Journal of pain and symptom management
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J Pain Symptom Manage · Feb 1991
Clinical Trial Controlled Clinical TrialAuricular transcutaneous electrical nerve stimulation (TENS) reduces phantom limb pain.
The present paper evaluates the efficacy of low frequency, high intensity auricular transcutaneous electrical nerve stimulation (TENS) for the relief of phantom limb pain. Auricular TENS was compared with a no-stimulation placebo condition using a controlled crossover design in a group of amputees with (1) phantom limb pain (Group PLP), (2) nonpainful phantom limb sensations (Group PLS), and (3) no phantom limb at all (Group No PL). ⋯ Ratings of mood, sleepiness, and anxiety remained virtually unchanged across test occasions and sessions, indicating that the decrease in pain was not mediated by emotional factors. Further placebo-controlled trials of auricular TENS in patients with phantom limb pain are recommended in order to evaluate the importance of electrical stimulation parameters such as pulse width and rate, and to establish the duration of pain relief.
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J Pain Symptom Manage · Feb 1991
Case ReportsBilateral burning foot pain: monitoring of pain, sensation, and autonomic function during successful treatment with sympathetic blockade.
We describe a patient with burning pain in both feet associated with local autonomic disturbances following bilateral traumatic sciatic mononeuropathies. The diagnosis of a sympathetically maintained pain was confirmed through a prompt response to sympathetic blockade. Although a mild alcohol-nutritional neuropathy was found, the clinical findings strongly suggested a diagnosis of bilateral causalgia. ⋯ Quantitative sensory testing revealed a dramatic alteration in the contralateral limb's thermal sense following unilateral block. This case underscores the potential for bilateral causalgia and provides additional evidence for a central mechanism operating in this disorder. The relationship between bilateral causalgia and the "burning feet syndrome" in alcoholic neuropathy is discussed.
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J Pain Symptom Manage · Jan 1991
Randomized Controlled Trial Comparative Study Clinical TrialEvaluation of patient-controlled analgesia (PCA) versus PCA plus continuous infusion in postoperative cancer patients.
The benefits of two dosing methods, patient-controlled analgesia (PCA) with morphine sulfate (MS) alone and PCA plus continuous infusion of morphine sulfate (PCA + CI) were clinically evaluated in a randomized, single-blinded study of 30 adult abdominal surgery patients. Doses were adjusted based on pain and sedation ratings. Respirations, pulse, blood pressure, pain and sedation ratings were assessed. ⋯ There seems to be a trend for the PCA + CI group to have less fluctuation in sedation between days and better pain control (as demonstrated by verbal and visual analog pain scores) on the third postoperative day. Statistical significance was not found, however. PCA plus continuous infusion of MS may be a beneficial approach to the management of postoperative pain in selected patients; studies to identify these patients need to be done.
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We treat cancer pain patients at their homes, in collaboration with their relatives and primary physician. Assistance is free. ⋯ In 118 patients treated with our model between October 1987 and December 1988, we assessed the symptoms that moved them to seek assistance, their previous therapies, and the effectiveness of our intervention. The data obtained suggest that (a) in our country, the majority of cancer patients do not obtain effective pain and symptom control; (b) our model yields satisfactory pain control and improvement in quality of life; and (c) there is a need for centers that teach and practice terminal care; our model may be useful as a working outline for such centers.