Pain medicine : the official journal of the American Academy of Pain Medicine
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To review the pathophysiology of fibromyalgia syndrome. ⋯ Multiple abnormal findings in fibromyalgia patients strongly indicate a neuropathic pain syndrome, reminiscent of complex regional pain syndrome or postherpetic neuralgia. In addition, fibromyalgia syndrome seems to share similar characteristics with these neuropathic pain syndromes, including ineffective response to many analgesics.
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Adverse and analgesic effects of acupuncture during the second and third trimesters of pregnancy were studied retrospectively in an observational study including 167 consecutive patients with lower back pain, pelvic pain, or both. In each patient acupuncture was given on at least two different occasions by three manual stimulations of two or more acupuncture or tender points, mainly LR-3 and LI-4 together with local tender points, at 15-min intervals. Possible adverse and analgesic effects were assessed by the midwife responsible for the acupuncture given in each patient. ⋯ Analgesia, as assessed by midwives involved, was good or excellent in 72% of patients. Acupuncture seems to be safe and effective for pain relief in lower back pain, pelvic pain, or both during the second and third trimesters of pregnancy. Nevertheless, prospective randomized studies are needed to confirm these findings.
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Mexilitine is an anti-arrhythmic agent used to treat neuropathic pain. The drug has a low side-effect profile with gastritis as the predominant complaint. The following two cases suggest that mexilitine can potentially cause persistent ophthalmic changes and should be used with caution in chronic pain patients with preexisting ocular disease.
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Dissociation disorders are a group of conditions characterized by a disruption of integrated function of consciousness, memory, or perception. The purpose of this report is to describe the impact of increased pain levels on the genesis of two types of dissociation disorders, dissociative fugue ( DF) and dissociative identity disorder ( DID), in patients with chronic pain ( PWCP). DESIGN/PATIENTS/INTERVENTIONS/OUTCOME MEASURES: From November 1992 to July 2000, 2 DID and 4 DF patients were identified from 2,544 consecutive PWCP evaluated and/or treated at the University of Miami Comprehensive Pain and Rehabilitation Center. The salient features of these six dissociation PWCP are presented. All four DF PWCP completed a dissociation experience scale first at the time of identification of the dissociation disorder (with chronic pain) and one alleging their experiences with dissociation predevelopment of chronic pain. ⋯ The frequency percentage for dissociation within PWCP is small compared with psychiatric populations. There may be an etiological association between the development of dissociation episodes and the development of chronic pain and/or increases in chronic pain.
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A U.S. Food and Drug Administration ruling required clinical trials to evaluate the safety and efficacy of deep brain stimulation devices, thereby limiting treatment to the investigational setting. ⋯ Deep brain stimulation has not been shown to produce effective long-term pain relief. Future studies of motor cortex stimulation and similar therapies will require appropriate control groups and accepted methods of data collection and analysis to support claims that predictable and reliable analgesic effects are produced in humans.