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2 results

  • Neuropathy – overview

  • from Chief complaints and diagnoses
  • Edited by Stephen H. Thomas
  • Book:
    Emergency Department Analgesia
    Published online:
    18 December 2009
    Print publication:
    25 September 2008, pp 289-300

  • Summary

    This chapter addresses perianal painful conditions encountered in the ED setting. Laxatives are the initial therapy for perianal pain from a variety of conditions. Topically applied nitroglycerin is widely recommended for pain caused by either anal fissures or thrombosed external hemorrhoids. The utility of NSAIDs in post-hemorrhoidectomy pain is demonstrated by trials of perioperative administration of agents such as ketorolac and diflunisal. For patients with chronic anal fissure or painful external hemorrhoids who fail nitroglycerin therapy, or who have intolerable side effects to the drug, calcium channel blockers have been recommended as an alternative means to reduce anal tone and relieve symptoms. Perianal pain may also be the presenting complaint for patients with Condylomata acuminatum.The systemic condition lichen sclerosus, usually treated with potent topical corticosteroids, causes perianal (and vulvar) pain that can be significantly alleviated with topical 1% pimecrolimus cream.

  • The impact of opioid and laxative prescribing habits on constipation in the primary care setting before and after the introduction of SIGN 44: Control of pain in patients with cancer

  • Pam Lanza, Margaret Carey
  • Journal:
    Primary Health Care Research & Development / Volume 7 / Issue 1 / January 2006
    Published online by Cambridge University Press:
    31 October 2006, pp. 3-9
    • Article
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  • The constipating effect of opioids used in cancer pain is widely acknowledged. Opioids account for about a half of constipation in cancer patients, making constipation one of the most prevalent side effects of cancer analgesia. Scottish Intercollegiate Guidelines Network (SIGN) guideline 44 (7.4.1) states explicitly that the appropriate intervention for opioid-induced constipation is a combination of softening and stimulating prophylactic laxatives. Previous literature suggests such practice is not commonplace, implicating a knock-on negative effect to patients' quality of life and highlighting the need for audit in this area. An audit of bowel management in Fife primary care was carried out comparing laxative prescribing practice before and after the publication of SIGN 44: Control of pain in patients with cancer. The data for the audit included all opioid prescriptions including both cancer and non-cancer patients. It was found that publication of SIGN 44 had no significant effect on adherence to the guideline by general practitioners in Fife, at six-, 12- and 18-months post-publication. Implications for quality of life and improving bowel management are discussed.