European journal of pain : EJP
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Randomized Controlled Trial Clinical Trial
Evaluation of effect of 3D video glasses on perceived pain and unpleasantness induced by restorative dental treatment.
Previous studies on modulation of anxiety, pain and unpleasantness have documented a positive effect of video glasses (I-Glasses, Virtual i-O, Seattle, USA) on the perceived pain and unpleasantness under different laboratory and clinical conditions. The aim of this study was to evaluate whether distraction induced by video glasses also had an effect on the perceived intensity of pain and unpleasantness during dental treatment. Pain and unpleasantness was evoked by the preparation (drilling) of a minor dental cavity (class I). ⋯ Differences in VAS ratings in the video and control situation were tested by Student's t-test. There was no statistically significant effect on the perceived pain (p=0.90) or unpleasantness (p=0.39), but the majority (74%) of the patients would still prefer to wear video glasses if they were to have another dental filling, and 73% had expected a positive effect of the video glasses. These findings suggest that perceived intensity of dental pain is resistant to a simple distraction technique.
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We have examined a hemispherectomized patient who complained of touch-evoked pricking and burning pain in her paretic hand, especially when the hand was cold. Psychophysical examination showed that for the paretic side she confused cool and warm temperatures, and confirmed that she had a robust allodynia to brush stroking that was enhanced at a cold ambient temperature. ⋯ The fMRI findings thus indicate that the central pain in this patient was served by brain structures implicated in normal pain processing. Possible pathophysiological mechanisms include plasticity as well as thalamic disinhibition.
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Randomized Controlled Trial Clinical Trial
Nalbuphine by PCA-pump for analgesia following hysterectomy: bolus application versus continuous infusion with bolus application.
The analgesic properties of the partial agonist-antagonist nalbuphine in the postoperative period are well known. When used for patient-controlled analgesia (PCA) the effectiveness of this substance is comparable to that of morphine or tramadol. However, the optimal programme for administration of nalbuphine in PCA-pumps has not been investigated. ⋯ Subjective rating of effectiveness by the patients was similar in both groups. The two administration settings of nalbuphine by PCA pump have shown to be equally effective in the treatment of postoperative pain following hysterectomy. However, as the total amount of nalbuphine was significantly lower in B-group, the use of this administration schedule should be encouraged.
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Case Reports
Inefficacy of high-dose transdermal fentanyl in a patient with neuropathic pain, a case report.
Pain partially responsive to opioids can lead to rapid escalating dosages due to tolerance development. In this report the case of a 58-year-old female with neuropathic pain using increasing transdermal (TTS) fentanyl dosages to a maximum dose of 3400 microg/h resulting in fentanyl plasma levels of 173 ng/ml is described. For pain relief an epidural infusion at the level T1-2 with bupivacaine was started. Immediate pain relief was accompanied by short lasting respiratory depression and drowsiness.
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Eighty-eight patients (58 women and 30 men; mean age 53.4 years) with chronic non-cancer pain present on average for 9.8 years were evaluated following treatment with intrathecal opioids for an average duration of 36.2 months. Outcome measures were global pain relief, physical activity levels, medication consumption, work status, intrathecal opioid side-effects, proportion of patients who ceased therapy and patient satisfaction. The most common diagnosis in this group was lumbar spinal or radicular pain after failed spinal surgery (n= 55, 63%). ⋯ Drug administration systems were permanently removed in five patients (6%). Intrathecal opioid therapy appears to have a place in the management of chronic non-cancer pain. Therapy does not seem to be significantly inhibited by the development of tolerance.