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West Indian med. j ; 47(suppl. 3): 42, July 1998.
Artigo em Inglês | MedCarib | ID: med-1688


Pain medicine is a relatively new speciality in clinical medicine. While it is widely accepted and recognized, there are some areas of controversy which makes this speciality interesting and open to diverse kinds of research opportunities and clinical innovations. In this presentation, several controversial areas have been selected for discussion because of their scientific merit, clinical applicability, and evolving status in the physician's armamentarium. EPIDURAL STEROIDS FOR LOW PAIN: Epidural steroid injections remain one of many modalities for managing chronic low back pain. The frequency, dose, kind of steroids used and management of complications are still open to discussion. Meta-analysis of the applicability of epidural steroids for low back pain leaves a lot to be desired. More importantly, the criteria for epidural steroid injection have not yet been clearly delineated. REFLEX SYMPATHETIC DYSTROPHY (RSD) AND NEUROPATHIC PAIN: Most clinicians propose that RSD has become a "legal phenomenon" rather than a medical one. This observation indicates the adversarial focus that the injured patient possesses as far as his recovery and rehabilitation are concerned. The different diagnosis techniques and the corresponding diverse therapeutic modalities available for treating RSD are still controversial. CANCER PAIN MANAGEMENT: Cancer pain management is very important in the overall management of the cancer patient, especially when dying and death appear inevitable. A proposed fourth step of the World Health Organization three-step ladder for pain management and its implication will be discussed. MORPHINE AS ANTI-ANALGESIC AGENT: Review of the pharmacological activity of morphine metabolities will be undertaken. A re-evaluation of morphine-3-glucuronide and its analgesic activity may help to explain some interesting physiological phenomena observed during morphine administration. PAIN EDUCATION AND PAIN CERTIFICATION: In the United States of America the education of medical and nursing students regarding pain therapy has been largely ignored. The situation is unfortunate since most young health care professionals have to deal with chronic pain problems as soon as they commence their practices. As pain medicine develops, it is important to have adequate credentialing.(AU)

Humanos , Dor , Doença Crônica , Analgesia Epidural/estatística & dados numéricos , Dor Lombar/terapia , Distrofia Simpática Reflexa/tratamento farmacológico , Neoplasias , Morfina/uso terapêutico , Terapias Complementares/estatística & dados numéricos , Medição da Dor
Diabetes;35(3): 324-7, Mar. 1986.
Preprint em Inglês | MedCarib | ID: med-14078


The effect of morphine (0.1 mg/kg) on insulin secretion stimulated by oral, intraduodenal, or intravenous administration of glucose was studied in seven healthy volunteers. When glucose was given intravenously, morphine had no effect on plasma glucose, insulin, glucose-dependent insulinotropic polypeptide (GIP), or pancreatic glucagon. Following oral glucose, morphine slowed gastric emptying and reduced plasma concentrations of glucose, insulin, and GIP. During intraduodenal infusion of glucose, insulin concentrations of plasma were also decreased by morphine, an effect best explained by decreased small intestinal transit with delayed absorption of glucose and delayed release of GIP. We conclude that clinically relevant doses of morphine have no direct effect on insulin secretion and that the changes observed were secondary to slowed gastric emptying and small intestinal transit (AU)

Humanos , Adolescente , Adulto , Masculino , Feminino , Motilidade Gastrointestinal/efeitos dos fármacos , Insulina/metabolismo , Morfina/farmacologia , Glicemia/análise , Duodeno , Peptídeos Semelhantes ao Glucagon/sangue , Esvaziamento Gástrico/efeitos dos fármacos , Polipeptídeo Inibidor Gástrico/sangue , Glucose/administração & dosagem , Glucose/farmacologia , Infusões Parenterais , Insulina/sangue , Neurotensina/sangue
Carib Med J ; 2(3): 118-21, 1940.
Artigo em Inglês | MedCarib | ID: med-4214


Post-anaesthetic excitement may occur in neurotic or alcoholic subjects even after heavy doses of barbiturate have been given. It may be prevented or modified by the pre-anaesthetic administration of morphia or allied drug. When present, it may be lessened or abolished by morphia (in alcoholics) or possibly by alcohol. (AU)

Humanos , Barbitúricos/efeitos adversos , Anestésicos/efeitos adversos , Agitação Psicomotora , Ópio/efeitos adversos , Morfina/uso terapêutico , Atropina/uso terapêutico