Regional anesthesia and pain medicine
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Although there is considerable information about the mechanisms through which injury stimuli produce acute pain, recent studies indicate that there are significant long-term consequences of persistent injury. Pain is exacerbated, in part, because of a reorganization of spinal cord circuitry in the setting of persistent injury. This review describes our studies of the contribution of the primary afferent neurotransmitter, substance P (SP), to these changes. ⋯ Taken together, these studies emphasize that persistent pain should be considered a disease state of the nervous system, not merely a symptom of some other disease conditions. In the setting of persistent injury, the nervous system undergoes dramatic changes that exacerbate and prolong the pain condition. Our studies underscore the importance of preventing the long-term changes that result from persistent injury.
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Reg Anesth Pain Med · Jan 1999
Case ReportsProgressive systemic sclerosis: intrathecal pain management.
At present, there is no reliable method for long-term treatment of severe pain from progressive systemic sclerosis (PSS) associated with Raynaud's phenomena leading to ischemia and ulcerations of the extremities. Long-term continuous intrathecal (IT) buprenorphine/bupivacaine analgesia was used in such a case. ⋯ Intrathecal infusion of buprenorphine/bupivacaine provided satisfactory long-term pain relief in a patient with PSS-associated Raynaud's phenomena, skin ulcerations, and intractable ischemic pain.
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Reg Anesth Pain Med · Jan 1999
ReviewNeuraxial techniques for cancer pain: an opinion about unresolved therapeutic dilemmas.
Epidural and intrathecal techniques are well established for minimizing cancer pain. However, several issues remain unresolved. ⋯ A subcutaneous tunnelling and fixation of the catheter, bacterial filters, minimum changes of tubings, weekly exit site care, site protection, and monitoring for any signs of infection are suggested for advanced cancer patients. Areas still needing clarification include the optimum use of spinal adjuvants, the appropriate spinal morphine-bupivacaine ratio, methods to improve spinal opioid responsiveness, and long-term catheter management during home-care programs.