Articles: pain-clinics.
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Although the greatest part of the human body is composed of muscle, diseases of the muscle, such as muscular dystrophies and inflamatory or metabolic myopathies, occur invery few patients. On the other hand, myalgia is one of the most common symptoms in routine clinical medicine. This is problematic, because muscular pain can be caused by many different physical and psychiatric diseases. In order to avoid unecessary and expensive laboratory tests a careful examination of clinical symptoms and signs is necessary.
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alpha(2)-Adrenozeptoragonisten agonists have shown antinociceptive and analgesic effects, which are not antagonized by naloxone. Therefore, the mechanism of action should be independent of opioid receptors. Most studies on this topic have been performed using clonidine. Experimentally the analgesic effect of clonidine can be suppressed by the inhibition of central adrenergic receptors. Furthermore, clonidine has analgesic effects at the spinal level. During recent years numerous studies have shown the analgesic effect of spinally or epidurally administered clonidine in humans. However, only very few studies have investigated the analgesic effect of parenterally administered clonidine in humans. ⋯ In our study the analgesic effect of 150 mug clonidine i.v. was equivalent to that of 5 mg morphine i.v. and 50 mg tramadol. Our results in humans confirm the dosage relationship of 1ratio30 found by Eisenach in sheep. Further studies on the use of parenteral clonidine for postoperative analgesia seem to be warranted.
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Thirty patients suffering from reflex sympathetic dystrophy accompanied by continuous spontaneous pain of the affected distal limb were investigated. The aim of the study was to determine whether a suprasystolic compression (cuff) fixed at the distal part of the affected limb and interrupting the distal circulation would influence the pain. In most cases, this so-called ischaemia-test led to a substantial suppression of pain, which occurred during the first or second minute after the cuff had been applied. Therefore, this test can be used as a new diagnostic tool to support the clinical diagnosis of reflex sympathetic dystrophy.
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At one of the symposia at the 16th congress of the German Society for the Study of Pain in Berlin in 1991 an update on the use of pumps and ports in pain treatment was presented. This article tries to focus on some of the conclusions of this meeding. (1) To avoid neurologial damage only analgesic substances that have been tested in animals and with which we have adequate clinical experience, e.g. opiates, clonidine and baclofen, should be used for spinal anaesthesia. (2) The increasing number of manufactures of pumps, ports, catheters and puncture needles should pay more attention to safety and reliability of their products to avoid technical complications and should try to achieve compatibility between the different accessories such as catheters, needles and connecting pieces. (3) The mode of application (spinal versus epidural, pump versus port or externalized catheter) depends on the predicted period of treatment (spinal application for long-term treatment requires more hygienic precautions) and on differences in the individual care of the patient (4). Spinal opiates for benign pain (in case of failure of less invasive pain regiments) have been tested successfully, but the follow-up is not yet long enough to allow recommendation of this therapy for general use. (5) Local anaesthetics are useful for short-term use. The addition of local anaesthetics for continuous low-flow infusion of opiates requires further comparative studies. (6) Spinal baclofen is effective against pain induced by muscle spasms but not against non-spasticity-related pain syndrome.
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Treatment of chronic pain disease is a scientific and clinical challenge encountered in all branches of medicine. Essential trigeminal neuralgia and chronic pain situations are noted for their exceptionally marked severity and also for their psychic and social consequences. It is not rare for a primarily somatic pain syndrome to develop into a painful disease in its own right, which is highly refractory to treatment. ⋯ Vincristine iontophoresis was applied in 33 patients hitherto unsuccessfully treated with various other methods. In 78% of the cases, attenuation of the pain was achieved. This noninvasive therapy proved to be free of side effects.