Pain
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Trigger point injections using dilute solutions of local anesthetic agents have proved effective for many patients with myofascial pain. The treatment itself, however, can produce severe pain and may occasionally be associated with complications. It was determined in this study that a local anesthetic solution administered by jet injection in the area of myofascial trigger points was capable of providing short-term pain relief equal to conventional trigger point injections using a hypodermic needle and syringe. The jet injector system produced significantly less pain during treatment than conventional trigger point injections and therefore was preferred by most subjects having the opportunity to compare both forms of treatment.
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In patients with intractable cancer pain who failed to respond to conservative and neurosurgical procedures for pain relief, repeated injections of epidural morphine were found to be beneficial. A small dose of morphine (2-4 mg per injection) relieved pain for 6-24 h. A permanent subcutaneous epidural catheter led to successful ambulatory treatment without complications. The implantation of the epidural catheter is a minor surgical procedure, done under local anesthesia and is considered safe even in terminal cancer patients.
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In a study to determine how children describe the experience of pain, we queried a convenience sample of 100 children in hospitals and 114 children in church and private schools who were between 9 and 12 years old. The questions were designed to seek correlations by age among boys and girls, and between hospitalized and non-hospitalized children that would aid health professionals in strategies that will identify and assist the child who is in pain. The preliminary results show that children clearly describe pain, that there are no appreciable differences by age groups, but that children who are hospitalized describe pain differently from children who are not.
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Case Reports
Inhibition of cutaneous nociception by deep musculoskeletal pain. A clinical observation.
A patient is reported in whom deep musculoskeletal pain apparently blocked transmission from nociceptive cutaneous fibers in an adjacent region. When the deep musculoskeletal pain was abolished with local anesthesia, the cutaneous hypalgesia disappeared. Naloxone did not influence the hypalgesia. Possible mechanisms are discussed.