Patient controlled analgesia (PCA):

PCA is a relatively new route of drug administration, offering great promise in both pain control and research. Results from the management of chronic pain shows that PCA can lead to significant improvements in ambulatory patients with cancer. The fundamental principle of PCA is that it allows patients to reach their own analgesic state and thereby achieve an individual balance between pain relief and the appearance of side-effects.

The point at which the patient becomes uncomfortable enough to make a demand has become known as the minimum effective (blood drug) concentration (MEC). The MEC represents that concentration which removes the distress of pain but not necessarily the sensation of pain. When using PCA, patients should load themselves to exceed their MEC and then demand to deliver the drug as needed to maintain it. This demand pattern ensures that the patient maintains satisfactory pain relief without excessive sedation. Preoperative education concerning PCA may greatly influence its post-operative use.

Transcranial Electrostimulation:

A new transcranial electrostimulation device, the PULSATILLA, has now been developed for use in acute and chronic pain. Quasi-resonance produced by the pulses in the antinociceptive region of the brain induce accelerated ß-endorphin secretion. It consists of a microcontroller-based stimulus generator with resident medical soft ware library, and a head set with electrodes. One electrode is placed on the forehead and another on the mastoid bone behind each ear. The battery-operated generator emits pulses of a fixed and controlled frequency and shape at a maximum of 4mA strengths. Treatment sessions last up to 30 mins.

Contra-indications: Epilepsy, glaucoma, CNS disease, demand cardiac pace maker and skin damage over electrode areas.