Pain usually results from activation of nociceptive afferents by actually or potentially tissue-damaging stimuli. Pain may also arise by activity generated within the nervous system without adequate stimulation of its peripheral sensory endings. For this type of pain, the International Association for the Study of Pain introduced the term neuropathic pain, defined as "pain initiated or caused by a primary lesion or dysfunction in the nervous system." While this definition has been useful in distinguishing some characteristics of neuropathic and nociceptive types of pain, it lacks defined boundaries. Since the sensitivity of the nociceptive system is modulated by its adequate activation (e.g., by central sensitization), it has been difficult to distinguish neuropathic dysfunction from physiologic neuroplasticity. We present a more precise definition developed by a group of experts from the neurologic and pain community: pain arising as a direct consequence of a lesion or disease affecting the somatosensory system. This revised definition fits into the nosology of neurologic disorders. The reference to the somatosensory system was derived from a wide range of neuropathic pain conditions ranging from painful neuropathy to central poststroke pain. Because of the lack of a specific diagnostic tool for neuropathic pain, a grading system of definite, probable, and possible neuropathic pain is proposed. The grade possible can only be regarded as a working hypothesis, which does not exclude but does not diagnose neuropathic pain. The grades probable and definite require confirmatory evidence from a neurologic examination. This grading system is proposed for clinical and research purposes.
The purpose of this study was to assess the efficacy of high voltage pulsed direct current (HVPC) for healing of pressure ulcers in patients with spinal cord injury. Seventeen patients having pressure ulcers in the pelvic region were randomly assigned to either an HVPC group or a placebo HVPC group. Treatments were given for 1 hour a day for 20 consecutive days. The HVPC protocol consisted of an aluminum-foil electrode placed over the ulcer and set at negative polarity in reference to the dispersive electrode placed on the thigh. Stimulator frequency was set at 100 pps, and an intensity of 200 V was used. Measurements of ulcer surface area were conducted before treatment and after treatment days 5, 10, 15, and 20. To measure ulcer area (in square millimeters), slides taken at each measurement time were projected at actual size, traced, and digitized. Percentage of change compared with pretreatment ulcer size was calculated for each measurement time. Ulcers in the HVPC group demonstrated significantly greater percentage-of-change decreases from their pretreatment size than did ulcers in the placebo group at days 5, 15, and 20. The results suggest that HVPC, in conjunction with good nursing care, can significantly increase the healing rate of pelvic ulcers in patients with spinal cord injury.
This article reviews the literature relevant to the possible causes, prevention, and treatment of hemiplegic shoulder pain. Shoulder pain and stiffness impede the rehabilitation of patients with hemiplegia. The cause of this complication is unknown, but it may be related to the severity of neurological deficits, preexisting or posthemiplegic soft tissue injury, subluxation, brachial plexus injury, or shoulder-hand syndrome. Shoulder pain may be preventable if risk factors can be identified and appropriate prophylaxis applied. Resolution of the condition depends on diagnosis and effective treatment at the onset of the symptoms. More clinical research is needed to clarify the cause of hemiplegic shoulder pain and to document the efficacy of prophylactic and treatment methods.
We concluded that the photographic and transparency methods, as applied in this study of ulcers, provided equivalently reliable measurements and that WSA measurements obtained by the two methods were equivalent. The transparency method was more economical than the photographic method in terms of time and equipment requirements.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.