Handbook of pain management by Michael Serpell; Mike Basler; et al

By Michael Serpell; Mike Basler; et al

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The most suitable alternative opioids after morphine are slow-release oxycodone or fentanyl patch, because they have less constipating effects, and these are the actual opioids tested in most of the human trials. Tramadol is a drug with a dual mode of activity: one-third of its activity is due to an opioid-like mechanism, the remainder being due to a mechanism similar to amitriptyline. It is truly a multi-modal drug in keeping with the underlying principle of current pain management strategies and should be considered before Step 3 opioids are used.

7. Ewing JA. Detecting alcoholism – the CAGE questionnaire. JAMA 1984; 252:1905–7. 8. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ 2006; 332:1430–4 9. Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ 2007; 334:1313–17. 10. McBeth J, Macfarlane GJ, Benjamin S, Silman AJ. Features of somatization predict the onset of chronic widespread pain. Arthritis Rheum 2001; 44:940–6. 11. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I.

Patients with hemiplegia or hemiparesis may present with central type pain syndromes. It is important to realize that a small fibre peripheral neuropathy may have few clinical signs. Significant new clinical findings may warrant referral to a neurologist. Functional assessment Many patients with chronic pain lose the ability to perform activities of daily living. It is important to get an accurate picture of baseline functional ability as a starting point to set therapeutic goals or measure the effectiveness of therapy.

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