Hand clinics
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Patients with reflex sympathetic dystrophy (complex regional pain syndromes) are often referred to pain medicine physicians for assistance in providing pain control during rehabilitation of their painful upper extremity. When deciding which pain control technique to use in an individual patient, physicians must consider both somatic and sympathetic blocks. Each of these nerve blocks has advantages and disadvantages that may be tailored to an individual patient's pain state and rehabilitation program to optimize recovery.
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The assessment of the possible efficacy of regional intravenous blocks or sympathetic blocks, in general, raises a number of questions that may be answered after studying the techniques of regional pharmacologic segmental blocks and their effects on the sympathetic system. The authors present an original clinical study evaluating the capacity of regional intravenous guanethidine to induce a sympathetic blockade compared with other techniques.
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The biomechanical properties of peripheral nerves still are not completely understood or quantified. This is partly because of the nonhomogeneous nature of nerves and the variation in the proportions of the components of different nerves. ⋯ The effects of stretch and compression on the vascular supply and conduction properties of normal animal nerves have been well studied. Similar studies in injured nerves will provide invaluable information for understanding the mechanics of nerve function and the prevention of stretch- and compression-related trauma.
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The advantages of proper management of postsurgical pain include fewer postoperative complications; increased early ambulation and mobilization; decreased opportunity for chronic pain syndromes to occur; shorter, less complicated rehabilitation; greater patient satisfaction; and increased patient adherence to prescribed regimens. In turn, greater adherence positively affects pain management and, therefore, patients, satisfaction with their surgeon. A variety of approaches may be used for the management of acute pain, and the "psychological preparation" of the patient prior to surgery plays a significant role. ⋯ Many of the approaches can be carried out relatively easily by the physician and his or her staff; in some cases, specialists, such as psychologists trained in behavioral medicine, are needed. Variables that affect patient adherence, both positively and negatively, include patient motivations, the nature and chronicity of the disorder, treatment variables, and the quality of the patient-doctor relationship. Physician behaviors may encourage or discourage patient adherence.