Pain
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Randomized Controlled Trial Clinical Trial
Regional intravenous guanethidine vs. stellate ganglion block in reflex sympathetic dystrophies: a randomized trial.
Regional intravenous guanethidine blocks and stellate ganglion blocks have been compared in a randomized trial. Nineteen patients, randomly allocated to two groups of therapy and exhibiting severe reflex sympathetic dystrophy following peripheral nerve lesions, have been treated. ⋯ Concerning the therapeutic effects (changes in pain scores and clinical signs--hyperpathia, allodynia, vasomotor disturbances, trophic changes, oedema and limited motion), recorded at the end of treatment and 1 month and 3 months follow-up, an intravenous guanethidine block carried out every 4 days up to a total of 4 blocks is comparable with a stellate ganglion block every day up to a total of 8 blocks. The results of this study show that regional sympathetic block with guanethidine is a good therapeutic tool in the treatment of reflex dystrophies, especially on account of its negligible risks and contraindications.
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Autonomic measures (skin conductance and heart rate) were obtained from subjects before (warning period), during (immersion period), and after (resting state) the performance of the Cold Pressor task under tolerance instructions. The Autonomic Perception Questionnaire was administered shortly before the Cold Pressor task. Skin conductance and heart rate during the warning period proved to be significant predictors of pain tolerance behaviorally measured. The Autonomic Perception Questionnaire did not reveal any relationship between awareness of autonomic arousal and pain tolerance nor between actual level of arousal and subjective awareness of this arousal.
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Previous to October 1st, 1981, 8 major Danish anaesthesiological departments registered 105 patients treated with extradural opiates for a period of more than 7 days, partially or completely on outpatient basis. Ninety-four suffered from painful malignant diseases and 11 patients from various painful benign diseases. The mean period of treatment was 65 days (range: 7-283 days) and of these 49 days (2-266 days) as outpatients. ⋯ Eleven patients managed injections without assistance. District nurses took care of medication for 46 patients, aided by a general practitioner in 5 cases. Three patients were supplied with continuous extradural infusion by means of a Mill Hill microinfusion pump.
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Drawings by low back pain patients depicting the severity, type, and location of their pain have been suggested as a brief screening technique for psychological involvement in the pain complaints. A study of 212 back pain patients showed that pain drawings cannot validly be used in this way, since over half of the patients meeting MMPI criteria for psychological involvement in their pain were incorrectly identified as normal on the Pain Drawing test.