Pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Psychological approaches during conscious sedation. Hypnosis versus stress reducing strategies: a prospective randomized study.
Stress reducing strategies are useful in patients undergoing surgery. Hypnosis is also known to alleviate acute and chronic pain. We therefore compared the effectiveness of these two psychological approaches for reducing perioperative discomfort during conscious sedation for plastic surgery. ⋯ Vital signs were significantly more stable in the HYP group. Patient satisfaction score was significantly higher in the HYP group (P < 0.004). This study suggests that hypnosis provides better perioperative pain and anxiety relief, allows for significant reductions in alfentanil and midazolam requirements, and improves patient satisfaction and surgical conditions as compared with conventional stress reducing strategies support in patients receiving conscious sedation for plastic surgery.
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Randomized Controlled Trial Clinical Trial
Infiltration of morphine into an abnormal wound; effects on pain relief and endocrine/immune response.
We wanted to evaluate pain relief and endocrine/immune response after local administration of morphine into an abdominal wound. In a randomised double blind design 29 patients undergoing hysterectomy received two blinded injections of morphine and saline. Before surgery the patients in the control group (n = 15) got 10 mg of subcutaneous morphine into an arm and at skin incision 30 ml of saline was infiltrated directly into the wound. ⋯ High doses of i.v. morphine reduced cortisol and IL-6 levels in the early hours after surgery. The injection of morphine into the wound did not improve pain relief or reduce the consumption of i.v. morphine after surgery. The endocrine stress response to trauma was modified by preoperative administration of morphine.
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Comparative Study Clinical Trial Controlled Clinical Trial
Pain processing during three levels of noxious stimulation produces differential patterns of central activity.
Previous functional imaging studies have demonstrated a number of discrete brain structures that increase activity with noxious stimulation. Of the commonly identified central structures, only the anterior cingulate cortex shows a consistent response during the experience of pain. The insula and thalamus demonstrate reasonable consistency while all other regions, including the lentiform nucleus, somatosensory cortex and prefrontal cortex, are active in no more than half the current studies. ⋯ Decreased rCBF was observed in the amygdala region. These responses were interpreted with respect to their contribution to the multidimensional aspects of pain including fear avoidance, affect, sensation and motivation or motor initiation. It is suggested that future studies examine the precise roles of each particular region during the central processing of pain.
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To our knowledge, this is the first report on pain-related abnormalities of the eye blink reflex (BR) in a clinical pain patient population. The objective of this study was to evaluate the possible neuropathic mechanisms underlying the burning mouth syndrome (BMS), by means of objective electrophysiological examination of the trigemino-facial system. We studied the BR with stimulation of the supraorbital nerve (SON) with particular emphasis on the occurrence of the pain-related ultralate R3 components, and the habituation response of the R2 components. ⋯ In two of these patients, the findings were segmental (i.e., unilateral), coinciding with the side of the subjective BM symptoms. The abnormalities of the BR tests appeared to be related to longer disease duration. Our results suggest a possible pathologic involvement of the nervous system in chronic BMS.
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Withdrawal responses to mechanical and thermal stimuli applied to the plantar surface of the hindpaw were measured before and after bone damage. In separate groups of rats the bone was injured by scraping the periosteum of the tibia, drilling a hole through the tibia, aspirating bone marrow, or drilling a hole through the calcaneus. Scraping the periosteum did not alter withdrawal responses to the mechanical stimuli, or evoke nocifensive behavior. ⋯ Primary hyperalgesia lasted up to 24 h after injury. Nocifensive behavior characterized by a lifting and guarding of the damaged limb was also observed after a hole was drilled through the tibia or calcaneus. Drilling a hole through the tibia or calcaneus should be a useful experimental model for investigating the mechanisms underlying bone pain.