The Clinical journal of pain
-
A retrospective survey of 1,661 patients seen over a 10-year period at a pain clinic yielded 55 patients with intractable neck pain as the presenting complaint. In 89% there was an industrial or motor vehicle accident as the precipitating event, 78% were involved in legal proceedings relating to the accident, and in 87% the pain radiated to neighboring structures. ⋯ Treatment mainly by psychotherapy or tricyclic antidepressants resulted in some benefit for 56% of patients. Legal compensation and change in occupation were not major factors influencing the outcome of treatment.
-
Reflex sympathetic dystrophy (RSD) usually occurs in an individual who has been experiencing significant personal stress, a state associated with increased discharge of norepinephrine (NE) from perivascular postganglionic sympathetic neurons. RSD is often precipitated by this sequence: traumatic arterial spasm, regional ischemia, neurogenic inflammation, and ischemic/edematous damage to membranes of preterminal perivascular nociceptive neurons. In the natural repair of these membranes, it is suggested that adrenoceptors appear and are ordinarily transitory; but in RSD, they are retained by the increased adjacent NE. This process delays further healing, produces pain, and releases inflammatory substances, resulting in interacting pathophysiologic vicious cycles.
-
Comparative Study
Why do people seek medical advice for back pain: a comparison of consulters and nonconsulters.
Respondents with back pain who had answered affirmatively to the question about back pain in a population study were divided into two groups depending on whether they had consulted or had not consulted a physician due to their back pain. There were 17 nonconsulters and 37 consulters. ⋯ Based on the results, we found that the nonconsulters differed from the consulters on many issues but had nevertheless rated their constant level of pain on two different occasions as being equally severe on a graphic rating scale (GRS). The groups differed as follows: The nonconsulters rated their work to be more stressful; had less frequently a spouse suffering or having suffered from chronic pain; had fewer abnormal pain drawings; woke up less frequently during the night; used sleeping pills less frequently; participated more often in sports; and had a higher frequency of repression on the MCT compared to a group of painless subjects.
-
Randomized Controlled Trial Clinical Trial
Trial of intravenous lidocaine on painful neuropathy in cancer patients.
In 10 cancer patients with cutaneous allodynia, intravenous lidocaine (5 mg/kg body weight) or 0.9% NaCl was given in a double blind, cross-over study to determine the analgesic effect. One patient had complete and one had partial pain relief with lidocaine infusion, whereas three patients experienced partial pain relief with placebo. Neither lidocaine nor placebo reduced pain intensity or consumption of analgesics significantly during the study period. Intravenous infusion of lidocaine cannot be recommended as routine pain treatment in cancer patients with cutaneous allodynia or pain, but further studies are needed to test the effect of lidocaine on different peripheral stimuli.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Diode laser in cervical myofascial pain: a double-blind study versus placebo.
We present a double-blind trial in which a pulsed infrared beam was compared with a placebo in the treatment of myofascial pain in the cervical region. The patients were submitted to 12 sessions on alternate days to a total energy dose of 5 J each. ⋯ Pain was monitored using the Italian version of the McGill pain questionnaire and the Scott-Huskisson visual analogue scale. The results show a pain attenuation in the treated group and a statistically significant difference between the two groups of patients, both at the end of therapy and at the 3-month follow-up examination.