Articles: pain-management.
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Critically ill patients experience many unpleasant and frightening events while in an ICU. Appropriate concern for pain, discomfort, and anxiety is required from caregivers. The use of reassuring mannerisms, honest communication, and analgesics and sedatives, especially during therapeutic paralysis, improves patient comfort and reduces the morbidity rate. This article reviews the therapeutic options for sedation and experience with these agents in the critically ill.
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The present report describes a nation-wide survey on the incidence, the indications and the efficacy of spinal cord stimulation (SCS), as assessed by the Belgian health authorities. The direct motive for this survey was the rapidly growing expenditures resulting from the increasing use of SCS. Between 1983 and 1992, nearly 700 SCS devices were implanted for a population of less than 10 million inhabitants. ⋯ In a third study, the impact of psychiatric screening on patient selection was evaluated. Of the 100 candidates, 36 were withheld from implantation with a SCS device because of psychiatric contra-indications. Patients who had received a positive psychiatric advice showed a significantly better therapeutic outcome than patients for whom the psychiatrist had made reservations.
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We reviewed our experience with spinal cord stimulation (SCS) in treating 116 patients with pain in one or both legs. All these patients were selected for an initial week of trial stimulation by the criteria: pain due to a known benign organic cause, failure of conventional pain control methods and absence of major personality disorders. Selected patients included 78 with the Failed Back Surgery Syndrome (FBSS), in whom proven correlation existed between the clinical picture and the neuroradiological and electromyogram abnormalities. ⋯ Seventy-seven patients (91%) were able to reduce their medication intake and 50 patients (60%) reported an improvement in lifestyle. FBSS patients responded more positively to the trial stimulation than the other patients. However, the later outcome was not affected by patient selection as long-term benefit was similar in all definitive SCS patients irrespective of aetiology.
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Stereotact Funct Neurosurg · Jan 1994
An experimental animal model of spinal cord stimulation for pain.
In spite of the routine usage of spinal cord stimulation (SCS) as treatment of chronic pain, there is an insufficient understanding of the mechanisms underlying its effect. The method was originally developed as a spin-off from experiments demonstrating the inhibitory control of nociceptive signals by the activation of large afferent fibers, and on the basis of these findings the gate-control theory was advanced. Later experiments showed that stimulation of the dorsal columns can inhibit the relay of nociceptive impulses to second-order neurons in the dorsal horn. ⋯ SCS was applied at the approximate level of Th-XII during 10-20 min and produced a marked augmentation of the stimulus threshold. This abnormally high threshold was not normalized until 30-60 min after the end of SCS. In awake animals SCS was applied via an implanted spinal electrode and the effect on behavior changes associated with mononeuropathy was studied.(ABSTRACT TRUNCATED AT 250 WORDS)