Articles: palliative-care.
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Comparative Study
An electrophysiological investigation into the pain-relieving effects of heterotopic nociceptive stimuli. Probable involvement of a supraspinal loop.
It has previously been shown that, in normal subjects, heterotopic painful stimuli induce parallel decreases in the sensation of pain and the nociceptive spinal flexion reflex RIII simultaneously evoked by electrical stimulation of the sural nerve. By contrast, heterotopic non-noxious stimuli were ineffective in this respect. In order to assess the possible involvement of supraspinal structures in these changes, we have now compared the effects of nociceptive electrical stimuli applied to the fourth and fifth fingers of the hand on the contralateral RIII reflex in 5 normal subjects and 5 tetraplegic patients suffering from a clinically complete spinal cord transection of traumatic origin. ⋯ These results show that the effects of heterotopic nociceptive stimulation observed in normal man are possibly mediated by a complex loop involving supraspinal structures. This further underlines the similarity between this phenomenon and the Diffuse Noxious Inhibitory Controls (DNIC) described in the rat, since the latter are observed in intact but not in spinal animals. These findings are discussed with reference to counter-irritation phenomena and procedures aimed at producing analgesia by somatic electrical stimulation.
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Twenty-two patients who had received high-dose radiotherapy (50-60 Gy) for non-small-cell lung cancer were retreated with palliative radiotherapy for symptoms that were due to locally recurrent disease. Twelve of the 23 (one patient was retreated twice) repeat courses produced symptomatic benefit. ⋯ There were no other serious complications, even though total tumour doses as high as 120 Gy were achieved. This experience demonstrates that repeated courses of radiotherapy can be given successfully and safely in spite of previous radical dosage.