Pain
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The antinociceptive activities of morphine, and its quaternary analogue methylmorphine, have been compared after intraperitoneal and intracerebroventricular administrations in the mouse paw formalin test. Systemic morphine inhibited both the early and late phases of the formalin-induced licking response and this activity was naloxone sensitive. ⋯ Systemic naloxone inhibited the central action of both opioids, whilst systemic methylnaloxone did not affect the central action of methylmorphine. The results indicate that the early phase of the response to formalin in the mouse may be inhibited by stimulation of central opioid receptors whilst inhibition of the late phase may involve both peripheral and central opioid receptors.
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Randomized Controlled Trial Comparative Study Clinical Trial
Facet joint injection and facet nerve block: a randomised comparison in 86 patients with chronic low back pain.
Eighty-six patients with refractory chronic low back pain were randomly assigned to receive either facet joint injection or facet nerve block, using local anaesthetic and steroid. There was no significant difference in the immediate response. ⋯ Patients who had complained of pain for more than 7 years were more likely to report good or excellent pain relief than those with a shorter history (P less than 0.005), but no other clinical feature was of value in predicting the response to infiltration. Facet joint injections and facet nerve blocks may be of equal value as diagnostic tests, but neither is a satisfactory treatment for chronic back pain.
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Randomized Controlled Trial Clinical Trial
The effect of experimental muscle pain on the background electrical brain activity.
The purpose of this project was to investigate whether specific effects in the background activity of the brain associated with the experience of pain can be depicted by means of quantitative electroencephalography (EEG). Lasting pain was induced by intramuscular infusion of hypertonic saline. The infusion was titrated to maintain pain for a sufficient time to obtain enough data for meaningful analysis. ⋯ In fact, Pearson correlation coefficients, as high as 0.92, were found between measures in the frequency band of 35-100 Hz and the beta frequency range. The unexplained variance in the heightened beta cortical power density can be attributed to the vigilance scanning of pain processes. Due to the fact that the statistically significant effect of pain on the topographic EEG measures were not different from imagined pain, we concluded that these effects are non-specific for pain.
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Case Reports
Cervicogenic headache: anesthetic blockades of cervical nerves (C2-C5) and facet joint (C2/C3).
In a series of 14 patients with cervicogenic headache, cervical nerve blockades (C2-C5 and facet joint C2/C3) have been carried out in order to elucidate possible underlying mechanisms and to evaluate the diagnostic potential of these procedures. Blockade of the C2 nerve resulted in freedom from pain in 5 of 10 patients and seemed to be the most informative procedure. ⋯ C4 and C5 nerve blockades are probably of little value in the work-up of such patients. When evaluating the C2/C3 facet joint injection, one has to take possible leakage of anesthetic agent from the joint into consideration, since the third occipital nerve which runs close to the facet joint may be anesthetized through the leakage.
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In this open study we reviewed the circadian distribution of extra doses of narcotic analgesics in 61 bed-ridden patients with cancer pain. The information was collected prospectively and retrospectively in 34 and 27 cases, respectively. All patients were receiving parenteral narcotics using the Edmonton Injector, and none had incidental pain or cognitive impairment. ⋯ Forty-five of 61 patients (76%) received most of their extra doses of narcotics between 10.00 and 22.00 h. The data suggest that our patients require a larger number of extra doses during day time. Our design cannot establish the reason for this circadian variation.