The Clinical journal of pain
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In light of the lack of any prior systematic evaluations of the prevalence and types of pain syndromes and treatments found in patients with AIDS, a chart review study was undertaken to evaluate this issue. Fifty-two of 96 charts reviewed (54%) had at least one note on nonprocedural pain or analgesic prescription. ⋯ Nearly one-third of patients with pain received codeine (31%), others received acetaminophen (27%), and 17% of patients received acetaminophen and oxycodone HCl. Specific pain management interventions must be evaluated and applied to control the nontrivial occurrence of pain in patients who have AIDS symptoms that may be overlooked by the physician given the overwhelming disease process.
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Infrared imaging (thermography) has developed rapidly over the past 10-15 years as a diagnostic imaging procedure. Despite scientific validation and proven use in the clinical setting, neuromuscular thermography has met with much criticism and skepticism. ⋯ The basic scientific foundation of medicine should preclude the prejudicial influence of emotion, politics, and anecdotes. Scientific investigations, for more than 2 decades now, have demonstrated that neuromuscular thermography is of proven value in the clinical evaluation of various pain disorders and neuromuscular conditions, including radicular pathology.
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Intravenous infusion of lidocaine has a pain-relieving effect in patients with painful diabetic neuropathy. We measured plasma beta-endorphin (beta-EP), dynorphin immunoreactivity (DYN), and met-enkephalin (MET) before and after lidocaine infusion in 8 patients with painful diabetic neuropathy and in 10 controls. The pretreatment level of beta-EP and DYN was identical in the two groups. ⋯ The concentration of DYN was stable, and MET was undetectable before and after lidocaine. Lidocaine reduced symptoms and pain score in diabetic patients was uncorrelated with the changes in beta-EP. Intravenous lidocaine increased plasma beta-EP and diminished complaints in patients with painful diabetic neuropathy.
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Homicide-Suicide (H-S) is a form of dual death where the murder is closely followed by the suicide of the perpetrator. H-S is extremely rare and has not previously been described within the chronic pain patient population. ⋯ Psychiatric examination data from the victims of H-S revealed a number of complex, psychiatric, social, vocational, and litigation problems. Demographically the case displays some characteristics associated with suicide pacts.
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Diagnostic epidural blocks were performed on 27 chronic pain patients sequentially using saline, fentanyl, and lidocaine solution. The patients were divided into one of four groups based on their response to the epidural solutions: placebo response group--pain relief with placebo solutions; fentanyl response group--pain relief with epidural fentanyl; lidocaine response group (LRG)--pain relief with lidocaine but not fentanyl; and no response group--no pain relief with any of the solutions used. The four groups were compared on the basis of age, sex, site of pain, duration of pain, narcotic use, pain assessment index, and workmen's compensation claims. ⋯ On the basis of the information gathered, it was theorized that, despite their response to epidural lidocaine, LRG patients may actually be a group of operant pain patients. Their failure to receive analgesia from epidural fentanyl may be a learned response such that they associate any sensory input from the affected area as painful. If follow-up studies support these findings, then the diagnostic opioid technique may be a more sensitive tool in diagnosing chronic pain.