Articles: pain-management.
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Pacing Clin Electrophysiol · May 1990
Case ReportsManagement of spinal cord stimulators in patients with cardiac pacemakers.
We report a case of spinal cord stimulation (neurostimulation) as treatment for angina pectoris pain in a patient with a demand pacemaker. The precautions to avoid inhibition of the demand pacemaker by the neurostimulator are discussed.
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The possible options for the management of acute pain are quite numerous and continue to expand as our understanding of the mechanisms of pain becomes increasing sophisticated. Many of the options discussed have been available for years, and their present underutilization may be a reflection of the lack of emphasis on the importance of management of acute pain. An illustration of this would be our present ritual of prescribing narcotics postoperatively, a longstanding, but unfortunately inadequate practice. ⋯ Certain techniques, such as continuous local anesthetic infusions, may warrant an escalated level of monitoring and ancillary care. Other techniques, such as the infiltration of a wound with local anesthetic or the addition of a nonsteroidal anti-inflammatory agent to a regimen of mild oral narcotics are so simple that excluding them from patient care is almost callous and inconsiderate. Attention to the mechanisms of pain that may be present in a given situation, whether it be muscle spasm, ischemia, inflammation, edema, or nerve injury, may guide the clinician toward a more rational approach in managing that pain.
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Celiac plexus block with alcohol was performed to relieve pain in 124 patients with abdominal malignancies. A transaortic technique was employed in which a single needle was advanced from a left posterior paramedian approach through the aorta to deposit anesthetic agent directly onto the celiac plexus. ⋯ No major hemorrhagic or neurologic complications were encountered. The transaortic method of celiac block is as effective as, easier to perform, and may be safer than the classic two-needle technique.
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In a postal survey, 1,009 randomly chosen individuals, aged 18-84, were asked about their pain problems. The pain prevalence depended on the kind of questions and definitions used, but prevalence was high overall. ⋯ At least 12% of the population was calculated as having sufficient pain problems to need some kind of care. This high figure indicates that the establishment of special treatment facilities can never be sufficient to meet the total demand for care due to pain.
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Case Reports
Utilization of transcutaneous electrical nerve stimulation in managing craniofacial pain.
This article describes a protocol for clinical application of variable parameter transcutaneous electrical nerve stimulation (TENS) for the management of craniofacial pain. The method described is easily applied and has been used successfully for several years in clinical practice. Several selected cases are presented that demonstrate the use of TENS along the prescribed protocol.