Articles: pain-management.
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Objective. To test the following hypotheses, based on computer modeling studies of spinal cord stimulation, by the analysis of data from chronic pain patients: I. the probability-of-paresthesia in a dermatome is highest when the cathode is placed at the corresponding segmental level; II. variation of the rostrocaudal position of the cathode in the lower cervical/high thoracic region results in less variation of the probability-of-paresthesia in a dermatome than stimulation in more caudal regions; III. when stimulating in the midthoracic region, the probability-of-paresthesia in a dermatome is low in comparison to other regions when the cathode is not at the corresponding segmental level. Method. ⋯ Conclusion. The success to be expected from spinal cord stimulation in chronic pain management is inversely related to the thickness of the dorsal cerebrospinal fluid layer at the cathode level. Therefore, preoperative measurement from transverse images can be helpful as a predictor for success.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pharmacologic and psychologic interventions for procedural pain.
This study evaluated a combined pharmacologic and psychologic intervention (combined intervention, CI) relative to a pharmacologic-only (PO) intervention in reducing child distress during invasive procedures in childhood leukemia. Predictors of child distress included age, group (CI, PO), and procedural variables (medications and doses, technical difficulty, number of needles required). ⋯ The data showed that pharmacologic and psychologic interventions for procedural distress were effective in reducing child and parent distress and support integration of the two approaches. Younger children experienced more distress and warranted additional consideration. Staff perceptions of the technical difficulty of procedures were complex and potentially helpful in designing intervention protocols.
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J Comput Assist Tomogr · Jul 1998
Percutaneous lumbar sympathetic plexus catheter placement for short- and long-term pain relief: CT technique and results.
The purpose of this work was to evaluate the use of percutaneously placed lumbar sympathetic plexus catheter placement under CT guidance in patients with complex regional pain syndrome (CRPS) or nonspecified neuropathic pain (NP) of the lower extremity. ⋯ Percutaneous lumbar sympathetic plexus catheter placement is easily performed, achieves short-term pain relief in the majority of patients, and may prove effective in long-term pain relief of CRPS patients.
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This report aims to present an orderly approach to the treatment of Chronic Regional Pain Syndrome (CRPS) types I and II through an algorithm. The central theme is functional restoration: a coordinated but progressive approach that introduces each of the treatment modalities needed to achieve both remission and rehabilitation. Reaching objective and measurable rehabilitation goals is an essential element. ⋯ This algorithm is a departure from the contemporary heterogeneous approach to treatment of patients with CRPS. The underlying principles are motivation, mobilization, and desensitization facilitated by the relief of pain and the use of pharmacologic and interventional procedures to treat specific signs and symptoms. Self-management techniques are emphasized, and functional rehabilitation is the key to the success of this algorithm.
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This article reports the results of a survey of acupuncture practice in chronic pain clinics in the United Kingdom. The survey reveals that acupuncture is widely used in the treatment of chronic pain with 84% of those responding stating that is was available at their clinics. The majority of practitioners had attended a course at one of the 'acupuncture schools' but in about one fifth of the clinics the practitioner had not received any formal training.