Articles: pain-management.
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Review Case Reports
Resolution of Lhermitte's sign in multiple sclerosis by treatment with weak electromagnetic fields.
Lhermitte's sign, the occurrence of an electrical sensation passing down the back to the legs on flexion of the neck is a common and characteristic feature of multiple sclerosis (MS) which is related to spinal cord lesions affecting the posterior columns and cervical nerve roots. The Lhermitte's sign, which has been reported to occur at some time in up to 25% of MS patients, is seldom painful but is often a cause of distress to the patient and usually a marker of increased disease activity. Treatment with extracranial picotesla range pulsed electromagnetic fields (EMFs) has been found efficacious in the management of various MS symptoms including pain syndromes. ⋯ As the cause of the Lhermitte's sign is thought to result from the spread of ectopic excitation in demyelinated plaques in the cervical and thoracic regions of the spinal cord, it is hypothesized that the effects of EMFs are related to the reduction of axonal excitability via a mechanism involving changes in ionic membrane permeability. A systemic effect on pain control systems is also postulated to occur secondary to the effects of EMFs on neurotransmitter activity and pineal melatonin functions. This report underscores the efficacy of picotesla EMFs in the management of paroxysmal pain symptoms in MS.
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Some children and adolescents with sickle cell disease experience frequent painful episodes. To gain information about the natural history of the pain and its impact on sleep and school attendance, we developed a home-based diary system. Eighteen children and adolescents completed 4756 diary days, with an average compliance of 75%. ⋯ Of the pain-associated absenteeisms, two-thirds occurred when pain was managed at home, and one-third when patients were hospitalized. The average consecutive number of school days missed was 2.7. These findings have implications for developmentally critical activities.
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Adjuvant analgesics are drugs that are not primarily used as analgesics but can produce analgesia in certain types of pain. Adjuvant analgesics can be administered together with non-opioid and opioid analgesics on each step of the WHO analgesic ladder. They should be given when an additional or specific indication exists, but should not be used as a substitute for a thorough treatment with opioids and nonopioids. ⋯ Biphosphonates (etidronate, clodronate, pamidronate derivates) also produce analgesic effects in patients with bone metastases. However, differences among the various compounds have not been clearly evaluated yet. Potent and specific radioisotopes are still under development and the use of calcitonin in bone pain is considered controversial.
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In this case report, we describe continuous subcutaneous infusion of opiates as PCAO (patient controlled analgesia in outpatients) in one patient with metastatic carcinoma of the rectum (liver and bone metastases, partial bowel obstruction) with severe cancer pain and vomiting in the terminal phase. The parenteral administration of opioids extended over 58 days. The infusion was powered by an external portable clockwork-driven syringe pump (Perfusor M, Braun Medical/Germany). ⋯ When he received outpatient radiation therapy the patient needed extra injection doses of up to 360 mg morphine a day. The PCAO procedure by continuous subcutaneous infusion with opiates is a safe and efficient method of pain management for outpatient patients suffering from severe cancer pain and intractable nausea in the terminal phase. Its validity has also been proven especially for radiation treatment of bone metastases.
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A child's pain is plastic and complex. In order to more effectively alleviate suffering, emphasis must shift from an exclusive focus on the source of tissue damage to a more comprehensive focus that includes factors that modulate pain. Evaluating a child's pain requires an integrated approach. ⋯ Pain assessment, like pain management, is a continuous process. Pain intensity rating scales should be used so children can provide a direct rating of their pain intensity and pain effect. Patients should receive some guidance about how to use the information from rating scales to develop consistent and objective criteria to know when children require analgesics and then to evaluate the effectiveness of those medications.