Ear pain in adults
The majority of patients can be treated exclusively and successfully by their primary physician. ear pain in adults Signs-symptoms-of-osteoarthritis. The use of opioids as a treatment for non-malignant chronic pain remains a subject of considerable debate. Until recently, opioids were reserved for use only in the treatment of acute pain and cancer pain syndromes. Non-malignant chronic pain was considered to be unresponsive to opioids, or the use of opioids was associated with too many risks. ear pain in adults Severe-stomach-pain. Fears of regulatory pressure, medication abuse and the development of tolerance create a reluctance to prescribe opioids and many studies have documented this "underutilization". Fortunately, recent studies of physicians specializing in pain, as well as those who do not, have shown that prescription of long-term opioids is increasingly common. Surveys and open label clinical trials support the safety and effectiveness of opioids in patients with chronic non-malignant pain. ear pain in adults Wrist pain diagnosisanatomy. (refs 1-6)(top of page) Efficacy Recently, several controlled trials have documented the effectiveness of opioids in the treatment of chronic non-malignant pain such as low back pain, post-herpetic neuralgia, and painful peripheral neuropathy. These studies support the use of opioids to provide direct analgesic actions and not just to counteract the unpleasantness of pain. In the treatment of chronic low back pain, transdermal fentanyl significantly decreased pain and improved functional disability. (ref 7)In a randomized, double-blind, placebo controlled trial, controlled-release oral opioids were more effective than tricyclic antidepressants in decreasing the pain of post-herpetic neuralgia. (ref 8) Other studies have documented the presence of opioid receptors in the peripheral tissues activated by inflammation. These findings suggest a role for opioids in the treatment of chronic inflammatory diseases such as rheumatoid arthritis and connective tissue disorders. The use of opioids for the treatment of non-inflammatory musculoskeletal conditions is more confusing. A randomized double-blind, placebo-controlled crossover study of oral controlled release morphine was performed in patients with chronic regional, soft tissue musculosketal pain conditions that were resistant to codeine, anti-inflammatory agents and anti-depressants. Although patients experienced a decrease in pain, they did not experience significant psychological or functional improvement. (ref 3) In contrast, another randomized, placebo-controlled clinical trial in patients with chronic non-malignant pain found that treatment with controlled-release codeine reduced pain as well as pain-related disability. (ref 1)(top of page) Risks of Abuse and Dependency studies found that all patients who developed problems with opioid use had a prior history of substance abuse maladaptive behaviors such as stealing or forging prescriptions rarely occur in patients suspected of dependence Terms such as addiction, misuse, overuse, abuse, and dependence have been used inconsistently to describe various behaviors, making interpretation of many research studies difficult. Nonetheless, studies investigating the risk of opioid abuse have been reassuring. In one study of 12,000 medical patients treated with opioids,(ref 9) only 4 patients without a history of substance abuse developed dependence on the medication. Dependence, in this article, was defined as a psychological rather than physical dependence involving a subjective sense of need for a specific psychoactive substance, either for its positive effects or to avoid negative effects associated with its abstinence. This now is the approved definition of the American Society of Addiction Medicine for psychological dependence. Dependence used alone SHOULD be reserved for physiological dependence that leads to a stereotyped withdrawal syndrome upon discontinuation of the medication, particularly in the field of pain medicine. Unfortunately, psychological dependence is generally confused with many terms and therefore best avoided in my opinion. The psychiatric literature is somewhat inconsistent with the substance abuse literature, e. g. , the Diagnostic and Statistical Manual, edition IV, (DSM-IV) defines substance dependence as a more serious form of substance abuse. This maladaptive pattern of substance use is characterized by tolerance, withdrawal, overuse, craving, inability to cut down, and excessive preoccupation with respect to obtaining the substance. Substance abuse is characterized in the DSM-IV by use leading to failure to fulfill roles/responsibilities, use in hazardous situations, legal problems resulting from use, and use despite negative consequences. Other studies of chronic opioid therapy found that all patients who developed problems with opioid use had a prior history of substance abuse.
Ear pain in adults
Wrist || Diagnosis-of-chest-pain || Pain-under-left-rib || Temporomandibular-joint