Articles: pain-management.
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Postgraduate medicine · May 1983
Chronic pain. A pharmacologic review and behavior modification approach.
Management of pain syndromes clearly requires a multidimensional approach and involves social, psychologic, and somatic factors. At the Behavioral Medicine/Pain Therapy Center of Jewish Hospital, St Louis, most patients significantly increase social and physical activity using the combined approach outlined. A majority of patients previously treated with complicated drug regimens do well on little or no medicine. When medications are required for long-term treatment, tricyclic antidepressants have been most successful.
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A radiological study was made in 33 patients of the position of the epidural catheter and the spread of the contrast medium Metrizamide (Amipaque) when used in volumes of 10, 15 and 20 ml. The puncture at the interspinal space L2/L3 and L3/L4 allows the safe inclusion of eight peridural segments in all cases, whereas puncture of the upper regions of the spine results in a less predictable effect with spread of the injected fluid to higher spinal segments. A larger volume of contrast medium of 15 ml allows the safe inclusion of a larger number of spinal segments. Abnormal presentation, areas of fluid loss and the distribution of the analgesics or local anaesthetics injected may be detected early, which allows correction or adaptation of decisions concerning the fluid volume or the concentration of analgesics such as morphine.
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Chronic pain can be treated by combining hypnosis with brief psychotherapy. Hypnosis alone, though useful for acute pain, is seldom effective in relieving chronic pain because it does not address the significant psychologic components in the patient's illness. Treatment using self-hypnosis in conjunction with brief psychotherapy, however, can enable the patient to recognize these components, to change from a passive to an active role in achieving relief, and to modify his attitude toward the pain. This procedure can both reduce suffering and lead the patient to deemphasize pain in his life.
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Results in 12 patients suffering from pain due to peripheral vascular pathology and treated with spinal neurostimulation are reported. The best results were obtained in stage III of vascular disease; however, our results indicate that regression of the pain symptom and healing of trophic lesions do not always correspond to any variation in blood flow.
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Transcutaneous stimulation is a proven effective way to relieve pain. Its optimal use requires an accurate patient diagnosis. Treatment of pain as a symptom only is likely to fail. ⋯ The technique is inexpensive, places the patient in control of his own pain, and has no known serious side effects. Its widespread application awaits the development of reasonable systems to provide this service to physicians and patients. Stimulation-induced analgesia deserves a place in the armamentarium of every physician dealing with the complaint of pain.