Relationship between somatosensory evoked potential components and cutaneous pain threshold: effects of transcutaneous electrical nerve stimulation.
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Biomedical subjects
Publications and source records attributed to M Zoppi.
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Transcutaneous electrical nerve stimulation (TENS) of the nervi cutaneus surae medialis was applied to 59 healthy subjects and 30 patients suffering from chronic myofascial pain in one lower limb, with an intensity of current that induced a well tolerated tingling sensation. Each period of stimulation lasted 24 minutes. The thresholds of the tactile, tingling and painful sensations were tested at fixed intervals before, during and after stimulation. Trains of constant current square waves in the distribution area of the stimulated nerve (local thresholds) and in other areas (general thresholds) were used. In all subjects repeated changes of the current were necessary in order to maintain constant tingling during the first period of TENS (changing phase); after that few if any changes of the current were necessary (steady phase). There were changes in thresholds within the territory of the electrically stimulated nerve, and marked changes elsewhere and generally in the body. In healthy subjects local thresholds increased during both phases of TENS; general thresholds decreased during the changing phase and increased during the steady phase. After TENS, thresholds showed the same trend as during the steady phase. Trends of the sensory thresholds during and after TENS differed in different subjects according to their thresholds before TENS. Thresholds did not return to normal for more than 20 minutes after TENS. In the group of 30 patients there was a significant difference between thresholds on the two sides of the body. The difference between the two sides was reduced by TENS. Pain relief induced by TENS may be related to this fact.
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To test the efficacy of a specialized transport service for sick newborns, changs in pH, Dextrostix values, and rectal temperature during transportation are compared in newborns transported by a specialized team and newborns referred by personnel of obstetric clinics to a neonatal intensive care unit. From January 1, 1974 to December 31, 1977 487 newborns below the age of 48 hours were transported by a specialized team and 336 were referred. The percentage of acidotic and hypothermic infants decreased significantly during transport by a specialized team, and there was a slight decrease in the percentage of hypoglycemic infants. In contrast, the percentage of referred newborns with acidosis and hypoglycemia increased and there was no decrease in the percentage of hypothermic newborns in this group. The advantage of specialized transportation is further underlined by the fact that these newborns were more severely ill than those brought by personnel of the referring clinics. The financial and administrative efforts involved in running a specialized transport system for newborns are justified.
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Skin potential and EMG responses induced in normal man by electrical stimuli applied to the skin were recorded in the four limbs in order to study somato-sympathetic and somato-motor reflexes. Different patterns of responses were observed in different conditions: alarm, habituation, sensitization and arousal. During alarm, sensitization and arousal, the responses were present in the four limbs; during habituation, the responses were only present in the stimulated and in the contralateral limb. Three sensory thresholds to cutaneous electrical stimulation were identified in habituated subjects: tactile, tingling and pain. Cutaneous and EMG responses appeared at tingling threshold. A relationship between skin potential level and skin potential response was observed.
In a group of patients suffering from reflex sympathetic dystrophies, the skin potential and EMG responses induced by electrical stimuli applied to the skin were recorded in the four limbs in order to study somato-sympathetic and somato-motor reflexes. In most patients, the amplitude, delay and shape of the cutaneous responses as well as the pattern of the EMG responses were different from those observed in normal subjects. In particular, it was possible to correlate the pattern of the cutaneous and muscular responses with the severity of the disease. The cutaneous sensory thresholds to electrical stimuli (tactile, tingling and pain threshold) showed different values in the dystrophic and in the contralateral limb. In all patients, a block of the sympathetic chain ipsilateral to the dystrophic limb was performed with local anesthetics. 1 h after the block, the cutaneous responses disappeared not only in the blocked limb but also in the contralateral limb. 48 h after the block, muscular and cutaneous responses as well as sensory thresholds showed a pattern similar to that observed in normal subjects. These findings show that the sympathetic block provides a resetting of the sensory thresholds and reflexes.
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This study was undertaken to assess the efficacy of ketorolac compared with placebo when delivered by electromotive drug administration (EMDA) in patients with pain from rheumatic disease. In EMDA, or iontophoresis, a low-intensity electric current is applied over the skin to deliver medication into body tissues. Although EMDA has been used to treat patients with various diseases, controlled studies are lacking in patients with rheumatic disease. This double-masked study included 60 patients (43 women and 17 men) aged 31 to 80 years with the following conditions: 12, epicondylitis; 30, scapulohumeral periarthritis; 10, gonalgia; and 8, metatarsalgia. They were divided randomly by a physician into 2 groups of 30 patients each for 5 sessions of active treatment (30 mg of ketorolac) or placebo (5 mL of normal saline). Treatment took place every other day for 20 minutes. Immediately before and after the five treatment sessions and 7 days after treatment ended, both patient and physician measured the degree of pain using a categoric scale (no pain, slight pain, intermediate pain, strong pain, and very strong pain) and evaluated pain intensity using the Scott and Huskisson Visual Analogue Scale (VAS). Seven days after treatment ended, both physician and patient judged the result of treatment using a second categoric scale (no improvement or intermediate, good, or very good result). Both ketorolac and placebo provided immediate, significant pain relief when delivered by EMDA, but only those patients receiving ketorolac experienced a further reduction in pain 7 days after treatment; those receiving placebo experienced a slight increase in pain. VAS values differed significantly between the two groups. Poor results (no improvement) were significantly higher in the placebo-treated group, while good results were significantly higher in the ketorolac-treated group. No patient reported any adverse effects during treatment. This study demonstrates that ketorolac relieves pain when delivered by EMDA and offers longer-lasting pain relief than does placebo.
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