Articles: pain.
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Clinical Trial
Post-operative epidural analgesia: effects on lung volumes.
A study was undertaken to assess the role of post-operative pain in reducing Functional Residual Capacity (FRC) and Vital Capacity (VC). The efficacy of post-operative epidural analgesia in reversing these changes was measured in eight subjects after upper abdominal operations. ⋯ These figures indicate the pain component in the post-operative reduction of these two lung capacities. This partial restoration may be of value in the prevention of post-operative pulmonary complications by avoiding closure of small airways during tidal breathing and by increasing the effectiveness of deep breathing and coughing in the removal of secretions and the reversal of atelectasis.
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One of the pre-operative screening tests for dorsal column stimulation involves direct acute precutaneous stimulation of the dorsal column. The test simulates the postoperative therapeutic situation, shows the patient's reactions to electrically induced paresthesias and enables physician and patient to evaluate beforehand the degree of pain relief to be obtained with the implant.
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Electrical stimulation of the nervous system has been advocated as a means of alleviating pain in situations in which more conventional methods have been ineffective. A chronically implanted electrode on the dorsal surface of the spinal cord may prove to be a valuable adjunct to the neurosurgeon's armamentarium for pain control in selected individuals. The physiologic basis for this action is unclear but has been related to Melzack and Wall's gate control theory. This preliminary report deals with a series of patients treated with implanted dorsal cord stimulators.
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Results of a series of dorsal column stimulation implants in 76 patients are tabulated and correlated to implant location, type of electrodes used and pain causes; complications are also discussed.
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The long-term (three-year) effect of dorsal column electrical stimulation for chronic pain in a group of 30 patients was generally decreased effectiveness with time, and increased stimulation thresholds. Further animal and human studies of this technique are recommended.