Pain
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Three studies are presented demonstrating the reliability of the pressure algometer as an index of myofascial trigger point sensitivity. The first study showed high reliability between and within experimenters when measuring marked trigger point locations. In study 2, significant between experimenter reliability in locating and measuring the same unmarked trigger point locations was shown, while study 3 supported the idea that trigger points are discrete points of focal tenderness within the muscle. The ability to quantify and reliably measure trigger point sensitivity opens the door to a range of clinical and research possibilities for myofascial and related musculoskeletal pain problems.
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The successful management of 5 consecutive patients with intractable phantom limb pain is described. The main therapy is a combination of a narcotic and antidepressant. ⋯ There were no signs of habituation or addiction. We conclude that narcotics can be safely and successfully utilized for long-term management of phantom limb pain.
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In order to substantiate accidental observations on the influence of skin temperature on itch, and to elucidate a possible involvement of thermoreceptors in itch generation, the effects of thermostimulation on clinical and experimental itch were studied. Eighteen patients with atopic dermatitis rated the intensity of spontaneous itch on one of their forearms before, during, and after its immersion in a waterbath of either 10 degrees C or 45 degrees C. In 40 normal subjects itch was elicited by histamine topically applied to a 7 cm2 skin area of the volar forearm. ⋯ The results indicate that changes in skin temperature have a marked influence on itch intensity. Whereas cooling seems to act directly on the sensory receptors mediating itch, warm stimuli could have a central inhibitory effect. A direct role of thermoreceptors in the generation of itch is improbable.
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DADL was administered to a patient who was analgetically tolerant to continuously infused, intrathecal morphine sulfate. DADL restored analgesia without respiratory depression but opiate withdrawal syndrome was not prevented. ⋯ Clonidine hydrochloride and decreasing doses of oral morphine were used to successfully treat the withdrawal syndrome, including somnolence. Further research is indicated to verify the findings of this one patient and investigate the efficacy of DADL to provide analgesia for morphine-tolerant patients.
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In an attempt to unravel the relationship between chronic pain and depression, the authors studied the incidence of depression, alcoholism, and chronic pain in first degree relatives of 100 chronic pain patients with and without depression. A higher incidence of major depression was found in first degree relatives of those patients with depression than those without depression. Familial incidence of alcohol dependence was similar in both groups of patients. These findings confirm an earlier report and raise questions about the notion of considering chronic pain simply as a variant of depression and suggest the possibility that the occurrence of major depression in chronic back pain might be related to genetic vulnerability to depression in these patients.