ABSTRACT
A questionnaire about attitudes and knowledge in palliative care treatment was sent to 185 general practitioners who participated such a seminar some months before. The response rate was low (69/185). Pain is the most frequent symptom. All the responding doctors assume they can treat pain adequately. However, none of them can answer the knowledge questions correctly. They appreciate the palliative care organizations for the help in symptom control or for difficulties in psychological symptoms. A multifactorial etiology might explain the difficult control of asthenia. This survey agrees with other studies that knowledge in symptom control and palliative care should be improved.
Subject(s)
Clinical Competence , Family Practice/education , Palliative Care , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/therapeutic use , Asthenia/etiology , Asthenia/prevention & control , Health Knowledge, Attitudes, Practice , Hospices , Humans , Morphine/administration & dosage , Morphine/therapeutic use , Neoplasms/physiopathology , Neoplasms/psychology , Nervous System Diseases/complications , Nociceptors/physiology , Pain/etiology , Pain/physiopathology , Pain/prevention & control , Practice Patterns, Physicians' , Surveys and QuestionnairesABSTRACT
This study sought to visualize spinal-cord stimulation activity by infra-red thermography in humans suffering from chronic lumbosciatic pain. All the patients had previously undergone neurosurgery for a herniated intervertebral disc. Temperature changes were evaluated in two defined body areas after starting, stopping, maintaining or not starting the stimulation. In one body area, corresponding to the pain location, the patient experienced stimulation paraesthesia, whereas in the non-painful (second) area no stimulation paraesthesia were present. The patients were studied on four consecutive days with a randomly chosen stimulation pattern. Temperature changes in identical and comparable skin areas were measured and statistically analysed. No statistically significant temperature variation was found between the painful and non-painful areas. These findings do not confirm the idea that spinal cord stimulation induces vasodilation in the affected pain area when stimulation is present. Infra-red thermography is not able to differentiate the stimulated from the non-stimulated areas.
Subject(s)
Back Pain/therapy , Electric Stimulation , Infrared Rays , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Postoperative Complications , Spinal Cord , Thermography/methods , Adult , Humans , Intervertebral Disc Displacement/physiopathology , Lumbar Vertebrae/physiopathology , Middle AgedABSTRACT
OBJECTIVE: The analysis of patient data concerning psychological structure and functioning produced an instrument to determine whether a neurostimulator ought to be implanted or not. DESIGN: A questionnaire containing 24 items was developed by a psychologist and tested in 40 chronic failed back surgery patients for whom a spinal cord stimulation seemed to be the only therapeutic approach. This questionnaire was based upon some crucial psychological themes, on which the patient took a position. A predictive indication factor (I.F.; %) for implantation of the neurostimulator was obtained from the 24 items. Six months after the implantation of the neurostimulator, we correlated the evaluation factor (E.F.; %) with a six-point evaluation scale considering the pain reduction. The aim was to compare the I.F. and E.F. to verify the correlation between them. This comparison was intended to answer the question if psychological variables included in our scale improve the success rate of the therapy. SETTING: Data were collected by a psychologist at the Pain Clinic of the University Hospital of Gent, Belgium. RESULTS AND CONCLUSIONS: The correlation between the I.F. and the E.F. was calculated for the 40 patients by the Spearman correlation test. A coefficient value of 0.8083 (p = 0.000) was found, indicating the existence of a very close correlation between the predictive I.F. and the E.F. The indication scale appears to be a useful instrument for clinical psychologists to predict the success rate of a spinal cord stimulator in this group of patients.
Subject(s)
Back Pain/therapy , Electric Stimulation Therapy , Psychoanalysis , Spinal Cord/physiology , Back Pain/psychology , Back Pain/surgery , Chronic Disease , Combined Modality Therapy , Humans , Neurotic Disorders/complications , Neurotic Disorders/psychology , Physician-Patient Relations , Psychotic Disorders/complications , Psychotic Disorders/psychology , Somatoform Disorders/psychology , Treatment FailureABSTRACT
Tramadol is a weak opioid with effects on adrenergic and serotonergic neurotransmission that is used to treat cancer pain and chronic non malignant pain. This drug was initiated in association with paroxetine and dosulepine hydrochloride in a tetraparetic patient with chronic pain. Fifty-six days after initiation of the treatment the patient presented hallucinations that only stopped after the withdrawal of psycho-active drugs and tramadol. The case report questions the long term use of pain killers combined with psycho-active drugs in chronic non malignant pain, especially if pain is under control.
