Such A Sharp Pain Free Download
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Nerve pain often feels like a shooting, stabbing or burning sensation. Sometimes it can feel as sharp and sudden as an electric shock. You may be very sensitive to touch or cold. You may also experience pain as a result of touch that would not normally be painful, such as something lightly brushing your skin.
Nerve pain can be difficult to treat, but there are many strategies you can try. Treating the underlying cause, if there is one, is the first step. Pain relief and other medicines can help, as can non-drug treatments such as exercise, acupuncture and relaxation techniques.
But because of the ethical and logistical difficulties of conducting pain experiments on human volunteers, marijuana's potential to relieve pain has yet to be conclusively confirmed in the clinic. Only a few such studies have been conducted and only one since 1981. Most tested the ability of cannabinoids to relieve chronic pain in people with cancer or acute pain following surgery or injury. Unfortunately, few of these studies are directly comparable because the methods used to conduct them varied greatly and in some cases appear to have been less than scientifically sound. However, after critically reviewing existing research on THC and pain relief, the IOM team concluded that cannabinoids can provide mild to moderate relief from pain, on a par with codeine. The IOM team also determined that the body's own cannabinoid system likely plays a natural role in pain control.
Another group of researchers compared two conventional painkillers, codeine and secobarbital (a short-acting barbiturate), with a synthetic compound similar to THC. This THC analog had previously been shown to block pain in animals, so it was being tested for its ability to relieve moderate to severe pain in cancer patients. Both comparisons were conducted in cancer patients who suffered moderate to severe pain. In one trial 30 such patients were given three different treatments, in random order, on consecutive days: a moderately strong dose of codeine, a standard dose of the experimental cannabinoid, and a placebo. Patients then rated the intensity of their pain on a three-point scale (none, slight, moderate) every hour for six hours. The second trial, which compared the cannabinoid with secobarbital in 15 patients, followed the same procedure. On average, participants found that the THC analog relieved mild, moderate, and severe pain as well as the codeine and better than the secobarbital.7
Much of what medical scientists have learned about marijuana's pain-relieving potential warrants further study, according to the IOM team. A logical next step in basic research would be to determine whether existing cannabinoids could be modified to retain their analgesic properties while reducing or removing unwanted side effects such as amnesia and sedation. But some of those side effects may make marijuana an especially useful pain reliever. Cannabinoids appear to reduce nausea, vomiting, and appetite loss as well as pain. And the euphoric lift that attracts recreational users to marijuana could benefit people with anxiety-producing disorders such as AIDS or cancer. In fact, for that reason the IOM team recommended that researchers undertake clinical studies of cannabinoid medications among cancer patients on chemotherapy and AIDS patients suffering from wasting or significant pain. The IOM also recommended that the following groups of patients be included in such studies:
But these future prospects offer little comfort to people with chronic pain that defies conventional treatments. Accordingly, the IOM researchers recommended the creation of an individual clinical trial program that would allow such patients to smoke marijuana under carefully controlled conditions for a limited period of time. Note that this is not the same as reopening the marijuana Compassionate Use Program that was closed in 1991 (see Chapter 11). As described in the IOM report, individual trials would be used to gather information to help develop alternative delivery methods for cannabinoid medications. Participants, who would be fully informed of their status as experimental subjects and the harms inherent in using smoking as a delivery system, would have their condition documented while they continued using marijuana. By analyzing the results of such trials, medical scientists could significantly increase their knowledge of both the positive and the negative effects of medical marijuana use.
Acute abdominal pain can represent a spectrum of conditions from benign and self-limited disease to surgical emergencies. Evaluating abdominal pain requires an approach that relies on the likelihood of disease, patient history, physical examination, laboratory tests, and imaging studies. The location of pain is a useful starting point and will guide further evaluation. For example, right lower quadrant pain strongly suggests appendicitis. Certain elements of the history and physical examination are helpful (e.g., constipation and abdominal distension strongly suggest bowel obstruction), whereas others are of little value (e.g., anorexia has little predictive value for appendicitis). The American College of Radiology has recommended different imaging studies for assessing abdominal pain based on pain location. Ultrasonography is recommended to assess right upper quadrant pain, and computed tomography is recommended for right and left lower quadrant pain. It is also important to consider special populations such as women, who are at risk of genitourinary disease, which may cause abdominal pain; and the elderly, who may present with atypical symptoms of a disease.
When evaluating a patient with acute abdominal pain, the physician should focus on common conditions that cause abdominal pain as well as on more serious conditions. The location of pain should drive the evaluation (Table 1). For some diagnoses, such as appendicitis, the location of pain has a very strong predictive value.
Colic (i.e., sharp, localized abdominal pain that increases, peaks, and subsides) is associated with numerous diseases of hollow viscera. The mechanism of pain is thought to be smooth muscle contraction proximal to a partial or complete obstruction (e.g., gallstone, kidney stone, small bowel obstruction). Although colic is associated with several diseases, the location of colic may help diagnose the cause. The absence of colic is useful for ruling out diseases such as acute cholecystitis; less than 25 percent of patients with acute cholecystitis present without right upper quadrant pain or colic.5
There are several specialized maneuvers that evaluate for signs associated with causes of abdominal pain. When present, some signs are highly predictive of certain diseases. These include Carnett's sign (i.e., increased pain when a supine patient tenses the abdominal wall by lifting the head and shoulders off the examination table) in patients with abdominal wall pain9; Murphy's sign in patients with cholecystitis5 (although it is only present in 65 percent of adults with cholecystitis and is particularly unreliable in older patients10); and the psoas sign in patients with appendicitis.3 Other signs such as rigidity and rebound tenderness are nonspecific.
Rectal and pelvic examinations are recommended in patients with lower abdominal and pelvic pain. A rectal examination may reveal fecal impaction, a palpable mass, or occult blood in the stool. Tenderness and fullness on the right side of the rectum suggest a retrocecal appendix. A pelvic examination may reveal vaginal discharge, which can indicate vaginitis. The presence of cervical motion tenderness and peritoneal signs increase the likelihood of ectopic pregnancy11 or other gynecologic complications, such as salpingitis or a tuboovarian abscess.
There are certain populations in which the spectrum of disease is significantly different than the majority of patients. Extra attention is warranted when evaluating special populations, such as women and older persons, with abdominal pain (Figure 1).
The onset of orofacial pain that is exacerbated during normal oral function is a key predictor for the transition from oral precancer to cancer (22). Regional orofacial pain and other sensory disturbances occur in 80% of patients with head and neck cancers (23). It is important to note that perineural spread of head and neck tumors can give symptomatology of trigeminal neuropathic pain, with sensation of burning, tingling, achy feelings as well as neuralgic symptoms such as sharp shooting electrical pains, and be triggered by function and even to present symptomatology of neurovascular disorders such as headache (9,24). A critical step is that a careful examination should be considered since the pain can be reported in any structure of the craniofacial region such as a toothache, pain in the gingiva, tongue, face, neck, ear and palate (17). The pain can be referred to the temporomandibular joint (TMJ) and be described as dull aching pain and present all the signs and symptoms of temporomandibular disorders (TMD), and therefore it could be misdiagnosed (25,26). Furthermore, intracranial tumors may present headache and orofacial pain symptoms such as trigeminal or glossopharyngeal neuralgia, so neuroimaging must be considered to confirm the diagnosis (27). It is important to recognize that symptoms of TMD, trigeminal neuralgia and persistent idiopathic facial pain are the three most common pain presentations in patients with intracranial tumors that come to the dental office (28).
It has been reported in a retrospective study that of 114 cases of metastatic tumors in the jaws, in 60% of these cases the lesion was the only indication of a primary malignancy elsewhere (29). Malignancies originating from thyroid, esophagus, breast, lung, kidney, liver, female reproductive system, prostate, colon and rectum can metastasize to the orofacial region (30-32). Bone metastases such as in the mandible present persistent pain, swelling and other sensory disturbances (30,33). It is very important to consider that symptomatology resembling trigeminal neuralgia has been reported as a symptom of prostate cancer when the metastatic lesion involved the mandible (34), and in breast cancer when it involved the pterygopalatine fossa (35). Lung and breast malignancies can metastasize to the TMJ, and TMJ pain may be the first symptom of metastasis (36). 781b155fdc