Articles: pain-clinics.
-
Even if the effectiveness of psychotherapy emphasising a cognitive behavioral approach is clearly shown by randomised controlled trials, it is difficult to motivate chronic pain patients to use this type of treatment. We compared the effectiveness of consultation and liaison models of co-operation between an outpatient pain clinic and a psychosomatic department in creating motivation to psychotherapy. ⋯ The liaison model of co-operation was significantly more effective to enhance physician's and patient's motivation for a psychosomatic approach to pain treatment. Psychotherapy is better accepted by patients suffering from chronic pain if it is offered in a multidisciplinary context and in the familiar surroundings of the pain clinic.
-
Fluoroscopy is an integral part of the practice of interventional pain management in present day modern medical practices. The major purpose of fluoroscopy in interventional pain management is correct needle placement to ensure target specificity and accurate delivery of the injectate. Fluoroscopy has become mandatory for multiple procedures based either on the definition of the procedure or the requirement of third parties. ⋯ The average exposure outside the apron was 1.345 mREM per patient and 0.778 mREM per procedure outside the apron and 0 mREM inside the apron. The levels of exposure are significantly below the annual limits recommended. It is concluded that it is feasible to perform all procedures under fluoroscopy in the described setting safely and effectively in interventional pain management.
-
Fluoroscopically guided, minimum threshold electrical stimulation of the right first, second, third, and fourth lumbar medial branches and the fifth lumbar dorsal ramus in each of eight healthy test subjects was performed. The stimulation thresholds and referral patterns were recorded. A composite drawing of the referral patterns was created. The composite drawings were compared to documented referral patterns already published by other authors. ⋯ All of the subjects' mapped referral sites coincided with each other, creating a well defined composite drawing. These referral zones are different than those reported after injection of the lumbar Z-joint, which may have clinical and therapeutic implications. These referral maps may provide the clinician with additional insight when evaluating a patient with lumbar, flank, or gluteal pain of undetermined etiology.
-
As a result of its accompanying co-morbidity, our lack of understanding regarding its mechanisms, and its resistance to conventional treatment, central pain is one of the most formidable challenges pain physicians are faced with. The objective of this review is to summarize recent advances in our understanding of the etiology, clinical presentation, and treatment of central pain, with special emphasis being placed on studies published within the past year. ⋯ Injury to the spinothalamocortical pathways is a necessary, but not sufficient factor in the pathogenesis of central pain. Perhaps because of the similarities in mechanisms, there is considerable overlap between effective treatments for central pain and those for peripheral neuropathic pain. Our poor understanding of the etiology of central pain and the relative lack of effective treatments emphasize the need for further research into this elusive disorder.
-
The alpha(2)-adrenoceptor agonist clonidine is one of the most widely investigated substances in anaesthesia and pain therapy. Recently, numerous experimental and clinical studies have allowed a better understanding of its underlying mechanisms of action and interactions with other analgesic drugs. ⋯ During the past decade clonidine has been investigated as an adjuvant for general and regional anaesthesia and in the postoperative period. There is no doubt that clonidine improves analgesia after systemic, spinal or peripheral opioids, and prolongs the analgesic action of most local anaesthetics. The side-effects of usual doses of clonidine are predictable. Given the clinical experience of an increasing number of hospitals, clonidine should no longer be considered an experimental drug, but a useful addendum to the pharmacological armamentarium.