Läkartidningen
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Severe neurogenic pain still constitutes a major problem since it is often resistant to conventional therapy. During the last 30 years electric activation of pain inhibitory mechanisms through stimulation both of peripheral nerves and of central nervous circuits has been used to great advantage. The simplest method of stimulation, transcutaneous electric nerve stimulation (TENS), is extensively used by physiotherapists as well as in pain clinics. ⋯ TENS originally served as a screening method to identify patients suitable for spinal cord stimulation therapy (SCS). The main indication is severe neuropathic pain of peripheral origin, but SCS has also been found valuable in extremity ischemia as well as in refractory angina pectoris. The most severe cases of neuropathic pain may benefit from intracranial stimulation via electrodes placed stereotactically in the posteromedial thalamus or epidurally over the motor cortex.
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Comparative Study
[Cardiopulmonary resuscitation via telephone instruction. Chest compression more appropriate for instruction via telephone than CPR].
Cardiopulmonary resuscitation (CPR) initiated by a bystander prior to arrival of the ambulance increases the chance of survival 2-3 times. Unfortunately a majority of patients do not receive such treatment. One way to approach the problem is to let the dispatcher instruct the witness in CPR via telephone when a presumed cardiac arrest occurs. ⋯ The difference was not significant. The results indicate that telephone instruction in CPR when a presumed cardiac arrest occurs might in certain cases preferably be restricted to chest compressions. The results of the trial are, however, difficult to translate into Swedish conditions, since ambulance response times in Sweden are much longer than in Seattle.