Pain
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Clinical Trial Controlled Clinical Trial
Inhibition of the human flexion reflex by low intensity, high frequency transcutaneous electrical nerve stimulation (TENS) has a gradual onset and offset.
The present study examines the inhibitory effect of segmentally applied TENS on the nociceptive component of the flexion reflex elicited in various lower limb muscles, in an attempt to gain some insight into the underlying mechanism. The flexion reflex from 11 normal subjects was recorded electromyographically from the biceps femoris (BF), the tibialis anterior (TA), and in 2 subjects, the hip flexor (HF), in the manner described in a previous paper [9]. Amplitude and area values of the flexion reflex of each muscle were computerized prior to, during, and 50 min after the application of placebo or low intensity TENS at 100 Hz, for 30 min to the low back, at levels of segmental innervation (L4-S1) similar to those of the muscles under study. ⋯ These findings showed that prolonged stimulation of large diameter fibers by conventional TENS application to the lumbosacral level, exerts a progressive and long latency inhibitory influence on a number of lower limb flexor motoneurons. In keeping with functional demand, this effect was found to be more prominent on the proximal than distal limb muscles. Furthermore, a gradual onset and offset of this inhibitory action is consistent with the results of some investigators demonstrating the possible involvement of endogenous opioids.
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The Varni/Thompson pediatric pain questionnaire (PPQ) represents an attempt to empirically assess the complexities of pediatric chronic, recurrent pain. This initial investigation targeted chronic musculoskeletal pain in children with juvenile rheumatoid arthritis. The PPQ provides a developmental step toward the comprehensive assessment of the pain experience in children with chronic pain. Further reliability and validity studies are needed to determine the generalizability of the PPQ with larger numbers of children with a variety of acute and chronic pain experiences across a diversity of settings.
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Case Reports Clinical Trial Controlled Clinical Trial
Dercum's disease (adiposis dolorosa). Treatment of the severe pain with intravenous lidocaine.
Dercum's disease (adiposis dolorosa) is associated with very painful subcutaneous fatty deposits normally localized to the lower extremities in which pain treatment is usually unsuccessful. Two patients with Dercum's disease have been treated repeatedly with intravenous lidocaine for several months each time resulting in immediate pain relief for 8 and 25 days respectively. ⋯ Hereafter, the patients were treated with peroral mexiletine and again had complete pain relief. We conclude that intravenous lidocaine or peroral mexiletine may be an effective analgesic treatment in patients with Dercum's disease.
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Clinical Trial Controlled Clinical Trial
The analgesic effect of tocainide in trigeminal neuralgia.
Tocainide is a derivative of lidocaine with anti-arrhythmic action and, unlike lidocaine, can be used for oral treatment. Tocainide was alternatively with carbamazepine given to 12 patients with trigeminal neuralgia in a double-blind cross-over study for 2 weeks. ⋯ The similarity in analgesic effect of the two drugs was striking. A possible analgesic mechanism could be that tocainide blocks the sodium channels in the hyperexcitable nerve membranes in the pain-producing foci in trigeminal neuralgia.
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Randomized Controlled Trial Clinical Trial
Intravenous lidocaine infusion--a new treatment of chronic painful diabetic neuropathy?
In a randomized double-blind, cross-over study the effect of intravenous lidocaine (5 mg/kg body weight) on the symptoms and signs of painful diabetic neuropathy of more than 6 months duration has been evaluated. Using a clinical symptom scale, there was significant beneficial effect 1 and 8 days after lidocaine infusion compared to after saline infusion (P less than 0.05 and P less than 0.02, respectively). ⋯ Lidocaine infusion had no effect on the objective measurements of neuropathy. Intravenous lidocaine infusion seems to be a new alternative treatment of chronic painful diabetic neuropathy.