Articles: pain-management.
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Case Reports Comparative Study
Hypnosis and chronic pain. Two contrasting case studies.
Some of the theoretical and technical problems associated with the use of hypnosis for chronic pain are discussed in the context of two similar case studies, one of which had an unsuccessful outcome. Different hypnotic strategies are discussed which depend on a careful, direct evaluation of the role of secondary gain and depression in maintaining the pain in the two patients. ⋯ Self-hypnotic procedures are described stressing the development of mastery and self-control over pain. Differences in the kinds of hypnotic intervention that are appropriate when secondary gain or depression are central to the pain problem, compared to the more direct techniques available when they are not, are discussed.
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Biofeedback, progressive muscle training, and relaxation tape home practice were implemented in an attempt to decrease knee pain in a subject diagnosed with osteoarthritis. Pain journal data suggested that the subject's pain levels decreased significantly during training and for 2 years posttraining. ⋯ One possible explanation for these changes was the home practice of her relaxation tape, as increased practice was inversely related to decreased pain. This clinical case report provided some preliminary information on the potential efficacy of psychological procedures in osteoarthritis pain management.
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The efficacy of self-hypnosis in the treatment of chronic pain was evaluated using a multiple baseline design for five patients referred to the Auckland Hospital Pain Clinic. Subjects were selected for high hypnotisability using the Stanford Hypnotic Clinical Scale. Daily records of pain intensity, sleep quality, medication requirements, and self-hypnosis practice were completed. ⋯ The patients showed an increase in personal locus of control and a shift of self-concept away from physical illness on the ISCRG. The results suggest that self-hypnosis can be a highly effective technique for some patients with chronic pain but not for all. Selection criteria and clinical factors other than hypnotisability need to be considered in further research, since even highly hypnotisable subjects may derive limited benefit from self-hypnosis.
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This review focuses on available anesthetic techniques for cancer patients, the indications, and appropriate agents for these potent tools in a stepwise approach to cancer pain. Anesthetic procedures are desirable when they will not compromise bodily functions important to the patient, and when tumor-directed therapy and noninvasive or less-invasive, low-risk approaches (primarily pharmacologic tailoring of analgesic drugs) fail to control pain. Nondestructive techniques include the epidural/intrathecal use of opioids via an implanted catheter, and local anesthetic blocks of nerves and sympathetic ganglia. ⋯ Destructive anesthetic procedures comprise injections of neurolytic agents (most commonly phenol or alcohol), and insertion of freezing probes, into nerves and ganglia. The types of nerve blocks performed, their complications, and success rates, and limitations of commonly used neurolytic agents as well as their proper applications, are described. The importance of proper patient selection and knowledge of the pathophysiology of the pain being treated is stressed, as is the appropriate timing of anesthetic procedures in the course of the disease.
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Comparative Study
Management of pain in pain clinic (review of 1348 cases).
Our series have shown that psychotherapy and physiotherapy when incorporated with specific therapy, produced a much better relief from pain and that the functional return of ability of the affected part was quicker.