Up to 3 percent of young women have bulimia nervosa as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV). The disorder usually includes binge eating followed by self-induced vomiting and incorporates a sense of los
Births among adolescents account for 13 percent of all births in the United States. Adolescents most commonly use contraception at the time of first intercourse but then often do not use contraception as sexual activity increases. Davtyan reviews cont
New margarines containing plant sterols and stanols claim to lower serum cholesterol concentrations. However, these products cost three to four times more than conventional margarines or butter. Law reviewed the results of randomized trials to assess
A relationship between connective-tissue diseases and silicone breast implants has been the focus of controversy since the early 1990s. The issue has not been fully resolved, despite the publication of three meta-analyses that failed to demonstrate an
Erectile dysfunction occurs 10 to 15 years earlier in men with diabetes than in men in the general population. Erectile dysfunction in men with diabetes tends to be multifactorial. Romeo and colleagues examined the relationship between glycemic contro
Physicians rarely receive instruction in designing exercise programs for older patients, although the evidence about the benefits of exercise is clear. Christmas and Andersen review the benefits of exercise and discuss how the physician can best tailo
Anal cancer accounts for about 2 percent of gastrointestinal cancers reported annually in the United States. It is estimated that approximately 3,400 new cases will be diagnosed in 2000. Recent epidemiologic and virologic studies have determined that
The morbidity and mortality associated with atherosclerotic coronary artery disease are mainly due to rupture of plaque, which often results in one of the acute coronary syndromes: unstable angina, non-Q-wave myocardial infarction or Q-wave myocardial
Over the past 25 years, morbidity and mortality have decreased significantly in children with sickle cell disease, and screening tests are now available to diagnose the disease in newborns. The incidence of sepsis caused by pneumococcal and Haemophilu
What is sickle cell disease? Sickle cell disease is a blood disease that children inherit from their parents. The disease causes the red blood cells to make abnormal hemoglobin. Hemoglobin is the part of blood that carries oxygen in the body.
Author: Kathryn M. Andolsek
Date: Feb 15, 1997
Holistic management of patients with cancer requires a solid foundation in the principles of pain management. Pain coexists with other common cancer symptoms such as fatigue, weakness, dyspnea, nausea, constipation and impaired cognition, and treating one of these conditions without worsening another can be challenging. Virtually all patients can be effectively treated with individualized integrated programs that combine systemic, pharmacologic, anticancer and, occasionally, invasive therapies. Levy discusses basic approaches to pain control and provides practical clinical guidelines for its treatment.
The author describes three basic approaches to the control of pain: modifying its source(s), altering the central perception of pain and blocking its transmission to the central nervous system. The Three-Step Analgesic Ladder of the World Health Organization is presented as a model of care. Selection of the appropriate analgesic drug is discussed, along with recommendations for the appropriate dosage, route of administration and dosing interval. Useful strategies to prevent persistent pain and relieve breakthrough pain are also discussed. The author outlines how to titrate the dosage of the drug aggressively, yet at the same time anticipate and manage its side effects. The use of sequential trials of analgesic medications and appropriate adjuvant drugs for common pain syndromes is also outlined.
The author concludes that pain relief in patients with cancer remains inadequate because of a lack of education about pain and the appropriateness of opioid therapy. The author believes that most clinicians should be able to optimize their patients' comfort and their ability to function by following the guidelines of pain management presented here.
Levy MH. Pharmacologic treatment of cancer pain. N Engl J Med 1996;335:1124-32.
"Tips from Other Journals" are written by the associate editors of American Family Physician.
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