Articles: pain-management.
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A meta-analysis was conducted to summarize the overall effect as well as scope of pediatric pain management research. The findings of this meta-analysis as related to effect size and methodologic characteristics are reported elsewhere. ⋯ The interventions reported consisted of strategies that attempted to increase the cognitive, affective, and/or biophysical skills of the child experiencing pain. Behavioral, self-report, and physiologic measures were used to ascertain children's response to the painful experience.
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The pathological course of the most common diseases of the shoulder includes pain as a main symptom. Besides other methods of treatment the infiltration of the suprascapular nerve can improve the therapeutic methods in many cases. ⋯ In 6 more patients it led to an significant reduction of pain. In conclusion this method of local anaesthesia can be recommended as an additional treatment of patients with pain of the shoulder because the rate of complications is low and the technique can easily be done.
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According to our results, permanent epidural anaesthesia was significantly superior to systemic opioid treatment in patients with serial rib fractures. The main advantages were not only continuous pain relief despite the fact that the nonepidural control group required more than twice the dosage of morphine derivatives; also, the respiratory and pain-related recovery time was reduced. Another advantage was the selective effect (due to the local application) on respiratory pain and therefore on respiration as a whole. ⋯ When morphine was temporary contraindicated (frequently the final diagnosis in the case of an "acute abdomen" delayed the administration of morphine) the use of bupivacaine alone provided a satisfactory result for a certain time (we never observed tachyphylaxis). Additional systemic pain relievers were only necessary when the patient was suffering from pain caused by other injuries beyond the area of effectiveness of the epidural catheter (the only obvious disadvantage of the local application technique). On the other hand, epidural anaesthesia enabled us to treat a patient's lower-leg fracture by interlocking nailing, while adding only 0.01 mg fentanyl (= 2 ml Fentanyl Janssen) and 1.2 mg flunitrazepam (Rohypnol).
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Journal of neurosurgery · Apr 1989
Spinal cord stimulation in management of chronic pain. A 9-year experience.
Between 1978 and 1986, 109 patients with chronic pain underwent spinal cord stimulation (SCS) at the authors' institute as part of their pain treatment program. The results of SCS in these patients at the end of the test period and at the latest follow-up examination are analyzed in relation to the etiology of their pain. ⋯ This experience supports the conclusion that the best indications for SCS are vasculopathic pain and post-herpetic neuralgia. No clinical usefulness was found for SCS in cancer pain or in central deafferentation types of pain.