Articles: pain-management.
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Arch Phys Med Rehabil · Nov 1998
High-frequency transcutaneous electrical nerve stimulation alters thermal but not mechanical allodynia following chronic constriction injury of the rat sciatic nerve.
To determine if daily transcutaneous electrical nerve stimulation (TENS) can alter the thermal and mechanical allodynia that develops after chronic constriction injury (CCI) to the right sciatic nerve of rats. ⋯ It appears that daily TENS can prevent thermal but not mechanical allodynia in this model. However, early intervention with the treatment is critical if it is to be effective at all.
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Recent advances in the application of regional anesthesia to the care of patients undergoing shoulder surgery are discussed. New techniques for the management of postoperative pain are highlighted, with an emphasis on interscalene patient-controlled analgesia and suprascapular block. ⋯ Intraoperative hypotension and bradycardia caused by activation of the Bezold-Jarisch reflex is considered. The ongoing debate regarding the use of paresthesia versus nerve-stimulator techniques is examined.
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Spinal cord stimulation (SCS) has been used for more than 30 years now, and although it has shown to be effective under certain well-described conditions of chronic pain, conclusive evidence on its effectiveness is still sparse. There is a need for more prospective and methodological good studies, in order to prove SCS efficacy for new or still questionable indications and to reveal prognostic factors for successful application. ⋯ In contrast to the early years when SCS was applied by independent physicians exploring the field of neurostimulation, the importance of information exchange and coordination of studies has now been recognized. Recent technical improvements of SCS devices may positively influence clinical outcome.
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Objectives. Recent technical improvements in implanted stimulation devices, in particular the development of programmable, multicontact devices, have facilitated their clinical application in the management of pain. If the capabilities of these devices are to be used to full advantage, adjustment after implantation demands a major investment of time and effort. ⋯ Results and Conclusions. Our patient-interactive computerized system has proven to be safe and effective clinically in adjusting implanted spinal cord stimulators. It offers advantages of data standardization and quality control, as well as delivery of novel pulse sequences and protocols to assess the treatment of pain and neurological disorders by electrical stimulation devices.