Failure of naloxone to effect chronic pain or stimulation induced pain relief in man

Sll2 STIMULATION OF THE PERIOSTEUM OF THE BONE FOR CHRONIC PAIN f:~t--lOiV REDUCTION (AN EXPERIMENTAL METHOD). Ronald M. Lawrence, | Tue 14:30 Department of Psychiatry, University of California, Los | Theatre D Angeles, CA 90024, USA Aim of Investigation: The periosteum of the bone has been shown to have a rich sympathetic nerve supply (SNS) and one of the etiologies for maintenance of chronic pain has been postulated as involving the SNS. Experimentally in cats Lawrence demonstrated the effectiveness of suppression of a painful stimulus by simultaneous periosteal stimulation (1976). The method is demonstrated on this videotape in two patients, one with severe rheumatoid arthritis and the other with lumbar discogenic disease. Method: The two volunteers are attached to battery operated stimulators (9 to 12 volts, i00 to 300 Hertz) for forty-five minutes (a tested parameter). The current is conducted to the periosteum in the involved areas via insulated needles. The voltage is gradually increased every three minutes keeping it at a level which can just be perceived by the subject. Results: In a series of six-thousand patients so treated, overall diminution of chronic pain was reported in 88 per cent of the subjects, graded from mild (6%), moderate (10%) to maximal (72%). These patients were polled by a written questionnaire as well as by verbal interviews. A double blind study, using muscle placements only, was also performed and comparative results show that periosteal stimulation obtained superior results. Conclusions: Low power electrical periosteal stimulation may offer a new method for chronic pain control which may be superior to transcutaneous electrical neurostimulation (reported studies show TENS to be effective in 30 to 50% of chronic pain cases). The method may also have some relationship to "hyperstimulation analgesia" as postulated by R. Melzack. Periosteal stimulation appears to be a simple, safe and inexpensive method for reducing chronic pain which ~p~r~yP~ rn be explored further. M O D I F I C A T I O N O F P H Y S I C A L S I G N S BY ( S U P E R F I C I A L ) ACUPUNCTURE. A.J.R. Macdonald, Pain Relief Clinic, C h a r i n g C r o s s H o s p i t a l , L o n d o n W6, UK.

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A i m of i n v e s t i g a t i o n : Acupuncture often involves deep n e e d l i n g into m u s c l e s and j o i n t s ; the n e e d l e s are then m a n i p u l a t e d to e l i c i t u n c o m f o r t a b l e o r b i z a r r e s e n s a t i o n s the C h i n e s e call t e c h i . T h i s s t u d y s o u g h t to d e t e r m i n e the e f f e c t s of a c u p u n c t u r e w h e n t h e s e p o t e n t i a l l y d i s t r e s s i n g and d a n g e r o u s m a n o e u v r e s w e r e a v o i d e d . Methods: S e v e n t e e n p a t i e n t s w e r e r e f e r r e d to a p a i n r e l i e f c l i n i c w i t h c h r o n i c low b a c k pain, ( m e a n d u r a t i o n 7 years, r a n g e 1-30 y e a r s ) , that bad n o t r e s p o n d e d to o t h e r measures. T h e y w e r e r a n d o m l y a l l o c a t e d to two g r o u p s : (I) A c u p u n c t u r e G r o u p ( e i g h t p a t i e n t s ) - the skin a l o n e w a s needled; as i n d i c a t e d in a v i d e o t a p e , 28 g u a g e a c u p u n c t u r e n e e d l e s w e r e i n s e r t e d swiftly, in a r e l a t i v e l y p a i n l e s s m a n n e r to an a p p r o x i m a t e d e p t h of 2 mm. into r e g i o n s of skin o v e r l y i n g t r i g g e r p o i n t s and o t h e r a b n o r m a l l y t e n d e r m u s c l e regions. (2) P l a c e b o G r o u p ( n i n e p a t i e n t s ) - i n e r t e l e c t r o d e s w e r e a t t a c h e d to r e g i o n s of skin that w o u l d h a v e b e e n n e e d l e d in the a c u p u n c t u r e g r o u p . Results: The a v e r a g e (%) r e d u c t i o n of p h y s i c a l s i g n s f o l l o w i n g a c o u r s e of t r e a t m e n t w a s m o n i t o r e d by i n d e p e n d e n t observers; it w a s s i g n i f i c a n t l y g r e a t e r in the a c u p u n c t u r e group (p