A device for the relief of phantom limb pain and rehabilitation in stroke.

PURPOSE: To determine if simple, robust spectacle mounted devices are feasible for the replacement of the mirror boxes currently used in the rehabilitation of patients suffering from phantom limb pain, complex regional pain syndrome and stroke. METHODS: Four devices, using three different optical systems were produced: plane mirror, astronomical telescope using cylindrical lenses and two reflecting prism systems. RESULT: The illusory effect of the devices was similar to that of the mirror box. CONCLUSIONS: Any of the systems would be suitable to replace the mirror box, but the reflecting prism system is the easiest to set up.

Guilty until proven innocent: a qualitative study of the management of chronic non-cancer pain among patients with a history of substance abuse.

INTRODUCTION: Physicians are often reluctant to prescribe strong opioids for chronic non cancer pain (CNCP). No study has qualitatively examined physicians' beliefs about prescribing opioids for CNCP to patients with a history of substance abuse (PWHSA). AIMS: To describe physicians' attitudes and experience of prescribing opioids for CNCP to PWHSA. DESIGN, SETTING AND PARTICIPANTS: Nineteen individual interviews and two focus groups were conducted with GPs, Addiction Specialists, Pain Specialists and Rheumatologists. RESULTS: Physicians were "reluctant" to prescribe opioids to PWHSA experiencing CNCP for fear of addiction, misuse or diversion of medications. Many exhibited "distrust" that such patients were experiencing "genuine pain", resulting in patients often being considered guilty until proven innocent. Such negative regard towards these patients was based on previous manipulative "drug seeking" encounters and often resulted in the under treatment of pain. Potential "flags" were identified that alerted physicians to the potential for abuse or diversion of their prescription including: doctor shopping, loosing prescriptions, frequent attendance and early requests for repeat prescriptions. Physicians reported different management approaches and stricter prescribing regimes for PWHSA to limit the potential of addiction, misuse and diversion. Examples of poor pain management were described where drug users had been under treated as a result of negative attitudes or inexperience of staff. DISCUSSION: Applying the chronic disease model to comorbid addiction and CNCP would ensure a health and social care system that makes it difficult to stigmatise patients experiencing these conditions and would facilitate the prescribing of opioid pain medication to patients who could benefit.

Comorbid chronic non-cancer pain and opioid use disorders.

Patients with chronic non-cancer pain and opioid dependence are difficult to treat effectively. This article reviews the common issues that arise in relation to assessment and treatment, and recommends the adoption of an integrated approach to this patient population.

Vasoactive properties of lignocaine administered by iontophoresis in human skin.

The vasoactivity of lignocaine has an important influence on its clinical efficacy and systemic vascular absorption. The aim of this study was to evaluate its vasoactive properties when administered by the non-invasive technique of iontophoresis. We used laser Doppler imaging to measure the forearm skin blood flow responses of seven healthy young males to iontophoretic delivery of two preparations of 20 g/l of lignocaine hydrochloride, one containing the preservatives methylparaben and propylparaben and one without. The subjects were blind to the order of drug administration, and we assessed analgesia at the sites using a pinprick test. Delivery of both preparations of (positively charged) lignocaine under the anode caused demonstrable analgesia, but no change in skin blood flow. An increase in perfusion was measured, however, when the preservative-containing preparation was administered under the cathode. There was little or no response to the solution without preservatives, although the difference in response between the two preparations was not statistically significant (P =0.063). Although there were no vasoactive effects of lignocaine at the relatively low dose used in the present study, our results suggest that the preservatives methylparaben and propylparaben are the most likely cause of the vasodilatation that we observed under the cathode, and may therefore have a significant influence on the vasoactivity of this preparation when administered by injection. Both are negatively charged in solution and have been reported to possess vasodilator properties. It might be worth considering the use of alternative, non-vasoactive preservatives in local anaesthetic preparations, or avoiding the use of additives altogether, when this is feasible.