Pain
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Clinical Trial Controlled Clinical Trial
The effects of transcutaneous electrical nerve stimulation on post-cesarean pain.
The purpose of this study was to examine the effect of continuous transcutaneous electrical nerve stimulation (TENS) near the incision site on post-cesarean pain and on analgesic intake during the early postoperative period. This investigation utilised a 2-group (TENS-treated and placebo TENS-treated), single-blind experimental design. Eighteen multiparous women, each having undergone an elective cesarean delivery, participated in the study. ⋯ However, pain resulting from internal structures, i.e., deep pain, afterbirth pain (due to uterine contractions), and the somatic pain associated with decreased peristalsis (gas pains) were not amenable to TENS. No significant differences in analgesic intake were observed. The possible reasons for these findings are discussed.
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Because of the likely involvement of central convergence of afferent inputs in mechanisms underlying referred pain, the activity of single neurones was recorded in the cat's trigeminal (V) subnucleus caudalis (medullary dorsal horn) to test for the presence and extent of convergent inputs to the neurones. In chloralose-anaesthetized or decerebrate unanaesthetized cats, electrical stimuli were applied to afferents supplying facial skin, oral mucosa, canine and premolar tooth pulp, laryngeal mucosa, cervical skin and muscle, and jaw and tongue muscles, and tactile and noxious mechanical and thermal stimuli were applied to skin and mucosa. Considerable proportions of caudalis neurones which could be functionally classified on the basis of their cutaneous receptive field properties as low-threshold mechanoreceptive (LTM), wide-dynamic-range (WDR), or nociceptive-specific (NS) neurones, could be excited by electrical stimulation of several of these afferent inputs. ⋯ On the basis of antidromic activation, 15% of these WDR and NS neurones were shown to have a direct projection to the contralateral thalamus. The findings question the use of terminology and classifications of somatosensory neurones based only on the cutaneous receptive field properties of the neurones since distinctions between the different neuronal populations become less obvious when properties other than those related to cutaneous afferent inputs are taken into account. Moreover, the observations of extensive convergence of different types of afferents, which was especially apparent in cutaneous nociceptive neurones, also suggest a role for these neurones in mediating deep pain and in spread and referral of pain.
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The assessment and development of pain in children is reviewed in the first part of a two-part series. Assessment of pain in children has relied on self-report measures that have included visual analogue procedures using concrete stimuli for ratings. Behavioral assessment procedures are more sophisticated, but research on behavioral assessment of pediatric pain has begun to emergy only recently. ⋯ There are preliminary indications that children's thoughts and attitudes about pain may change with age in a manner that contributes to more intense feelings of pain in adolescence than childhood. Children undergoing painful medical procedures show declining emotional outbursts with age and increasing signs of self-control and muscular rigidity. Possibilities for integrating the study of the developmental aspects of pain with social learning theory, cognitive developmental theory, and the psychology of physical symptom perception are discussed.
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In order to determine the relationship between trigger point sensitivity and the referred symptoms of myofascial pain, VAS ratings of referred pain intensity and pressure algometer measures of myofascial trigger point sensitivity were taken pre and post treatment of the muscle containing the trigger point with passive stretch. The results in 20 subjects, experiencing unilateral or bilateral myofascial head and neck pain, showed that myofascial trigger point sensitivity decreases in response to passive stretch as assessed by the pressure algometer, and that trigger point sensitivity and intensity of referred pain are related.