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Showing papers in "Pain in 1975"


Journal ArticleDOI
Ronald Melzack1
01 Sep 1975-Pain
TL;DR: The McGill Pain Questionnaire as discussed by the authors consists of three major classes of word descriptors (sensory, affective and evaluative) that are used by patients to specify subjective pain experience.
Abstract: The McGill Pain Questionnaire consists primarily of 3 major classes of word descriptors--sensory, affective and evaluative--that are used by patients to specify subjective pain experience. It also contains an intensity scale and other items to determine the properties of pain experience. The questionnaire was designed to provide quantitative measures of clinical pain that can be treated statistically. This paper describes the procedures for administration of the questionnaire and the various measures that can be derived from it. The 3 major measures are: (1) the pain rating index, based on two types of numerical values that can be assigned to each word descriptor, (2) the number of words chosen; and (3) the present pain intensity based on a 1-5 intensity scale. Correlation coefficients among these measures, based on data obtained with 297 patients suffering several kinds of pain, are presented. In addition, an experimental study which utilized the questionnaire is analyzed in order to describe the nature of the information that is obtained. The data, taken together, indicate that the McGill Pain Questionnaire provides quantitative information that can be treated statistically, and is sufficiently sensitive to detect differences among different methods to relieve pain.

6,007 citations


Journal ArticleDOI
01 Dec 1975-Pain
TL;DR: The distribution of the variances of the values obtained by means of both scales was not homogenous, indicating that the homogeneity of the distribution of variances should always be checked and a Kruskall‐Wallis H‐test used, if they are inhomogenously distributed.
Abstract: The effect of analgesics on pathological pain in a double-blind, complete cross-over design was assessed by means of two rating scales, a verbal rating scale (VRS) and visual analogue scale (VAS). The VRS is widely used, but has several disadvantages as compared to the VAS. The results obtained by means of the VRS showed higher F-ratios (analysis of variance and Kruskall-Wallis H-test) than those obtained by means of the VAS. The VRS, which transfers a continuous feeling into a digital system, seems to augment artificially the measurement of effects produced by analgesics, and the VAS seems to assess more closely what a patient actually experiences with respect to change in pain intensities. The correlation between the two scales was highly significant (r = 0.81, P less than 0.001). The calculated regression line (y=-29.6 + 0.55-x) was not similar to the line of identity and showed much lower values for the VAS, supporting our interpretation. The distribution of the variances of the values obtained by means of both scales was not homogenous. This indicates that the homogeneity of the distribution of variances should always be checked and a Kruskall-Wallis H-test used, if they are inhomogenously distributed.

794 citations


Journal ArticleDOI
01 Jun 1975-Pain
TL;DR: Single dorsal horn neurons have been recorded extracellularly in 8 anesthetized (pentobarbital‐Na) cats and in 1 unanesthetization decerebrated cat to determine their excitability and responded to noxious heating in a quantitatively similar manner as the primary C‐heat nociceptors.
Abstract: 1. (1) Single dorsal horn neurons have been recorded extracellularly in 8 anesthetized (pentobarbital-Na) cats and in 1 unanesthetized decerebrated cat. The animals were either spinalized by transection of the cord at L 1 (6 experiments) or a cold block was used for reversible spinalization at L 1 (3 experiments). 2. (2) Sixty-five units were recorded in the dorsal horn and in the dorsolateral funiculus which could be excited by electrical stimulation of the ipsilateral plantar nerves and by natural stimulation of the skin in the foot region. The recording position of the microelectrode was verified histologically. 3. (3) According to their excitability by electrical stimulation of the afferent nerve fibers and by natural stimulation of the receptive fields, 2 major classes of units could be distinguished in the spinalized cat. Class 1 cells were excited by electrical stimulation of myelinated axons (group II) in the plantar nerves. Four out of 9 could be excited by low threshold cutaneous mechanoreceptors; 5 had input probably from deep receptors. Class 2 cells , which were more than twice as common as class 1 cells, could, like the latter, be excited by electrical stimulation of group II myelinated afferent fibers in the plantar nerves, but in addition, were excited by electrical stimulation of C-fibers. 4. (4) When stimulated naturally, virtually all of the class 2 cells received an excitatory input from low threshold cutaneous mechanoreceptors and also from receptors excited by noxious radiant heat stimulation in their receptive fields. They responded to noxious heating in a quantitatively similar manner as the primary C-heat nociceptors.

407 citations


Journal ArticleDOI
Ronald Melzack1
01 Dec 1975-Pain
TL;DR: The data indicate that the procedure provides a powerful method for the control of some forms of severe pathological pain by brief, intense transcutaneous electrical stimulations at trigger points or acupuncture points.
Abstract: The purpose of this study was to examine the effects of brief, intense transcutaneous electrical stimulations at trigger points or acupuncture points on severe clinical pain. The McGill Pain Questionnaire was used to measure the change in pain quality and intensity produced by stimulation. The data indicate that the procedure provides a powerful method for the control of some forms of severe pathological pain. The average pain decrease during stimulation sessions was 75% for pain due to peripheral nerve injury, 66% for phantom limb pain, 62% for shoulder-arm pain, and 60% for low-back pain. The duration of relief frequently outlasted the period of stimulation by several hours, occasionally for days or weeks. Different patterns of the amount and duration of pain relief were observed. Daily stimulation carried out at home by the patient sometimes provided gradually increasing relief over periods of weeks or months. Control experiments, which included two forms of placebo stimulation, showed that brief, intense electrical stimulation is significantly more effective than placebo contributions. Possible neural mechanisms that underlie these patterns of pain relief by brief, intense stimulation are discussed.

400 citations


Journal ArticleDOI
01 Jun 1975-Pain
TL;DR: The results can be considered as evidence that the mechanism of analgesia from the inferior raphe nucleus is similar to that already described in the dorsal Raphe nucleus, which seems to be sustained by serotoninergic mechanisms.
Abstract: In the cat, electrical stimulation of the inferior central nucleus of the raphe induces a powerful analgesia. This stimulation totally suppresses the behavioural reactions elicited by strong pinches applied to the tail or to the four limbs; it strongly modifies the threshold of the jaw opening reflex obtained by tooth pulp stimulation and considerably affects the behavioural reactions elicited by continuing such stimulation. The results can be considered as evidence that the mechanism of analgesia from the inferior raphe nucleus is similar to that already described in the dorsal raphe nucleus. The analgesia obtained by stimulation of raphe nuclei seems to be sustained by serotoninergic mechanisms and relationships between these are discussed. In preliminary experiments, analgesia induced by CI stimulation has been suppressed by administration of naloxone, a specific opiate antagonist.

305 citations


Journal ArticleDOI
01 Dec 1975-Pain
TL;DR: This report will present an overview of those structures in the spinal cord which are concerned, or probably concerned, with nocicepfive mechanisms and correlate the structural observations, insofar as possible, with current neurophysiological concepts.
Abstract: This report will present an overview of those structures in the spinal cord which are concerned, or probably concerned, with nocicepfive mechanisms and correlate the structural observations, insofar as possible, with current neurophysiological concepts. A voluminous litera, ture is now available on both neuroanatomical and physiological aspects of the nocicepfive pathways, despite which major gaps in knowledge persist. An effort to identify these lacunae will be made. The discussion is divided into the following sectiozs: (I) Organization of primary afferents in the dorsal roots. (II) Organization of primary afferents in the dorsal horn and tract of Lissauer. (II1) Cytoarehitecture and synaptology of the dorsal horn in relation to nocicepfive input (a) marginal zone (lamina I) r4,75, (b) substanfia gelatinosa (laminae II and HI), (c)nucleus magnocellulafis or propfius (laminae IV, V, and VI). (IV) Neurons of origin of the spinothalamic tracts. (V) Spinal nociceptive tracts, lateral and ventral spinothalarrfic tracts: origin~ fiber composition, and caliber spectram. (VI) Other potential nociceptive pathways. (VII) Descending control of nocicepfive input. (VIII) Species differences.

181 citations


Journal ArticleDOI
01 Sep 1975-Pain
TL;DR: Computer controlled radiant heat stimulation for a combined psychophysical and electrophysiological research in pain was achieved by the use of an infrared Laser beam, suitable for recording of averaged evoked responses as well as for determination of pain and thermal thresholds.
Abstract: Controlled radiant heat stimulation for a combined psychophysical and electrophysiological research in pain was achieved by the use of an infrared Laser beam. The computer controlled stimuli, being of very brief duration (down to 5 msec) and sharply localized, are suitable for recording of averaged evoked responses as well as for determination of pain and thermal thresholds. These stimuli can be applied to any locus on the skin. The threshold energy delivered by this technique is similar to that obtained by the Hardy-Wolff-Goodell method. Special precautions were taken to avoid injury to the skin and the eyes.

160 citations


Journal ArticleDOI
01 Mar 1975-Pain
TL;DR: The threshold, frequency and refractory period data obtained in this study are similar to those found for wide dynamic range cells in the ventral half of the dorsal horn in the monkey and suggest that activation of these cells is a sufficient condition to produce pain in man.
Abstract: These studies have examined threshold, frequency, and refractory period characteristics of a neural population in the anterolateral quandrant (ALQ) of the spinal cord of man, stimulation of which produces pain. Subjects were 18 conscious humans undergoing percutaneous anterolateral cordotomy for relief of intractable pain. Pain could be produced by ALQ stimulation in all subjects. Pain thresholds ranged from 120 to 1000 muA (at 50 pulses/sec; 0.2 msec pulses), but the majority of thresholds were below 300 muA. A linear relationship was found between stimulation frequency and percentage of subjects reporting pain. This relationship ranged from 5 to 25 pulses/sec with 100% reporting pain at 25/sec and 0% at 5/sec. In 2 of 3 subjects, increases in stimulation frequency up to 500/sec did not produce pain when stimulation intensity was below threshold at 50/sec. The neuronal refractory period for pain in these subjects ranged between 1.0 and 2.0 msec, but the majority of relative refractory periods fell between 1.0 and 1.5 msec. The threshold, frequency, and refractory period data obtained in this study are similar to those found for wide dynamic range cells in the ventral half of the dorsal horn in the monkey and suggest that activation of these cells is a sufficient condition to produce pain in man.

144 citations


Journal ArticleDOI
01 Jun 1975-Pain
TL;DR: The gate theory appears to offer a way in which non-destru~;tive intervention into the nervous system might provide pain control without attenuated loss of neurological function, and an increased empbasis on neurophysiological research in pain has occurred.
Abstract: The publication in 1965 of ti~e gate theory of pain perception by Melzack and Wall reawakened interest in the therapy of chronic pain and has led to a resurgence of interest in the use of electrical stimulation of the afferent nervous system for pain relief 19. Prior to the popularization of the gate theory, interest in pain as a treatable condition was limited to a few centers, and the techniques available for the control of pain were small in number. Drug therapy is only partially effective and carries serious side effects. Nerve blocks are effective in certain condition= ~ut d~ have limitations and side effects. Major procedures available for pain relief require destruction of some part of the nervous system with consequent loss of function. The gate theory appears to offer a way in which non-destru~;tive intervention into the nervous system might provide pain control without atten6ant loss of neurological function zT. P In addition to this increased interest in the use of electrical stimulation, tottake advantage of the therapeutic principles suggested by this gate theory, an increased empbasis on neurophysiological research in pain has occurred. Out of this io.creased interest new therapeutic techniques have evolved. At the present time several forms of electrical stimulation of the:afferent nervous system have proven ability to relieve pain. Other techniques of stimulation are of value in the diagnostic sense, and several forms of electrical stimulatior, of the central nervous system can still be considered investigative. Electrical stimulation has been employed with the application of the electrode externally on the skin or orifice lining. Peripheral nerves have been stimulated by 3mall electrodes applied on the skin, over key sites along the course, or by electrodes inserted through the skin for temporz.ry or

131 citations


Journal ArticleDOI
Kevin Kane1, Arthur Taub1
01 Jun 1975-Pain

119 citations


Journal ArticleDOI
01 Mar 1975-Pain
TL;DR: Electrophysiological analysis of 82 L7 dorsal horn neurons antidromically activated from the contralateral C1 anterolateral quadrant of unanesthetized rhesus monkeys indicates that pain may be signaled by the combined output of dorsal horn laminae I and IV‐VI but that activation of only laminaes IV‐ VI wide dynamic range neurons is sufficient to produce pain.
Abstract: An electrophysiological analysis has been made of 82 L7 dorsal horn neurons antidromically activated from the contralateral C1 anterolateral quadrant (ALQ) of unanesthetized rhesus monkeys (bilateral carotid ligation). This analysis was made to compare refractory periods and antdromic activation thresholds with these same parameters of ALQ stimulation required to produce pain in conscious humans. Refractory periods of laminae IV-VI cells that were optimally but not exclusively responsive to noxious skin stimulation ranged from 0.8 to 2.8 msec ( m = 1.5 ) and were briefer than those of lamina I cells. The latter ranged from 1.1 to 10 msec ( m = 4.7 msec ). Electrical thresholds of laminae IV-VI cells were, in general, much lower than those of laminae I cells. Unlike lamina I cells, refractory periods and electrical thresholds of laminae IV-VI nociceptive neurons closely parallel those of ALQ-evoked pain in man. However, both lamina I and laminae IV-VI neurons usually responded to nociceptive skin temperatures (> 43 °C). This analysis indicates that pain may be signaled by the combined output of dorsal horn laminae I and IV-VI but that activation of only laminae IV-VI wide dynamic range neurons is sufficient to produce pain.

Journal ArticleDOI
01 Sep 1975-Pain
TL;DR: Five patients out of a group of ten who had dorsal column electrodes implanted for the relief of chronic pain were examined for the influence of the stimulation on the spontaneous pain and on the thresholds for touch, vibration and cutaneous pain induced by pinching.
Abstract: Five patients out of a group of ten who had dorsal column electrodes implanted for the relief of chronic pain were examined for the influence of the stimulation on the spontaneous pain and on the thresholds for touch, vibration and cutaneous pain induced by pinching. Stimulation producing paraesthesias resulted in an almost immediate abolishment of spontaneous pain and was accompanied by significant elevations of both tactile and vibratory thresholds. Elevation of thresholds was confined to segments below the site of implantation and occurred bilaterally also when the paraesthesias were restricted to one side. The changes of thresholds generally persisted for some time after the stimulation but these effects were short lasting in comparison with the effect on spontaneous pain. Elevation of sensory thresholds is presumably not due to blocking of the primary neurones but to central inhibitory mechanisms. The thresholds for induced cutaneous pain were not influenced by dorsal column stimulation except for one case in whom an abnormally low threshold within an hyperaestethic area became normalized.

Journal ArticleDOI
01 Jun 1975-Pain
TL;DR: The hypothesis that the neuroticism associated with chronic pain is the result of it, and may be reversible when the pain is reduced or abolished, is supported.
Abstract: Of 113 patients treated in a 2-year period, for whom complete data were available, 29 who received surgery for pain relief were compared with 84 who did not, both groups receiving psychological treatment and rehabilitation. Using an analysis of covariance to eliminate pre-treatment differences, the surgery patients showed significantly greater reductions on the MMPI Hysteria and Hypomania scales, and on the invalidism scale of a Health Index, and this was associated with a significantly greater reduction of pain. These differences obtained despite a greater increase in activity levels by the non-surgery patients at the time of testing. The results support the hypothesis that the neuroticism associated with chronic pain is the result of it, and may be reversible when the pain is reduced or abolished.


Journal ArticleDOI
01 Sep 1975-Pain
TL;DR: Among the more impressive services of hypnosis is its contribution to the relief of pain, which goes back to the early 1800, before ether and chloroform were introduced.
Abstract: Among the: more impressive services of hypnosis is its :ontribution to the relief of pain. The testimony of pain relief goes back to the early 1800~, before ether and chloroform were introduced, when hypnosis --commonly in the form of mesmerism demonstrated its success in major surgery with,~ut pain. Controversial claims and exaggerations led to a fluctuating history of acccptance and rejection, oNy now being

Journal ArticleDOI
01 Mar 1975-Pain
TL;DR: The threshold at which noxious stimulation with a pressure algometer gives rise to a complaint of pain has been studied in neurological and psychiatric patients with pain and in two patients with fluctuating pain of organic origin.
Abstract: The threshold at which noxious stimulation with a pressure algometer gives rise to a complaint of pain has been studied in neurological and psychiatric patients with pain and in two patients with fluctuating pain of organic origin. A correlation of r = 0.69 (P

Journal ArticleDOI
01 Jun 1975-Pain
TL;DR: The analysis of oscillations showed that the afferent discharge of a limb controls the contralateral sympathetic output through central mechanisms, and that the cutaneous pain threshold may be exerted through a negative feedback loop.
Abstract: In a group of 30 subjects suffering from sympathetic reflex dystrophies of the limbs, the sympathetic ganglia of the affected side were blocked with a local anesthetic. Using an original method, we measured the cutaneous pain threshold before the block and at prefixed intervals after the block during a period of 2 days. In all subjects the cutaneous pain threshold showed damped oscillations both in the limb ipsilateral to the block and in the contralateral one. The analysis of these oscillations showed: (a) that the sympathetic control of the cutaneous pain threshold may be exerted through a negative feedback loop (skin-afferent input-CNS-sympathetic output-skin); (b) that the afferent discharge of a limb controls the contralateral sympathetic output through central mechanisms.

Journal ArticleDOI
01 Dec 1975-Pain
TL;DR: Programmes, can. focus on psychological components of acute and pro.. hal responses, hypochondfiacal and depressive ickness roles and interpersonal manipulation and cognitive and mot0rstrategieS to allay emotional reactions and enhance personal control.
Abstract: : Clinicians: famiharwith .ff,Le importance of psychological and social determiiate\"distress and enhance many forms of treat~ody of .: kn~ iedge is::recent :and rather poorly ci:~iNan: is !ef~.detyendent~upon intuitive inter. : e l ' i : ' ~.etively :evaluated strategies. generally available ~:oi a-li:!~~ec~ntll deVei6~merits., o fps~61og ica l treatment.procedures found to be and~sometimeSel!mina!ing pain-are: d~ect analgesic suggeshypnosis; or through placebo instructions ~,~, cognitive and mot0rstrategieS to allay\"emotional reactions and enhance personal control ~, filmed.ori:live exposure to Others undergoing comparable threatening experiences, but not manifesting excessive emotional or avoidance bebaviourL~. *~, and contigency management 1°. These and other techniques, when embedded in comprehensive treatment.programmes, can. focus on psychological components of acute and pro.. hal responses, hypochondfiacal and depressive ickness roles and interpersonal manipulation ~-. s~ra~egies:deriving from a concemrated study fisms controlling pain seems consideraNe.

Journal ArticleDOI
01 Mar 1975-Pain
TL;DR: There is considerable variation within this review in the treatment of individual toxins, and this variation reflects the differences in the extent to which the compounds have been characterised.
Abstract: This review considers a range of.toxins which produce or are likely to produ::e pain in man and other higher animals. The term 'toxin' is used, ilt accord wi~h Vogt 4n8, to describe any naturally-occurring substance of animal or plan:, origin that is both foreign and damaging to the victim. Since it is common experierce that ma ay bites and stings are far more painful tkan is to be expecte~t from ::he extent of t~ae: physical trauma produced, particular emphasis is given to v:moms. The term 'yen .~ ~.' is used here to describe the complete secretion of the .~peciatised venom gtand.~ o ,,n animal, and it follows from this that some partially or .;omgletely pu

Journal ArticleDOI
01 Sep 1975-Pain
TL;DR: The taxonomy developed by the Task Force on Taxonomy of the International Association for the Study of Pain is described as well as the basis for it.
Abstract: An ideal taxonomy should be comprehensive and its categories should be mutually exclusive. Every item should have a particular place either on its own or with other items that resemble it. This is rarely, if ever, achievable in practice in medicine. The reasons for this are explained. The taxonomy developed by the Task Force on Taxonomy of the International Association for the Study of Pain is described as well as the basis for it.


Journal ArticleDOI
01 Mar 1975-Pain

Journal ArticleDOI
01 Sep 1975-Pain
TL;DR: Two patients with posterior thoracic pain associated with cysts of the septum posticum are described, one of which was relieved by surgical removal of the cysts; the second patient's symptoms temporarily resolved after myelography.
Abstract: The authors describe two patients with posterior thoracic pain associated with cysts of the septum posticum. One patient's pain was relieved by surgical removal of the cysts; the second patient's symptoms temporarily resolved after myelography. Posterior thoracic pain can be ascribed to myelographically proven arachnoid cysts when the pain is persistent, positionally exacerbated and associated with radicular sensory changes. Excision of the cysts may provide pain relief for some patients.

Journal ArticleDOI
01 Sep 1975-Pain
TL;DR: The treatment of post-herpetic v_eura!gia by undercutting or denervating the skin cannot now be cal~ed 'a recently introduced treatment which has given promising results', and should be dismissed as an old method that has been abandoned as it is of no value.
Abstract: We wi!l have to get used to paying a lot of money for e~,.erything, including books, but no-one is rec0mmer~ded to,spend £ 7250forlthis book. It just does nbt have that amount of good things in it. There is a Useful. cha~fer~by L Co: Wt~iteof the Massachusetts General Hospital in Boston, based on a Iifetime's experien~ 6f Nin-i:elieving procedures and operations. This means that his recommendations are not jUst p0t~uiar beliefs or hearsay evid¢nce, but that they are based on this 1argo serie~ of hiS0wn cases. He covers tfigeminal,7"~" gt0ssopbaryngeal av.d vagal neuralgia, post-herpetic neuralgia, atypical facial pain, temporal artefifis, migrainous neuralgia, pain following lumbar disc surg~ery, arachnoiditis affecting the lumbar and sacral roots, intercostal neuralgia, pain following amputations, gastrOinteStir~al pain; and syrnpath~tomy as therapy for painful conditions~ : There.is: a. I~a.ciical e_ha~ter b} Dudley; Hart, which is particularly"o useful on the management of~the rheumatic dis0rders by drugs. But ~tiis cfiapter iS not welt written; some punctuation would have'hel~d2 :: : "As' the Standardof writing is even lower in the chapter by Stanley A. Feldman, the chapter :;ttould have : ~ n properly edited; For instance, Feldman gives a short section on pain threshold;~. but this subject was covered ~;n detail by E. C. Huskisson in his chapter on the mechanisms and measurement of pain. The whole chapter by Feldman on chemical methods of neuretysis should have been made more succinct and condensed. The treatment of post-herpetic v_eura!gia by undercutting or denervating the skin cannot now be cal~ed 'a recently introduced treatment which has given promising results'. If it is to be mentioned at all, it should be dismissed as an old method that has been abandoned as it is of no value. No book should have sentences such as Pare due .o trauma, will be carried along the appropriate somatic nerve." Feldman's writing of English is not good enough. f'or example, he uses ~maltreatment" to mean bad or poor treatment, whereas the word of course means rough handling or ill-use. If the medica| editor of a book consisting of the contributions of various writers does net go through the manuscripts'to ensure ~ood or even adequate English and clarity of expression, then the publishers ShouldemP]oy an editor tO do this. P. W. Nathan

Journal ArticleDOI
01 Dec 1975-Pain
TL;DR: It is suggested that aprotinin acts on biochemical mechanisms that cause the ischemic pain, presumably it inhibits kininogenases and tissue protein‐hydrolyzing enzymes activated in the course of ischemia.
Abstract: Twenty patients with peripheral arterial disease and 10 normal controls were submitted to i.v. injection of aprotinin, polypeptide (mol.wt. 6512) extracted from bovine lung, in order to examine its effects on: (a) lower limbs pain, (b) lower limbs sensibility, (c) calf blood flow. Aprotinin (100,000 KIU i.v. diluted in NaCl 0.9%) was given in a single dose or twice a day for a week; for control the same subject received, before or after aprotinin, an equivalent volume of diluent (0.9% NaCl). The results demonstrate that aprotinin is able to increase the initial pain limit walking tolerance and to decrease the intensity of pain at rest and of myalgic or ‘trigger’ areas. No variation was observed on skin sensibility and on calf blood flow, both basal resting and hyperemic. The favorable effect of examined polypeptide on ischemic pain can be attributed neither to increase of calf blood flow nor to influence on perception of painful stimuli. It seems therefore to suggest that aprotinin acts on biochemical mechanisms that cause the ischemic pain. Presumably it inhibits kininogenases and tissue protein-hydrolyzing enzymes activated in the course of ischemia.

Journal ArticleDOI
01 Mar 1975-Pain
TL;DR: The n~ajority of contributors to this monograph, one of a series in Anesthesiology, are an,.
Abstract: The n~ajority of contributors to this monograph, one of a series in Anesthesiology, are an,.'sthetists. ,~,s the tit!e states, it is mainly concerned with the treatment of chronic pain. The more basic aspects are discrssed in a short first chapter which is hardly adequate if clinical syndromes are to be c, is:ussed as we!,l. Thalamotomy is clearly the method of preference of the neurosurgeon who contributes tc this book although other methods are mentioned. Thalamotomy is discussed at length anu sic~e effec;s and longterm results frankly stated. It is not clear why the results in the benign groups a \"e qualified as 'remarkably encouraging\" when immediately following the author states 'however a~'ter initial success pain recurrence was common . . . . '. The chapters on radiotherapy, anticancer drugs and the use of hormones, and the psychological a:;pects are fctlowed by the a!::.c~t Gbligatory discussion cn the management of Pain Clinics. The excellent illustrations, together with the descriptions, g've a good understanding of the techniq,ae of blocking uerve conduction. Presumably this is meant to enable o~hers to apply these methods and therein lurks a danger. Neurolyt,c agents used in blocking conduction, by causing destructive lesions are, except in the hands of the very experienced, risky procedures. In inaccessible locations such as the coeliac or stellate gang!ion the) may give rise to serious compfications. When used on som~ttic afferent nerves the lesion is often not permanent. Those who are confronted with the late resuits of such me0~ods are aware of the formidable diagnostic and therapeutic problems such patients present when partial regeneration is superimposed upon the original painful condition. Thi:.'. holds true for ;dl destructive lesions. There is he. short~.ut to success. IExtreme[if meticulous clinical analysis, very careful selection and abo,:e all patience and restraint should be the motto of anyone called upon to treat chronic pain.


Journal Article
R. B. Lal1
01 Aug 1975-Pain
TL;DR: In this article, a review of literature on crystal growth from melt, vapor phase and float zone was reviewed and the physical phenomena important for crystal growth in zero-gravity environment was analyzed.
Abstract: A study was undertaken to analyze different growth techniques affected by a space environment. Literature on crystal growth from melt, vapor phase and float zone was reviewed and the physical phenomena important for crystal growth in zero-gravity environment was analyzed. Recommendations for potential areas of crystal growth feasible for space missions are presented and a bibliography of articles in the area of crystal growth in general is listed.