Articles: pain-clinics.
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Temporal summation of pain is suggested to be an important factor during various clinical conditions. Controversies exist as to whether temporal summation exists for Adeltafibre-mediated first pain. The aim of the present human experimental study was to investigate the importance of stimulus configuration (intensity, inter-pulse interval, location) for temporal summation of radiant (laser)- and contact-heat-induced pain. ⋯ Taking the latency from stimulation to perception into consideration, we were able to differentiate and find summation of first (Adeltafibre-mediated) and second pain (C fibre-mediated). Summation of first pain was more pronounced for high (38 degrees C) than for low (30-32 degrees C) baseline temperature. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.
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We report organisation principles and three year experience of Acute Pain Service in general surgery clinic. 481 patients were treated after abdominal and vascular interventions, hemorrhoidal varices and mammectomies. Continuous epidural, combined spinal-epidural, intrapleural anaesthesia and continuous brachial plexus block were used for pain control. Time of analgesia varied from 1 to 4 days. ⋯ In 2% of cases cardiovascular complications were observed. Respiratory depression occurred in 1 patient. The work of APS team was assessed as very good by both surgeons and patients.
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Several pathophysiological mechanisms may be responsible for initiation and maintenance of chronic postherpetic pain. (1) Peripheral nociceptive fibers can develop abnormal sensitization. Secondary to this, central nociceptive "second-order" neurons in the spinal cord dorsal horn can also be sensitized, i.e. they become hyperexcitable and start responding to non-noxious stimuli. (2) Degeneration of nociceptive neurons may trigger anatomical sprouting of low-threshold mechanosensitive terminals to form connections with central nociceptive neurons and may subsequently induce functional synaptic reorganization in the dorsal horn. According to these mechanisms theoretical possibilities of therapeutical interventions to prevent postherpetic neuralgia are (1) adequate analgesia in the acute phase (analgesics, antidepressants, sympathetic blocks) and (2) prevention of C-fiber degeneration by reducing the inflammatory reaction (antiviral drugs, corticosteroids, neurotrophins). ⋯ Although there is no clear evidence in favor of a prevention of postherpetic neuralgia for any of the interventions, it is definitely reasonable to perform the best analgesia possible during the acute phase of herpes zoster.
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Tricyclic antidepressants (TCA) have been shown to provide analgesia for a variety of neuropathic and headache pain syndromes regardless of the presence of depression. There is a high incidence of depression in patients with chronic pain, thereby making tricyclic antidepressants particularly suitable for chronic pain patients. We wanted to study patterns of use of tricyclic antidepressants in our Pain Management Center (Beth Israel Hospital, Boston, MA, U.S.A.) primarily to answer four questions: (1) What percentage of all patients were treated with tricyclic antidepressants? (2) How many patients were treated with each antidepressant, and what was the dose range used for individual antidepressants? (3) Were tricyclic antidepressants beneficial for chronic pain, and was that response dependent on a particular dose? (4) Did patients receive an adequate TCA trial, and what factors led to the discontinuation of a TCA trial? ⋯ Tricyclic antidepressants were used in 25% of patients referred to a multidisciplinary pain center and were commonly used in low to intermediate doses, even in situations in which there were neither side effects nor optimal clinical response.
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During the last two decades, knowledge has increased significantly regarding the treatment of acute pain. One of these advances has been the implementation of multidisciplinary Acute Pain Services in the hospital setting to take on accountability for acute pain management. Acute Pain Services are expanding rapidly in the Canadian health care system. ⋯ The purpose of this study was to examine the effectiveness of, and staff satisfaction with, one Canadian Acute Pain Service. Results of the study indicated that staff were generally satisfied with the Acute Pain Service and felt that the program had made a significant impact on the treatment of acute pain within the hospital; although improvements in pain outcomes were not noted. Adequate communication mechanisms and resources to allow for appropriate workload, education and clinical support are critical to the development and success of an Acute Pain Service.