Pain
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Case Reports Clinical Trial Controlled Clinical Trial
An association between phantom limb sensations and stump skin conductance during transcutaneous electrical nerve stimulation (TENS) applied to the contralateral leg: a case study.
This report describes a placebo-controlled study of transcutaneous electrical nerve stimulation (TENS) applied to the contralateral lower leg and outer ears of an amputee with non-painful phantom sensations. The subject received TENS or placebo stimulation on separate sessions in which baseline periods of no stimulation alternated with periods of TENS (or placebo). Throughout the two sessions, continuous measures of stump skin conductance, surface skin temperature and phantom intensity were obtained. ⋯ In contrast, during periods of electrical stimulation the pattern of electrodermal activity was consistently curvilinear indicating an initial decrease followed by an increase in sudomotor responses. Changes in stump skin conductance correlated significantly with changes in phantom sensations both in TENS and placebo sessions suggesting a relationship between sympathetic activity at the stump and paresthesias referred to the phantom. Two hypotheses are presented to account for these findings.
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In an attempt to clarify the correlation between the spread of a local anesthetic and a radiographic contrast medium in the epidural space, a lumbar epidural catheter was inserted in 21 cancer patients. In group I, 10 patients, a single dose of bupivacaine 0.5%, 8 ml, was injected. The epidural block was evaluated by assessing loss of pin-prick sensation. ⋯ In group I there was no statistically significant correlation between the spread of contrast medium and the extension of the epidural block either in the cephalad or in the caudad direction. In group II there was a statistically significant correlation in both the cephalad and caudad direction. It is concluded that epidurography can provide an estimate of the epidural block, but cannot predict the exact segmental distribution of the block.
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Case Reports
Psychophysical observations on patients with neuropathic pain relieved by a sympathetic block.
Patients with sympathetically maintained pain (SMP) were tested with noxious heat pulses, innocuous mechanical stimuli, and transcutaneous electrical nerve stimulation before and during local anesthetic sympathetic blocks that relieved their pain. The perceived intensity of the pain evoked by these stimuli was measured by the patients' responses on a visual analog scale and compared to the responses obtained when the same stimuli were applied to contralateral normal skin. In 5 of 7 patients tested, graded noxious heat stimuli (43-51 degrees C) applied to painful skin resulted in heat-pain intensity ratings that were essentially identical to the responses obtained when the same stimuli were applied to the normal side. ⋯ The coexistence of A beta-evoked pain with normal heat-evoked pain and normal heat-pain summation suggests that the central abnormality cannot be a simple hypersensitivity of wide-dynamic-range neurons. The effect of sympathetic blockade on A beta-evoked pain and its summation suggests that the crucial sympathetic interaction may take place centrally. The results show that there is considerable heterogeneity of sensory abnormalities among patients with SMP.(ABSTRACT TRUNCATED AT 400 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural steroids, epidural morphine and epidural steroids combined with morphine in the treatment of post-laminectomy syndrome.
Epidural morphine injection followed by a steroid has been reported to be effective for the post-laminectomy pain ('failed back') syndrome. This double-blind, parallel study was undertaken to evaluate that mode of therapy. Twenty-two patients who had undergone at least one prior laminectomy, who were still symptomatic, were randomized to receive 50 mg of lidocaine epidurally with: (a) 75 mg triamcinolone diacetate (TR); or (b) 8 mg of preservative-free morphine (MP); or (c) both (TR and MP), at 1 month intervals for 3 consecutive months. ⋯ No patient given morphine had pain relief for more than 1 month. Life-threatening ventilatory depression occurred in the group given triamcinolone and morphine. The use of morphine alone or combined with slow release triamcinolone does not appear to be appropriate for the treatment of the post-laminectomy pain syndrome.
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Comparative Study
Immediate and long-term phantom breast syndrome after mastectomy: incidence, clinical characteristics and relationship to pre-mastectomy breast pain.
Phantom breast syndrome (PBS) following mastectomy has already been reported by other authors. The temporal course, character and extent of these phenomena, however, have not yet been elucidated. In a prospective study, we investigated the incidence, clinical picture and the temporal course of PBS. ⋯ The present incidence of PBS is close to the incidence reported by others. Persistent phantom pain may, however, be more common than usually expected. Also persistence of cicatrix pain seems to be more common than generally expected.