Pain
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Randomized Controlled Trial Clinical Trial
Quantitative sensory examination during epidural anaesthesia and analgesia in man: effects of morphine.
In a double-blind placebo-controlled cross-over study the effects of epidural morphine (4 mg) on somatosensory functions were investigated in 10 healthy volunteers. Detection, pain detection and pain tolerance thresholds to thermal, mechanical and electrical stimuli as well as magnitude rating of short-lasting stimuli of the same modalities were monitored before and for 10 h after epidural administration of 4 mg of morphine or saline. Epidural morphine induced a naloxone-reversible (0.1 mg/kg, i.v.) increase in pain detection threshold to heat and mechanical stimuli and in pain tolerance threshold to heat, mechanical and electrical stimuli. ⋯ Segmental distribution of pruritus was reported by 7 subjects following epidural morphine which was replaced by a short-lasting burning sensation following naloxone administration. Naloxone (0.1 mg/kg) preceeded by placebo did not change somatosensory functions. These results indicate that the somatosensory effect of epidural morphine is dependent on the types of afferent fibres activated as well as on the duration and intensity of the stimulus.
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Clinical Trial Controlled Clinical Trial
Enhancement of morphine analgesia by fenfluramine in subjects receiving tailored opioid infusions.
We evaluated the ability of fenfluramine, a serotonin releaser, to increase the analgesic potency of morphine administered by tailored i.v. infusion. Ten normal volunteers participated in 4 test sessions, involving different treatments on different days: (1) oral placebo/saline infusion, (2) oral placebo/morphine infusion, (3) oral fenfluramine (60 mg)/saline infusion, and (4) oral fenfluramine/morphine infusion. Subjects experienced repetitive painful dental electrical stimuli at strong but tolerable intensities during testing. ⋯ Fenfluramine significantly increased the analgesic potency of morphine during the opioid infusion, while fenfluramine alone produced borderline analgesic effects. Fenfluramine alone decreased alertness slightly, but did not significantly increase morphine side effects. Thus, we conclude that fenfluramine enhances the analgesic potency of morphine without a parallel increase in opioid side-effect potency.
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Variability of physiological parameters was used as a measure of stress in the newborn infant. There was a significant increase in variability of the heart rate (P < 0.01) when the stab of the heel prick occurred in addition to the other elements of the procedure (positioning, warming, alcohol swab cleansing and squeezing). This dummy procedure itself caused some increase in variability although this was not significant at the 5% level. There were similar significant increases in variability of the respiratory rate and O2 and CO2 tensions in the blood (P < 0.05) during the stab procedure.
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We have reviewed our experience with spinal cord stimulation in treating patients with the failed back surgery syndrome and have assessed patient and patient-selection characteristics as predictors of the long-term outcome. Neuroradiological investigations eliminated the possibility of a surgically treatable lesion and electromyogram assessed the chronic radicular suffering in correlation with the complaints and the clinical examination of the patient. Excellent pain relief (75% or more) during 1 week of trial stimulation and no major psychiatric or psychological pathology were criteria of selection. ⋯ Thirty-five patients (55%) continued to experience at least 50% of pain relief at the latest follow-up. Fifty-eight patients (90%) were able to reduce their medication, 39 patients (61%) reported a change in lifestyle, in that their ability to perform daily activities had improved significantly. Fifty-three patients (83%) continued to use their device at the latest follow-up.
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In multiple studies cultural affiliation has been found to have an important influence on perception of and response to experimental and acute pain. Despite that evidence little work has been directed to understanding the cultural dimensions of the chronic pain experience. We present the results of a quantitative study of reported chronic pain perception in 372 chronic pain patients in six ethnic groups, who were under treatment at a multidisciplinary pain-management center. ⋯ This study suggests a biocultural model may be useful in conceptualizing the complex interaction of biological, cultural and psychosocial factors in the process of human pain perception. Although it is likely that intense pain affects attitudes and emotions, it is also very likely that attitudes and emotions influence reported perceptions of pain intensity. Pain intensity variation in this study population is not significantly associated with diagnosis, present medication types, or types of past treatments or surgeries for pain.