Articles: function.
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The analgesic effect of acupuncture in chronic gonarthrosis pain was studied in a placebocontrolled trial completed by 97 patients. Each patient was treated twice a week, receiving 10 acupuncture treatments in all. Before and after tee course of treatment all patients were examined by an unbiased independent examiner and the overall pain score was measured over 10 days using VAS scales; functional parameters (resilience) were measured with a modified Lysholm questionnaire. ⋯ After ten treatments the overall reduction in pain score was 47.5% in the verum group (follow-up 48.2%), and 26.1% in the placebo group (follow-up 26.1%). The results are statistically significant (P<0.05); they show that in gonarthrosis pain the analgesic effect of verum acupuncture exceeds that of placebo acupuncture. Measurement of the functional parameters according to the Lysholm score showed no significant change.
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Interpleural analgesia is a method of postoperative analgesia that was developed by Kvalheim and Reiestad in 1984. The main indication is postoperative pain after unilateral thoracic and upper abdominal surgery. Many authors report good analgesic effects and better postoperative lung function following cholecystectomy. ⋯ The local anaesthetic of choice is bupivacaine (in concentrations of 0.25-0.75%, injection volumes of 10-40 ml, with or without epinephrine, applied as bolus or infusion), but others, such as lidocaine or morphine, are also being tested. Risks involved in this method are pneumothorax when the catheter is placed blind and the systemic toxicity of the local anaesthetic. This review provides information on the mechanism of action, the technique, the clinical use to date and possible risks.
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Systemic analgesia is used in obstetrics to alleviate the pain in labour and to prevent adverse effects on the fetus due to maternal pain and stress and subsequent complications such as prolonged labour. To supplement psychological support tranquillizers such as diazepam are useful in allaying anxiety and increasing patients' acceptance of labour. Possible side-effects include neonatal hypothermia and poor muscle tone of the newborn when large doses are given. ⋯ Thus, in many cases adequate pain relief afforded to parturients by systemic analgesia may result in altered adaptive functions of the newborn. This makes it reasonable to consider alternative methods, including epidural anaesthesia, which is highly effective and fairly unproblematic. Drug administration in the management of labour pain can be recommended if only small doses are needed and in parturients who refuse regional anaesthesia or for whom it is contraindicated or not available.
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Modern concepts of pain therapy involve neuronal mechanisms of endogenous analgesia. Recent animal experiments have provided new insights into the anatomy, physiology and neurobiology of endogenous antinociception. We have shown that antinociception can be maximally activated by disinhibition-and not by direct electrical or chemical excitation-in the midbrain periaqueductal grey matter. ⋯ The high order in the discharges of these neurons is maintained, at least in part, by tonically active descending systems. Thus, the spinal shock syndrome seen in some species after acute spinalisation may result from the loss of order in spinal neuronal discharges normally provided by the brain. The use of modern methods in studies of the functional neuroanatomy, neurophysiology and neurobiology of endogenous antinociception may help in the achievement of better application of results from basic sciences to clinically relevant pain problems.
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The quantitative approach to the study of descending inhibition of spinal nociceptive transmission was initiated in Heidelberg through the use of natural, noxious stimulation and examination of the modulation of the encoding properties of spinal dorsal horn neurons. This important approach required control of the noxious stimulus, which had previously been inadequately considered, and the parametric assessment of modulatory influences on the encoding properties of spinal dorsal horn neurons. As a consequence, descending inhibition of spinal nociceptive transmission was found not to be homogeneous throughout the brainstem, but rather to be significantly different from different brainstem nuclei. ⋯ Most recently, the same approach has been profitably applied to studies that have focused onfacilitatory influences descending from many of the same brainstem sites. As a consequence, it has been proposed that there exists an endogenous pain facilitating system analogous to the well-accepted endogenous pain inhibitory system. While the function of the facilitatory system remains unknown, it is proposed that it may be important to long-lasting pain conditions that exist in the absence of pathology.