ISSN:0749-8047    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Abstract: Both regional intravenous guanethidine and reserpine have been reported as effective in the treatment of reflex sympathetic dystrophy. Reserpine depletes storage of norepinephrine, and guanethidine interferes with transport of norepinephrine while depleting storage in the sympathetic nerve terminal. The purpose of this study was to compare drug efficacy in double-blind fashion. Twelve patients, 10 ofwhome had previous stellate or lumbar sympathetic blocks, were entered into this double-blind cross-over study. Each patient Successively received 20 mg guanethidine in 50 ml 0.5% lidocaine, 1.25 mg reserpine in 50 ml 0.5% lidocaine, and 50 ml 0.5% lidocaine with a 1-week interval between medications. At the end of the study and before the code was broken each patient had the option of continuing treatment with any of the three drugs: the patient merely asked for the first, second or third drug. Pain assessment used verbal ordinal, numeric, and visual analog scales. Follow-up asted for a minimum of 6 months. Changes in pain intensity for the first 3 days did not differ siginificantly among guanethidine, reserpine, and control group. Pain relief from significantly among guanethidine, reserpine, and control groups. Pain relief from 2 to 14 months was achieved in two patients receiving reserpine. One receiving guanethidine, and none receiving lidocaine. None of the patients experienced permanent relief. No different was found between reserpine and guanethidine.

ISSN:0749-8047    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Abstract: Diagnostic epidural blocks were performed on 27 chronic pain patients sequentially using saline, fentanyl, and lidocaine solution. The patients were divided into one of four groups based on their response to the epidural solutions: placebo response grou-pain relief with placebo solutions; fentanyl response group-pain relief with epidural fentanyl; lidocaine response group (LRG)-pain relief with lidocaine but not fentanyl; and no response group-no pain relief with any of the solutions used. The four groups were compared on the basis of age, sex, site of pain, duration of pain, narcotic use, pain assessment index, and workmen's compensation claims. The comparisons resulted in the conclusion that LRG patients had a much longer average duration of pain than the other groups. On the basis of the information gathered, it was theorized that, despite their response to epidural lidocaine, LRG patients may actually be a group of operant pain patients. Their failure to receive analgesia from epidural fentanyl may be a learned response such that they associate any sensory input from the affected area as painful. If follow-up studies support these findings, then the diagnostic opioid technique may be a more sensitive tool in diagnosing chronic pain.

ISSN:0749-8047    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Abstact: The long-term analgesic effects and the complications of epidural narcotic analgesia (ENA) were investigated in 40 cancer patients in whom systemic narcotic therapy failed to relieve pain or caused unacceptable side effects. In 32 patients, an externally fixated polyamide epidural catheter was used (‘external group’), and in 8 patients, a polyurethane epidural catheter was tunneled and connected to a subcutaneous access port (“internal group”). The average duration of catheter treatment was 80.9 days (range 9–533 days). Twenty-five patients were treated as outpatients, and 15 remained hospitalized. Initially, all patients had significant or complete pain relief from 10 mg morphine/day, but the daily epidural morphine requirement showed a threefold increase during the first 3 weeks. During ENA, other methods of pain relief (radiotherapy, chemotherapy, surgery, epidural administration of local anesthetics, and nerve blocks) were necessary in 14 patients. Pharmacological side effects were of minor importance, with transient pruritus being the main subjective complaint. In the “external” group, 31 catheter replacements were necessary, mostly due to backflow of injected morphine outside the catheter. In two patients of the internal group, neurological complications occurred, but these disappeared spontaneously after removal of the system. They were presumably due to epidural fibrosis with compression of the spinal cord. Further technical improvements are necessary for the easier use and higher safety of the catheter technique.

ISSN:0749-8047    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Abstact: To control costs, the University of Tennessee Center for Pain Management added an ambulatory pain rehabilitation program to its existing inpatient hospitalization program. The impact of this program was assessed by comparing the first 25 patients treated in 1985 (prior to the introduction of outpatient management) with the first 25 patients treated in 1987 (after outpatient management was established). Twenty of the 25 patients seen in 1985 required hospitalization, while in 1987 nine patients were hospitalized and 10 patients were placed in outpatient rehabilitation. The total cost for treating 25 patients in 1985 was $571,200 but decreased to $191,000 in 1987. Hospital charges were the greatest single cost factor in 1985 (321,500) but were only $61,000 in 1987. Success rates as measured by a return to previous employment were not significantly changed (13 of 25 returned to work in 1985, and 11 of 25 returned to work in 1987).

ISSN:0749-8047    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Abstract: The purpose of this study was to assess the impact of outpatient group treatment for chronic pain patients and their spouses on psychological symptomatology, marital adjustment, and locus of control. There was a significant improvement in mean scores on four of the seven measures pre- and post-treatment. This data suggests that group treatment can significantly reduce chronic pain related problems especially anxiety, depression, and interpersonal sensitivity for the patient as well as for the spouse. It also supports other findings for the effectiveness of brief group therapy programs for chronic pain patients. Although this study has several limitations the results warrant further investigation using control groups and a larger sample size.

ISSN:0749-8047    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Abstract: This study reports on the effectiveness of an individualized shaping treatment program for sitting and standing intolerance in a patient with chronic low back pain following a laminectomy for removal of an intradural tumor. Functional assessment of sitting and standing tolerance, observation of pain behaviors, and a self-report measure regarding the pain experience were carried out during baseline, treatment, posttreatment, and at a 6-month follow-up. By the end of the 6-week inpatient treatment, the patient was able to stand still for 25 min and to sit for 15 min. The overall pain behavior diminished significantly. These findings underscore the importance of relatively simple and cost-effective individualized behavioral programs for chronic pain patients.

ISSN:0749-8047    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Abstract: Intravenous infusion of lidocaine has a pain-relieving effect in patients with painful diabetic neuropathy. We measured plasma beta-endorphin (beta-EP), dynorphin immunoreactivity (DYN), and met-enkephalin (MET) before and after lidocaine infusion in 8 patients with painful diabetic neuropathy and in 10 controls. The pretreatment level of beta-EP and DYN was identical in the two groups. After lidocaine, beta-EP increased in diabetic patients from 3.4 to 5.5 pmol/L (median) (p < 0.02) and in controls from 3.4 to 5.0 pmol/L 1p < 0.02). The concentration of DYN was stable, and MET was undetectable before and after lidocaine. Lidocaine reduced symptoms and pain score in diabetic patients was uncorrelated with the changes in beta-EP. Intravenous lidocaine increased plasma beta-EP and diminished complaints in patients with painful diabetic neuropathy.

ISSN:0749-8047    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Abstract: In light of the lack of any prior systematic evaluations of the prevalence and types of pain syndromes and treatments found in patients with AIDS, a chart review study was undertaken to evaluate this issue. Fifty-two of 96 charts reviewed (54%) had at least one note on nonprocedural pain or analgesic prescription. Although chest pain was the most prevalent pain location (22%), presumably because of the high incidence of Pneumocystis carinii pneumonia, other possible AIDS-related entities, such as peripheral neuropathy and thrombophlebitis, were also found. No specific AIDS syndromes could be identified that were related to a higher incidence of pain. Nearly one-third of patients with pain received codeine (31%), others received acetaminophen (27%), and 17% of patients received acetaminophen and oxycodone HCI. Specific pain management interventions must be evaluated and applied to control the nontrivial occurrence of pain in patients who have AIDS symptoms that may be overlooked by the physician given the overwhelming disease process.

ISSN:0749-8047    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Abstract: Infrared imaging (thermography) has developed rapidly over the past 10–15 years as a diagnostic imaging procedure. Despite scientific validation and proven use in the clinical setting, neuromuscular thermography has met with much criticism and skepticism. The emotional and political controversy surrounding thermography has distracted the medical community to such an extent that the real issue of utmost importance to the practicing physician is often ignored. The basic scientific foundation of medicine should preclude the prejudicial influence of emotion, politics, and anecdotes. Scientific investigations, for more than 2 decades now, have demonstrated that neuromuscular thermography is of proven value in the clinical evaluation of various pain disorders and neuromuscular conditions, including radicular pathology.

ISSN:0749-8047    

出版商:OVID    

年代:1989

数据来源: OVID