Articles: pain-management.
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Anesthesia and analgesia · Oct 1981
Failure of transcutaneous electrical stimulation to alleviate experimental tourniquet pain.
It has been proposed that transcutaneous electrical nerve stimulation (TENS) acts by stimulation of large nerve fibers which inhibits further propagation of nociceptive input conducted along smaller C-nerve fibers. We evaluated the effectiveness of TENS in alleviation of ischemic pain (C-fiber mediated) experimentally produced by the submaximal-effort tourniquet test. ⋯ Time from inflation of the tourniquet to onset of intolerable pain was noted together with a visual analog-derived intensity of pain for 10 subjects studied on three separate occasions. The results showed no statistically significant prolongation in the duration of ischemia tolerated nor reduction in the subjective intensity of pain during either single- or dual-channel stimulation in comparison to control levels.
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Conventional transcutaneous electrical nerve stimulation was applied to 114 patients diagnosed as having peripheral neuropathy (N = 18), peripheral nerve injury (N = 21), radiculopathy (N = 36) and musculoskeletal disorders (N = 39) to determine optimal electrode placements and stimulation parameters for pain relief. Treatment outcomes were assessed primarily through evaluation of the present pain intensity (PPI) rating scale, Immediate improvements in PPI scores occurred in patients in all these diagnostic categories. ⋯ In certain instances (subjects with radiculopathy or peripheral nerve injury) a positive relationship existed between higher intensity stimulation and amelioration of pain. Greater pain relief was reported among patients with minimal previous medical or surgical treatment in every diagnostic group.
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A case of a 36-year-old man, with a history of traumatic amputation below the elbow on the left side, resulting in intractable phantom limb pain, is described. The patient failed to respond to a variety of medications including several analgesics, tranquilizers, and a beta-blocker. Other extended series of conventional treatment modalities, which included stellate ganglion and peripheral nerve blocks and neuromal excision with the anterior transposition of the ulnar nerve, did not relieve the pain. Acupuncture was then attempted with the subjective relief of phantom limb pain and the objective result that the patient could wear a prosthesis.
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NIDA research monograph · May 1981
Treatment of chronic pain: the Center for Pain Studies, Rehabilitation Institute of Chicago.
The Center for Pain Studies of the Rehabilitation Institute of Chicago (formerly known as the Low Back and Pain Clinic) has developed a multidisciplinary program for the management of chronic pain. Typically patients present a variety of chronic pain syndromes, most frequently low back pain, which have not responded to previous treatment including surgery, physical therapy, medication, vogue therapies, and other pain management programs. Patient capability to engage in normal daily activities such as standing, walking, sitting, lifting, etc. is often limited; most are unable to work or carry on pre-injury activities. ⋯ Economic factors often occasion additional alteration in personal and family relations. Frequently a spouse not employed outside the home goes to work. Compensation programs and aid from public agencies may provide insufficient support or, conversely, compensation practices may establish perverse incentives toward recovery by providing the patient with net income equal to or greater than normally received.