Physical medicine and rehabilitation clinics of North America
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Much progress has been made in the assessment and management of neuropathic pain over the past 5 years. Assessment has improved with the Neuropathic Pain Scale, a new, easily administered, diagnostic tool. Mechanistically, recent studies indicate that peripheral neuropathic pain is generated through a focal inflammatory process rather than axonal destruction. ⋯ Mexiletine is a reasonable alternative agent in patients who have not had a satisfactory response to, or cannot tolerate, the AEDs or antidepressants. Long-acting opioids should be considered in patients refractory to these adjunctive agents. With the advent of the topical lidocaine patch, the first drug with an FDA-approved indication for postherpetic neuralgia, a revolutionary new agent is now available for the treatment of neuropathic pain that does not have any systemic side effects.
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Phys Med Rehabil Clin N Am · May 2001
ReviewMagnetic resonance imaging of the peripheral nervous system.
An accurate diagnosis is the essential first step toward a successful treatment plan in patients who present with pain and suspected nerve entrapment. Pain and dysfunction are often related to an acute traumatic event or a classic presentation that leads to a straightforward clinical diagnosis. The diagnostic approach to abnormalities of the peripheral nervous system always begins with a thorough history and physical examination. ⋯ MR imaging remains an evolving technique with ongoing improvements in technology and developing clinical experience, resulting in greater diagnostic capacity. In this article current technique and strategies for image analysis and the authors' specific clinical experience with MR imaging of peripheral nerve disorders are reviewed. The exact role of MR imaging in the evaluation of these disorders will be further defined with additional experimental work and published clinical experience.
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Phys Med Rehabil Clin N Am · Aug 2000
ReviewAn anesthetic approach to amputation and pain syndromes.
Primary anesthetic intervention is a very effective modality in the prevention of phantom limb pain. The first phase is reduction of the preamputation pain by epidural or intrathecal infusion with local anesthetic and opioid. The catheter can be used for the operative phase, along with an intraneural catheter placement, if necessary. ⋯ Other modalities include dorsal column stimulation to facilitate inhibitory descending pathways. An intrathecal delivery system can be placed to infuse clonidine, local anesthetic, and opioid. For pain management, implantable intrathecal delivery systems may become an important tool for the future management of postamputation pain syndrome.
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This article provides a description of the clinical infrastructure of a stroke center, including staffing requirements, technical capabilities, and recommended clinical protocols. These recommendations have been developed to assist in establishing new acute stroke centers that can deliver quality care and to aid in evaluating the relative strengths and weaknesses of existing stroke centers.
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Quality and number of subjects in blinded controlled clinical trials about the nutrition and dietary supplements discussed here is variable. Glucosamine sulfate and chondroitin sulfate have sufficient controlled trials to warrant their use in osteoarthritis, having less side effects than currently used nonsteroidal anti-inflammatory drugs, and are the only treatment shown to prevent progression of the disease. Dietary supplements of ephedrine plus caffeine for weight loss (weight loss being the current first line recommendation of physicians for osteoporosis) show some promise, but are not sufficient in number of study subjects. ⋯ If these supplements were required to undergo clinical trials necessary for a new drug by the FDA, they would not be released yet to the public. Several nontoxic supplements appear promising, though need further study. Because they have essentially no toxicity (such as folic acid with B12, soluble fiber, and vitamin E) and may have efficacy, some of these supplementations may be useful now, without randomized clinical trials.