ABSTRACT
Investigations of the evoked potentials (EPs) to noxious laser stimulation have indicated consistent strong linear relationships between subjective response (R), stimulus intensity (S), and EP amplitude (A). Thirty patients with chronic intractable benign pain syndromes (CIBPS) were tested to determine whether their patterns differed from previous studies with normal volunteers. Nearly half of the CIBPS patients were found to be relatively insensitive to acute pain stimuli. A large number were also found to show negative relationships between S and A. These differences from control subjects were considered of potential importance in their implications concerning the nature of chronic pain and its differences from the acute pain process.
Subject(s)
Nociceptors/physiopathology , Pain, Intractable/physiopathology , Somatosensory Cortex/physiopathology , Adult , Aged , Evoked Potentials , Female , Humans , Male , Middle Aged , Pain, Intractable/psychology , Reaction Time/physiology , Sensory ThresholdsABSTRACT
Minimal conduction velocities of peripheral nerves contributing to acute thermal pain sensation in human volunteer subjects were calculated. Purely thermal stimulation was administered by a low power laser beam directed at the subjects' fingers, and subjective pain responses correlated with a peak in the event-related brain potential (ERBP). These cerebral responses were found to preclude C fiber peripheral activity from this phenomenon.
Subject(s)
Fingers/innervation , Nerve Fibers/physiology , Nociceptors/physiology , Synaptic Transmission , Thermosensing/physiology , Cerebral Cortex/physiology , Electroencephalography , Evoked Potentials , Humans , Neural Conduction , Peripheral Nerves/physiology , Reaction Time/physiologySubject(s)
Brain/physiopathology , Pain/physiopathology , Animals , Cats , Electroencephalography , Evoked Potentials, Somatosensory , Ganglia, Spinal/physiology , Humans , Mechanoreceptors/physiology , Models, Neurological , Nociceptors/physiopathology , Pain, Intractable/physiopathology , Peripheral Nerves/physiology , Sensory Thresholds/physiology , Skin/innervation , Spinal Cord/physiopathology , Synaptic Transmission , Tinnitus/physiopathology , Trigeminal Neuralgia/physiopathologySubject(s)
Brain/physiopathology , Hot Temperature/adverse effects , Pain/physiopathology , Adult , Electroencephalography , Female , Humans , Lasers , Male , Middle Aged , Pain/etiology , Sex Factors , Time FactorsSubject(s)
Neoplasms/complications , Pain, Intractable/therapy , Patient Care Team/methods , Death , Goals , Humans , Nurse Clinicians/statistics & numerical data , Pain, Intractable/etiology , Pain, Intractable/psychology , Pharmacy Service, Hospital/statistics & numerical data , Psychology, Clinical/methodsSubject(s)
Outcome and Process Assessment, Health Care , Pain, Intractable/therapy , Adolescent , Adult , Aged , Analgesics , Antidepressive Agents, Tricyclic , Attitude , Barbiturates , Female , Follow-Up Studies , Humans , Male , Middle Aged , Morphine Derivatives , Pain, Intractable/psychology , Substance-Related Disorders/epidemiology , Tranquilizing AgentsSubject(s)
Epidural Space , Spinal Canal , Spinal Cord Compression/etiology , Spinal Neoplasms/complications , Dexamethasone/therapeutic use , Epidural Space/pathology , Humans , Lung Neoplasms/pathology , Neoplasm Metastasis , Paraplegia/pathology , Prognosis , Spinal Canal/pathology , Spinal Cord Compression/drug therapy , Spinal Cord Compression/pathology , Spinal Cord Compression/radiotherapy , Spinal Neoplasms/pathology , Spinal Neoplasms/therapyABSTRACT
The authors have recently reviewed the results of their consecutive cases of decompressive thoracic or lumbar laminectomy for spinal cord compression from epidural metastatic neoplasia at the City of Hope National Medical Center over the 15-year period, 1960-1974. This limited series tends to demonstrate the effect of case selection on results, as well as contrast the type of patient with paraparesis seen at a cancer treatment center with that seen at a community or county hospital.
Subject(s)
Laminectomy/methods , Neoplasm Metastasis/surgery , Spinal Cord Compression/surgery , Spinal Cord Neoplasms/surgery , Adult , Aged , Breast Neoplasms/surgery , Epidural Space , Female , Hodgkin Disease/surgery , Humans , Kidney Neoplasms/surgery , Lymphoma, Large B-Cell, Diffuse/surgery , Lymphoma, Non-Hodgkin/surgery , Male , Middle Aged , Paraplegia/surgery , Spinal Cord Neoplasms/mortalityABSTRACT
The authors present the concept that a multi-disciplinary interdepartmental pain center should include: 1) an initial out-patient pain clinic, 2) an inpatient pain service for diagnosis of pain problems and treatment of patients with intractable pain, including pain from cancer, 3) a psychotherapeutically-oriented chronic benign Pain Unit, 4) facilities for clinical and basic pain research, and 5) affiliations for an adequate teaching program.
Subject(s)
Hospital Departments/organization & administration , Pain Management , California , Education, Medical , Hospital Departments/economics , Hospital Units , Humans , Neurosurgery/methods , Outpatient Clinics, Hospital/organization & administration , Pain, Intractable/therapy , Psychotherapy/methods , ResearchABSTRACT
The functional behavior of slowly adapting cutaneous mechanoreceptors under combined thermal-mechanical stimulation was investigated by single-unit recordings from the lumbar dorsal roots of the cat. Increased sensitivity to bimodal stimulation was observed in 24 of the 28 units studied, employing stimulus-response functional behavior as the basis for judgment. Low-threshold receptors generally did not exhibit increased spontaneous firing as accompaniment to heightened sensitivity, while such enhanced basal activity was usually observed in moderate-threshold units in addition to increased reactivity. Information theory calculations performed on these stimulus-response data revealed that 15 of the 24 "heat-sensitive" receptors were additionally characterized by an enhanced ability to transmit neural information under bimodal stimulation. These results were interpreted as supporting pattern theories of pain as opposed to the concept of receptor specificity. No contradiction was observed, however, between the present results and those of other investigators. The present conclusions derive from new criteria for thermal reactivity based upon innovative stimulus conditions.
Subject(s)
Mechanoreceptors/physiology , Pain , Skin/innervation , Thermosensing/physiology , Animals , Cats , Information Theory , Models, Neurological , Pain/etiology , Synaptic TransmissionABSTRACT
Use of a fiber optic needle scope attached to the Todd-Wells stereotactic unit has facilitated electrode placement during percutaneous trigeminal tractotomy.