Articles: pain-management.
-
Acupuncture has played an important part in pain research. Bischko was the first in the Western hemisphere to undertake surgery using acupuncture analgesia. This tonsillectomy was performed in 1972. ⋯ Various ways of treating pain by means of acupuncture will be discussed: e.g. body acupuncture (with or without supportive transcutaneous electrical nerve stimulation); treatment via the so-called somatotopies (ear, oral mucous membrane, scalp acupuncture according to Yamamoto etc.). The Ludwig Boltzmann Acupuncture Institute, in close collaboration with the II. Dept. of Internal Medicine at the Kaiserin-Elisabeth Hospital, Vienna, has been able to demonstrate on inpatients with a variety of conditions, that acupuncture could significantly reduce the quantity of analgesics required.
-
Stereotact Funct Neurosurg · Jan 1993
Clinical TrialExperience with 509 plate electrodes implanted epidurally from C1 to L1.
This article summarizes the experience gained with implantation of 509 plate electrodes performed by a single neurosurgeon. 350 patients were subjected to implantation of plate electrodes in the dorsal epidural space. 227 patients were implanted for chronic pain management (reflex sympathetic dystrophy, failed back syndrome/arachnoiditis, pain following spinal cord injury, nerve injury pain and other miscellaneous pain conditions), 105 patients for motor disorders (spasms/spasticity following spinal cord or head injury, cerebral palsy, multiple sclerosis, spasmodic torticollis and other miscellaneous conditions) and 18 patients for both. A total of 509 electrodes were implanted in the dorsal epidural space. ⋯ Electrode migration occurred in 1.1% of the patients and electrode breakage in 4 patients. 288 (70%) of the implanted electrodes are still being used. Technical factors relevant to the surgical implantation of plate electrodes at various levels in the spine are presented and discussed.
-
Pain management is an essential part of postoperative care. The present availability of multiple modalities of patient controlled and continuous regional analgesia requires the reorganization of existing hospital structures to be efficacious and safe. This article presents an Acute Pain Service (APS) as a model for a reorganized structure. ⋯ Prerequisites of an APS are careful selection of suitable techniques as well as the formulation of protocols and standing orders for the techniques. Inservice training of involved personnel, dedicated single ward trials and introduction of the revised technique for general use are further essential steps in its development. The organizational structures proposed include selection of the appropriate technique for a patient by the theatre anaesthetist, preparation and documentation by the recovery nurse, monitoring and ongoing skilled assessment by the ward nurse and ward rounds, advice and 24 h availability by anaesthetists.
-
Intravenous administration of local anaesthetics has repeatedly been recommended for the treatment of chronic pain. Some authors have also reported on their use in postoperative pain management. However, most of these publications are case reports or refer to rather old studies or investigations based on study designs that fail to meet present scientific standards. ⋯ During the first 24 h after surgery 12 patients in the lidocaine group required a total of 550 mg meperidine in addition, while 8 patients in the control group required a total of 300 mg meperidine. The postoperative meperidine consumption was not significantly diffent between the lidocaine group and the control group. Intravenous lidocaine infusion did not significantly reduce postoperative pain after tonsillectomy in the dosage used.
-
Baseline measures associated with outcome are described for amitriptyline and brief psychotherapy used in the outpatient treatment of chronic "psychogenic" pain. The results delineate patient profiles associated with suitability for these treatments. These may serve as guidelines for choice in the treatment of heterogeneous pain clinic patients.