Pain
-
Case Reports
Anterior spinal artery syndrome--a complication of cervical intrathecal phenol injection.
Spinal nerve block by intrathecal phenol-glycerine infusion is commonly employed for relief of severe pain in terminal carcinomatosis and, frequently, a dramatic regional anesthetic effect is achieved. However, nerve block by this procedure may in very rare instances give rise to serious complications. We have seen a case of terminal malignant melanoma in which clinical manifestations, indicative of anterior spinal artery syndrome, developed following the injection of 0.3 ml of 10% phenol-glycerine into the cervical subarachnoid space at the C4--C5 level for the control of severe right arm pain. This report describes the clinical course of the patient over a period of 4 months after the nerve block and the post-mortem findings along with a brief review of the literature.
-
Twenty patients suffering from phantom limb pain were assessed for suitability for treatment by electrical stimulator implant to the peripheral nerve or the spinal cord. Twelve were so treated and seven obtained excellent and three partial relief of pain. One patient maintains excellent relief of pain by trancutaneous electrical stimulation. Factors that might influence the responsiveness of pain to electrical stimulation and the qualitative results from such treatment are discussed.
-
The results of two experiments suggest that sensory and affective verbal descriptors provide a valid scaling method which discriminates between the sensory intensity and the affect, or unpleasantness, of electrocutaneous stimuli. Twenty-four subjects judged the sensory intensity and affect of noxious electrocutaneous stimuli by choosing verbal descriptors from randomized lists and by cross-modality matching to time duration and to handgrip force. The psychophysical functions for sensory intensity generated by the descriptor and the cross-modality functions for sensory intensity generated by the descriptor and the cross-modality methods are the same. ⋯ The discriminative power of the descriptor method is demonstrated further in an experiment in which 32 subjects rated either the sensory intensity or the affect of the electrocutaneous stimuli immediately before and after an i.v. administration of 5 mg diazepam. This common minor tranquilizer significantly lowered affective descriptor responses (P less than 0.005) without altering sensory descriptor and sensory and affective handgrip responses. These experiments indicate that sensory and affective verbal pain descriptors may be used as a valid and sensitive tool for the evaluation of pain and pain control methods.
-
The results of two experiments show that ratio scales of sensory and affective verbal pain descriptors are valid, reliable and objective. In the first experiment, 16 subjects rated 15 sensory and 15 affective verbal pain descriptors by numerical magnitude estimation and by cross-modality matching to handgrip force. Ratio scales of sensory and affective verbal pain descriptors computed for two separate groups were highly correlated between the groups (sensory, r = 0.97; affective, r = 0.98), as well as over session (r = 0.99, 0.98). ⋯ This result supports the validity of cross-modality matched ratio scales of verbal stimuli. The reliability of these scales is shown by the high between-session, between-group and between-experiment correlations. The objectivity is shown by the similarity of within-subject and between-subject correlations for both group and individual descriptor scales.