Articles: pain-management.
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It has been helpful in our practice to separate somatic from sympathetic-mediated peripheral nerve pain. We would recommend application of the new nomenclature of type I complex regional pain (sympathetic dystrophy) and type II complex regional pain (causalgia) (see Table 1). We believe it is essential that both of these conditions be separated into their early and late phases and that the treatment alternatives be customized for the individual patient and the peripheral nerve involved. ⋯ The surgeon occasionally may be involved in the manipulation and pinning of contracted joints, as well as release of muscle or joint contractures, followed by a supervised program of early range of motion. Finally, it is important that both physician and surgeon serve as patient advocates when questions of workers' compensation intervene that could deter proper treatment programs or when the patient needs the encouragement and guidance to continue with treatments that don't always initially appear to have immediate results. Finally, requests to the surgeon to find an operative cure must be resisted while continued psychological encouragement is provided.
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Opiates remain the most common form of analgesic therapy in the burn patient today. Because of increased opiate requirements, optimal relief of burn pain continues to be a problem for these patients. The purpose of this article is to summarize those alternative pain control methods that appear in the literature. ⋯ Ketamine has been extensively used during burn dressing changes but its psychological side-effects have limited its use. Clonidine, however, has shown promise in reducing pain without causing pruritus or respiratory depression. Other forms such as transcutaneous electrical nerve stimulation (TENS), psychological techniques, topical and systemic local anaesthetics are also useful adjuncts.
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J Dev Behav Pediatr · Aug 1997
Clinical TrialSwaddling after heel lance: age-specific effects on behavioral recovery in preterm infants.
We examined responses of preterm infants to swaddling after a heel lance. Fifteen preterm infants from two postconceptional age (PCA) groups (Group 1: n = 7, PCA < 31 wk; Group 2: n = 8, PCA > or = 31 wk) were observed for 30 minutes during blood sampling followed by routine care; blood sampling followed by swaddling; and no blood sampling and routine care. ⋯ Infants 31 weeks PCA or older exhibited protracted behavioral disturbance that was significantly reduced by the use of swaddling. We discuss the significance of these findings.
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The weight of available evidence suggests that reflex sympathetic dystrophy (RSD) is a complex clinical entity that (1) occurs predominantly in young adult women; (2) has five clinical types but presents most frequently as minor traumatic dystrophy; (3) has primary signs and symptoms (e.g., pain, edema, stiffness, and discoloration) that are expressed highly in each clinical type, whereas secondary signs and symptoms are variable; (4) responds well to treatment, regardless of its clinical type; and (5) is managed best when treatment is started early. It can be concluded that RSD is a multifaceted disease that responds well when managed with a multimodal treatment program aimed at the various interacting components of the disorder. The recognition and documentation of the variation of the clinical features of RSD may allow for its earlier diagnosis and treatment and thus significantly improve the chances for a successful outcome.