Pain
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Clinical Trial Controlled Clinical Trial
The efficacy of transdermal fentanyl in the treatment of postoperative pain: a double-blind comparison of fentanyl and placebo systems.
Forty consenting patients scheduled for abdominal surgery were entered into a double-blind comparison of the efficacy of transdermal fentanyl (TTS-fentanyl) and placebo (TTS-placebo) in the treatment of postoperative pain. All patients were allowed supplementary pethidine (25-50 mg) if pain relief was inadequate provided that their respiratory rate was greater than 10 breaths/min and there was no pronounced CNS depression. Visual analogue pain scores (VAPS), sedation rating scores (SRS), blood samples for the determination of fentanyl concentration, blood pressure, pulse and respiratory rate were determined hourly for 48 h from the time of TTS system application. ⋯ In contrast, the amount of supplementary pethidine administered in the 0-12 h period was similar in both groups which was consistent with the long delay time (mean +/- S. D. value of 16.6 +/- 10 h) before clinically effective concentrations of fentanyl were obtained from the systems. The profile of side effects was similar in the 2 groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Clinical Trial Controlled Clinical Trial
The effect of intravenous lidocaine on nociceptive processing in diabetic neuropathy.
In a double-blind controlled design, 7 patients with painful diabetic neuropathy received lidocaine 5 mg/kg or saline intravenously over a period of 30 min. Thermal sensibility quantified by thermotest was not affected by lidocaine. ⋯ Lidocaine also increased the threshold in 4 healthy subjects, but did not affect the Hoffmann reflex. These results suggest that lidocaine exerts its pain-relieving effect on the spinal level in diabetic neuropathy.
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Case Reports
Central post-stroke pain--somatosensory evoked potentials in relation to location of the lesion and sensory signs.
Somatosensory evoked potentials (SEPs) were studied in 27 patients with central post-stroke pain and in 19 controls. A scoring system for SEP was used, in which increasing abnormalities rendered increasing scores. SEPs evoked by electrical stimulation of the median and tibial nerves were compared to perception thresholds for touch, vibration, innocuous and noxious temperature. ⋯ Decreased touch and vibration sensibility had a high correlation with high SEP scores, while no correlation was found between reduced temperature sensibility and SEP. The patients with thalamic lesions had the most severely affected SEPs, the ones with lower brain-stem lesions were the least affected. The results support the notion that the SEP is dependent on the lemniscal pathways and that lesions of the spinothalamic pathways are crucial for the development of CPS.
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Iatrogenic Cushing's syndrome has been reported after the use of nasal, aerosol, oral, and intramuscular steroid preparations. Presented is a case of Cushing's syndrome due to an epidural injection of methylprednisolone. A 24-year-old man had left arm pain after an occupational injury. ⋯ The patient eventually underwent a second surgical procedure for his pain and required steroid coverage. His pain subsequently showed slow improvement. Urinary-free cortisol normalized 4 months after onset; however, the patient's cushingoid appearance persisted for 12 months.
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Recent studies have suggested that spouses of chronic pain patients are at risk for emotional and marital maladjustment. This study explored the role of patient and spouse gender in mediating the effects of chronic pain on the spouse's adjustment. Eight-three chronic low back pain patients and their spouses completed measures of physical and psychosocial disability, pain behaviors, marital satisfaction, and depression. ⋯ In female but not male patient couples, spouses reported significantly less depression than did patients. Significant relationships were more frequently observed between spouse-rated patient dysfunction and spouse's depression and marital adjustment in male patient couples. The results suggest a stronger relationship for female than for male spouses between the spouse's perception of patient dysfunction and the spouse's emotional and marital adjustment.