Articles: pain-management.
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A retrospective study of 30 patients who met the clinical criteria for saphenous nerve entrapment at the adductor canal is described. Patients experienced symptoms, usually anterior knee pain, for an average of 36 +/- 7 months. Each patient received an average of 1.9 +/- 0.4 saphenous nerve blocks at the adductor canal during treatment. ⋯ Age, medications taken, number of blocks performed, and length of followup were unrelated to outcome. Length of symptoms did significantly correlate with final pain level (r = 0.39, P less than 0.05). The diagnosis of this syndrome, description of the saphenous nerve block at the adductor canal, and the possible etiology are presented.
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Over a 3 1/2-year period, a series of 20 chronic pain patients with back pain and with documented organic difficulties were treated by means of implanted spinal cord stimulation. Short-term treatment outcome was found to be significantly related to diagnosis, with single nerve root injury and mononeuropathy patients having better treatment outcomes than arachnoiditis patients with multiply injured nerve roots. Outcome was not related to the psychological evaluation, or age, sex, number of previous pain surgeries, pain location, the Minnesota Multiphasic Personality Inventory, or the Pain Assessment Index. Implications for patient selection are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized trial of Codetron for pain control in osteoarthritis of the hip/knee.
Patients suffering from pain due to osteoarthritis of the hip and knee participated in a double-blind placebo controlled trial using daily Codetron home care units for 6 weeks over the tibial, saphenous, popliteal and sciatic nerves, and tender points. Seventy-four percent of patients in the real Codetron (Group A) and 28% of the patients in sham Codetron (Group B) improved their pain level more than 25% as measured by visual analogue scale. ⋯ Other functional parameters proved to be insensitive to change in this study. This is highly suggestive of beneficial effect of nonhabituating Codetron as a complementary modality in the therapy of chronic pain conditions such as osteoarthritis.
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Biofeedback, progressive muscle training, and relaxation tape home practice were implemented in an attempt to decrease knee pain in a subject diagnosed with osteoarthritis. Pain journal data suggested that the subject's pain levels decreased significantly during training and for 2 years posttraining. ⋯ One possible explanation for these changes was the home practice of her relaxation tape, as increased practice was inversely related to decreased pain. This clinical case report provided some preliminary information on the potential efficacy of psychological procedures in osteoarthritis pain management.
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Case Reports Comparative Study
Hypnosis and chronic pain. Two contrasting case studies.
Some of the theoretical and technical problems associated with the use of hypnosis for chronic pain are discussed in the context of two similar case studies, one of which had an unsuccessful outcome. Different hypnotic strategies are discussed which depend on a careful, direct evaluation of the role of secondary gain and depression in maintaining the pain in the two patients. ⋯ Self-hypnotic procedures are described stressing the development of mastery and self-control over pain. Differences in the kinds of hypnotic intervention that are appropriate when secondary gain or depression are central to the pain problem, compared to the more direct techniques available when they are not, are discussed.