Minerva anestesiologica
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Postoperative pain treatment is the challenge of the new century; we know that even starting from the 24(th) week of gestational age, the fetus can feel pain and that memory of uncontrolled pain can change the pain threshold in children. We have now new drugs and new tools for an optimal pain control also in children and this review is an update on the new therapies and devices which can help us in the daily clinical practice.
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In neuropathies there are complex reactions that modify the homeostatic equilibrium of pain system. In such a context the Scrambler Therapy (ST5) interferes with pain signal transmission, by ''mixing'' a ''non-pain'' information into the nerve fibres. The aim of this study is to evaluate the effectiveness of ST5 in the treatment of neuropathic pain. The ST5 consists of a multiprocessor apparatus able to simulate 5 artificial neurons by the application of surface electrodes on skin pain areas. A total of 226 patients, all suffering from intense drug-resistant neuropathic pain, were recruited for this trial in 2004. ⋯ is draen that ST5 produced a statistically significant (P<0.0001) pain relief in all treated neuropathies.
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Minerva anestesiologica · Jul 2005
Review Practice Guideline GuidelineOpioid therapy for chronic noncancer pain: practice guidelines for initiation and maintenance of therapy.
Contemporary standard pharmacological care for the treatment of noncancer pain includes the use of opioid medications. The responsiveness of neuropathic pain to opioids has long been an area of controversy. Evidence from multiple randomized controlled trials indicates that opioids can relieve pain in a variety of neuropathic pain syndromes. ⋯ Opioid rotation refers to the switch from one opioid to another when the degree of analgesia obtained is limited by the persistence of adverse effects or the occurrence of clinically relevant tolerance. This approach is based on the observation that a patient's response varies from opioid to opioid. At present, after 1) appropriate selection of patients and 2) longitudinal patient care with routine assessment of degree of analgesia, functional daily activities, adverse events and aberrant behaviors is carried out, opioid therapy can be the safest and most effective treatment measure for quality of life improvement in the chronic pain patient.