Pain clinic Health Dictionary

Pain Clinic: From 1 Different Sources


a clinic that specializes in the management and relief of pain. Pain clinics are usually directed by anaesthetists.
Health Source: Oxford | Concise Colour Medical Dictionary
Author: Jonathan Law, Elizabeth Martin

Pain

An unpleasant sensory or emotional experience that is derived from sensory stimuli and modified by individual memory, expectations and emotions.... pain

Clinical Trial

A controlled research study of the safety and effectiveness of drugs, devices or techniques that occurs in four phases, starting with the enrolment of a small number of people, to the later stages in which thousands of people are involved prior to approval by the licensing authorities (for example, the Food and Drug Administration).... clinical trial

Clinical Governance

A framework through which health organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care.... clinical governance

Referred Pain

Pain felt in one part of the body which is actually arising from a distant site (e.g. pain from the diaphragm is felt at the shoulder tip). This occurs because both sites develop from similar embryological tissue and therefore have

common pain pathways in the CENTRAL NERVOUS SYSTEM. (See also PAIN.)... referred pain

Clinic

A facility, or part of one, devoted to diagnosis and treatment or rehabilitation of outpatients. See “outpatient services”; “ambulatory care”.... clinic

Clinical Audit

A MEDICAL AUDIT carried out by health professionals.... clinical audit

Facial Pain

Many causes, including neuralgia, frontal sinusitis, eye troubles (pain of glaucoma being referred to the temples), dental problems, shingles, psychogenic, migraine; pain referred from lungs or heart. See appropriate entries for each of these complaints.

Maria Treben’s Facial Pack: of any of the following – Thyme, Mullein, Chamomile or Yarrow. Fill small muslin bag and steep in boiling water. Ring out. Apply as hot as possible.

Internal: Chamomile tea. ... facial pain

Abdominal Pain

(Acute). Sudden unexplained colicky pain with distension in a healthy person justifies immediate attention by a doctor or suitably trained practitioner. Persistent tenderness, loss of appetite, weight and bowel action should be investigated. Laxatives: not taken for undiagnosed pain. Establish accurate diagnosis.

Treatment. See entries for specific disorders. Teas, powders, tinctures, liquid extracts, or essential oils – see entry of appropriate remedy.

The following are brief indications for action in the absence of a qualified practitioner. Flatulence (gas in the intestine or colon), (Peppermint). Upper right pain due to duodenal ulcer, (Goldenseal). Inflamed pancreas (Dandelion). Gall bladder, (Black root). Liver disorders (Fringe Tree bark). Lower left – diverticulitis, colitis, (Fenugreek seeds). Female organs, (Agnus Castus). Kidney disorders, (Buchu). Bladder, (Parsley Piert). Hiatus hernia (Papaya, Goldenseal). Peptic ulcer, (Irish Moss). Bilious attack (Wild Yam). Gastro-enteritis, (Meadowsweet). Constipation (Senna). Acute appendicitis, pain central, before settling in low right abdomen (Lobelia). Vomiting of blood, (American Cranesbill). Enlargement of abdominal glands is often associated with tonsillitis or glandular disease elsewhere which responds well to Poke root. As a blanket treatment for abdominal pains in general, old-time physicians used Turkey Rhubarb (with, or without Cardamom seed) to prevent griping.

Diet: No food until inflammation disperses. Slippery Elm drinks. ... abdominal pain

Clinical

Clinical means literally ‘belonging to a bed’, but the word is used to denote anything associated with the practical study or observation of sick people – as in clinical medicine, clinical thermometers.... clinical

Clinical Care

Professional specialized or therapeutic care that requires ongoing assessment, planning, intervention and evaluation by health care professionals.... clinical care

Clinical Condition

A diagnosis (e.g. myocardial infarct) or a patient state that may be associated with more than one diagnosis (such as paraplegia) or that may be as yet undiagnosed (such as low back pain).... clinical condition

Clinical Event

Services provided to patients (history-taking, physical examination, preventive care, tests, procedures, drugs, advice) or information on clinical condition or on patient state used as a patient outcome.... clinical event

Clinical Guidelines

Systematically developed statements which assist clinicians and patients to decide on appropriate treatments for speci?c conditions. The guidelines are attractive to health managers and patients because they are potentially able to reduce variation in clinical practice. This helps to ensure that patients receive the right treatment of an acceptable standard. In England and Wales, the NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (NICE) is developing national guidelines with advice from health-care professionals and patients to improve clinical e?ectiveness of NHS care. Some doctors have reservations about guidelines because (1) health-care managers might use them primarily to contain costs; (2) in?exibility would discourage clinical innovations; (3) they could encourage litigation by patients. (See also HEALTH CARE COMMISSION; MEDICAL LITIGATION.)... clinical guidelines

Clinical Information System

An information system that collects, stores and transmits information that is used to support clinical applications (e.g. transmission of laboratory test results, radiology results, prescription drug orders). Electronic medical records are one method by which clinical information systems can be created.... clinical information system

Clinical Observation

Clinical information, excluding information about treatment and intervention. Clinical information that does not record an intervention is by nature a clinical observation. The observer may be the patient or related person (information about symptoms, family history, occupation or lifestyle) or a health care professional (information about physical signs, measurements, properties observed or diagnoses). While information about the nature of a planned or performed treatment is excluded by the definition, clinical observations may be recorded on the results of a treatment, on progress during the course of a treatment, or on the result of a treatment.... clinical observation

Clinical Pathway

A multidisciplinary set of daily prescriptions and outcome targets for managing the overall care of a specific type of patient, e.g. from pre-admission to post-discharge for patients receiving inpatient care. Clinical pathways are often intended to maintain or improve quality of care and decrease costs for patients in particular diagnosis-related groups.... clinical pathway

Clinical Performance Measure

An instrument that estimates the extent to which a health care provider delivers clinical services that are appropriate for each patient’s condition; provides them safely, competently and in an appropriate time-frame; and achieves desired outcomes in terms of those aspects of patient health and patient satisfaction that can be affected by clinical services.... clinical performance measure

Clinical Practice Guideline

A systematically developed statement to assist practitioner and patient decisions about appropriate health care for one or more specific clinical circumstances.... clinical practice guideline

Clinical Significance

A conclusion that an intervention has an effect that is of practical meaning to older persons and health care providers. Even though an intervention is found to have a statistically significant effect, this effect may not be clinically significant. In a trial with a large number of participants, a small difference between treatment and control groups may be statistically significant, but clinically unimportant. In a trial with few participants, an important clinical difference may be observed that does not achieve statistical significance. (A larger trial may be needed to confirm that this is a statistically significant difference).... clinical significance

Clinical Signs

The physical manifestations of an illness elicited by a doctor when examining a patient – for example, a rash, lump, swelling, fever or altered physical function such as re?exes.... clinical signs

Clinical Symptoms

The experiences of a patient as communicated to a doctor, for example, pain, weakness, cough. They may or may not be accompanied by con?rmatory CLINICAL SIGNS.... clinical symptoms

Day Surgical Centre / Clinic

A free-standing ambulatory surgery centre, independent of a hospital.... day surgical centre / clinic

Clinical Psychology

Psychology is the scienti?c study of behaviour. It may be applied in various settings including education, industry and health care. Clinical psychology is concerned with the practical application of research ?ndings in the ?elds of physical and mental health. Training in clinical psychology involves a degree in psychology followed by postgraduate training. Clinical psychologists are speci?cally skilled in applying theoretical models and objective methods of observation and measurement, and in therapeutic interventions aimed at changing patients’ dysfunctional behaviour, including thoughts and feelings as well as actions. Dysfunctional behaviour is explained in terms of normal processes and modi?ed by applying principles of normal learning, adaption and social interaction.

Clinical psychologists are involved in health care in the following ways: (1) Assessment of thoughts, emotions and behaviour using standardised methods. (2) Treatment based on theoretical models and scienti?c evidence about behaviour change. Behaviour change is considered when it contributes to physical, psychological or social functioning. (3) Consultation with other health-care professionals about problems concerning emotions, thinking and behaviour. (4) Research on a wide variety of topics including the relationship between stress, psychological functioning and disease; the aetiology of problem behaviours; methods and theories of behaviour change. (5) Teaching other professionals about normal and dysfunctional behaviour, emotions and functioning.

Clinical psychologists may specialise in work in particular branches of patient care, including surgery, psychiatry, geriatrics, paediatrics, mental handicap, obstetrics and gynaecology, cardiology, neurology, general practice and physical rehabilitation. Whilst the focus of their work is frequently the patient, at times it may encompass the behaviour of the health-care professionals.... clinical psychology

Clinical Risk Management

Initially driven by anxiety about the possibility of medical negligence cases, clinical risk management has evolved into the study of IATROGENIC DISEASE. The ?rst priority of risk managers is to ensure that all therapies in medicine are as safe as possible. Allied to this is a recognition that errors may occur even when error-prevention strategies are in place. Lastly, any accidents that occur are analysed, allowing a broader understanding of their cause. Risk management is generally centred on single adverse events. The threat of litigation is taken as an opportunity to expose unsafe conditions of practice and to put pressure on those with the authority to implement change. These might include senior clinicians, hospital management, the purchasing authorities, and even the Secretary of State for Health. Attention is focused on organisational factors rather than on the individuals involved in a speci?c case.... clinical risk management

National Institute For Clinical Excellence (nice)

This special health authority in the National Health Service, launched in 1999, prepares formal advice for all managers and health professionals working in the service in England and Wales on the clinical- and cost-e?ectiveness of new and existing technologies. This includes diagnostic tests, medicines and surgical procedures. The institute also gives advice on best practice in the use of existing treatments.

NICE – its Scottish equivalent is the Scottish Health Technology Assessment Centre – has three main functions:

appraisal of new and existing technologies.

development of clinical guidelines.

promotion of clinical audit and con?dential inquiries. Central to its task is public concern about ‘postcode prescribing’ – that is, di?erent availability of health care according to geography.

In 2003 the World Health Organisation appraised NICE. Amongst its recomendations were that there should be greater consistency in the methods used for appraisal and the way in which results and decisions were reported. WHO was concerned about the need for transparency about the con?ict between NICE’s use of manufacturers’ commercial evidence in con?dence, and believed there should be greater de?nition of justi?cation for ‘threshold’ levels for cost-e?ectiveness in the Centre’s judgement of what represents value for money.

In all, WHO was congratulatory – but questions remain about the practical value and imlementation of NICE guidelines.... national institute for clinical excellence (nice)

Pain Management Programme

A set of strategies to address an individual’s pain management requirements and supportive of the individual’s pain control.... pain management programme

Clinical Ecology

Environmental medicine. Treatment of allergies by natural medicines. The science that endeavours to bridge physics and chemistry; including such disciplines as homoeopathy, acupuncture, herbalism, etc. ... clinical ecology

Eyes – Pain

A number of causes including reflex pain from inflammation of the middle ear or decayed teeth. Eyeball tender to touch.

Alternatives. Plantain, Ginkgo. Teas, tablets, etc.

Topical. Cold compress: Witch Hazel.

Supplements. Daily. Vitamins C (500mg); E (400iu). Beta-carotene. Palming. ... eyes – pain

Griping Pain

Acute pain in the abdominal cavity. Non-recurring.

Tea. Combine equal parts: Avens, Catmint, Thyme. 2 teaspoons to each cup boiling water; infuse 5 minutes. Half-1 cup freely.

Alternative: quarter of a teaspoon powdered Ginger, or Cinnamon in honey.

Enema: Catmint, Chamomile or Balm.

See: COLIC.

Persistent griping should be investigated. ... griping pain

Clinical Trials

(See EVIDENCE-BASED MEDICINE.) Clinical trials aim to evaluate the relative effects of di?erent health-care interventions. They are based on the idea that there must a fair comparison of the alternatives in order to know which is better. Threats to a fair comparison include the play of chance and bias, both of which can cause people to draw the wrong conclusions about how e?ective a treatment or procedure is.

An appreciation of the need to account for chance and bias has led to development of methods where new treatments are compared to either a PLACEBO or to the standard treatment (or both) in a controlled, randomised clinical trial. ‘Controlled’ means that there is a comparison group of patients not receiving the test intervention, and ‘randomised’ implies that patients have been assigned to one or other treatment group entirely by chance and not because of their doctor’s preference. If possible, trials are ‘double-blind’ – that is, neither the patient nor the investigator knows who is receiving which intervention until after the trial is over. All such trials must follow proper ethical standards with the procedure fully explained to patients and their consent obtained.

The conduct, e?ectiveness and duplication of clinical trials have long been subjects of debate. Apart from occasional discoveries of deliberately fraudulent research (see RESEARCH FRAUD AND MISCONDUCT), the structure of some trials are unsatisfactory, statistical analyses are sometimes disputed and major problems have been the – usually unwitting – duplication of trials and non-publication of some trials, restricting access to their ?ndings. Duplication occurs because no formal international mechanism exists to enable research workers to discover whether a clinical trial they are planning is already underway elsewhere or has been completed but never published, perhaps because the results were negative, or no journal was willing to publish it, or the authors or funding authorities decided not to submit it for publication.

In the mid 1980s a proposal was made for an international register of clinical trials. In 1991 the NHS launched a research and development initiative and, liaising with the COCHRANE COLLABORATION, set out to collect systematically data from published randomised clinical trials. In 1994 the NHS set up a Centre for Reviews and Dissemination which, among other responsibilities, maintains a database of research reviews to provide NHS sta? with relevant information.

These e?orts are hampered by availability of information about trials in progress and unpublished completed trials. With a view to improving accessibility of relevant information, the publishers of Current Science, in 1998, launched an online metaregister of ongoing randomised controlled trials.

Subsequently, in October 1999, the editors of the British Medical Journal and the Lancet argued that the case for an international register of all clinical trials prior to their launch was unanswerable. ‘The public’, they said, ‘has the right to know what research is being funded. Researchers and research funders don’t want to waste resources repeating trials already underway.’ Given the widening recognition of the importance to patients and doctors of the practice of EVIDENCE-BASED MEDICINE, the easy availability of information on planned, ongoing and completed clinical trials is vital. The register was ?nally set up in 2005.... clinical trials

Spiritual Pain

Spiritual pain is what may be felt when one of a person’s four key spiritual relationships (with other people, with oneself, with the world around, or with ‘Life’ itself) is traumatised or broken. A bad trauma in one of the ?rst three relationships can lead to damage to the last of them – that of the relationship with Life itself. For example, a wife deserted by her husband for another woman may not only feel devastated by the loss of her partner around the place, but may also feel a pain caused by the shattering of her beliefs about life (about faithfulness, hope, love, security, etc.). It is as if there is a picture at the centre of each person of what life should be about – whether or not held in a frame by a belief in God; this picture can be smashed by a particular trauma, so that nothing makes sense any more. The individual cannot get things together; everything loses its meaning. This shattering of someone’s picture of life is the source of the deepest pain in any spiritual trauma. The connection is often made between spiritual pain and meaninglessness. If the shattering of the picture, on the other hand, is done by the individual – for instance, by breaking his or her own moral or religious code – the pain may take the form of guilt and associated feelings. Hence, the therapist will be intent upon helping a client to recognise and come to terms with this ‘pain beneath the pain’.... spiritual pain

Pain-relievers

See: ANALGESICS. ... pain-relievers

Myofascial Pain Syndrome

See temporomandibular joint syndrome.... myofascial pain syndrome

Pain Relief

The treatment of pain, usually with analgesic drugs. Paracetamol, aspirin and codeine are the most widely used drugs in this group. Pain accompanied by inflammation is often alleviated by nonsteroidal anti-inflammatory drugs (NSAIDs). Severe pain may require treatment with opioids, such as morphine.

Other methods of pain relief include massage, ice-packs, poultices, TENS, acupuncture, or hypnosis. Surgery to destroy pain-transmitting nerves (as in a cordotomy) is occasionally performed when other treatments fail.... pain relief

Pelvic Pain

See abdominal pain.... pelvic pain

Period Pain

See dysmenorrhoea.... period pain

Retrosternal Pain

Pain in the central region of the chest, behind the sternum. Causes include irritation of the oesophagus, angina pectoris, or myocardial infarction. (See also chest pain.)... retrosternal pain

Testis, Pain In The

Pain in a testis may be caused by mild injury, a tear in the wall of the testis due to a direct blow, orchitis, epididymo-orchitis, and torsion of the testis (see testis, torsion of). Sometimes, no cause is found and the pain disappears without treatment. If the wall of the testis is torn, an operation to repair it may be needed. ... testis, pain in the

Trial, Clinical

A test on human volunteers of the effectiveness and safety of a drug. A trial can also involve systematic comparison of alternative forms of medical or surgical treatment for a particular disorder. Patients involved in clinical trials have to give their consent, and the trials are approved and supervised by an ethics committee.... trial, clinical

Tea For Back Pain

Back pain is usually an affection caused by both external and internal problems. Standing too long, pregnancy, weight lifting or pulmonary problems could cause severe back pains. Other than a prolonged pain localized in your back area, this affection could also interfere with your coronary and circulatory systems: the blood pressure is high and it’s hard for your heart to pump oxygen in your system. How a Tea for Back Pain Works A Tea for Back Pain’s main purpose is to make your body release enough endorphins to induce a state of calmness and well-being to your entire organism. In order to do that, a Tea for Back Pain must contain an important amount of nutrients, acids, volatile oils, antioxidants, enzymes and minerals (such as sodium, iron, magnesium and manganese). Efficient Tea for Back Pain An efficient Tea for Back Pain must show results as quickly as possible and be one hundred percent sure (when choosing an herbal treatment, always be well informed of the risks). If you don’t know which teas could have a positive effect on your health, here’s a list for guidance: - Ginger Tea – will bring relief to your pain and improve your general health in no time. You can also take it in case you’re suffering from anemia, asthenia, loss of appetite or headaches. However, in order to avoid other health complications, make sure you’re using a small amount of herbs when preparing this decoction. Otherwise, you might develop an acid foods and drinks intolerance. - Turmeric Tea – not very popular among Europeans, this Tea for Back pain acts as a great pain reliever, calming all your affected areas and restoring your general health in no time. You may also want to try it in case you’re suffering from inflammations, bruises, spreads, skin or digestive issues. Make sure you don’t drink more than 2 cups per day and everything will be fine. - Valerian Tea – used as a great sedative since ancient times, when the Greeks and the Romans drank a cup of it before every night, this Tea for Back Pain will nourish your nervous system and bring relief to your wounded areas. However, make sure you pay attention to the amount of tea you’re ingesting in order to avoid hallucinations and even death. Tea for Back Pain Side Effects When taken properly, these teas are generally safe. However, exceeding the number of cups recommended per day may lead to a series of affections, such as nausea, upset stomach, vomiting and even death. If you’ve been taking one of these teas for a while and you’ve noticed some unusual reactions from your body, ask for medical assistance immediately! If you have the green light from your doctor and there’s nothing that could interfere with your treatment, choose a Tea for Back Pain that fits best your needs and enjoy its health benefits!... tea for back pain

Analgesics  - Pain-relievers - Anodynes

Herbs taken orally for relief of mild pain. May also be applied externally. An analgesic may also be an antispasmodic, relieving cramp (Cramp bark etc.). Throughout history, Opium Poppy has always been the most effective analgesic, but must be given by a qualified medical practitioner except applied externally as a poultice. The same rule may apply to Aconite, Arnica and Belladonna.

Mild analgesics:– Black Cohosh, Black Willow, Catnep, Chamomile, Cowslip root (Bio-Strath), Cramp bark, Devil’s Claw, Gelsemium, Guaiacum, Hops, Jamaican Dogwood, Ladyslipper, Lobelia, Passion flower, Rosemary, Skullcap, St John’s Wort, Skunk Cabbage, Valerian, White Willow bark, Wild Lettuce, Wild Yam, Wintergreen, Yerbe Mate tea, Poke root, White Poplar.

Skullcap, Mistletoe, Valerian and Feverfew are herbs of choice. All four are believed to have an anti- prostaglandin effect, the first three given in combination; the latter (Feverfew) appearing to work best singly. ... analgesics  - pain-relievers - anodynes

Atypical Facial Pain

see persistent idiopathic facial pain.... atypical facial pain

Chronic Idiopathic Facial Pain

see persistent idiopathic facial pain.... chronic idiopathic facial pain

Chronic Pelvic Pain

(CPP) intermittent or constant pain in the lower abdomen or pelvis of at least six months’ duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy. It may be caused by an underlying gynaecological condition, such as *endometriosis or adhesions, but bowel or bladder disorders (e.g. irritable bowel syndrome, interstitial cystitis), visceral hypersensitivity, and psychological conditions may all contribute.... chronic pelvic pain

Clinical Commissioning Groups

(CCGs) self-governing bodies set up by the Health and Social Care Act 2012, following the abolition of *primary care trusts and *strategic health authorities, to commission most NHS services in England. CCGs are formed of all GP practices within a given geographical area, and all GP practices must belong to a clinical commissioning group. All CCGs have their own constitution and governing body, which (in addition to GPs) must include at least one registered nurse and at least one secondary care specialist doctor. There are currently 195 CCGs in England.... clinical commissioning groups

Teas For Menstrual Pain

Menstrual pain is known for its acute and localized action on the abdominal area. However, not all women suffer from this affection.The good thing about menstrual pain, however, is that this is not a chronic disease and that it can go away as quickly as it came to you. All you have to do is treat it properly and wait for your body to respond. If the pain is very powerful and you need to put a stop to it, you may want to try taking an herbal treatment, in which case Raspberry leaf tea, Corn silk tea and Wild yam tea could be the answer. How Teas for Menstrual Pain Work Most of these Teas for Menstrual Pain involve helping your body release the right amount of endorphins in order to fight localized pain. Although menstrual pain is probably the most popular cause of distress for women around the world, alternative medicine found new ways to fight it alongside with traditional medicine. However, choosing one of these Teas for Menstrual Pain will only make your system healthier, without having to worry for possible side effects. The main characteristic of these Teas for Menstrual Pains is that they have a pleasant taste and fragrance and that they are generally safe, unlike traditional medicines. A cup of raspberry leaf tea brings relief to your abdominal area, by calming the muscles and increasing the uterus action. Efficient Teas for Menstrual Pain If you have a heavy menstrual flow or a severe pain crisis during periods, you may find out that the following Teas for Menstrual Pain could be the right answer to your problems: - Cramp Bark Tea – thanks to its antispasmodic and anti-inflammatory properties, Cramp Bark Tea is one of the best Teas for Menstrual Pain there is! Unfortunately, it’s rather inaccessible to the European public. However, if you find a shop that specializes in Cramp Bark products, hold on to it! Cramp Bark Tea can also be used as a detoxifier and a good face cleanser; when used topically, it may bring relief to your skin sores. - Raspberry Leaf Tea – this is a tea that may also come in hand in case you want to perform natural cosmetic procedures at home. Just soak a compress in Raspberry Leaf Tea and apply it on your face for 5 minutes to open and clean your pores. However, a cup of Raspberry Tea per day will improve your general health, bringing relief to those of you who are suffering from severe menstrual pain. - Corn Silk Tea – on this Teas for Menstrual Pain list, Corn silk Tea use needs extra caution. It is true that it can calm your menstrual pain, but you also need to measure the amount of tea you drink in order to avoid other complications: Corn Silk Tea is a very powerful urinary stimulant. - Wild Yam Tea – one of the most dangerous Teas for Menstrual Pain, Wild Yam Tea can bring relief to all kinds of pain, starting with menstrual pain, stomach pain and ending with migraines and severe headaches. However, don’t take this tea if you have protein S deficiency or a hormone-sensitive condition, such as breast cancer, uterine fibroids or endometriosis. Teas you should avoid During menstruation, you may want to avoid all teas based on a high level of acids, such as green or black teas . They will only make your pain insufferable, by increasing your stomach acidity and also your heart beat. Teas for Menstrual Pain Side Effects When taken according to specifications, these Teas for Menstrual Pain are rarely dangerous. However, if you’ve been taking one of them for a while and you’re experiencing some unusual reactions from your body, talk to a doctor as soon as possible. In high dosages, these teas may cause urinary dysfunctions, nausea, headaches and vomiting. First, make sure you’re not allergic to the tea you’re about to take in order to avoid other health complications. Once you have the green light from your doctor, give these Teas for Menstrual Pain a try and enjoy their wonderful benefits wisely!... teas for menstrual pain

Breast (female) Tenderness, Pain

May be from hormonal imbalance for which Agnus Castus is almost specific.

Rosemary. 1 teaspoon leaves to cup boiling water; infuse 15 minutes. Half-1 cup 2-3 times daily.

Tea. Formula. Equal parts leaves, Agnus Castus, Rosemary, Balm. 1-2 teaspoons to each cup boiling water; infuse 15 minutes; 1 cup 2-3 times daily.

Evening Primrose oil. 10 drops (or 2 × 250ml capsules) 3 times daily.

Poke root. Internally and externally.

Yorkshire gypsy device: fix a cabbage or a rhubarb leaf beneath brassiere.

Liquid Extract Blue Cohosh BHP (1983): 0.5-1ml, Thrice daily. Alternative: Liquid Extract Rosemary BHP (1983): 2-4ml. Thrice daily.

Vitamins. All-round multivitamin and mineral supplement. Vitamin C (1g daily). Vitamin E (400iu daily). ... breast (female) tenderness, pain

Clinical Ethics

consideration of the moral issues attendant upon, and questions arising from, clinical practice, as distinct from research. In North America, it is common for hospitals to employ a clinical ethicist or provide a formal clinical ethics consultation service. In the UK, clinical *ethics committees are increasingly common in the NHS.... clinical ethics

Clinical Medical Officer

see community health.... clinical medical officer

Clinical Medicine

the branch of medicine dealing with the study of actual patients and the diagnosis and treatment of disease at the bedside, as opposed to the study of disease by *pathology or other laboratory work.... clinical medicine

National Clinical Assessment Service

(NCAS) see Practitioner Performance Advice.... national clinical assessment service

Persistent Idiopathic Facial Pain

(atypical facial pain, chronic idiopathic facial pain) a chronic pain in the face that has no known cause and does not fit the classic presentation of other cranial neuralgias. It may be stress-related, and in some cases appears to be associated with defective metabolism of *tyramine. Treatment may involve the use of antidepressants.... persistent idiopathic facial pain

Rest Pain

pain without prior exertion, usually experienced in the feet or chest (*angina pectoris), that indicates an extreme degree of *ischaemia.... rest pain

Feet – Pain In

(Metatarsalgia)

Causes: foot-strain, deformity, osteoporosis, high heels throwing the body out of its normal posture, tight shoes.

Feet are often painful because one or more of the bones are out of alignment and which may be adjusted by simple osteopathy. The process can be assisted by foot-baths of Chamomile flowers, Arnica flowers, or Comfrey to relax muscles and tendons.

Alternatives. Alfalfa, Chaparral, Ligvites, Prickly Ash.

Topical. Aromatherapy. (Sensitive feet) Oils of Pine, Eucalyptus or Thyme – 6 drops, any one, to 2 teaspoons Almond oil. Warm. Massage into foot and wrap round with damp hot towel.

General. Acupuncture. Shoes should be bought in the afternoon, particularly if feet swell during the day. Shoes that fit well in the morning may have become too tight by tea-time. ... feet – pain in

Back Pain

Pain affecting the back, often restricting movement. The pain usually lasts for only a week or so but can recur in some people. Rarely, persistent back pain causes long-term disability.

Back pain is usually caused by minor damage to the ligaments and muscles in the back. The lower back is especially vulnerable to these problems because it supports most of the body’s weight and is under continual stress from movements such as bending, twisting, and stretching. Less commonly, lower back pain may result from an underlying disorder such as a prolapsed intervertebral disc (see disc prolapse) in the spine.

In most cases, back pain can be treated with over-the-counter painkillers (see analgesic drugs) such as aspirin and related drugs, nonsteroidal antiinflammatory drugs, or muscle-relaxant drugs. If the pain persists, a heat pad, a wrapped hot-water bottle or, sometimes, an ice-pack, may provide additional relief. Generally, it is advisable to remain as active as the pain permits. People whose pain worsens or is still too severe to allow normal movement after several days should consult a doctor for medical tests.

Investigations for back pain, such as X-rays, CT scanning, or MRI, sometimes reveal abnormalities, such as disc prolapse, that require surgical treatment and can be treated by a microdiscectomy.

Other treatments for back pain include acupuncture, spinal injection, exercise, or spinal manipulation.... back pain

Chest Pain

Pain in the chest, which is often without serious cause, but which may be a symptom of an underlying disorder requiring urgent treatment. The pain may be in the chest wall or in an organ within the chest. The most common causes of pain in the chest wall are a strained muscle or an injury, such as a broken rib. A sharp pain that travels to the front of the chest may be due to pressure on a nerve root attached to the spinal cord as a result of, for example, osteoarthritis of the vertebrae. Pain in the side of the chest may be due to pleurodynia. The viral infection herpes zoster (shingles) may cause severe pain along the course of a nerve in the chest

wall. In Tietze’s syndrome, inflammation at the junctions of the rib cartilages causes pain on the front of the chest wall.

Pain within the chest may be caused by pleurisy, as a result of bronchitis, pneumonia, or, rarely, pulmonary embolism. Cancerous tumours of the lung (see lung cancer; mesothelioma) may cause pain as they grow and press on the pleura and ribs. Acid reflux may lead to heartburn, a burning pain behind the sternum. The common heart disorder angina pectoris causes pain in the centre of the chest that may spread outwards to the throat, jaw, or arms. Myocardial infarction (heart attack) and acute pericarditis both also produce severe pain in the centre of the chest. Mitral valve prolapse may cause sharp chest pain, usually on the left side. Chest pain may also be a result of anxiety and emotional stress (see hyperventilation; panic attack).... chest pain

Child Health Clinic

(in Britain) a special clinic for the routine care of infants and preschool children, formerly known as a child welfare centre. Sometimes these clinics are staffed by doctors, *health visitors, and clinic nurses; the children attending them are drawn from the neighbourhood around the clinic. Alternatively, general practitioners may run their own child health clinic on a regular basis, with health visitors and other staff in attendance; it is unusual for children not registered with the practice to attend such clinics. The service provides screening tests for such conditions as *congenital dislocation of the hip, suppressed squint (see cover test), and impaired speech and/or hearing. The *Guthrie test may also be performed if this has not been done before the baby leaves hospital. The staff of child health clinics also educate mothers (especially those having their first child) in feeding techniques and hygiene and see that children receive the recommended immunizations against infectious diseases. They also ensure that the families of children with disabilities receive maximum support from health and social services and that such children achieve their maximum potential in the preschool period. See also community paediatrician.... child health clinic

Clinical Global Impression

(CGI) rating scales commonly used by clinicians to measure symptom severity and treatment response in treatment studies of patients with psychiatric illnesses. Many researchers consider them to be a good tool to measure the clinical utility or relevance of a given treatment. The Clinical Global Impression–Severity scale (CGI-S) is used to rate the severity of the patient’s symptoms relative to the clinician’s past experience with patients who have the same diagnosis. Scores range from 1 (normal) to 7 (extremely ill). The Clinical Global Impression–Improvement scale (CGI-I) measures change in the patient’s presentation from baseline. Scores range from 1 (very much improved) to 7 (very much worse). A score of 4 indicates no change.... clinical global impression

Complex Regional Pain Syndrome

(CRPS, reflex sympathetic dystrophy, RSD, Sudek’s atrophy) neurological dysfunction in a limb following trauma, surgery, or disease, characterized by intense burning pain, swelling, stiffness, and sweaty shiny mottled skin. It is caused by overactivity of the sympathetic nervous system. The *ESR is often elevated, X-rays may reveal some patchy osteoporosis, and a bone scan usually demonstrates increased blood flow. Early treatment with splinting and physiotherapy are essential, in combination with *sympatholytic drugs, corticosteroids, and regional sympathetic blocks; *sympathectomy may be required in chronic cases.... complex regional pain syndrome

Objective Structured Clinical Examination

(OSCE) a type of examination used increasingly in the health sciences (medicine, dentistry, nursing, physiotherapy, pharmacy) to assess clinical skills in examination, communication, medical procedures, and interpretation of results. The examination usually takes the form of a circuit of stations around which each candidate moves after a specified time interval (5–10 minutes) at each station. Stations are a mixture of interactive and noninteractive tasks. Some have an examiner and a simulated patient, either an actor for assessment of communication or history-taking skills or a manikin of a specific part of the body (e.g. to demonstrate how to use an auriscope). Other stations have investigation results with a list of questions that are to be completed on computer-marked examination papers. Each station has a different examiner and the stations are standardized with specific marking criteria, thus enabling fairer comparison with peers.... objective structured clinical examination



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