Läkartidningen
-
Severe neurogenic pain still constitutes a major problem since it is often resistant to conventional therapy. During the last 30 years electric activation of pain inhibitory mechanisms through stimulation both of peripheral nerves and of central nervous circuits has been used to great advantage. The simplest method of stimulation, transcutaneous electric nerve stimulation (TENS), is extensively used by physiotherapists as well as in pain clinics. ⋯ TENS originally served as a screening method to identify patients suitable for spinal cord stimulation therapy (SCS). The main indication is severe neuropathic pain of peripheral origin, but SCS has also been found valuable in extremity ischemia as well as in refractory angina pectoris. The most severe cases of neuropathic pain may benefit from intracranial stimulation via electrodes placed stereotactically in the posteromedial thalamus or epidurally over the motor cortex.
-
Postoperative nausea and vomiting (PONV) continues to be a clinical problem with an unacceptably high incidence. Several studies have been performed that compare different antiemetics but thus far no successful monotherapy has been found. ⋯ In patients at great risk it is meaningful to recommend prophylactic antiemetics with a 2- or even 3-drug regimen, e.g. droperidol, ondansetron and dexamethasone. If the patients experience PONV despite treatment or prophylaxis, they should be treated with a drug from a group different from the one used earlier.
-
The cerebral circulation is innervated by sympathetic, parasympathetic and sensory nerves which store a number of neurotransmitters. The significance of these for primary headache has been evaluated. ⋯ Upon treatment with sumatriptan, head pain subsided and neuropeptide release normalized. These data show the involvement of sensory and parasympathetic mechanisms in the pathophysiology of primary headache.