Journal of pain and symptom management
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J Pain Symptom Manage · Jan 1995
Review Randomized Controlled Trial Clinical TrialIntravenous regional sympathetic blockade for pain relief in reflex sympathetic dystrophy: a systematic review and a randomized, double-blind crossover study.
The first aim was a systematic review of intravenous regional sympathetic blocks (IRSBs) in patients with reflex sympathetic dystrophy (RSD). Randomized controlled trials (RCTs) of IRSBs in patients with RSD were identified by MEDLINE search (1966 to May 1993) and by hand search of 30 journals (1950 to May 1993). Authors of eligible trials were asked for information on additional trials and for unpublished data. ⋯ Sixteen patients with diagnosis of RSD were recruited, but only nine entered the double-blind phase. The trial was stopped prematurely because of the severity of the adverse effects. No significant difference was found between guanethidine and placebo on any of the outcome measures.(ABSTRACT TRUNCATED AT 250 WORDS)
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J Pain Symptom Manage · Jan 1995
ReviewA critique of instruments and methods to detect, diagnose, and rate delirium.
This document reviews existing instruments for evaluation of delirium. Instruments have been grouped into four categories: tests that screen for cognitive impairment, delirium diagnostic instruments, delirium-specific numerical rating scales, and laboratory and paraclinical exams. ⋯ Important factors in choosing an instrument, besides the appropriateness of its psychometric characteristics, include administration time constraints, level of rater expertise, and patient capabilities. By familiarizing investigators with the variety of evaluation instruments available, this work should permit more appropriate instrument selection in future studies on delirium.
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Local anesthetics administered to block nerve conduction for surgical anesthesia and to provide analgesia in management of acute pain have become a standard of anesthesiology practice. These drugs have had an important role in the multimodality management of chronic pain as well, and this role is expanding since the revival of systemic administration. ⋯ There is also evidence that intravenous local anesthetics can relieve acute pain. Furthermore, the novel idea that acute procedural and postprocedural pain control with local anesthetics could prevent the development of chronic pain syndromes, including chronic neuropathic pain syndromes, adds another important potential dimension to the role of local anesthetics in pain management.
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Topical capsaicin has been studied in a variety of conditions by uncontrolled and controlled trials. It is attractive because it is a simple, safe treatment. Although these studies suggest an analgesic effect, even placebo-controlled trials have been impossible to blind due to the burning sensation induced by the capsaicin. ⋯ A careful scrutiny of the results of these trials to date as well as clinical experience indicate at best a modest effect with the currently available preparations with many patients failing to find relief, finding the relief unsatisfactory, or being unable to tolerate the burning sensation. Occasional patients appear to have a very good result, and these unusual cases may not be reflected by clinical trials. Topical capsaicin is generally not satisfactory as a sole therapy for chronic painful conditions, although it may serve as an adjuvant to other approaches.
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J Pain Symptom Manage · Feb 1994
ReviewCognitive-behavioral interventions for children's distress during bone marrow aspirations and lumbar punctures: a critical review.
Children with cancer often have difficulty coping with the invasive medical procedures that are part of diagnosis and treatment. Bone marrow aspirations and lumbar punctures are painful and cause some children severe anxiety and distress. The increased risk and expense of general anesthesia and the relative ineffectiveness of sedatives and anxiolytics has prompted clinicians to examine nonpharmacologic methods for controlling pain and distress. This report critically examines intervention studies that focus on cognitive-behavioral strategies such as distraction, imagery, or hypnosis for reducing procedural distress in children with cancer.