Pain
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Clinical Trial Controlled Clinical Trial
Cutaneous hypersensitivity following peripheral tissue damage in newborn infants and its reversal with topical anaesthesia.
The flexion reflex threshold has been used as a measure of sensation in a group of premature infants born at 27-32 weeks postmenstrual age. The threshold in an area of local tissue damage created by routine heel lances was half the threshold on the intact heel on the other side. ⋯ Treatment with placebo had no effect. The results show that the newborn infant central nervous system is capable of mounting a chronic pain response to local injury which can be reduced by local anaesthetic.
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Although adequate assessment of pain and anxiety during burn wound care serves important clinical and scientific goals (e.g., determination of medication dosage and evaluation of treatment effects), few data are actually available. Studies which compare self-reported pain with observational ratings frequently suffer from small sample sizes or questionable data analysis techniques. This paper presents a study in which 126 burn wound dressing changes were independently rated by patient and nurse(s). ⋯ It is argued that it is not useful to discuss the present and earlier studies only in terms of correctness or incorrectness of observational ratings. Recommendations for future studies include the study of pain-related behaviors, coping mechanisms and effects of treatments. Considering the vast differences in prescription regimes among centers, a multicenter trial would be particularly interesting.
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This paper describes the patterns of pain induced from lumbar facet joints, from the posterior primary rami of L5, and from the medial articular branches of the posterior primary rami from T11 to L4 in patients undergoing diagnostic spinal infiltrations for chronic pain. No consistent segmental or sclerotomal pattern was found in 385 observations on 138 patients. Pain radiating to the buttock or trochanteric region occurred mostly from the L4 and L5 levels, while groin pain was produced from L2 to L5. The nerves supplying the facet joints gave rise to distal referral of pain significantly more commonly than the joints themselves.
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Forty patients with cancer pain receiving intermittent narcotics were admitted to a prospective study designed to assess the cognitive effects of narcotics. Twenty patients had undergone no change in narcotic dose or type greater than or equal to 7 days (stable dose, SD, group), and 20 patients had undergone an increase of greater than or equal to 30% in dose less than or equal to 3 days before (increased dose, ID, group). Age, primary tumor, type, dose and route of narcotic were not different between the SD and ID group. ⋯ Mean percentual change in FT 10 sec, FT 30 sec, A, RM, and VM after the narcotic dose were 97 +/- 9%, 100 +/- 14%, 100 +/- 13%, 100 +/- 15%, 98 +/- 19%, in the SD group, vs. 77 +/- 14% (P less than 0.001), 83 +/- 13% (P less than 0.001), 124 +/- 21% (P less than 0.001), 60 +/- 21% (P less than 0.001) and 68 +/- 21% (P less than 0.001) in the ID group, respectively. Our results suggest that patients who undergo a significant increase in the dose of intermittent narcotics experience significant cognitive impairment, that disappears after 1 week of the increase. More research is needed to better characterize the cognitive toxicity of intermittent narcotics, and to determine the cognitive effects of long acting narcotics, continuous infusions, or of the addition of amphetamines.