Articles: pain-management.
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Comparative Study
Spinal cord stimulation for nonspecific limb pain versus neuropathic pain and spontaneous versus evoked pain.
To compare the outcome of spinal cord stimulation (SCS) in patients with nonspecific limb pain versus patients with neuropathic pain syndromes and in patients with spontaneous versus evoked pain. ⋯ SCS is as effective for treating nonspecific limb pain as it is for treating neuropathic pain, including limb pain associated with root damage.
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Neurolytic celiac plexus block (CPB) under radiological guidance is often performed to manage pain associated with pancreatic cancer. Serious complications related to the block are rare. Computed Tomography (CT)-guided neurolytic CPB is advocated to improve the efficacy of the block and to reduce the incidence of associated complications. We describe a case of superior mesenteric vein thrombosis associated with neurolytic CPB performed under CT guidance.
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Randomized Controlled Trial Clinical Trial
Cervical mobilisation: concurrent effects on pain, sympathetic nervous system activity and motor activity.
Recent findings that spinal manual therapy (SMT) produces concurrent hypoalgesic and sympathoexcitatory effects have led to the proposal that SMT may exert its initial effects by activating descending inhibitory pathways from the dorsal periaqueductal gray area of the midbrain (dPAG). In addition to hypoalgesic and sympathoexcitatory effects, stimulation of the dPAG in animals has been shown to have a facilitatory effect on motor activity. This study sought to further investigate the proposal regarding SMT and the PAG by including a test of motor function in addition to the variables previously investigated. ⋯ There was a decrease in superficial neck flexor muscle activity (P<0.0002) at the lower levels of a staged cranio-cervical flexion test. This could imply facilitation of the deep neck flexor muscles with a decreased need for co-activation of the superficial neck flexors. The combination of all findings would support the proposal that SMT may, at least initially, exert part of its influence via activation of the PAG.
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Clinical nursing research · May 2001
Generalizability and clinical utility of a practice-based infant pain assessment instrument.
The purpose of this study was to determine the clinical usefulness and generalizability of an infant pain assessment instrument. Earlier work showed that this instrument--an algorithm derived from a model of infant pain assessment-possessed excellent content validity, criterion-like validity, and 3-month stability (test-retest reliability). In this study, generalizability was determined by comparing the percentage agreement between inexperienced pediatric nurses and one author, both using the tool to assess pain of infants in various clinical settings, and by comparing the percentage agreement between one author who used the tool to assess pain and the infant's pediatric nurse caretaker who used his or her clinical expertise, not the tool, to assess pain across various clinical settings. The results show excellent generalizability.
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The number of patients handicapped by chronic pain is increasing in Sweden. Many of these patients do not receive adequate care despite guidelines issued in 1994 by the National Board of Health and Welfare recommending councils to establish multidisciplinary pain teams according to the guidelines issued by the International Association for the Study of Pain. A survey of Swedish general hospitals reveals that these recommendations have not yet been implemented. With the exception of university hospitals only one out of five hospitals has set up specialised pain care teams; in remaining hospitals the organisation of pain management leaves much to be desired.