Pain relief achieved by transcutaneous electrical nerve stimulation and/or vibratory stimulation in a case of painful legs and moving toes

A patient is described with painful legs and moving toes. The pain had been occurring for more than 15 years, and a variety of therapies had been attempted with only partial, if any, success. Only morphine had succeeded in relieving the pain, but it had to be discontinued to avoid tolerance and dependence. We devised a treatment consisting of transcutaneous electrical nerve stimulation (TENS), vibratory stimulation (VS), and a combination of the two methods (TENS + VS). TENS brought about partial pain relief, but was less effective than VS; dual stimulation (TENS + VS) led to complete alleviation of the pain. Four months later, the patient was applying dual stimulation himself at home and was thus able to maintain complete relief with 3 or 4 weekly sessions. We suggest that dual stimulation results in a large-scale recruitment of large-diameter afferent fibres and may thus set up a powerful inhibitory control of nociception in our patient.

[Methodology of clinical studies of myorelaxants]

Myorelaxants, a specific pharmacologic group, are often prescribed. However, for many molecules, therapeutic trial methodology is not adapted. A review of the fundamental aspects of pharmacological trial clearly show a need for diagnosis and inclusion criteria, definition and validation for methods of assessment, analysis of the dose-response curve on term of effectiveness according to the pharmacologic and clinically established rules. Rational prescription of myorelaxants will arise from this principles.

[The Psychotic Anxiety Scale (PAS). Evaluation of inter-rater reliability and correspondence factorial analysis]

We recently proposed the first scale for evaluating anxiety in psychotics: the "Psychotic Anxiety Scale" (PAS). The first version of this scale was tested in 45 psychotic patients. The multiple correspondence factorial analysis revealed that 4 factors account for respectively 50%, 18%, 17% and 10% of the variance. This scale thus evaluates anxiety along 4 axes: severity of the symptomatology, evolution in time, hetero-aggressiveness and self-aggressiveness. This analysis supports the hypothesis of the lack of specificity for the anxiety in psychotics, but distinguishes the nevrotic anxiety from the psychotic anxiety. The inter-rater reliability was assessed by a method which compared a rater with the others along 2 axes: the severity, and the profile of the assessment. The interrater reliability was unsatisfactory for only three items. They have been modified and a new version of the PAS is proposed.

[Peripheral neuropathy and cyclosporin. Apropos of 2 cases]

We report two cases of peripheral neuropathy arose during treatment with cyclosporine. The first observation was in a 24 year-old female treated because of a recent diabetes mellitus, the second in a 52 year-old male whose treatment was given after a cardiac transplantation. Chronology, clinical presentation and morphological findings on nerve biopsy were very close in both cases ans intrinsic imputability was stated as "possible" according to the method used to assess unexpected or toxic drug reaction by the French Regional Drug Monitoring Centers. It remains to confirm with similar reports the putative part played by cyclosporine as strongly suggested in ours.