Pain
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Randomized Controlled Trial Clinical Trial
Regional intravenous guanethidine vs. stellate ganglion block in reflex sympathetic dystrophies: a randomized trial.
Regional intravenous guanethidine blocks and stellate ganglion blocks have been compared in a randomized trial. Nineteen patients, randomly allocated to two groups of therapy and exhibiting severe reflex sympathetic dystrophy following peripheral nerve lesions, have been treated. ⋯ Concerning the therapeutic effects (changes in pain scores and clinical signs--hyperpathia, allodynia, vasomotor disturbances, trophic changes, oedema and limited motion), recorded at the end of treatment and 1 month and 3 months follow-up, an intravenous guanethidine block carried out every 4 days up to a total of 4 blocks is comparable with a stellate ganglion block every day up to a total of 8 blocks. The results of this study show that regional sympathetic block with guanethidine is a good therapeutic tool in the treatment of reflex dystrophies, especially on account of its negligible risks and contraindications.
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Acupuncture therapy for patients suffering from tennis elbow has shown itself to be an excellent alternative to steroid injections. Twenty-one out of 34 patients who were treated with acupuncture became much better--completely free of pain. ⋯ In a control group of 26 patients who received only steroid injections, 8 patients reported a corresponding improvement. The ancient Chinese technique adapted to Western conditions has, in the above cases, neither caused any side effects nor worsened the condition of any patient, and is well worth trying as therapy for this disabling complaint.
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Autonomic measures (skin conductance and heart rate) were obtained from subjects before (warning period), during (immersion period), and after (resting state) the performance of the Cold Pressor task under tolerance instructions. The Autonomic Perception Questionnaire was administered shortly before the Cold Pressor task. Skin conductance and heart rate during the warning period proved to be significant predictors of pain tolerance behaviorally measured. The Autonomic Perception Questionnaire did not reveal any relationship between awareness of autonomic arousal and pain tolerance nor between actual level of arousal and subjective awareness of this arousal.
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Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale.
The visual analogue scale (VAS) is a simple and frequently used method for the assessment of variations in intensity of pain. In clinical practice the percentage of pain relief, assessed by VAS, is often considered as a measure of the efficacy of treatment. However, as illustrated in the present study, the validity of VAS estimates performed by patients with chronic pain may be unsatisfactory. ⋯ As shown in this study the absolute type of VAS seems to be less sensitive to bias than the comparative one and is therefore preferable for general clinical use. Moreover, the patients appear to differ considerably in their ability to use the VAS reliably. When assessing efficacy of treatment attention should therefore be paid to several complementary indices of pain relief as well as to the individual's tendency to bias his estimates.