Articles: pain-management.
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Comparative Study
Acute pain management services: a comparison between Air Force and U.S. hospitals.
The purpose of this descriptive study was to assess the prevalence of acute pain management services (APMS) in Air Force medical facilities. There are no published reports on the current status of Air Force pain programs. This study used a telephone survey to all facilities worldwide that house an anesthesia department. ⋯ S. hospitals (42%). Formal pain programs are becoming more prevalent in Air Force hospitals. These findings suggest an increased awareness of the need for pain management and future establishment of pain programs.
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J Altern Complement Med · Dec 1999
Complementary and alternative medicine and psychologic factors: toward an individual differences model of complementary and alternative medicine use and outcomes.
Complementary and alternative medicine (CAM) is in widespread use. Study of the psychologic factors associated with CAM use may provide descriptions of subgroups of health care consumers and give further insight into the reasons for using alternative therapies. ⋯ Above average use of CAM is associated with higher education, greater well-being and higher Absorption. The personality traits associated with alternative therapies are compatible with participation in these therapies and may facilitate the capacity to benefit from them.
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There are numerous methods cited in the literature on the treatment of painful neuroma. Nonsurgical methods range from injections with various materials into the nerve end to desensitization of nerve pain conduction pathways. Some surgical treatments aim to alter the environment of the amputated nerve end by transposing it into muscle or bone, others have designed various flaps to protect truncated nerve ends from scar tissue, and still others try to "cap" the nerve with silicon, a nerve graft, or epineurium to prevent nerve regeneration. ⋯ The authors review the common treatments for painful neuromas. In addition, they review the preliminary results of the extended autologous venous nerve conduit as a novel technique of treating painful neuromas. They also report recent investigations into the pathophysiology of injured nerves.
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Clinical Trial
Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study.
Although electrical stimulation of the precentral gyrus (MCS) is emerging as a promising technique for pain control, its mechanisms of action remain obscure, and its application largely empirical. Using positron emission tomography (PET) we studied regional changes in cerebral flood flow (rCBF) in 10 patients undergoing motor cortex stimulation for pain control, seven of whom also underwent somatosensory evoked potentials and nociceptive spinal reflex recordings. The most significant MCS-related increase in rCBF concerned the ventral-lateral thalamus, probably reflecting cortico-thalamic connections from motor areas. ⋯ A model of MCS action is proposed, whereby activation of thalamic nuclei directly connected with motor and premotor cortices would entail a cascade of synaptic events in pain-related structures receiving afferents from these nuclei, including the medial thalamus, anterior cingulate and upper brainstem. MCS could influence the affective-emotional component of chronic pain by way of cingulate/orbitofrontal activation, and lead to descending inhibition of pain impulses by activation of the brainstem, also suggested by attenuation of spinal flexion reflexes. In contrast, the hypothesis of somatosensory cortex activation by MCS could not be confirmed by our results.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparative reliability and validity of chronic pain intensity measures.
Reliable and valid measures of pain are essential for conducting research on chronic pain. The purpose of this longitudinal study was to compare the reliability and validity of several measures of pain intensity. One hundred twenty-three patients with chronic pain were administered telephone interview versions of 0-10 scales of current, worst, least and average pain, immediately prior to beginning a multidisciplinary treatment program. ⋯ Contrary to prediction, the composite measures did not show a statistically significant superiority to the individual ratings in terms of their ability to detect change in pain intensity from pre-treatment to various points after treatment. The composite scores did, however, show greater stability than did the individual ratings after treatment. The practical conclusions of this study are; (1), individual 0-10 pain intensity ratings have sufficient psychometric strengths to be used in chronic pain research, especially research that involves group comparison designs with relatively large sample sizes, but, (2), composites of 0-10 ratings may be more useful when maximal reliability is necessary, (e.g. in studies with relatively small sample sizes, or in clinical settings where monitoring of changes in pain intensity in individuals is needed).