Postanaesthesia care units used to echo with cries of patients in pain after general anaesthesia. Each as-needed dose of analgesia was given only after permission of the surgeon or anaesthesiologist. Once conscious, patients were required to request each subsequent analgesic dose until hospital discharge. Not surprisingly, nearly half the patients who have an operation experience moderate to severe pain after surgery. Acute pain control has advanced dramatically and is now a field with dedicated texts, journals, and research. Despite improved surgical techniques that have transformed many operations into same-day procedures, inadequately controlled pain may still extend the length of hospital stay and predispose to expensive, time-consuming complications such as pneumonia. Recognition of economic and humanitarian benefits of pain control has prompted worldwide attention from professional groups, insurers, and governments. This paper describes the process of acute pain and measures to control it with drugs or non-pharmacological interventions. Even brief intervals of acute pain can induce long-term neuronal remodelling and sensitisation ("plasticity"), chronic pain, and lasting psychologial distress. Hence, acute pain and other types of pain (cancer-related or chronic) that are classified as distinct actually have many similarities.

Among nonlipid serum markers examined, only C-reactive protein levels are statistically significantly affected by statins. These findings suggest that statin-mediated anti-inflammatory effects may contribute to the ability of statins to reduce risk for cardiovascular disease. Overall, however, available data are insufficient to support recommendations for using nonlipid serum markers in decisions regarding statin therapy for individual patients.

No abstract

Few placebo-controlled trials have investigated the treatment of breakthrough pain (BTP) in patients with chronic pain. We evaluated the efficacy and safety of intranasal ketamine for BTP in a randomized, double-blind, placebo-controlled, crossover trial. Twenty patients with chronic pain and at least two spontaneous BTP episodes daily self-administered up to five doses of intranasal ketamine or placebo at the onset of a spontaneous BTP episode (pain intensity > or =5 on a 0-10 scale). Two BTP episodes at least 48 h apart were treated with either ketamine or placebo. Patients reported significantly lower BTP intensity following intranasal ketamine than after placebo (P < 0.0001) with pain relief within 10 min of dosing and lasting for up to 60 min. No patient in the ketamine group required his/her usual rescue medication to treat the BTP episode, while seven out of 20 (35%) patients in placebo group did (P = 0.0135). Intranasal ketamine was well tolerated with no serious adverse events. After ketamine administration, four patients reported a transient change in taste, one patient reported rhinorrhea, one patient reported nasal passage irritation, and two patients experienced transient elevation in blood pressure. A side effect questionnaire administered 60 min and 24 h after drug or placebo administration elicited no reports of auditory or visual hallucinations. These data suggest that intranasal administration of ketamine provides rapid, safe and effective relief for BTP.

We identified 28 epidemiological surveys by applying a sensitive search in Medline and CancerLit databases, supplemented by hand searches. Only two surveys enrolled more than 10,000 patients with cancer. The remaining were hospital or clinic-based surveys of at most a few hundred patients. Fourteen surveys were conducted in the United States. The majority of the remaining studies were conducted in Europe (Finland, France, Germany, UK/Ireland). No single survey identified a prevalence of any type of pain below 14%. The prevalence of pain reported in these surveys varies with the specific type of pain (e.g., breakthrough pain) and/or population studied. Based on these surveys an aggregate statement could not be deduced regarding the correlation between the occurrence of pain and patient factors, disease characteristics, the setting in which care is provided (e.g., primary care or specialized oncology or pain treatment clinics), or specific treatments directed towards the underlying disease and its associated pain. However, these surveys suggest that a significant number of patients with cancer worldwide will, during the course of their disease, experience pain that requires medical and/or other treatment.

Science Conference. Despite dramatic advances in cancer biology and a widening array of treatment options, cancer continues to cause devastating suffering not only to hundreds of thousands of patients who die of it each year in the United States, but also to some patients who are successfully treated and become cancer survivors. Pain, depression, and fatigue are prominent contributors to suffering in many of these individuals. Clinical research on these symptoms holds out the hope of relief for suffering through better understanding of these symptoms and the development of new, more effective treatments.

No abstract

We identified 28 epidemiological surveys by applying a sensitive search in Medline and CancerLit databases, supplemented by hand searches. Only two surveys enrolled more than 10,000 patients with cancer. The remaining were hospital or clinic-based surveys of at most a few hundred patients. Fourteen surveys were conducted in the United States. The majority of the remaining studies were conducted in Europe (Finland, France, Germany, UK/Ireland). No single survey identified a prevalence of any type of pain below 14%. The prevalence of pain reported in these surveys varies with the specific type of pain (e.g., breakthrough pain) and/or population studied. Based on these surveys an aggregate statement could not be deduced regarding the correlation between the occurrence of pain and patient factors, disease characteristics, the setting in which care is provided (e.g., primary care or specialized oncology or pain treatment clinics), or specific treatments directed towards the underlying disease and its associated pain. However, these surveys suggest that a significant number of patients with cancer worldwide will, during the course of their disease, experience pain that requires medical and/or other treatment.