PubMed Health⌕ Search

Biomedical subjects

Warren A Katz

Publications and source records attributed to Warren A Katz.

8 recordsLinked to original sources
PubMed2005

Section 4: treating the patient in pain.

Physicians may choose from a variety of pharmacologic and nonpharmacologic options to treat patients with painful rheumatic diseases. Osteoarthritis (OA) is the most common type of arthritis requiring pain management. New disease-modifying antirheumatic drugs and biologic response modifiers can improve disease states in patients with rheumatoid arthritis (RA). After the inflammatory component of RA is minimized with such agents, treatment goals shift to those similar to secondary OA and other degenerative joint diseases. Relief of pain and improvement in functional status are essential components of effective therapy. A pure analgesic such as acetaminophen and nonsteroidal antiinflammatory drugs, including the cyclooxygenase-2-selective inhibitors for those at risk for gastrointestinal side effects, may be used at the lowest effective doses. Combination therapy for acetaminophen and an opioid may maximize pain relief and provide greater speed and duration of action than the separate components. Use of the atypical opioid tramadol with acetaminophen often results in an improved side-effect profile compared with stronger opioids, with similar levels of pain relief. Adjunctive therapy with agents such as topical analgesics, intraarticular hyaluron, tricyclic antidepressants, anticonvulsants, muscle relaxants, and anxiolytics may also be helpful. Nonpharmacologic therapies such as exercise, physical therapy, and psychologic counseling may also diminish pain and improve outcome in patients with rheumatic diseases. One may also consider yoga, acupuncture, biofeedback, massage, relaxation techniques, and other alternative therapies.

Acupuncture Therapy↗
PubMed2005

Section 3: The nature of pain: pathophysiology.

An understanding of the pathophysiology of pain involves the concepts of neuronal plasticity at the levels of the nociceptor neurons, spinal cord, and brain. Neuroplasticity allows the neurons in the brain to compensate for injury and adjust their activity in response to new situations or changes in their environment. This is an important physiologic event in the development of central sensitization. Other concepts include modulatory effects at the nociceptor, sympathetically mediated pain, the "wind-up" phenomenon, central sensitization, and descending and ascending central modulatory mechanisms for the perception of pain, as well as the related pain motivations and behaviors. Numerous modulatory mechanisms for pain have been postulated that control the degree of pain perceived and the emotional and behavioral phenomena associated with a patient's pain experience. These numerous mechanisms take place at all levels of the nervous system: peripheral nerves, spinal cord, and brain. Despite great advances in unraveling the complexities of the pathophysiology of pain, much remains to be discovered. It is hoped that further research into this critical area will lead to better therapies.

Acute Disease↗
PubMed2005

Section 2: The importance of improving function in patients with pain.

When evaluating pain in the rheumatic diseases, assessment of adequate therapy has expanded from purely biochemical measures and joint counts to determining the degree of function. Because pain is an important predictor of function, instruments have been developed that attempt to measure how disease and pain affect parameters such as activities of daily living, quality of life, ability to work, and emotional well-being. Some measures, such as visual analogue scales, measure only the intensity of pain; multidimensional scales assess a variety of factors related to the patient's overall ability to function. The Short Form-36 measures the impact of disease on overall quality of life; adaptations have been made to some specific diseases. The Health Assessment Questionnaire was one of the first multidimensional questionnaires developed for rheumatic diseases, and this has been further refined for rheumatoid arthritis with the Multidimensional Health Assessment Questionnaire.

Health Status Indicators↗
PubMed2002

Use of nonopioid analgesics and adjunctive agents in the management of pain in rheumatic diseases.

Antirheumatic analgesic medications generally fall into one of the following categories: acetaminophen, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, traditional opioids, or adjunctive analgesics. This article does not discuss corticosteroids, opioids, or topical analgesics. Acetaminophen, usually indicated early for mild pain, is often used in combination with other drugs. It has established safety. Traditional NSAIDs are effective in relieving moderate pain in certain inflammatory and noninflammatory conditions. There are many effective choices, but as a class it is fraught with the risk of serious peptic ulcer disease and its complications. Cyclooxygenase-2 specific inhibitors are NSAIDS that reduce the gastrointestinal risk and platelet-mediated bleeding. All NSAIDs may produce peripheral edema, hypertension, and potentiate warfarin. The evidence that coxibs cause thrombotic heart disease is weak. Tramadol is an alternative to musculoskeletal pain management, particularly in patients with moderate to moderately severe pain who do not respond to or who cannot tolerate acetaminophen, NSAIDs, or opioids. The role of analgesic adjuvants is discussed.

Analgesics↗
PubMed2002

Cyclooxygenase-2-selective inhibitors in the management of acute and perioperative pain.

Postsurgical pain is often undertreated. Opioids are frequently used in perioperative analgesia, but concern about side effects can result in administration of an inadequate dose for pain relief. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used increasingly for postoperative analgesia. The use of balanced analgesia-a combination of opioids, NSAIDs, and local anesthesia utilizing agents from other classes (eg, ketamine, clonidine)-improves the efficacy of pain relief and decreases risk of side effects. While lacking some of the troublesome side effects of opioids, nonselective NSAIDs may cause bleeding as a result of their inhibitory effects on COX-1. For this reason, COX-2-selective inhibitors (coxibs) are attractive opioid-sparing analgesic options in the perioperative setting. Factors in addition to side effects such as time to onset of action, duration of action, maximum pain relief, use of rescue medication, and other factors relevant to a given pain model are important in determining overall analgesic efficacy. Clinical studies show that COX-2-selective inhibitors are effective for the treatment of preoperative and postoperative pain and reduce postsurgical requirements for opioids. This evidence supports a role for COX-2-derived prostaglandins as key mediators of nociceptive pain and peripheral sensitization (hyperalgesia). Pain management in the perioperative setting and the role of COX-2-selective inhibitors in acute and postoperative pain are reviewed here.

Acute Disease↗