Articles: pain-management.
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Many patients arrive at the accident and emergency (A&E) department in pain. To quantify this problem a retrospective analysis was performed of the clinical records of 502 consecutive patients arriving by ambulance at the A&E department over a 20-day period. A total of 273 (54%) of the patients had pain as a symptom on arrival and 69 (14%) were given opioid analgesia in the A&E department. ⋯ C.). There were wide variations in the attitudes of services around the country to future developments. The authors suggest that paramedics should be trained to administer intravenous opioid analgesia.
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Comparative Study Clinical Trial Controlled Clinical Trial
A highly successful and novel model for treatment of chronic painful diabetic peripheral neuropathy.
To investigate why, in spite of a vast variety of treatment agents, the alleviation of pain in patients with diabetic neuropathy is difficult. Previous studies have not used a treatment algorithm based on anatomic site and neuropathophysiological source of the neuropathic pain. ⋯ This study presents a new rationale and hypothesis for the successful treatment of chronic painful diabetic peripheral neuropathy. It uniquely bases the treatment algorithm on the types and sources of the pain.
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Spinal cord stimulation (SCS) has routinely been used since the beginning of the 1970s. The initial indications for stimulation were the so-called deafferentation or neurogenic pain. Further work has confirmed that neurostimulation is useful in severe peripheral vascular disease in relieving pain and increasing capillary blood flow and oxygen tension. ⋯ During SCS treatment significant improvement was obvious: chest pain, ST-segment depression, and the extent of heart failure could be reduced. Both patients reached a better NYHA functional class, exhibited increased working capacity and reported reductions in anginal attacks and pain. Th