The Clinical journal of pain
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Randomized Controlled Trial Clinical Trial
Evaluating skin anesthesia after administration of a local anesthetic system consisting of an S-Caine patch and a controlled heat-aided drug delivery (CHADD) patch in volunteers.
The objective of this study was to evaluate the depth and duration of skin anesthesia after the administration of a local anesthetic system consisting of an S-Caine (Zars, Salt Lake City, UT) patch coupled with a controlled heat-aided drug delivery (CHADD; Zars) patch. ⋯ The local anesthetic system consisting of a combination of S-Caine and CHADD patches provided a statistically significant dermal anesthesia effect compared with placebo in this volunteer study. If confirmed in other studies, this system has promise as a noninvasive method of producing dermal anesthesia for minor surgical procedures or intravenous insertion.
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Research on the pathophysiology of chronic pain has begun to challenge the traditional diagnostic and treatment paradigms for the patient with neuropathic pain. The heterogeneous nature of neuropathic pain indicates that more than one anatomic lesion is most likely responsible for the clinical presentation of a particular syndrome. Numerous pharmacologic agents that have shown improved efficacy in the treatment of neuropathic pain have been developed over the past decade. For the practicing clinician, an important concern is whether the current paradigm for classification of neuropathic pain syndromes is comprehensive enough to address this rapidly expanding body of knowledge.
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Randomized Controlled Trial Clinical Trial
Flumazenil potentiation of postoperative morphine analgesia.
The goal of this study was to test the effect of concomitant administration of flumazenil (FL) and morphine (MO) on immediate postoperative analgesia and the MO requirement to control pain in human beings. ⋯ Flumazenil afforded lower MO consumption during the immediate postoperative period. Cognitive, hemodynamic, and respiratory functions were better after MO plus FL than after MO alone.
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Although pain is always intense and unpleasant, the capacity to experience this sensation is, under normal circumstances, fundamental to the preservation of bodily integrity. Clinically, however, after injury to peripheral tissue or directly to the nervous system, spontaneous and evoked pain manifest that serve no physiologic function, are crippling to patients, and are difficult to treat. ⋯ This spinal neuronal plasticity is shown to be a key contributor to pathologic pain hypersensitivity. The potential for the molecular mechanisms responsible for the spinal plasticity in revealing new targets for future treatment is also discussed.
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In almost every neuropathic pain state caused by peripheral nerve damage, whether due to trauma or disease, both structural damage and an inflammatory response exist. ⋯ These data suggest the possibility of an important interaction between the immune system and the nervous system in neuropathic pain and suggest that drugs modulating the immune system may be useful therapies in at least some neuropathic pain states.