Journal of pain and symptom management
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J Pain Symptom Manage · Feb 1991
Case ReportsBilateral burning foot pain: monitoring of pain, sensation, and autonomic function during successful treatment with sympathetic blockade.
We describe a patient with burning pain in both feet associated with local autonomic disturbances following bilateral traumatic sciatic mononeuropathies. The diagnosis of a sympathetically maintained pain was confirmed through a prompt response to sympathetic blockade. Although a mild alcohol-nutritional neuropathy was found, the clinical findings strongly suggested a diagnosis of bilateral causalgia. ⋯ Quantitative sensory testing revealed a dramatic alteration in the contralateral limb's thermal sense following unilateral block. This case underscores the potential for bilateral causalgia and provides additional evidence for a central mechanism operating in this disorder. The relationship between bilateral causalgia and the "burning feet syndrome" in alcoholic neuropathy is discussed.
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J Pain Symptom Manage · Feb 1991
Clinical Trial Controlled Clinical TrialAuricular transcutaneous electrical nerve stimulation (TENS) reduces phantom limb pain.
The present paper evaluates the efficacy of low frequency, high intensity auricular transcutaneous electrical nerve stimulation (TENS) for the relief of phantom limb pain. Auricular TENS was compared with a no-stimulation placebo condition using a controlled crossover design in a group of amputees with (1) phantom limb pain (Group PLP), (2) nonpainful phantom limb sensations (Group PLS), and (3) no phantom limb at all (Group No PL). ⋯ Ratings of mood, sleepiness, and anxiety remained virtually unchanged across test occasions and sessions, indicating that the decrease in pain was not mediated by emotional factors. Further placebo-controlled trials of auricular TENS in patients with phantom limb pain are recommended in order to evaluate the importance of electrical stimulation parameters such as pulse width and rate, and to establish the duration of pain relief.
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The present study examined the psychometric properties of the Daily Sleep Diary (DSD), an instrument developed for monitoring sleep among chronic pain patients. As part of a comprehensive evaluation, 46 chronic pain patients completed the DSD each morning. Items assessed the number of hours slept, length of sleep onset, frequency of awakenings during the night that resulted in trouble falling back to sleep, early morning awakening, quality of sleep, lack of restfulness, and the previous night's sleep compared to usual sleep. ⋯ Pain severity was related to fewer hours slept and delayed sleep onset. The DSD items correlated with measures of both depression and anxiety. The results emphasize the importance of including sleep in both assessment and treatment of chronic pain patients.
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Undertreatment of cancer pain is widely recognized. This study sought to determine if inadequate communication about pain intensity between health care providers and their patients could represent a significant factor interfering with the control of cancer pain. One hundred and three consecutive patients with solid tumors and normal mental status examinations were screened within 48 hr during two study periods. ⋯ Improved correspondence was noted with lower patient VAS scores. This study demonstrates that health care provider impressions of patient pain are often quite different than those of the patient and that these discrepancies are most pronounced in patients with significant pain. The routine use of pain assessment tools, such as the VAS, could enhance patient-caregiver communication and improve care for patients with cancer pain.