Articles: pain-management.
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A reliable, safe approach to achieving unilateral anesthesia in multiple contiguous thoracic dermatomes would be of great benefit to anesthesiologists in the acute and chronic pain setting. The multidermatomal intercostal technique is one such approach, although the anatomical mechanism of this nerve block is a matter of debate. At our pain clinic, we have used another technique, a modification of the paravertebral block, to achieve multiple segments of unilateral sensory blockade. ⋯ In order to clarify the mechanism of bilateral blockade resulting from a unilateral technique, we injected four fresh cadavers with colored latex solution using the paravertebral-peridural approach. This revealed spread of the latex across the midline prevertebrally to the contralateral paravertebral space. We conclude that the paravertebral-peridural thoracic block is a reliable, safe technique for achieving unilateral anesthesia over multiple dermatomes with a single injection.
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The problem of nociception and pain development in radicular pain syndromes is not clarified. In the pathophysiology of pain of radicular compression caused by stenosis or disc prolapse, morphological complex nerve root/ganglion is the key structure. Chronic compression forces on the nerve structure cause structural changes. ⋯ The membrane threshold shift in nociceptive fibers is an important prerequisite for pain perception in nerve root compression. New biochemical aspects in the pathophysiology of radicular syndromes are presented, which could explain the discrepancy between pain and objective clinical findings. The article concludes that a better understanding of the nerve root pathophysiology will bring a more differentiated pain-management strategy.
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Chronic pain can be described as a syndrome or process of decompensation not unlike any other chronic disease or illness. As such, chronic pain patients are often difficult to work with because of the pervasive personal, social, emotional, and physical impact of the syndrome on their lives and the lives of their families. ⋯ This curve now in use at our institution describes both the progression and the recovery of the illness. The pain curve is used as an educational tool to aid patients in addressing important recovery issues such as denial and the disease process, the progression of symptoms in a chronic illness, medication and alcohol use and abuse in the management of chronic pain, the impact on and from the family and the importance of peer support.
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Comparative Study
Acupuncture treatment in epicondylalgia: a comparative study of two acupuncture techniques.
The purpose of this study was to compare the pain-alleviating effect of classical acupuncture with superficial needle insertion in 82 patients suffering from lateral epicondylalgia. Sessions were 20 min long, two to three times weekly with 10 treatments in all. ⋯ No such differences could be observed at the follow-ups after 3 months and 1 year. This study showed that classical "deep" acupuncture is superior to superficial needle insertion in the short-term symptomatic treatment of lateral epicondylalgia, but not at 3- and 12-month follow-up.
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As previously stated in this paper, the therapeutic goal in the management of patients with chronic pain conditions in the face, head and neck is management and rehabilitation, striving for a 50 percent decrease in pain, a 50 percent increase in function and mobility, and a 50 percent decrease in medication with the elimination of agents with an addicting potential. These results will best be obtained through proper diagnosis and utilization of the aforementioned techniques in an interdisciplinary fashion as has been described.