is not yet possible to determine which of these factors specifically cause an individual's neuropathic pain.However, all of these factors can result in sensory loss, paresthesias (positive numbness or tingling), dysesthesias (painful or unpleasant burning, tingling or electric shock phenomenon), hyperesthesia (increased perception of mildly painful stimuli), hyperpathia (subthreshold stimuli producing pain), or allodynia (nonpainful stimuli producing pain).It has been demonstrated that the way in which pain is perceived and evaluated by patients affects their mood.The noradrenergic system may also be involved in the control of pain in situations of severe danger (e.Nociceptive nerve endings signal the pain but the brain does not register the pain.Some of the treatment modalities are, in fact, also used for somatic pain, but some agents are CNS specific.In general, neuroleptics have not proven to be effective.Amitriptyline is also associated with significant anticholinergic side effects that cannot be tolerated in some patients, including cardiac arrhythmias in elderly patients, urinary retention, and dry mouth.Nortriptyline has been shown in controlled clinical trials to be as effective in postherpetic neuralgia as amitriptyline but with far fewer side effects.The side effects most common with TCAs include dry mouth, somnolence, weight gain, constipation, and memory impairment.The selective serotonin reuptake inhibitors (SSRIs) are also frequently used in chronic pain patients, although they do not appear to have direct analgesic properties.SSRIs have few serious side effects but can cause somnolence, changes in weight, and some memory impairment.Antiepileptic drugs (AEDs), are useful in the treatment of neuropathic pain and migraine.Their effect on neuronal activity, also poorly understood, includes suppression of paroxysmal discharges, reduced neuronal hyperactivity, and suppression of aberrant discharges.AEDs act both centrally and peripherally.AEDs include gabapentin, lamotrigine, levetiracetam, oxcarbazepine (a metabolite of carbamazepine), tiagibine, topiramate, and zonisamide.Because each AED works, presumably, by a different mechanism, each one tends to be effective only in a subgroup of patients, as has been shown with gabapentin in the treatment of PHN and diabetic neuropathy.Several drugs may need to be tried before the desired results are seen and results will vary among patients, even those suffering from the same underlying disease.For example, among 3 patients with similarly caused damage to the nervous system, the resulting neuropathic pain may be due to the sodium channel in one patient, the calcium channel in another, and a different channel in a third.Johnson syndrome (lamotrigine, phenytoin, and zonisamide), aplastic anemia (carbamazepine), and teratogenicity (carbamazepine, valproate, and possibly others).Patients often report that lower doses take the edge off their pain, but substantial relief may require very high does.Like other drugs used for neuropathic pain, opioids can be effective in a select subgroup of patients.Topical therapy (patches or creams) can be useful for patients who have small areas that are hyperesthetic.This pain often abates after 3 or 4 uses, but if the patient stops regular use, the "hot pepper response" returns and tolerance needs to be rebuilt.These therapies are short acting and many of them are difficult to apply.Physical therapy is important for neuropathic pain management because active people heal and adapt faster.Training tight muscles or muscles that are in spasm (a common cause of trigger points) to relax can substantially improve a patient's level of function.In addition, patients must maintain muscle tone and the support that muscles provide, because loss of tone and support can lead to other problems such as back instability and tight, painful joints.However, as patients begin to improve and increase their activity, they may initially request more pain medication to offset the pain related to the activity.One of many possible theories is that if a peripheral nerve is cut during surgery, the central pain system continues to function and adapts to the fact that no signal is being sent from the cut nerve.This may result in sensitivity to any response being increased to the point that when a signal comes in (i.It has been demonstrated that nerves will try to grow back after being severed, although often in an aberrant manner, such as neuromas.This input to the nervous system of a nonnoxious stimuli appears to reduce the amount of noxious input.Spinal cord stimulators are most useful in unilateral limb disease but can be used bilaterally, and in different areas of the body.Limitations to their use include the lack of clinical trials to support their use in neuropathic pain, a battery life of 5 to 7 years, and the risk for infection.TENS has not been shown to be effective in treating neuropathic pain, perhaps because the electrodes are placed on the nerve endings rather than connected directly to the nerve.The principles of adjuvant medication use in neuropathic pain treatment are outlined in Table 2.For example, a previously stable patient who presents with uncontrollable pain may be under the influence of several factors.While it may be true that the underlying disease process that is causing the pain has gotten worse, it is also just as likely that the absorption of previously tolerable drug therapy may have changed, the patient may have become tolerant to the effects of the drugs, or the patient may be experiencing significant personal distress (e.For example, an insomniac patient may do better on a pain treatment with a somnolence side effect, when a majority of the dose is given at night.For medications with significant potential side effects, the treatment should start at a low dose and be titrated up slowly.For newer drugs with less side effects, doses can be started at therapeutic levels.Similarly, adequate time should be given to determine the success or failure of treatment.If a medication works, it is reasonable to treat any side effects associated with high therapeutic doses when necessary.When possible, side effects should be anticipated and aggressively managed.The importance of this cannot be overstated.Chronic pain inflicts significant sensory and emotional burdens on our patients and both must be addressed to ensure successful outcomes.Most neuropathic pain patients experience some improvement when physicians adopt a holistic approach to treatment.Shoaf SE, Smoller B, Dubner R.Watson CP, Vernich L, Chipman
M, Reed K.Mechanisms of action of anticonvulsant agents.Therapeutic safety
monitoring: what to look for and
when to look for it.Ellison N, Loprinzi CL, Kugler J,
et al.Treatment of chronic
pain by spinal cord stimulation.What can we learn from failed neuropathic pain trials?From paroxysmal to chronic pain in trigeminal neuralgia: Implications of central sensitization
James C.Motor cortex stimulation for pain control induces changes in the endogenous opioid system
J.Ataxic vs painful form of paraneoplastic neuropathy
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