Pain
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The heat beam dolorimeter (HBD) was developed to evaluate cutaneous pain thresholds in humans. In the present study, the hypothesis that a patient's underlying pain status affects his pain tolerance to an incident HBD stimulus was tested. Twenty-seven chronic pain patients with a variety of clinical problems unresponsive to conventional algological therapy were scheduled for neurosurgical procedures. ⋯ Twenty-four of the 27 patients reported significant pain relief following surgery. Our results show that, in chronic pain patients, endogenous pain significantly affected incident pain perception in the HBD test when compared with the responses of normal pain-free volunteers. Consequently, HBD may be useful in objectively assessing chronic pain and its relief by neurosurgical procedures.
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In sciatalgic patients and before any treatment, the goal of this work was to compare the amplitude of the late component (N150-P220) of the brain evoked potential (BEP) between resting pain-free conditions and a neurological induced pain produced by the Lasègue manoeuvre. The study was carried out with 8 inpatients affected with a unilateral sciatica resulting from an X-ray identified dorsal root compression from discal origin. The sural nerve was electrically stimulated at the ankle level while BEPs were recorded monopolarly from the vertex. ⋯ Results show that the Lasègue manoeuvre performed on the affected side induced a significant increase in the amplitude of N150-P220; performed on the normal side, this same manoeuvre resulted in a significant decrease of the N150-P220 amplitude. These variations were observed whatever was the side (normal or affected) under sural nerve stimulation. The possible neural mechanisms of these changes and clinical implications of these data are then discussed.
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We applied calcitonin in a single-shot treatment to 10 patients with persistent or acute phantom limb pain. Nine patients responded immediately and noted a clear analgesic effect. In contrast a group of non-phantom pain patients of heterogeneous composition did not respond at all, except 1 patient with chronic stump pain. We believe that this could be an exciting new approach to the treatment of phantom limb pain.
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The present study reports on a controlled investigation of 38 patients with signs and symptoms of presumed oral galvanism, referred to the Department of Oral and Maxillofacial Surgery of the University of Helsinki for examination and treatment. A significant difference in mental health and in intraoral sensitivity threshold was found between patients and controls: patients with oral galvanism were mentally more disturbed and had a lower sensibility threshold than those in the control group. ⋯ The possibility of exposure to mercury was excluded through a head hair analysis. The psychic background of complaints and findings is emphasized and a hypothesis for the mechanism giving rise to discomfort is presented.
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Clinical Trial Controlled Clinical Trial
Reliability and validity of verbal descriptor scales of painfulness.
Previous studies have provided information about the reliability and validity of verbal descriptor scales of sensory intensity and unpleasantness and have shown that these two dimensions can be differentially affected by pharmacological manipulations. Since the relation between these dimensions and the general term 'pain' is not known, two experiments developed a verbal descriptor scale of painfulness and compared the sensitivity of this scale to pharmacological manipulations used previously with scales of sensory intensity and unpleasantness. In exp. ⋯ Seven electrical stimuli spaced between individually determined pain threshold and tolerance values were delivered in random sequence 6 times before and after double-blind intravenous infusions of placebo, 0.11 mg/kg diazepam, 0.66 microgram/kg fentanyl or a combination of the diazepam and fentanyl doses. Mean responses were reduced significantly after all active drugs but not after placebo. These results suggest that the term pain does not represent a simple combination of sensory intensity and/or unpleasantness and shows that the sensitivity to an inert placebo, an active placebo, and an analgesic can vary with the type of pain assessment procedure.