Articles: pain.
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J. Neurol. Neurosurg. Psychiatr. · Sep 1987
Clinical Trial Controlled Clinical TrialThermal sensitivity is not changed by acute pain or afferent stimulation.
The effect of conditioning stimulation on thermal sensitivity and clinical pain was studied in 40 patients and six healthy subjects. Thresholds regarding cold, warm and heat pain perception did not differ significantly between the painful and non-painful skin areas in patients or between patients and healthy subjects before stimulation. ⋯ No significant changes in thermal sensitivity were observed during and after conditioning stimulation in any of the test groups, although 24/40 (60%) of the patients reported reduction of their clinical pain intensity. The results indicate that (a) thermal sensitivity is not influenced by the presence of clinical pain, (b) the effects of stimulation on thermal sensitivity (thresholds) and clinical pain are not closely related, (c) central inhibitory effects of TENS and vibration are crucial for their pain relieving capacity.
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Neurolytic celiac plexus block (NCPB) is an effective method for relief of the pain of pancreatic cancer, but many physicians are reluctant to use the technique because of the perception that the incidence of complications is high. We analyzed the incidence of complications and the quality of pain relief obtained during the use of NCPB in 136 patients with pancreatic cancer. ⋯ Radiographically guided needle placement did not affect quality of pain relief or the incidence of complications. This neurolytic pain block is effective, has a low incidence of neurologic complications, and deserves more widespread use in patients with pancreatic cancer.
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Ten patients underwent implantation of intrathecal morphine catheters with subcutaneous implantation of morphine Infusaid pumps for the treatment of intractable pain of malignant origin from May 1984 to October 1985. All patients exhibited a good initial response to intrathecal morphine and developed some degree of tolerance. All patients with bony metastasis and/or lumbarsacral plexopathy developed rapid tolerance. ⋯ Complications included a pump pocket infection requiring the removal of the implanted system. There was no pump failure, respiratory depression, urinary retention, or mortality related to the use of the morphine infusion system. It is recommended that intrathecal morphine infusion be instituted when narcotics have been identified as necessary for pain relief, before the development of significant systemic tolerance.