The Clinical journal of pain
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The continuous subcutaneous infusion of buprenorphine, a new approach to the relief of severe cancer pain, has been carried out using a portable infusion pump. The efficacy of this method was examined in 30 patients by visual analogue scale. ⋯ The minimum effective blood concentration was not detectable by high-performance liquid chromatography. Advantages of this therapy are its simplicity, applicability in many types of cancer, multiple sites of administration, and easier training on the part of health personnel.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized trial of Codetron for pain control in osteoarthritis of the hip/knee.
Patients suffering from pain due to osteoarthritis of the hip and knee participated in a double-blind placebo controlled trial using daily Codetron home care units for 6 weeks over the tibial, saphenous, popliteal and sciatic nerves, and tender points. Seventy-four percent of patients in the real Codetron (Group A) and 28% of the patients in sham Codetron (Group B) improved their pain level more than 25% as measured by visual analogue scale. ⋯ Other functional parameters proved to be insensitive to change in this study. This is highly suggestive of beneficial effect of nonhabituating Codetron as a complementary modality in the therapy of chronic pain conditions such as osteoarthritis.
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Case Reports Comparative Study
Hypnosis and chronic pain. Two contrasting case studies.
Some of the theoretical and technical problems associated with the use of hypnosis for chronic pain are discussed in the context of two similar case studies, one of which had an unsuccessful outcome. Different hypnotic strategies are discussed which depend on a careful, direct evaluation of the role of secondary gain and depression in maintaining the pain in the two patients. ⋯ Self-hypnotic procedures are described stressing the development of mastery and self-control over pain. Differences in the kinds of hypnotic intervention that are appropriate when secondary gain or depression are central to the pain problem, compared to the more direct techniques available when they are not, are discussed.
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Biofeedback, progressive muscle training, and relaxation tape home practice were implemented in an attempt to decrease knee pain in a subject diagnosed with osteoarthritis. Pain journal data suggested that the subject's pain levels decreased significantly during training and for 2 years posttraining. ⋯ One possible explanation for these changes was the home practice of her relaxation tape, as increased practice was inversely related to decreased pain. This clinical case report provided some preliminary information on the potential efficacy of psychological procedures in osteoarthritis pain management.
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There continues a significant debate over the best contemporary method for treating trigeminal neuralgia. Glycerol injection into the trigeminal cistern has been used in a consecutive series of 200 patients. A total of 80% of the patients have had good or excellent pain relief. ⋯ A recurrence rate of 24% has been the single largest disadvantage of the procedure. Reinjection is usually successful in treatment of recurrence. The combination of efficacy, minimal and temporary neurologic dysfunction, and low complication rate make this procedure, in our opinion, the procedure of choice for the first step, when surgical treatment is required.