bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pregabalin in patients with postoperative dental pain
Authors: Hill C.M. , Balkenohl M. , Thomas D.W. , Walker R. , Mathé H. , Murray G. 
Published: September 2002

Pregabalin is an analogue of the inhibitory neurotransmitter gamma‐aminobutyric acid. In preclinical models, it has shown activity as an analgesic agent. A randomized, double‐blind, placebo‐controlled, parallel‐group trial was undertaken to compare pregabalin to placebo and 400 mg of ibuprofen using a dental pain model. Study medication was administered postoperatively to patients who had undergone elective surgery to remove one or two third molars, at least one of which was mandibular and fully or partially impacted in bone. The study was conducted in the UK at a single centre and evaluated pregabalin at doses of 50 and 300 mg. Primary efficacy parameters included pain relief (PR), pain intensity difference (PID), pain relief intensity difference (PRID), time to onset of analgesia, and duration of analgesia. The patient';s global impression of the study medication was used as a secondary efficacy parameter. Efficacy data were evaluated for the intent‐to‐treat (ITT) population, defined as all randomized patients who took study medication. Results showed that there were statistically significant differences in PR, PID, and PRID between the 300‐mg pregabalin group and placebo. In addition, the 300‐mg pregabalin group had a significantly longer duration of analgesia than the ibuprofen group and had the highest score on the patient global impression of study medication. Adverse events were reported more frequently in the pregabalin 300‐mg group.Pregabalin appears to have significant analgesic properties in the third molar extraction model. Further research is needed to confirm these findings.
Improving the quality of pain treatment by a tailored pain education programme for cancer patients in chronic pain
Authors: de Wit Rianne , van Dam Frits , Loonstra Simone , Zandbelt Linda , van Buuren Anneke , van der Heijden Karin , Leenhouts Gerleen , Duivenvoorden Hugo , Abu‐Saad Huda Huijer 
Published: September 2002

Educational interventions, aiming to increase patients' knowledge and attitude regarding pain, can affect pain treatment. The purpose of this study was to evaluate the effects of a Pain Education Programme (PEP), on adequacy of pain treatment, and to describe characteristics predicting change in adequacy. The PEP consists of a multi‐method approach in which patients are educated about the basic principles regarding pain, instructed how to report pain in a pain diary, how to communicate about pain, and how to contact healthcare providers. The effects of the PEP were evaluated taking into consideration the lack of well‐established outcome measures to evaluate adequacy of pain treatment, the lack of long‐term follow‐up, and the influence of missing data.A prospective, randomized study was utilized in which 313 chronic cancer patients were followed‐up until 8 weeks postdischarge. Adequacy of pain treatment was evaluated by means of the Amsterdam Pain Management Index (APMI), consisting of an integrated score of patients' Present Pain Intensity, Average Pain Intensity, and Worst Pain Intensity, corrected for patients' Tolerable Present Pain, with the analgesics used by the patient.At pretest, 60% of the patients in the hospital were treated inadequately for their pain. Postdischarge, the control group patients were significantly more inadequately treated at 2 weeks after discharge (56%vs 41%), at 4 weeks after discharge (62%vs 42%) and at 8 weeks after discharge (57%vs 51%) than the intervention group patients. While the level of inadequacy in the control groups remained relatively stable at all assessment points, a slight increase in the percentage of patients being treated inadequately was found in the intervention group patients over time. A beneficial effect of the PEP was found for patients both with and without district nursing. Variables predicting an improvement in adequacy of pain treatment consisted of the PEP, the APMI score at baseline, patients' level of physical functioning, patients' level of social functioning, the extent of adherence to pain medication, patients' pain knowledge, and the amount of analgesics used.These findings suggest that quality of pain treatment in cancer patients with chronic pain can be enhanced by educating patients about pain and improving active participation in their own pain treatment. The benefit from the PEP, however, decreases slightly over time, pointing at a need for ongoing education.
Opioids in non‐cancer pain: a life‐time sentence?
Authors: Dellemijn Paul L.I. 
Published: September 2002

There is continuing reluctance to prescribe strong opioids for the management of chronic non‐cancer pain due to concerns about side‐effects, physical tolerance, withdrawal and addiction. Randomized controlled trials have now provided evidence for the efficacy of opioids against both nociceptive and neuropathic pain. However, there is considerable variability in response rates, possibly depending on the type of pain, the type of opioid and its route of administration, the time to follow‐up, compliance and the development of tolerance.Five patients were selected with nociceptive or neuropathic pain in whom other pharmacological or physical therapies had failed to provide satisfactory pain relief. They received transdermal fentanyl (starting dose 25 μg/h) for at least 6 weeks. Transdermal fentanyl dosage was titrated upwards as required. Transdermal fentanyl provided adequate pain relief in patients with nociceptive pain (diabetic ulcer, osteoporotic vertebral fracture, ankylosing spondylitis) or neuropathic pain with a nociceptive component (radicular pain due to disc protrusion, herpetic neuralgia). The duration of treatment ranged from 6 weeks to 6 months for four cases. In the case of ankylosing spondylitis, treatment was carried out for 2 years, stopped and then restarted successfully. There were no withdrawal effects or addictive behaviour on treatment cessation, regardless of duration of the treatment. In conclusion, strong opioids may provide prolonged effective pain relief in selected patients with nociceptive and neuropathic non‐cancer pain. Transdermal fentanyl treatment can often be temporary and can easily be stopped following adequate pain relief without withdrawal effects or any evidence of addictive behaviour.
Approaching cancer pain relief
Authors: Lickiss J. Norelle 
Published: September 2002

Pain is defined as an unpleasant experience—it is subjective and achieving pain relief is achieving a change in the patient's experience. There needs to be an adequate concept of a human person (an ecological model will be discussed) and a logical process for approaching pain relief in an individual patient (e.g. the plan used in the Sydney Institute of Palliative Medicine).Communication with the patient is critical to get a grasp of him or her as a person, their environment, personal experience and cultural background. Then encourage him or her to tell the story of the cancer saga as they perceive it, listening carefully for the matters which may have given rise to acute distress (for example, delay in diagnosis) and how they adjusted to this. The individual is conveying a great deal about him or herself as they tell their story. Next the story of the treatment and their experience of it, and then the response of their tumour to it—then the story of their pain: when it began, its characteristics, how it evolved, what factors worsen the pain, what relieves it, etc.This is followed by careful clinical examination to clarify what could be the most likely mechanism(s) responsible for the noxious stimulus. Some investigation (e.g. X‐ray) may be justified to assist clarification—but not before making a clinical diagnosis (best guess) and commencing treatment with drugs or other logical measures with some local action—depending on the most probable mechanism. Paracetamol/non‐steroidal anti‐inflammatory drugs (NSAIDs) etc may be logical.Threshold factors should be attended to—comfort, concern always, or anxiolytic or antidepressant drugs if the patient is pathologically anxious or depressed.The opioid drugs—with morphine still as the gold standard—should be appropriately used. This involves careful calibration of dose (below sedative level) normally with an immediate‐release, preparation—and, in the case of morphine, specific counselling concerning ‘myths’ to ventilate fears of dying, fears of addiction, fear of tolerance etc. It is irresponsible to use an opioid without assessing the prior state of the bowel (? loaded) or without prescribing a laxative.When neuropathic pain does not respond to a correctly calibrated opioid, it may be necessary to add certain antidepressants, anticonvulsants, gabapentin, steroid etc.A system must be set in place for evaluation of pain relief: relief is usually possible.
The development of use of oral morphine within the last 10 years in Japan
Authors: Takeda Fumikazu 
Published: September 2002

Japan's national cancer relief programme was initiated with a field‐test of the WHO guidelines for cancer pain management in 1982. It revealed in an excellent result that 87% of 156 cancer patients could be completely relieved of their persistent pain, but this result were ignored by most Japanese health professionals, because of their lack of interest in cancer pain relief. The WHO guidelines were published in 1986 and made quite an impact on those health professionals in Japan. In 1987, a special research team appointed by the Ministry of Health and Welfare of Japan (MOHW) initiated discussion on the philosophy of palliative care in Japan. According to the recommendations made by this research team, the MOHW established a new policy on palliative care, edited manuals on palliative care for terminally ill cancer patients which included guidelines on cancer pain management, and revised narcotics control measures by 1992 in order to much improve the accessibility of opioid analgesics to cancer patients who need them for effective pain relief. The annual consumption of morphine for medical purposes was only 65 kg in 1986 in Japan, but it rose to 973 kg in 1999. Currently, morphine is mostly given by mouth and two‐thirds of morphine preparations consumed are MS Contin Tablets. However, the current morphine consumption per capita in Japan is still less than one‐sixth of the consumption in the United States.In order to achieve further improvement, educational effort should be much emphasized. In the 1990s, approximately 70% of medical and nursing schools in Japan have initiated their educational curriculum for cancer pain relief and palliative care. There have been government‐sponsored, medical, nursing and pharmaceutical societies‐sponsored seminar courses on appropriate morphine use in cancer pain management, palliative care and opioid availability, all of which have increasingly strengthened postgraduate education.
Opioid use in chronic pain management in the Philippines
Authors: Javier Francis O. , Magpantay Lyde A. , Espinosa E.L. , Harder S.M. , Unite M.A. 
Published: September 2002

The aim of this investigation was to determine current opioid use in the Philippines and the reasons why its use is very low. We surveyed 314 doctors in Metro Manila to determine their specialty, possession of narcotics license, and knowledge of opioid use beyond the terminal stage.We found that the majority of respondents possess a narcotics licence. All of them see pain patients in their practice. They agree that opioids should not be reserved for the terminally ill; 235 have prescribed opioids for non‐cancer pain. A small minority believes that use of opioids for non‐cancer pain can lead to addiction. Opioids that were most easily recalled were morphine, meperidine and nalbuphine. The survey contradicts the national data for opioid use. With an INCB (International Narcotics Control Board) allocation of 87 kilograms annually, less than 15 kilograms are consumed every year. Fentanyl has a 7 gram usage versus a 100 gram INCB allocation.We conclude that actual opioid use in the Philippines is minimal. However, the correlation between survey results and actual usage indicates a strong awareness of the usefulness of opioids but hesitancy in opioid prescription.
Acute pain management after surgery or in the emergency room in Switzerland: a comparative survey of Swiss anaesthesiologists and surgeons
Authors: Wilder‐Smith Oliver H. G. , Möhrle Jörg J. , Martin Nadine C. 
Published: September 2002

The treatment of acute pain remains unsatisfactory despite advances in pain research and the publication of numerous guidelines. The aim of this study was to survey postoperative and emergency room acute pain treatment in Switzerland, particularly regarding compliance with practice guidelines on therapeutic responsibility, treatment algorithms, pain documentation, quality control and education.A representative sample of anaesthesiologists and surgeons (general and orthopaedic) was selected from all Swiss hospitals with regular surgical activity and sent a 256 point questionnaire on acute pain management.Five hundred and seventy five doctors were contacted in 98 hospitals, 44% of doctors (covering 89% of hospitals) returned fully completed questionnaires. Half the respondents work in a hospital with an acute pain service. For postoperative pain management, only 10% of prescription is by algorithm, less than a third of respondents regularly determine pain scores, only 15% perform any statistical analysis of pain management, less than one third regularly meet to discuss management problems, and half claim not to have received—or be receiving—formal (i.e. structured/accredited) pain education. The situation is even less satisfactory for emergency room analgesia. Respondents accept the contribution of postoperative and emergency room analgesia to reduced costs and improved medical outcomes. Asked to highlight their major concerns in acute pain management, lack of education and inadequate organisation are listed in first and second positions.This survey suggests that compliance with published practice guidelines for acute pain management can be improved, and highlights the need for continuing organisational and educational development in acute analgesia, particularly for the emergency room. © 2002 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Science Ltd. All rights reserved.
Detection of inter-atrial conduction defects with unfiltered signal-averaged P-wave ECG in patients with lone atrial fibrillation
Authors: Platonov P.G. , Carlson J. , Ingemansson M.P. , Roijer A. , Hansson A. , Chireikin L.V. , Olsson S.B. 
Published: September 2002

Abstract

Aims
To demonstrate a possible inter-atrial conduction delay in patients with lone paroxysmal atrial fibrillation (PAF) using ‘unfiltered’ signal-averaged P-wave ECG (PSAECG) and compare these results with those obtained with conventional filter settings.

Methods and Results
Twenty one patients with lone PAF and 20 healthy volunteers (control group) were enrolled in the study. An orthogonal lead surface ECG was high-pass filtered at 0·8 Hz, averaged with template matching, and combined into a spatial magnitude (‘unfiltered’ technique). Results were compared with conventionally filtered (40–300 Hz) PSAECG. The filtered technique revealed no differences in P-wave duration between the two groups (121±12 vs 128±15 ms, control and PAF groups respectively, ns). Double-peaked P-wave spatial magnitudes (interpeak distance &gt;30 ms) were revealed in 11 of 21 PAF patients but only in two of 18 controls (P&lt;0·01). The nadir in the spatial magnitude was located significantly later in the PAF group (114±13 vs 103±9 ms,P &lt;0·01).

Conclusion
‘Unfiltered’ PSAECG revealed significant differences in orthogonal P-wave morphology in patients with lone PAF, indicating the possibility of an inter-atrial conduction delay, while conventional P-wave duration analysis failed to discriminate between the two groups.
Cerebral Cryptococcal Granuloma in a Cat
Authors: Foster S F , Charles J A , Parker G , Krockenberger M , Churcher R M , Malik R 
Published: September 2002

In the December issue of Journal of Feline Medicine and Surgery, the following case report was published with several errors. The corrected version of this case report follows in full. The publishers apologise for this error. A 7-year-old spayed domestic shorthaired cat presented with a history of having two seizures in the previous 6 weeks. During the seizures, the cat lost consciousness, paddled its limbs, rolled and urinated. There were no pre-ictal signs but the cat was weak and unable to walk normally in the post-ictal period.
Iatrogenic Hyperadrenocorticism in a Cat following a Short Therapeutic Course of Methylprednisolone Acetate
Authors: Ferasin L 
Published: September 2002

Iatrogenic hyperadrenocorticism (or iatrogenic Cushing's syndrome) is an adrenal disorder that may result from long-term administration of glucocorticoids for therapeutic purposes, most often given to treat allergic or immune-mediated disorders. Prolonged treatment with synthetic glucocorticoids can suppress hypothalamic corticotrophin releasing hormone and plasma adrenocorticotrophic hormone (ACTH), thus causing a functional inactivity of the adrenal cortex. The result is a clinical syndrome of hyperadrenocorticism but with basal and ACTH-stimulated plasma cortisol concentrations that are consistent with spontaneous hypoadrenocorticism (Addison's disease). Whilst iatrogenic hyperadrenocorticism is relatively frequent in dogs, the diagnosis of iatrogenic hyperadrenocorticism in cats is very uncommon because this species has been found to be remarkably resistant to prolonged administration of glucocorticoids. To the author's knowledge, there are only two published clinical cases of feline iatrogenic Cushing's syndrome. This report describes a case of iatrogenic hyperadrenocorticism in a cat, and shows how normalisation of the adrenal function was achieved with supportive treatment and withdrawal of glucocorticoid administration.
Insulin Sensitivity Decreases with Obesity, and Lean Cats with Low Insulin Sensitivity are at Greatest Risk of Glucose Intolerance with Weight Gain
Authors: Appleton DJ , Rand JS , Sunvold GD 
Published: September 2002

This study quantifies the effects of marked weight gain on glucose and insulin metabolism in 16 cats which increased their weight by an average of 44.2% over 10 months. Significantly, the development of feline obesity was accompanied by a 52% decrease in tissue sensitivity to insulin and diminished glucose effectiveness. In addition, glucose intolerance and abnormal insulin response occurred in some cats. An important finding was that normal weight cats with low insulin sensitivity and glucose effectiveness were at increased risk of developing impaired glucose tolerance with obesity. High basal insulin concentrations or low acute insulin response to glucose also independently increased the risk for developing impaired glucose tolerance. Male cats gained more weight relative to females and this, combined with their tendency to lower insulin sensitivity and higher insulin concentrations, may explain why male cats are at greater risk for diabetes. Results suggest an underlying predisposition for glucose intolerance in some cats, which is exacerbated by obesity. These cats may be more at risk of progressing to overt type 2 diabetes mellitus.
A retrospective study of cardiac rhythm disorders
Authors: Van Wassenhoven Michel 
Published: September 2002

AbstractRetrospective studies can be considered as the first step towards an evaluation and improvement of homoeopathic practice. Through these preliminary studies, criteria for future prospective studies can be chosen as well as suitable homoeopathic practitioners to conduct them. From this study, we can conclude that disorders of heart rhythm seem to be an excellent subject for research into the efficacy of homoeopathy. Especially for paroxysmal supraventricular tachycardia, all patients were cured and able to discontinue their allopathic medication. In view of the fact that 50% of the patients included in this study stopped the use of allopathic drugs, one can conclude that homoeopathy certainly has a place in the treatment strategy of these diseases.
Biotypology I: Scope and history
Authors: Marino F 
Published: September 2002

AbstractFrom ancient times, the principal medical cultures tried to classify individuals according to their morpho-functional characteristics in order to study and understand their tendencies in terms of health and sickness. In the last two centuries, in Europe and America, a number of academic schools emerged whose theoretical concepts and ideas were important theroretically but had relatively little practical application. By contrast, in France and Italy, there was the joining of biotypological schools and homoeopathy, which permitted the correlation between biotypes and their relevant homoeopathic remedies. This article outlines the evolution of biotypological thinking and the results of the above said merger.
Homeopathic effect on heart rate variability
Authors: Ruiz G , Torres J-L , Michel O , Navarro R 
Published: September 2002

AbstractWe record ECGs from healthy human subjects during 24-h long intervals, using ambulatory equipment. We calculate from the data various parameters, searching for those that change in a clear and systematic way under a homoepathic stimulus, (Strophantus hispidus 30 c). The energy fraction at high frequencies in the power spectrum of heart rate variability fulfills this condition, and we are able to interpret our results in a way consistent with the information on this medicine in the homeopathic Materia Medica.
Was Kent a Hahnemannian?
Authors: Cassam A 
Published: September 2002

AbstractThis article voices concern at the trend among an influential section of homeopaths the world over, to jettison Hahnemann’s similimum principle and replace it with Kent’s almost exclusive concentration on mental and psychic symptoms. This concern raises the question whether Kent was a true Hahnemannian.In order to discuss this question, two schools of thoughts are investigated. The first argues that Hahnemann’s theories were scientific whereas Kent’s were metaphysical. The second criticises Kent’s more severely for being metaphysical. At the same time, it accuses Hahnemann himself of increasingly losing his way, with increasing age, into metaphysical homeopathy.The author believes there was no break in Hahnemann’s thinking as alleged, but a gradual development with increasing experience, together with judicious use of
rational
insight, when scientific explanation was not yet available. The yardstick used to accuse Hahnemann of being metaphysical is
crudely
empirical and long outdated.
Homeopathic terminology: A consensus quest
Authors: Guajardo G , Bellavite P , Wynn S , Searcy R , Fernandez R , Kayne S 
Published: September 2002

AbstractThe aim of this project is to develop a common homeopathic terminology to improve communication. A questionnaire was sent by email to an international group of experts. As a result of an iterative process we propose that a number of terms which are inaccurate, unclear or have become outdated should be replaced by new terms. The main areas in which terminology should be updated are: concepts relating to: homeopathic pharmacology, research, homeopathic medicine, the principle of similarity, homeostasis and disease imitation, miasms, experimental homeopathy, provings and pathogenic trials.