Articles: pain.
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There is a sub-group of patients with non-malignant medical conditions who have severe, intractable pain and who require chronic opioid administration for adequate pain control. Reported here is a systematic clinical evaluation of 52 such patients who were referred after they had failed numerous, non-opioid pain treatments. Major causes of pain were irreversible degenerative and/or traumatic injuries to the musculoskeletal system. ⋯ Once pain relief was achieved, patients did not escalate their dosage, and they were able to maintain pain relief for long time periods. Although opioids produced dependence in all patients and complications of constipation and edema in about one third, high daily opioid dosage treatment appeared to be the only medical means to achieve adequate pain control in these subjects. We conclude that opioid maintenance should be utilized as a last resort treatment in patients who fail other pain treatments.
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Case Reports
Wandering nerve graft technique for management of the recalcitrant painful neuroma in the hand: a case report.
A new technique for the management of the painful neuroma following ray amputation of the index finger is reported. The rationale behind this operative procedure, which is based on both clinical and experimental work, is outlined. The patients' follow-up to 4 years postoperatively is presented.
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Applied neurophysiology · Jan 1988
Dorsal root entry zone lesions in the treatment of pain following brachial plexus avulsion, spinal cord injury and herpes zoster.
This paper details the long-term results in patients treated with dorsal root entry zone (DREZ) lesions for the treatment of pain following brachial plexus avulsion, spinal cord injury, and herpes zoster. With our current operative technique, 82% of patients with brachial plexus avulsion injuries were afforded long-term pain relief. Patients with pain confined to dermatomes just below the level of spinal injury also did well with DREZ lesions, although the results were less good in patients with diffuse pain or with sacral pain. The postoperative results in patients with postherpetic pain were disappointing.
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Acta Anaesthesiol Belg · Jan 1988
Balanced anesthesia and patient-controlled postoperative analgesia with fentanyl: minimum effective concentrations, accumulation and acute tolerance.
Minimum effective fentanyl concentrations (MEC) were determined in 230 ASA I-III patients undergoing a variety of elective surgical procedures under balanced anesthesia, and in 40 patients recovering from comparable operations and anesthesia during postoperative intravenous self-administration of fentanyl (demand dose 34.5 micrograms) by means of the On-Demand Analgesia Computer. Following induction of anesthesia with fentanyl 4 micrograms/kg, repetitive fentanyl reinjections (0.1-0.2 mg) were given intraoperatively whenever systolic blood pressure or pulse rate increased to more than 20% of preinduction values, resulting in an intraoperative fentanyl consumption of 4.2 +/- 1.2 micrograms/kg/h. Duration of postoperative patient-controlled analgesia (PCA) was 20.2 +/- 4.3 h during which time 15.5 +/- 12.9 demands per patient were registered, resulting in a postoperative fentanyl consumption of 0.46 +/- 0.35 micrograms/kg/h. ⋯ Individual MECs increased gradually during anesthesia (mean slope 0.0191 ng/ml/min) but decreased under PCA conditions (-0.0008 ng/ml/min); difference not significant. While the postoperative decrease could be explained by diminishing pain intensity during the observation period, the slight intraoperative increase is discussed as acute tolerance rather than as accumulation. It is concluded that repetitive fentanyl injections as indicated by clinical needs will not lead to relevant accumulation in serum, and that analgesic therapy should be individualized both intra- and postoperatively.
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Int J Psychiatry Med · Jan 1988
The influence of problems with concentration and memory on emotional distress and daily activities in chronic pain patients.
This study examined concentration and memory problems in chronic pain patients as they related to emotional distress and interference with daily activity. Three hundred and sixty-three chronic pain patients were divided into two groups based on how much they expressed difficulty in concentrating and remembering things. ⋯ The results showed that problems in concentration and memory were related to emotional distress, poor family support, and interference with daily activities. It is suggested that techniques to improve concentration and memory should be incorporated as part of a multidisciplinary pain program.