Rehabilitation and MS

Unfortunately, most people with MS will develop disability, which may or may not be permanent, at some point in their lives. Effective management of this is dependent on co-ordinated services that can be accessed by the person with MS in a timely and effective fashion. Neurological rehabilitation is a process of active change by which the person with MS acquires the knowledge and skills necessary for optimum physical, psychological and social function. It requires a dedicated multidisciplinary team with a clear understanding of the MS disease process, the mechanisms of disablement, and the skills to educate and treat people with disability so that they may participate fully in their chosen roles. This review considers the necessary components to the rehabilitation process and when such input may be most appropriate.     

Pain and cancer

The Cornell Medical Index was used to provide more information regarding the personality disturbance of cancer patients referred to a Pain Clinic. There was no significant correlation between the scores of the Cornell Medical Index and the response to procedures for pain relief of a sample of 54 patients with presistent pain referred from the Radiotherapy and Tumor Clinics. There were significant differences between the scores of this referred sample of 55 patients at the Radiotherapy anr Tumor Cinics who had not been referred. These differences indicate that the sample of patients referred to the Pain Clinic had more personality disturbance and that there were significant differences in the areas of Depression, Gastrointestinal symptoms, Hypochondriasis and Asthenia, and Psychosomatic symptoms. The relationship between the complaint of pain and the emotional state of the patient as a reaction to cancer has been discussed.     

Developments in MS over the Past 17 Years the MS Forum and The International MS Journal

When The International MS Journal (IMSJ) first appeared in 1994 multiple sclerosis (MS) was an under-recognized disease of little interest therapeutically. Its frequency was not great enough to interest the major pharmaceutical companies, its cause was unknown and evidence of any major therapeutic effect was lacking.     

The Neuromodulation of Neuropathic Pain by Measuring Pain Response Rate and Pain Response Duration in Animal

Objective

Neuropathic pain causes patients feel indescribable pain. Deep Brain Stimulation (DBS) is one of the treatment methods in neuropathic pain but the action mechanism is still unclear. To study the effect and mechanism of analgesic effects from DBS in neuropathic pain and to enhance the analgesic effect of DBS, we stimulated the ventral posterolateral nucleus (VPL) in rats.

Methods

To observe the effect from VPL stimulation, we established 3 groups : normal group (Normal group), neuropathic pain group (Pain group) and neuropathic pain+DBS group (DBS group). Rats in DBS group subjected to electrical stimulation and the target is VPL.

Results

We observed the behavioral changes by DBS in VPL (VPL-DBS) on neuropathic pain rats. In our study, the pain score which is by conventional test method was effectively decreased. In specific, the time of showing withdrawal response from painful stimulation which is not used measuring method in our animal model was also decreased by DBS.

Conclusion

The VPL is an effective target on pain modulation. Specifically we could demonstrate changes of pain response duration which is not used, and it was also significantly meaningful. We thought that this study would be helpful in understanding the relation between VPL-DBS and neuropathic pain.     

Pain assessment and management

Little research is currently available related to pain management by neuroscience nurses. However, due to concerns about the potential for altering neurological status, some neurosurgery patients may not receive optimal pain management. This paper describes findings from a pain related survey which was distributed during the Canadian Association of Neuroscience Nurses June 1998 national conference. The survey was intended to assess Canadian neuroscience nurses pain management knowledge and to explore pain management techniques after intracranial surgery. While 60% of respondents answered four pain assessment and management case study related questions correctly, some respondents rated pain differently when it was expressed by a smiling or grimacing patient. The most common methods for pain control after intracranial surgery included intermittent codeine and/or morphine, often by intramuscular injection. Findings from this study suggest that some neuroscience nurses require further education about pain management and that many patients do not receive optimal pain management after intracranial surgery.     

Pain emotion and homeostasis

Pain has always been considered as part of a defensive strategy, whose specific role is to signal an immediate, active danger. This definition partially fits acute pain, but certainly not chronic pain, that is maintained also in the absence of an active noxa or danger and that nowadays is considered a disease by itself. Moreover, acute pain is not only an automatic alerting system, but its severity and characteristics can change depending on the surrounding environment. The affective, emotional components of pain have been and are the object of extensive attention and research by psychologists, philosophers, physiologists and also pharmacologists. Pain itself can be considered to share the same genesis as emotions and as a specific emotion in contributing to the maintenance of the homeostasis of each unique subject. Interestingly, this role of pain reaches its maximal development in the human; some even argue that it is specific for the human primate.     

Pain and thyroid hormones

The role of endocrine systems in chronic pain mechanisms is slowly getting increasing experimental and clinical consideration. Many painful conditions appear to be directly and/or indirectly induced, reduced or, in some cases, modulated by hormones. We have done much work in trying to understand the relationship between hormones and pain, with particular attention to the hypothalamus–pituitary–gonadal axis. To expand our knowledge of this field, we have directed our attention to another axis, the hypothalamus–pituitary–thyroid (HPT). The literature on thyroid functions is vast but very few studies have focused on the HPT axis and pain. The few available data are considered in the present review to stimulate interest in the possible interactions between the HPT axis and pain.