Pain
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A psychophysical study has been carried out in 10 normal human subjects to examine whether conscious perception of pain is necessary for the development of secondary hyperalgesia. Prolonged thermal stimulation of the skin was applied to the subjects at intensities known to evoke discharges in polymodal nociceptors but insufficient to evoke pain sensations. During this stimulation the development of punctate and of stroking hyperalgesia was examined as was the presence of a skin flare indicative of nociceptor activation. ⋯ No difference was observed between the onset of flare and of stroking hyperalgesia. These results show that cutaneous hyperalgesia can be evoked in normal human subjects by prolonged thermal stimulation of the skin at temperatures that are not perceived as painful. The development of a flare in all subjects simultaneously with stroking hyperalgesia but before the perception of pain suggests that activation of nociceptors is necessary for the hyperalgesia to occur.(ABSTRACT TRUNCATED AT 250 WORDS)
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The aim of this nationwide survey was to evaluate the extent of pain problems, the principles of pain management and the use of newer drug delivery techniques in terminal cancer patients. 'Terminal period' was defined as an expected life span of about 2 weeks. Another aim was to evaluate the level of knowledge of physicians and nurses and to assess their educational needs regarding management of cancer pain. A total of 456 questionnaires were sent to chairmen and head nurses of 6 major specialties (228 departments) that treat cancer patients in Sweden. ⋯ More than 50% of physicians and nurses admit that they have inadequate knowledge about pain evaluation techniques, newer analgesics and newer drug delivery systems. More aggressive use of opioids administered by more humane routes and better use of adjuvant therapy can be expected to improve pain management for the terminal patient. There is also a need for better physician and nurse education.
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Twenty-one patients with post-mastectomy pain syndrome (PMPS) were entered in an open-label trial of topical 0.025% capsaicin treatment (3 daily applications for 2 months). Out of 19 evaluable patients, 2 (10.5%) reported complete disappearance of all symptoms, and 11 (57.9%) had a reduction of pain which was never worse than mild at the end of treatment. ⋯ This is the first independent confirmation of the usefulness of capsaicin in the PMPS, following the recent publication of a randomized, placebo-controlled clinical study showing significant pain relief with 0.075% capsaicin but not with vehicle cream. Further experimental and clinical research on the properties of capsaicin in other painful peripheral neuropathies is desirable.
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Twenty-six patients with extensive gynecologic, colorectal or genitourinary cancer who suffered uncontrolled, incapacitating pelvic pain were enrolled in this study during a 1-year period. All the patients receiving oral opioids who developed poor pain response due to the progression of disease or untoward side effects necessitating other modes of therapy were eligible to participate. Bilateral percutaneous neurolytic superior hypogastric plexus blocks with 10% phenol were performed in every patient, 1 day after receiving successful diagnostic blocks using 0.25% bupivacaine (BUP). ⋯ No complications related to the block were experienced by any patient. In conclusion, neurolytic superior hypogastric plexus block was both effective in relieving pain in 69% of the patients studied (95% confidence interval of 48-85%). Additional neurolytic blocks using higher volumes of the neurolytic agent may be needed in patients with extensive retroperitoneal disease, a group in whom moderate or poor results should be expected.