Pain
-
Randomized Controlled Trial Comparative Study Clinical Trial
Relief of post-herpetic neuralgia with the N-methyl-D-aspartic acid receptor antagonist ketamine: a double-blind, cross-over comparison with morphine and placebo.
Pain and sensory thresholds were examined before and after intravenous administration of ketamine (0.15 mg/kg), morphine (0.075 mg/kg) or saline in 8 patients with post-herpetic neuralgia. A randomized, double-blind, cross-over study design was used. Post-herpetic neuralgia was associated with impaired sensory function, as shown by reduced tactile and warm sensation in the affected compared with the contralateral non-affected skin area. ⋯ Side effects were observed in all the 8 patients after injection of ketamine and in 6 patients after injection of morphine. The present results support the hypothesis that the N-methyl-D-aspartic acid (NMDA) receptors are involved in the control of post-herpetic neuralgia including allodynia and wind-up-like pain. The NMDA receptors also may play a role in the modulation of thermal perception.
-
Clinical Trial
Percutaneous cervical cordotomy and subarachnoid phenol block using fluoroscopy in pain control of costopleural syndrome.
We examined the efficacy of percutaneous cervical cordotomy (PCC) and subarachnoid phenol block using fluoroscopy (SAPB-F) for control of chest and/or back pain from costopleural syndrome. The efficacy of each block was evaluated by changes in pain score (PS), analgesic dose and performance status 1 week after the block, as well as by the complications. Between 1980 and 1986, PCC was performed in 10 patients. ⋯ There were no complications and no changes in performance status. From this study we concluded that PCC is an effective method of pain control for costopleural syndrome, but a risk of serious complications is involved. SAPB-F is an effective and safe method and should be the first choice of nociceptive pathway block.
-
In this study we examined the effect of partial sciatic nerve ligation (PSNL) on the receptive field size, the baseline firing rate (BFR) and the response of spinal dorsal horn (DH) neurons to mechanical stimulation. In addition, we tested the effect of adenosine agonist, 5'-N-ethylcarboxamide-adenosine (NECA), and the adenosine antagonist caffeine on these parameters. Adult male Sprague-Dawley animals were used. ⋯ The mean receptive field size (RFS) of neurons (both ipsilateral and contralateral to the ligation) in the operated animals was significantly larger than the RFS of unoperated animals (right side: 180 +/- 2.8 mm2 compared to 66 +/- 2.3 mm2; left side: 93 +/- 31 compared to 65 +/- 21). Twenty-four percent of all neurons in the operated group had bilateral receptive fields; in contrast, only 3% of the neurons in the control animals showed bilateral receptive fields. To examine the effects of adenosine agonist and antagonist, NECA and caffeine were applied next to the recording electrode.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Medullary on-cell activity during tail-flick inhibition produced by heterotopic noxious stimulation.
Reflex responses and neuronal excitation elicited by noxious stimuli applied to a given body site can be inhibited by application of noxious stimulation to another, even distant body region. Such heterotopic noxious stimulation (HNS) has been proposed to act via 'diffuse noxious inhibitory controls' (DNIC) which involve supraspinal components. The so-called on-cells of the rostral ventromedial medulla (RVM) in rats are thought to facilitate nociceptive transmission. ⋯ Such HNS elicited strong activation of on-cells, followed by depression even when HNS continued. When this depression was intense, tail-heating failed to elicit vigorous on-cell firing, and TF was retarded or abolished. These results are compatible with the hypothesis that antinociception elicited by HNS involves depression of on-cell firing and hence lack of facilitation of nociceptive transmission.
-
Comparative Study
On the absence of correlation between responses to noxious heat, cold, electrical and ischemic stimulation.
Is a person's response to one noxious stimulus similar to his/her responses to other noxious stimuli? This long-investigated topic in pain research has provided inconclusive results. In the present study, 2 samples were studied: one using 60 healthy volunteers and the other using 29 patients with coronary artery disease. Results showed near-zero correlations between measures of heat, cold, ischemic, and electrical laboratory pains, as well as between these laboratory pains and an idiopathic pain, the latency to exercise-induced angina in the patients. ⋯ Reliability analyses indicated retest correlations on the order of 0.60 for these measures, indicating that the lack of correlation between modalities was not due to unreliability within a measure. These studies fail to demonstrate alternate-forms reliability among these tests, and also fail to support the notion that a person can be characterized as generally stoical or generally complaining to any painful stimulus. In practice, this implies that a battery of tests should generally be used to assess pain sensitivity and also that assessments of one pain modality are not generally useful for making inferences about another.