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PubMed1988

Chronic intractable pain: an atypical presentation of multiple sclerosis.

Both acute paroxysmal pains and a variety of chronic pain syndromes have been described in multiple sclerosis. These usually occur in the setting of well-established disease. Although paroxysmal pain has been recognized as a rare first symptom in this disorder, presentation with severe, continuous dysesthesias of long duration has not been previously appreciated. We report the cases of three patients in whom refractory continuous pain signalled the onset of demyelinating disease. These observations further define the clinical spectrum of multiple sclerosis and have implications for the evaluation of patients with chronic neuropathic pains of unknown etiology.

Adult↗
PubMed1988

Intraspinal opiates for treatment of intractable pain in the terminally ill cancer patient.

The discovery of opiate receptors and then their endogenous ligands in 1974 (Snyder et al., 1974) has elucidated a vast pharmacology of opiates providing a basis for their diverse clinical applications. With the awareness of quality of life as a primary goal in terminal cancer patients, widespread attention has been drawn to the direct delivery of long-term intraspinal analgesics to cancer patients for who all medical pain control regimens have failed (Coombs & Saunders, 1974). Intraspinal administration of opiates and nonopiate analgesics is not only appealing on theoretical grounds but provides a minimally invasive method to insure otherwise unobtainable pain relief while eliminating obtundation and systemic side-effects associated with conventional therapy (Cobb et al., 1984; Harbaugh et al., 1982; Leavens et al., 1982; Malone et al., 1985; Onofrie et al., 1981; Poletti et al., 1981). Although intraspinal opiates have been used in the treatment of postoperative and benign-pain syndromes (Asari et al., 1981; Cousins & Mather, 1984), in our discussion we review the basic science, current techniques and possible future improvements in spinal analgesia in the control of chronic cancer pain.

Humans↗
PubMed1985

Deep brain stimulation for alleviating chronic intractable pain.

The authors present their 4-year experience with 18 patients who had deep brain stimulation. Most were referred because of chronic pain of varied etiology. All conventional modalities of management had failed. Both the paraventricular gray matter and the sensory thalamus were target sites. The 18 patients underwent a total of 21 implants. Follow-up ranged from 6 months to 4 years with moderate relief of prestimulation pain in 14 patients (77%). Patients with failed back syndrome secondary to multiple disc operations fared well. Patients with pain secondary to progressive neurologic disorders or cancer had only short-lived benefits, while those with pain from cauda equina injury or vascular disease had a poor result. Deep brain stimulation appears to be an effective means of controlling chronic pain in selected cases.

Adult↗
PubMed1975

Stimulation of the posterior columns of the spinal cord for relief of intractable pain.

Sixty-nine patients with chronically incapacitating pain were treated with an implantable stimulator over the posterior columns of the spinal cord. Evaluations at 24, 30 and 34 months showed a progressive decrease in the number of patients considered to have an excellent result. Evaluation of 60 patients with pain of benign origin after implantation of the stimulating device showed only ten patients who could be considered to have an excellent result on the basis of their own report of pain relief. The most common failure of the stimulating devices was failure of stimulation into a painful part.

Ankylosis↗