Articles: pain-management.
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In five depressive patients associated with chronic pain, the efficacy of electroconvulsive therapy (ECT) for pain relief was evaluated retrospectively. In all of the patients treatment with tricyclic antidepressant medication was not successful, but ECT alleviated or diminished the chronic pain associated with depression. It seems that ECT as a treatment for chronic pain in patients with depression should be taken into consideration in cases in which other treatments have failed.
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Spinal cord stimulation has become an accepted technique used in the management of chronic neuropathic pain syndromes. However, a number of problematic questions remain unanswered. This introduction states some of these problems and concentrates on the problem of whether low back pain can be relieved by stimulation. This paper introduces subsequent contributions to this symposium, which offer some interesting new techniques, and attempts to answer some of the problems presented.
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Acta Anaesthesiol Scand · Jul 1999
Case ReportsClinical experience using intrathecal (IT) bupivacaine infusion in three patients with complex regional pain syndrome type I (CRPS-I).
To date, there is no reliable method for treating the severe pain and for modifying the natural evolution of CRPS-I. Therefore, we explored the effect of long-term IT bupivacaine infusion (with or without buprenorphine) on this syndrome. ⋯ The IT pain treatment with bupivacaine (with or without buprenorphine) alleviated the "refractory" pain, but affected neither the associated symptoms and signs of the CRPS-I, nor its natural evolution. Thus, the IT treatment cannot be recommended in preference to other pain treatment regimens for CRPS-I.
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The following account discusses the possible mechanisms by which spinal cord stimulation can control symptoms of Complex Regional Pain Syndromes. A review of the literature with a methodology for its incorporation in a treatment algorithm and associated technical aspects is suggested.
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Over the last 10 years, there has been a fundamental change in physicians' attitudes toward analgesia and sedation in pediatrics. In this time, basic and clinical research have provided a wealth of information. ⋯ Fortunately, the attitude of physicians toward these matters has changed significantly and much more attention is now paid to the alleviation of pain and provision of adequate sedation. However, there remains, according to most estimates, incongruity between these advances and what is practiced clinically.