Treatment of chronic pain syndrome.

We address the psychological and pharmacological treatment of chronic pain syndrome. The commonly used pain management protocols in each area are described. Psychological management procedures that are covered include relaxation methods, patient education, cognitive therapy techniques, and patient compliance enhancement. Concerning pharmacological management, the World Health Organization ladder analgesic guidelines are described, as well as adjunct medications, such as antidepressants, anxiolytics, and hypnotics.

Violent teens. Can physicians help?

In April, 15 suburban high school students were killed and more than 20 wounded in Littleton, Colorado, the victims of two violent adolescent boys. During the same week, another adolescent boy, Thomas Koskovich, was found guilty of capital murder in New Jersey's rural Sussex County. A week before that, in Toms River, teenager Sam Manzie, was sentenced to a lifetime in prison for the earlier senseless slaying of an even younger boy. For several years, we have been reading in newspapers and been watching on television other examples of teenage violence. Why?

Chronic benign pain.

Chronic benign pain (CBP) can be defined as a type of unpleasant sensory experience that arises from inflammation, visceral stress or damage, or other such pathophysiologic process(es), and that is not associated with a metastatic process. A patient's complaint of pain should be taken seriously by the practitioner, both in terms of the discomfort evoked and the likelihood that the potential cause of the pain requires diagnostic evaluation. This article reviews the diagnosis and treatment of the following common conditions associated with CBP syndromes: fibromyalgia, lower back pain syndrome, sickle-cell disease, reflex sympathetic dystrophy syndrome, and peripheral neuropathies.

Diagnosis and clinical management of headaches.

In this article, we will first present an overview of the epidemiology and classification of headaches, distinguishing between primary headaches (in which the headache itself is the primary disorder) and secondary headaches (ie, headaches due to an underlying condition, such as a neoplastic and/or space-occupying lesion, a cerebrovascular accident, or other type of structural brain lesion). We will use the current classification system of the International Headache Society, focusing on primary headache disorders (migraine, tension-type headache, cluster headache), which we will discuss from the practical clinical perspectives of diagnosis and clinical management. Throughout this article, we will emphasize the chronicity and periodicity of headaches as a type of chronic pain syndrome.

Psychiatric and psychological aspects of chronic pain.

To gain a better understanding and a more complete assessment of chronic pain syndrome, the psychosocial, psychological, psychodynamic, and psychiatric aspects of this condition should be included in patient evaluation. As illustrated in the two case studies presented, this approach leads to clearer recognition of the biological and psychosocial needs of patients, and allows for more effective treatment measures to be taken.

Management and pharmacotherapy of chronic pain syndromes including opioid pharmacotherapy.

Emphasizing the importance of an interdisciplinary approach in the treatment and management of patients with chronic pain syndromes (CPS), this article reviews, first, nonpharmacologic approaches and modalities for CPS patients, and next, pharmacologic approaches for CPS patients. Flexibility and the use of multiple modalities are emphasized. The article concludes with the controversial subject of the use of long-term analgesic opioid pharmacotherapy in patients with chronic benign pain syndromes.

Violence: a public health issue in New Jersey.

Violence should be viewed from biological, psychological, ethnological, and anthropological perspectives. Consideration of theories on biopsychosocial vulnerabilities and cultural and environmental factors have implications for diagnostic, therapeutic, and rehabilitative approaches.

Medicolegal aspects of treating drug and alcohol addiction.

The authors present an overview of different areas of interface between medicine and the law, applicable to the treatment of patients with drug and alcohol problems. The five case reports are a sample of the medicolegal issues that can arise in the treatment of drug addicts and alcoholics.

Evaluation and treatment of post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is a common anxiety disorder seen by general practice physicians as well as by specialists. The authors review current assessment criteria, psychotherapy procedures, and psychopharmacological management of PTSD patients.

What to expect from a psychiatric consultation.

The authors present guidelines for psychiatric consultations. The authors emphasize the need for specifics in presenting reasons for psychiatric consultation and/or referral to consultants, and the need for responsive consultation and communication.

The diagnosis and management of depression: an overview.

The authors present an overview of the diagnosis, treatment, and management of depressed patients. They discuss current psychotherapeutic techniques, the psychopharmacologic management of depression, and guidelines for referral of depressed patients to mental health professionals.

What about Halcion?

Although Halcion has received a great deal of attention and scrutiny, Halcion and the other benzodiazepines have a place in the pharmacotherapy of anxiety, panic, and sleep disturbances. Obviously, any physician's prescribing practices are going to be influenced by a variety of factors, including the popular press, to some extent. However, by paying careful attention to prudent and appropriate prescribing practices, following indications and guidelines for safety, efficacy, and patient acceptance, and by prescribing Halcion with the same cautions one would prescribe any other short-acting benzodiazepine or other hypnotic, this medication can be safe, efficacious, and a useful adjunct to the treatment of insomnia. Side effects--even such rare ones as musical hallucinations--will occur, to a greater or lesser extent, as with any medication, but these can be managed by the prudent physician, taking into account the risk/benefit considerations of Halcion, or any benzodiazepine, as a physician would in prescribing any medication for any reason.

Prescription drug abuse.

Prescription drug abuse (PDA) accounts for much drug-related morbidity and mortality. The PDA issue contains several interrelated dimensions: regulatory, practical, and clinical. Historical and current governmental efforts to regulate prescribing practices are reviewed. The authors discuss the many ways that prescription drugs can be diverted for abuse purposes and how potential abuse situations can be identified in the clinical setting. Types of prescribers at risk for promoting PDA are discussed and remedies for PDA are offered in terms of physician and patient education.