Treatment of myofascial pain.

OBJECTIVE: To investigate the effectiveness of ultrasound treatment and trigger point injections in combination with neck-stretching exercises on myofascial trigger points of the upper trapezius muscle. DESIGN: Depression and anxiety associated with chronic pain were assessed using the Beck Depression Inventory (BDI) and the Taylor Manifest Anxiety Scale (TMAS). The study population comprised 102 patients who had myofascial trigger points in one side of the upper trapezius. The patients were randomly assigned to one of three groups: group 1 received ultrasound therapy to trigger points in conjunction with neck-stretching exercises; group 2 received trigger point injections and performed neck-stretching exercises; and group 3, the control group, performed neck-stretching exercises only. Treatment effectiveness was assessed using subjective pain intensity (PI) with a visual analog scale, pressure pain threshold (PT) with algometry, and range of motion (with a goniometer) of the upper trapezius muscle. RESULTS: Compared with the control group, patients in groups 1 and 2 had a statistically significant reduction in PI, an increase in PT, and an increase in range of motion. There were no statistically significant differences between treatment groups 1 and 2. Although not statistically significant, patients in the control group had better results at the 3-mo follow-up. The BDI scores indicated depression in 22.9% of the patient, with 4.8% of the patients having severe depression. High anxiety scores on the TMAS were present in 89.3% of the patients. When BDI and TMAS scores were compared with PI or PT levels, no significant correlations were found, but when compared with pain duration before treatment, correlations were significant. CONCLUSIONS: Patients with myofascial pain syndrome had higher scores for anxiety than for depression. When combined with neck stretching exercises, ultrasound treatment and trigger point injections were found to be equally effective.

Neoplasia epitelial papilar sólido-cística do pâncreas: relato de um caso / Solid and cystic papillary epithelial neoplasm of the pancreas: a case report

Os autores apresentam um caso de neoplasia epitelial papilar sólida e cística do pâncreas e suas pricipais características à ultrasonografia, tomografia computadorizada e ressonância magnética

Long-term results of peridural morphine in 225 patients.

The long-term results of peridural morphine in 225 cancer patients have been evaluated. Two methods were employed: percutaneously implanted catheter (175 patients) and subcutaneous reservoirs (50 patients). In the 225 patients, the mean duration of implantation of the peridural catheter was 47.3 days (7-420 days), the mean daily dose of morphine was 13.4 +/- 6.9 (5-80 mg) delivered by 2.6 +/- 0.7 (1-8) injections. The mean duration of action was calculated to be 9.3 +/- 3.8 h (3-32 h). Satisfactory analgesia was achieved in 133 patients (59.1%) in whom peridural morphine was the sole analgesic treatment. Peridural morphine appeared to be especially effective in patients with pain arising in the abdominal region. Complications due to morphine and the catheter were evaluated.