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At least 397 records · Page 22Linked to original sources
PubMed1993

Intrathecal infusional therapies for intractable pain: patient management guidelines.

This article focuses on appropriate patient selection for and management of patients selected for continuous spinal infusional opioid therapy. Patients with cancer-related pain who have undergone sequential strong opioid drug trials, who have intractable, unmanageable side effects, and who have undergone a successful spinal opioid efficacy trial are candidates for implantable spinal infusional therapy. Patients with noncancer-related chronic pain, who have failed all conventional syndrome-specific therapies before neuroablative surgical procedures, including sequential strong opioid drug trials, who have intractable, unmanageable side effects, and who have undergone successful spinal opioid efficacy trial are deemed candidates for implantable spinal infusional therapy. Patients with chronic noncancer-related pain and patient with cancer-related pain who have life expectancies greater than 3 mo all have implanted programmable infusion pumps. Patients with cancer-related pain who have life expectancies less than 3 mo have implanted permanent epidural catheters connected to external pump systems. Management guidelines for complications of therapy broadly categorized as surgical, mechanical, and pharmacologic are presented.

Analgesia, Epidural↗
PubMed1980

Gammathalamotomy in intractable pain.

Thalamotomy aiming at the CM-Pf complex and using stereotactic gamma irradiation has been performed in a series of 52 patients with severe pain due to malignancy. Lesions were produced either contra- or ipsilaterally to the side of the pain as well as bilaterally. Eight patients experienced good pain relief, 18 had moderate relief, and in 24 the operation did not significantly influence the pain. A second operation following recurrence of pain was rarely of value. There was a tendency towards more efficient relief of pain located in the face or in the arm and shoulder than of pain in the lower part of the body. Although contralateral lesions seem to be most effective, ipsilateral operations may also give some relief. The best results were obtained when the lesions were placed close to the wall of the third ventricle and at the level of the posterior commissure. Postmortem examination of 21 brains disclosed that the mean error in the placing of the lesions was about 1 mm. It is concluded that medial thalamotomy may be tried as a last resort in the treatment of cancer pain in selected patients with a short life expectancy.

Aged↗
PubMed1989

Percutaneous epidural catheterization for intractable pain in terminal cancer patients.

We examined the effects of long-term percutaneous epidural catheterization for pain relief in nine terminally ill gynecologic cancer patients. All patients were free of side-effects such as respiratory depression, nausea, vomiting, urinary retention, or pruritus. Analgesia was excellent in six patients. Puncture-site skin inflammation occurred in four patients. Catheter dislodgement occurred in three patients. Although percutaneous epidural catheters were well tolerated in a few patients for an extended period of time, the frequency of catheter problems demonstrate that other methods such as catheter tunneling or implantable systems should be considered for long-term epidural administration of narcotics. This method appears to be most effective in patients suffering from pain due to nerve root involvement.

Analgesia, Epidural↗
PubMed1985

[Percutaneous epidural electrical stimulation of the spinal cord for intractable pain--with special reference to deafferentation pain].

In a study of 44 patients with different types of chronic pain, mostly associated with deafferentation, chronic percutaneous epidural spinal stimulation has proved useful treatment achieving an initial 52% incidence of pain amelioration overall. Long-term result showed at six months in 86%, at 1 year in 90%, although technical problems, which included electrode displacement and required minor operative readjustment, affected 48% of those permanently implanted. No other complications were seen. Success bore no relationship to quality of pain reported by the patients or to duration of pain. The patients with denervation caused by nerve or root lesions responded better than those with cord lesions even though electrical paresthesia were delivered to the area of pain in each case. A decline in effectiveness with time was noted in small numbers of our cases despite persistence of paresthesia in the area of pain. It is suggested that late failure reflects plasticity of the nervous system in adapting to new inputs. Morphine study was carried out in some of these patients. Morphine did not help to ameliorate the pain in many cases with deafferentation pain. And also Naloxone was administered during successful pain-relieving stimulation. This did not result in recurrence of pain. The Somato Sensory Responses were recorded in 25 patients before and during neurostimulation. When stimulation was applied the late component was suppressed in most of those who enjoyed a good result. The early component was not changed in those patients even during stimulation. These results suggest that spinal cord stimulation would suppress the denervative hypersensitivity of dorsal horn in the patients with deafferentation pain.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

The use of the opiate antagonist, naloxone, in the treatment of intractable pain.

Thirteen adult patients with established thalamic syndrome, resistant to prior analgesic and other therapy, were treated with intravenous infusions of the opiate antagonist, naloxone. A total of twenty treatments were administered with doses of naloxone varying from 4.0-8.0 mgs. Seven patients exhibited beneficial effects with the duration of the resultant pain relief ranging from four days to two and a half years. In these patients, pain and hyperpathia were completely obtunded in six out of seven and partially in one. Side effects of therapy were minimal and of short duration being mainly confined to the cardiovascular system. During therapy all patients had continuous E.C.G. monitoring. In certain ischaemic conditions of the central nervous system, endogenous opioids possibly reduce cerebral blood flow via. inhibition of the locus coeruleus and subsequent release of noradrenaline: hence naloxone by inhibiting the opioids could increase cerebral perfusion pressure. This study has shown the benefit of treating patients with cerebral ischaemic lesions with an opioid antagonist. The rapidity of onset of pain relief in these patients would appear to indicate a mode of action by increasing cerebral perfusion.

Aged↗
PubMed1997

Deep brain stimulation for intractable pain: a 15-year experience.

OBJECTIVE: During the past 15 years, we prospectively followed 68 patients with chronic pain syndromes who underwent deep brain stimulation (DBS). The objective of our study was to analyze the long-term outcomes to clarify patient selection criteria for DBS. METHODS: Patients were referred from a multidisciplinary pain clinic after conservative treatment failed. Electrodes for DBS were implanted within the periventricular gray matter, specific sensory thalamic nuclei, or the internal capsule. Each patient was followed on a 6-monthly follow-up basis and evaluated with a modified visual analog scale. RESULTS: Follow-up periods ranged from 6 months to 15 years, with an average follow-up period of 78 months. The mean age of the 54 men and 14 women in the study was 51.3 years. Indications for DBS included 43 patients with failed back syndrome, 6 with peripheral neuropathy or radiculopathy, 5 with thalamic pain, 4 with trigeminal neuropathy, 3 with traumatic spinal cord lesions, 2 with causalgic pain, 1 with phantom limb pain, and 1 with carcinoma pain. After initial screening, 53 of 68 patients (77%) elected internalization of their devices; 42 of the 53 (79%) continue to receive adequate relief of pain. Therefore, effective pain control was achieved in 42 of 68 of our initially referred patients (62%). Patients with failed back syndrome, trigeminal neuropathy, and peripheral neuropathy fared well with DBS, whereas those with thalamic pain, spinal cord injury, and postherpetic neuralgia did poorly. CONCLUSION: DBS in selected patients provides long-term effective pain control with few side effects or complications.

Adult↗
PubMed1997

Advances in nursing patients with intractable pain.

Caring for patients with prolonged persistent pain remains one of nursing's greatest challenges. Increased knowledge and understanding of pain pathways, however, has enabled new treatments to be incorporated into pain management regimes. Of particular interest has been the association of the N-methyl-D-aspartate (NMDA) receptors with the development of hyperalgesia and 'wind-up'. This review will explore the physiological processes associated with these phenomena, and the use of NMDA receptor antagonists such as ketamine and dextromethorphan to prevent and treat persistent pain. The importance of nurses understanding the modes of action of these drugs will be illustrated through presentation of two case histories.

Anesthetics, Dissociative↗
PubMed1998

Treatment of intractable pain with topical large-dose capsaicin: preliminary report.

UNLABELLED: Complex regional pain syndromes (CRPS) and neuropathic pain are often poorly controlled by conventional pharmacologic interventions. We administered 8-methyl-N-vanillyl-noneamide (capsaicin) at doses of 5%-10% to individuals with such disorders in this trial. Previous limitations to trials with larger-dose, topical concentrations of capsaicin included intense burning sensations experienced after application. To enable patients to tolerate the high concentrations, we first performed regional anesthesia. All patients reported at least some relief. Of 10 patients, 9 obtained substantial analgesia that lasted 1-18 wk. At Week 1 after therapy, the mean verbal analog scale (VAS) scores decreased from 8.0 to 3.0. At Week 4 after therapy, mean VAS score was 4.5. Analgesia lasted from < 1 wk (1 patient) to more than 50 wk (1 patient). Patients received one to eight treatments. With one exception, patients receiving more than one treatment obtained additional relief with subsequent treatment. Pain responsive to opioids was the only side effect of treatment. Large-dose capsaicin administered with regional anesthesia may effectively minimize refractory CRPS and neuropathic pain. A double-blind, placebo-controlled study in patients with bilateral peripheral neuropathy using epidural anesthesia with and without large-dose topical capsaicin is in progress. IMPLICATIONS: Sensory neuropathies are associated with many diseases. Pain from these disorders can produce greater disability than the primary disease processes themselves. Currently available therapies are limited. However, the intermittent application of large-dose topical capsaicin may provide significant pain relief, decrease chronic analgesic dependence, and decrease aggregate health care expenditures.

Administration, Topical↗
PubMed1985

[Initial experiences with simultaneous combined radiation and cytostatic chemotherapy in the modification of intractable pain by inoperable tumor growth in the ENT area].

Patients with malignant tumours of the ENT, who show signs of tumour progression after operation, radiation and chemotherapy, could be treated with a new combined therapy. We present a patient who was successfully treated by combined radiation and chemotherapy with Cisplatin, Ifosfamid, and BCNU. This therapy offers a chance of tumour reduction even for repeatedly treated patients. The relief of pain proves the success of the therapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Experience with dorsal column stimulation (DCS) in the operative treatment of chronic intractable pain.

The results of DCS in 50 patients are altogether favourable; they are better for the group of amputation and phantom pain than for the group of peripheral nerve lesions. For patients with malignoma pain no valid comment can be given. The influence of DCS is mostly immediate in bouts of acute pain, slower in chronic permanent pain, where a longer period of stimulation is needed. The observation of such longer stimulation periods together with the experience that during DCS there is a shift in the pain threshold, even in segments above the stimulus including also the face, seems to indicate a participation of higher neuronal centers in the assumed gate control.

Amputation Stumps↗
PubMed1982

Intravenous lidocaine for the treatment of intractable pain of adiposis dolorosa.

Adiposis dolorosa (Dercum's disease) is a syndrome of painful adipose tissue which occurs most often in post-menopausal women and is associated with obesity, asthenia, and emotional disturbances. The etiology is uncertain, but is probably multifactorial. Numerous treatments to relieve the pain have generally been unsuccessful. A patient with adiposis dolorosa was treated with intravenous infusions of lidocaine over a two-year period. Relief from pain lasted from two to 12 months after each infusion. A single-blind placebo infusion did not relieve the pain. Lidocaine infusions did not relieve the pain of diabetic neuropathy or of angina in this patient. The mechanism of relief of pain of adiposis dolorosa by lidocaine is uncertain, but previously reported central effects of lidocaine suggest that alterations in the central nervous system may be responsible.

Adiposis Dolorosa↗
PubMed1997

[Two cases of crush syndrome associated with intractable pain].

We describe two patients (a 21-year-old woman and a 26-year-old man) with crush syndrome who were injured by being buried under collapsed buildings in the Kobe-Awaji Earthquake, and thereafter developed severe pain in the affected limbs. On arrival at our ICU 3 days after the injury, sensation and muscular power were completely absent in both patients. Emergent fasciotomy was performed for the woman. In both patients, burning pain and allodynia occurred in the affected legs between 1 and 3 weeks following the injury while sensation and muscular power partially recovered over the same time period. Pain was not effectively controlled by oral or intramuscular analgesics. Continuous epidural analgesia with 0.25% bupivacaine at a rate of 2 ml.h-1 was effective for relieving pain in the woman, but was not effective in the man, for whom supplemental analgesics, transcutaneous nerve stimulation and near infrared radiation were required to relieve pain. We conclude that persistent pain is one of the important complications of crush syndrome, and that early treatment of pain including epidural analgesia is necessary and may improve functional prognosis of affected patients.

Adult↗
PubMed1990

Retrograde adriamycin sensory ganglionectomy: novel approach for the treatment of intractable pain.

Selective sensory ganglionectomy by means of retrograde suicide transport of adriamycin was performed on 3 patients with neuropathic pain in the areas of the trigeminal and intercostal nerves, producing significant pain relief, particularly from hyperalgesic pain. Adriamycin ganglionectomy is considered as a less invasive and highly selective pain treatment, which may possibly become an alternative for surgical ganglionectomy or rhizotomy.

Aged↗