Articles: pain-management.
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We treat cancer pain patients at their homes, in collaboration with their relatives and primary physician. Assistance is free. ⋯ In 118 patients treated with our model between October 1987 and December 1988, we assessed the symptoms that moved them to seek assistance, their previous therapies, and the effectiveness of our intervention. The data obtained suggest that (a) in our country, the majority of cancer patients do not obtain effective pain and symptom control; (b) our model yields satisfactory pain control and improvement in quality of life; and (c) there is a need for centers that teach and practice terminal care; our model may be useful as a working outline for such centers.
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In order to provide a data bank to allow a more precise and effective implementation of spinal cord stimulation, a computerized analysis of 1,375 combinations obtained from electrode arrays located in the thoracic and cervical epidural area was performed. 67 electrode arrays implanted in 34 subjects were subjected to analysis. During the stimulation trial, all the available combinations were systematically tested and the results entered into a computerized database. ⋯ Analysis of the data allow the surgeon (1) to define the characteristics of the stimulation-induced paresthesiae; (2) to define the spectrum of the electrical parameters used to stimulate the spinal cord; (3) to define the population of implanted electrode arrays/contacts; (4) to study objectively how the position of the electrodes within the spinal canal, their vertebral level and the interelectrode distance affect the electrical parameters and the stimulation-induced responses. The multifactorial systematic analysis of such a large number of combinations provides the basis for further developments in the area of electrical stimulation of the nervous system.
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Despite advances in the understanding of pain mechanisms and innovative strategies to assess pain patients, there continues to be a substantial proportion of patients who do not appear to benefit from treatment interventions available. One possible explanation for these results is the tendency to treat chronic pain patients as a homogeneous group with generic treatments--adherence to "patient and treatment uniformity myths." Following from the traditional medical model, several attempts have been made to identify specific subgroups of patients exclusively on the basis of physical factors. ⋯ Alternative strategies to classify subgroups of pain patients based on combinations of physical, psychosocial, and behavioral measures (i.e., multiaxial strategies) are presented. The efforts to classify homogeneous subgroups of chronic pain patients are reviewed, and the potential utility of customizing therapeutic interventions to patient characteristics is discussed.