Pain management
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The Army Pain Management Task Force was charged with recommending pain management strategies for Army Medical Command that would optimize quality of life for patients living with acute and chronic pain. Among their recommendations was the development of the Pain Assessment Screening Tool and Outcomes Registry (PASTOR). ⋯ The two foci of PASTOR are to enhance the clinical encounter and provide data for comprehensive evaluations of treatment effectiveness. The potential of such information for the future of clinical management is described.
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Phantom limb syndrome (PLS) is a syndrome including stump pain, phantom limb pain and not-painful phantom sensations, which involves a large part of amputee patients and often has devastating effects on their quality of life. The efficacy of standard therapies is very poor. ⋯ Epidural and peripheral blocks limited to the first three postamputation days can only reduce acute pain but cannot prevent the later development of PLS. Recent studies have shown that ambulatory prolonged peripheral nerve block (up to 30 days postamputation) may represent a new possible option to treat phantom pain and prevent the development of PLS and chronic pain.
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Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacological intervention that activates a complex neuronal network to reduce pain by activating descending inhibitory systems in the central nervous system to reduce hyperalgesia. The evidence for TENS efficacy is conflicting and requires not only description but also critique. ⋯ The purpose of this article is to provide a critical review of the latest basic science and clinical evidence for TENS. Additional research is necessary to determine if TENS has effects specific to mechanical stimuli and/or beyond reduction of pain and will improve activity levels, function and quality of life.