George Heidrich

Sickle cell-related pain: Perceptions of medical practitioners

Pain is the most common problem encountered by patients with sickle cell disease (SCD). We report the results of a survey sent to hematologists and emergency department (ED) physicians regarding their perceptions and practices concerning pain and its management. Hematologists and ED physicians differed considerably in their perceptions about the natural history of the pain, and about the percentage of patients who are addicted to analgesics. Fifty-three percent of the ED physicians and 23% of the hematologists thought that more than 20% of patients are addicted. These beliefs and perceptions about SCD-related pain and the prevalence of addiction must be addressed if clinical care is to be changed substantively.

Pain Perception in Burn Patients with Stress Disorders

Abstract Of 134 participants in a burn center analgesia study, 104 were studied to determine the relationshipbetween current symptoms of post-traumatic stress disorder (PTSD) and pain experienced both non-procedurally and during debridement. On many variables, the 43 patients who met DSM-III Criteria for PTSD were different from the 61 who did not. As predicted, they reported more procedural and non-procedural pain, despite equivalent doses of analgesic medication. They also had larger burns and a higher prevalence of DSM-III delirium. Despite less actual responsibility for the burn, they lelt more guilty about the burn event. Finally, PTSD sufferers were more likely to be male, married, and employed. The implications of these data, in light of recent psychophysiological findings in PTSD, are discussed

Relative Analgesic Potency of Oral Zomepirac and Intramuscular Morphine in Cancer Patients with Postoperative Pain

A twin crossover assay of oral zomepirac and intramuscular morphine was completed in 159 cancer patients with postoperative pain. Zomepirac was a surprisingly effective oral analgesic in these patients, 100 mg orally being roughly equivalent to 16 mg intramuscular morphine. Time-effect data indicate that the peak effect for oral zomepirac may occur slightly later than that for morphine but that zomepirac is relatively rapidly effective after oral administration. Side effect occurrence was roughly in the same range for both drugs, with drowsiness, nausea, dry mouth, and feelings of weakness being observed after both drugs while sweating was observed more frequently after zomepirac. The assay further provided a demonstration of the effectiveness of the twin crossover design as a clinical assay method, providing increased sensitivity of crossover data in a patient population available for only a limited number of study treatments.