Current review of pain
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Uncommon stimulation refers to the use of peripheral nerve and spinal cord stimulation for nontraditional applications. There has been much interest recently with subcutaneous suboccipital stimulation for occipital neuralgia, sacral stimulation for pelvic pain, trigeminal stimulation for trigeminal neuralgia, and spinal cord stimulation for angina and peripheral ischemia. The indications and techniques used for accomplishing each method are discussed.
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Postherpetic neuralgia (PHN) is the most common and devastating complication of acute herpes zoster (HZ). HZ occurs more frequently in the patient with human immunodeficiency virus (HIV) and with certain leukemias and lymphomas. PHN occurs more frequently in the elderly, in patients with severe pain in the acute stage, and in patients with lesions in the ophthalmic branch of the trigeminal nerve. ⋯ A wide variety of therapeutic approaches have been advocated over the years, but most are not very effective. Early aggressive treatment of HZ with antiviral drugs may be the most important step in prophylaxis against PHN. This article reviews the current knowledge of the pathogenesis and treatment of PHN.
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Current review of pain · Jan 2000
ReviewIs lumbar discography a determinate of discogenic low back pain: provocative discography reconsidered.
Provocative lumbar discography was investigated in a series of clinical studies at the Stanford University of Medicine, Stanford, CA. This work demonstrated that pain intensity during disc injection is strongly influenced by the subject's emotional and psychological profiles, chronic pain behavior, and ongoing compensation claims whether the patient has any back pain illness or not. Pain reproduction was also primarily related to penetration of the dye through the outer annulus and could not reliably be used to confirm the location of the pain source.
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This article reviews the objectives of psychological evaluations, as well as the standard pain center evaluation protocol that uses a pain questionnaire, a structured clinical interview, and pain assessment measures that include pain intensity rating scales and the McGill Pain Questionnaire. The most frequently used measures of psychological status, such as the Beck Depression Inventory and the Minnesota Multiphasic Personality Inventory (MMPI), are reviewed. Psychological predictors of invasive procedures and of disability are also outlined. The importance of listening to the patient in a multidisciplinary setting is emphasized.
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Referred pain, that is, pain perceived in an area other than that in which the noxious stimulation takes place, is very frequent in the clinical setting. There are various forms of referred muscle pain from viscera and from somatic structures. Examples of the latter are referred pain from one muscle to another muscle (as in myofascial pain syndromes) and referred pain from joints (as in osteoarthritis of the knee). ⋯ Referred muscle pain from viscera with hyperalgesia is not completely understood; it is hypothesized that it is due to both central (sensitization process) and peripheral (intervention of reflex arcs) mechanisms. Referred muscle pain from other muscles or from joints is not easily explained by the mechanism of "central convergence" in its original form, because in dorsal horn neurons there is little convergence from deep tissues. It has been proposed that convergent connections from deep tissues to dorsal horn neurons are not present from the beginning but are opened by nociceptive input from skeletal muscle, and referral to myotomes outside the lesion is due to a spread of central sensitization to adjacent spinal segments.