Articles: pain.
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All the medical, surgical and engineering personnel in the UK who have used spinal cord stimulation (SCS) in patients, attended a workshop to discuss their results. The major use of SCS has been for multiple sclerosis and intractable pain. ⋯ Further information on long term benefit is needed and the use of SCS in other conditions, such as spinal injury and peripheral vascular disease, is not yet established. SCS cannot be recommended for use outside large centres as x-ray screening, urodynamic and neurophysiological assessment facilities are required as well as biological engineering assistance.
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ADs have achieved popularity in the treatment of chronic pain syndromes associated with organic and psychogenic illness. This is surprising as there is little evidence from controlled studies that they are of value other than in the treatment of depression. There is good evidence for an intimate relationship between the neurotransmitters involved in the regulation of pain and mood and the mode of action of both opiates and antidepressants. ⋯ This would have important implications for improving knowledge of pain biochemistry and physiology. Few areas of modern therapeutic endeavour allow prescription of drugs in the absence of objective evidence of benefit. Current practice in chronic pain reflects the problems associated with psychological assessment in chronic physical illness, the complexity of chronic pain syndromes, and the natural desire to explore every avenue to relieve patients' symptoms.
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A review of conditions producing shoulder pain in the adult indicates the diverse nature of the various processes. Particularly important are diseases leading to articular abnormalities of the glenohumeral, acromioclavicular, and sternoclavicular articulations as well as surrounding structures such as the rotator cuff. Accurate diagnosis of the conditions requires careful radiographic examination supplemented with specialized techniques, including fluoroscopy, arthrography, and conventional or computed tomography.