Articles: pain-management.
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La Radiologia medica · May 1993
[Percutaneous neurolysis of the celiac plexus. Description of a new CT-guided technique and preliminary results].
June 1991 to June 1992, twelve CT-guided percutaneous celiac plexus neurolyses were performed by a new simplified technique with the patient in left-hand side decubitus and a single right lumbar needle access. CT guidance allows the interventional radiologist to locate the best access point on the skin, to give the needle the appropriate depth and inclination to avoid passing through pleura, parenchyma and vessels, and finally to check the correct position of the needle tip and the spread of neurolytic solution. ⋯ The analgesic value of celiac plexus neurolysis has been proved complete and lasting. The technique is quick and safe (apart from inevitable hypotension due to splanchnic vasodilatation).
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J Assoc Nurses AIDS Care · Apr 1993
ReviewPain characteristics and their management in persons with AIDS.
Discussion of pain problems in persons with AIDS has been limited in medical and nursing literature, yet pain is a major source of suffering and concern for patients. Common pain characteristics are described in 100 persons with CDC-defined AIDS, using the 1987 definition. ⋯ Treatment responses were individualized, with drug users requiring more frequent use of opiates. General treatment strategies are suggested with special emphasis on the unique needs of PWAs.
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Tijdschr Kindergeneeskd · Apr 1993
[Pediatric Pain Groups. Management related to pain in hospitalized children].
By means of multidisciplinary Pediatric Pain Groups in hospitals possibilities are created to implement recent knowledge about prevention of pain and relief of pain in children. The activities of these groups are amongst others: developing and testing pain protocols, applying systematic pain assessment and giving information about pediatric pain. These activities result in a reduction of pain in children and in prevention of needless suffering of pain in hospitalized children.
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Randomized Controlled Trial Comparative Study Clinical Trial
Modified suprascapular nerve block with bupivacaine alone effectively controls chronic shoulder pain in patients with rheumatoid arthritis.
Chronic shoulder pain is a common and disabling symptom in patients with rheumatoid arthritis (RA). It has been previously shown that a suprascapular nerve block (SSNB) using the standard mixture of bupivacaine and adrenaline (Ba) plus methylprednisolone (P), which is routinely used in pain clinics, results in a considerable improvement in pain relief and range of movement compared with conventional intra-articular steroid injections in such patients. ⋯ Results favoured Ba alone; the differences between the two treatments reached statistical significance for stiffness (at 12 weeks) and active abduction (at one week). It is concluded that the addition of P to the SSNB mixture confers no benefit in these patients.
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Regional anesthesia · Mar 1993
Review1992 Bonica Lecture. Advances in chronic pain management since gate control.
Two pain treatment systems that developed soon after the publication of the gate theory are probably a direct result of its publication: neuraxial opiate administration and electrical stimulation of the spinal cord and peripheral nerves and receptors. Although the use of these modalities has become widespread in managing chronic pain, there is disagreement about their long-term efficacy. This presentation will attempt to review the data regarding the mechanisms of action of these modalities and their efficacy in treating chronic pain of malignant and nonmalignant origin. ⋯ Long-term spinal opiate administration has been shown to be more effective than systemic opiates in some patients with cancer pain, but often must be combined with local anesthetics to provide satisfactory pain relief. Loss of effect over time is a significant problem. Since the identification of spinal opiate receptors and the introduction of spinally administered narcotics, a number of other receptors that are important in both sensitization and suppression of pain projection systems have been characterized. Agonists and antagonists to many of these receptors are being developed, and a few are available for clinical trials. Long-term electrical stimulation of the spinal cord produces substantial analgesia below the stimulated spinal segments in some patients with chronic pain. Although initial results are usually encouraging, long-term efficacy may be disappointing. It is postulated that analgesia associated with spinal stimulation is associated with both stimulation of large fiber ascending tracts and blockade of spinothalamic pathways. Transcutaneous electrical nerve stimulation (TENS) has come into widespread use in managing chronic pain and has had limited trials in cancer pain patients. It is well accepted by patients and physicians, but clinical studies of long-term efficacy have yielded variable results. The analgesic action is probably the result of both large afferent fiber activation and blockade of peripheral nociceptors.