Measurement of nerve dysfunction in neuropathic pain

Neuropathic pain is difficult to diagnose and treat. Both can be made easier if the nerve dysfunction can be quantified. The two basic modes of evaluation are subjective and objective. This article presents currently used methods in both arenas. Discussion is also given to some basic neurophysiology necessary to understanding the use of these testing methods.

Oral transmucosal fentanyl citrate as an additional premedicant for adult cardiac surgery patients

OBJECTIVE

To investigate the efficacy of a combination of midazolam and oral transmucosal fentanyl citrate (OTFC) as a preoperative medication for adult cardiac surgery patients compared with the use of midazolam alone.

DESIGN

A randomized, prospective study.

SETTING

University teaching hospital.

PARTICIPANTS

Patients scheduled for elective coronary artery bypass surgery.

INTERVENTIONS

All patients were given 50 micrograms/kg of midazolam intramuscularly in their rooms. Group I received 300 micrograms of OTFC Oralet (Anesta Corp, Salt Lake City, UT) if they weighed less than 70 kg and 400 micrograms of OTFC Oralet if they weighed more than 70 kg. Group II received a placebo Oralet. A radial artery catheter, two internal jugular venous catheters, and a pulmonary artery catheter inserted through one of the internal jugular catheters were placed in each study patient. Fentanyl was administered intravenously as a rescue drug.

MEASUREMENTS AND MAIN RESULTS

Ninety percent of midazolam/OTFC patients reported feeling no pain during catheter placement, compared with 50% of midazolam/placebo patients. Fifty percent of the placebo group required fentanyl supplement of 50 micrograms intravenously because of complaints of pain, compared with 10% of the OTFC group. The midazolam/OTFC group scored approximately 20% better than the placebo group in the independent observer score of patient analgesia and the anesthesiologist rating for ease of invasive catheter placement. No myocardial ischemic events were noted in either group as determined by electrocardiogram. All patients found the Oralet mode of delivery very acceptable.

CONCLUSIONS

The OTFC Oralet provides effective analgesia and sedation when combined with midazolam for invasive catheter placement in adult cardiac surgery patients. The OTFC Oralet with its gradual onset lessens the possibility of overmedicating with fentanyl, and it offers a very acceptable mode of delivery for a preemptive analgesic.

[Specifics of cognitive behavioral therapy in schizophrenia. Integrated program of psychological therapy]

According to the authors, information processing disorders contribute essentially to the vulnerability of the schizophrenic patient. Attentional/perceptual and cognitive disorders exert a pervasive influence on more complex levels of overt behavior in schizophrenia. Conversely, behavioral deficits influence cognitive functioning as well. Psychosocial rehabilitation of patients with schizophrenia must therefore address the impact of disordered attentional/perceptual and conceptual processes and their integrating organization on behavior as well as the effects of behavioral dysfunctions on cognition. The Integrated Psychological Treatment Program (IPT) for schizophrenic patients provides means of addressing these interactions. The designation "integrated" implies that the treatment is directed at cognitive disorders as well as behavioral/social deficits by using highly structured interventions, and is carried out with "reality-oriented" material. This treatment approach has been developed by Brenner and al., since 1976. The original IPT includes five subprograms: Cognitive Differentiation, Social Perception, Verbal Communication, Social Skills and Interpersonal Problem Solving. Patients first work on improving disordered basic cognitive functions in the Cognitive Differentiation subprogram. Exercises are directed at impairments in attentional/perceptual and conceptual processes. Mastery of this subprogram leads to the Social Perception subprogram, which aims at disturbances in processes of stimulus discrimination and interpretation on perceiving and assessing social interactions. The Verbal Communication subprogram follows successful completion of the previous subprograms and trains associative-semantic processes as well as basic skills necessary for conversation. In the Social Skills subprogram, interpersonal behaviors and self-instructions required for gaining instrumental and emotional aims are taught.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of depressed patients: current trends. Combination cognitive group therapy with cognitive adjustment for depressed inpatients]

Depressed patients represent a major part of the inpatient population. The following treatment program was developed in order to respond to this problem in a symptom- and cost-effective way. Cognitive therapy was chosen for it's learning aspect and combined with pharmacotherapy. The four-week treatment program is implemented in an open-ended group setting, where daily therapy sessions are associated with various group activities. The pre- and posttreatment and six months follow-up results of the first 80 patients are presented.