Articles: pain.
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Usually, pain is caused by the excitation of nociceptors or of nociceptive afferent fibers. The responsiveness of the nociceptors can be modulated by endogenously released algesic substances or local hormones. Lesioned and regenerating nerve fibers show enhanced excitability and spontaneous activity. ⋯ Inhibition of spinal neurons, and analgesia, can be produced by stimulation of brain stem structures. Pharmacologically, pain inhibitory systems may involve serotonin and endogenous opioids as transmitter or modulator substances. For pain therapy, pain inhibitory systems may be activated e.g. by morphine and ther analgesic drugs, focal brain stimulation, various means of somatosensory afferent stimulation and by psychological influences such as stress.
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Anesthesia and analgesia · Dec 1981
Delayed onset of epidural anesthesia in patients with back pain.
Onset and completeness of anesthesia were compared in 15 patients with back pain or sciatica and in 10 patients without back pain given lumbar epidural anesthesia with 20 to 25 ml of 1.5% mepivacaine, 80 mg of methylprednisolone, and 1:200,000 epinephrine. Sensory block was complete within 30 minutes in patients without back pain. Eleven of 15 (73%) patients with back pain had delayed onset of anesthesia ranging from 35 to 95 minutes. ⋯ Differences in time of onset between affected nerves and contralateral nerves were also significant (p less than 0.01). The nerve roots involved, as determined from the myelogram or the electromyogram, or those adjacent to them, were the roots with delayed onset of block. Any effect of the steroid on nerve blockade was ruled out as there was solid anesthesia in patients without back pain.
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In a pain management program (200 patients), a group of daily users of oxycodone compound (29 patients) and a subgroup who were taking a "high dose" of oxycodone compound (13 patients) were compared with a group of 171 non-users of oxycodone compound. A significantly lower treatment success rate was observed in the users (P = 0.04) and high-dose users (P = 0.03). ⋯ Continued study of these findings is necessary. Meanwhile, in patients with chronic pain, there should be cautious use of this compound.
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J. Neurol. Neurosurg. Psychiatr. · Dec 1981
Comparative StudyExtradural diamorphine in the control of pain following lumbar laminectomy.
Catheters were inserted into the extradural space under direct vision at the time of surgery for prolapsed intervertebral disc or lumbar canal stenosis. In the post-operative period, diamorphine (3 mg in 5 ml water) was injected through the catheter when patients requested analgesia. In only four of 49 patients was significant pain relief not achieved after extradural diamorphine injection. ⋯ As judged by the improved mobility and by grading on a linear analogue pain scale, the quality of analgesia achieved was better than after intramuscular papaveretum (10-20 mg) and extradural diamorphine was requested less frequently. There were no serious side-effects in the patients studied, although the technique was not used in patients over 55 years of age. Extradural diamorphine appeared to be less effective in two patients who had undergone re-explorations.