Current review of pain
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Current review of pain · Jan 2000
ReviewNeuromodulation: spinal cord and peripheral nerve stimulation.
Spinal cord and peripheral nerve stimulation for relief of chronic intractable pain have been used since the mid-1960s. Multiple mechanisms of action have been theorized without a clear-cut winner. ⋯ Efficacy studies consistently show an overall 50% improvement in long-term pain control in patients who have failed conservative or other invasive modalities. With improvements in today's technology, one hopes that better analgesia will be attainable.
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Postherpetic neuralgia (PHN) is the most common and devastating complication of acute herpes zoster (HZ). HZ occurs more frequently in the patient with human immunodeficiency virus (HIV) and with certain leukemias and lymphomas. PHN occurs more frequently in the elderly, in patients with severe pain in the acute stage, and in patients with lesions in the ophthalmic branch of the trigeminal nerve. ⋯ A wide variety of therapeutic approaches have been advocated over the years, but most are not very effective. Early aggressive treatment of HZ with antiviral drugs may be the most important step in prophylaxis against PHN. This article reviews the current knowledge of the pathogenesis and treatment of PHN.
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Current review of pain · Jan 2000
ReviewIs lumbar discography a determinate of discogenic low back pain: provocative discography reconsidered.
Provocative lumbar discography was investigated in a series of clinical studies at the Stanford University of Medicine, Stanford, CA. This work demonstrated that pain intensity during disc injection is strongly influenced by the subject's emotional and psychological profiles, chronic pain behavior, and ongoing compensation claims whether the patient has any back pain illness or not. Pain reproduction was also primarily related to penetration of the dye through the outer annulus and could not reliably be used to confirm the location of the pain source.
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This article reviews the objectives of psychological evaluations, as well as the standard pain center evaluation protocol that uses a pain questionnaire, a structured clinical interview, and pain assessment measures that include pain intensity rating scales and the McGill Pain Questionnaire. The most frequently used measures of psychological status, such as the Beck Depression Inventory and the Minnesota Multiphasic Personality Inventory (MMPI), are reviewed. Psychological predictors of invasive procedures and of disability are also outlined. The importance of listening to the patient in a multidisciplinary setting is emphasized.