Articles: pain-management.
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Epidural or intrathecal opiate analgesia, combined with bupivacain by means of an implanted pump, represents a possibility for providing good pain management for cancer patients as well as other chronic pain patients. Several indications, for implantation of a percutanously refillable pump are demonstrated in 27 patients. Twenty-four patients were treated with epidural and 3 with intrathecal catheters. ⋯ In the course of 2 years there has been no significant increase in the daily dose of buprenorphin given epidurally to patients with chronic pain. There were no addiction problems with opiates given epidurally or intrathecally by means of implanted pumps. Because of a 13% complication rate, pumps and epidural or intrathecal catheters should only be implanted by an experienced team.
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Contemporary orthopaedics · Mar 1991
Sciatic nerve block for residual limb pain following below-knee amputation.
Ten adult patients with diffuse nonphantom limb pain in the residual limb following below-knee amputation underwent from one to four sciatic nerve blocks for the treatment of that pain. Amputation had been performed for peripheral vascular insufficiency in eight patients and for problems resulting from open fractures in two. None of the patients had responded to prosthetic modification, oral medication, or transcutaneous nerve stimulation for treatment of their pain. At one-year following treatment with sciatic nerve blocks as described in this report, one patient had not responded well to treatment but six patients had a resolution of their symptoms, and three had less subjective pain adequate to resume their normal daily activities.
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Sixty-nine patients undergoing spinal cord stimulation (SCS) were studied for a period of up to 8 years. Indications, implantation techniques, and stimulation systems are presented in this article. Pain-suppressor effects of SCS are reviewed, assessing the clinical efficacy over time as well as complications with the stimulation device. ⋯ Decrease of the efficacy of pain alleviation occurs during the first 3 years after implantation. Most failures are noted in patients presenting with failed back surgery. This study also demonstrates that SCS systems should offer the capability of both monopolar and bipolar stimulation modes by the use of multipolar electrodes.
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Psychodynamic concepts postulate a psychogenesis of physical pain proposing several assumptions about the conversion of mental suffering into physical pain. Behavioural concepts, on the other hand, emphasize psychological conditions as risk factors for chronicity and describe psychological reactions to chronic pain. Patients with painful diseases and inadequate coping strategies very often display symptoms of anger, anxiety, or depression. ⋯ Subjects included in the study were given diagnoses of low back pain, tension headache, rheumatoid arthritis, and ankylosing spondylitis. Treatment effects in different diagnostic groups were compared to each other, supporting the assumption that pain reduction is greatest in low back pain and least in ankylosing spondylitis. Subjects with inflammatory rheumatic diseases showed some improvement in self-reported physical complaints and in their feelings of well-being.