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PubMed2003

Deep brain stimulation for the treatment of intractable pain.

Deep brain stimulation (DBS) plays an important role in the treatment of chronic pain when other less invasive treatment modalities have been exhausted. DBS is an apparently safe and effective treatment option for a select group of patients. Further research into the mechanisms of pain relief by DBS and careful prospective outcomes studies should help to define better the optimal techniques for DBS and clarify which patient populations may be best helped by this interventional procedure.

Animals↗
PubMedDate not supplied

Intractable pain management with intravenous narcotic administration at home.

Administration of intravenous narcotics in a patient's home is a relatively new therapeutic method of controlling excruciating cancer-related pain. As with any new therapy, there are many questions and concerns related to administration and management. This article presents information derived from a literature review designed to improve understanding and technique.

Home Care Services↗
PubMed1976

[Stereotactic brain operations in intractable pain (author's transl)].

The indications for central stereotactic procedures in chronic painful states are essential neuralgia, postherpetic neuralgia, anaesthesia dolorosa, causalgia, phantom-limb pain, the thalamic syndrome and pain neoplastic diseases. Stereotactic surgery applied for these conditions consists of nucleotomy of the tractus spinalis nervi trigemini, mesencephalotomy, thalamotomy, hypophysectomy, psychosurgical interventions, and chronic stimulation with implanted electrodes. The techniques and results of the interventions are reported.

Brain↗
PubMedDate not supplied

Intrathecal infusion of bupivacaine with or without buprenorphine relieved intractable pain in three patients with vertebral compression fractures caused by osteoporosis.

BACKGROUND AND OBJECTIVES: At present, there is no reliable method of relieving "refractory" pain in patients with compression fractures of the vertebral bodies caused by osteoporosis. We explored the possibility of relieving this type of pain by intrathecal (i.t.) infusion of bupivacaine with or without buprenorphine. METHODS: An 18-g nylon i.t. catheter was inserted via a lumbar interspace with its tip positioned at the level of the fractured vertebra from which the maximal pain originated. Bupivacaine (2.375-5.0 mg/mL) with (n = 1) or without (n = 2) buprenorphine (0.015 mg/mL) was infused through the i.t. catheter from an external electronic pump. The infusion began in the operating room at a basic rate of 0.1-0.2 mL/h, with optional bolus doses (0.1 mL, 1-4 times/h) via patient controlled analgesia. The daily dose of i.t. bupivacaine was adjusted to provide satisfactory pain relief [visual analogue scores (VAS) = 0-2 on a scale of 0-10]. RESULTS: Satisfactory pain relief was obtained with daily doses of i.t. bupivacaine ranging from 10 to 70 (mean approximately 25) mg and buprenorphine from 0.02 to 0.2 (mean = 0.15) mg. The duration of i.t. treatment was 37, 387, and 407 days, respectively. Two patients terminated the i.t. treatment when it was no longer needed. Treatment was discontinued in the third patient because of death caused by irreversible heart failure. The 2 surviving patients were still free of pain 1,074 and 1,476 days after termination of the i.t. treatment. No severe complications occurred. CONCLUSIONS: Continuous intrathecal infusion of bupivacaine, with or without buprenorphine, appeared to be an effective method for the long-term treatment (months to > 1 year) of "refractory" pain from vertebral compression fractures, in this small group of patients.

Aged↗
PubMed1993

Control of intractable pain in erythromelalgia by using spinal cord stimulation.

A 69-yr-old woman with severe, long-standing erythromelalgia possibly secondary to multiple deep-vein thromboses, was treated with transcutaneous electrical nerve stimulation for the burning pain in her legs and feet. Problems developed, and she was subsequently successfully managed with spinal cord stimulation. The relief was reproduced after a 6-mo period of no stimulation by reestablishing spinal cord stimulation.

Aged↗
PubMed1988

Intractable pain: a neglected area of medical education in the UK.

Unease over the previous management of 67 patients referred for treatment to 3 pain relief clinics led us to investigate the current state of education in pain and pain control in the UK. Twenty-seven medical schools provided data which revealed; (i) in 4 schools no teaching whatsoever is given in these subjects; (ii) in the remainder it is accorded an average of 3.5 hours during the 5 year course, with little evidence of multidisciplinary teaching; (iii) only 10 schools (37%) regularly set questions on pain control in formal examinations. A survey of 219 general practitioners revealed a wide-ranging lack of knowledge about the facilities and approach to treatment at their local pain relief clinic. These findings have wide reaching implications for medical education. At the undergraduate level they demonstrate a need for more multidisciplinary teaching and practical experience in specialist units. Thereafter specialists in pain control must enable practising doctors to keep abreast of new developments. This may require them to devote more time writing for a non-specialist audience and devising short, postgraduate courses.

Education, Medical↗
PubMed1975

Experience with dorsal column stimulation for relief of chronic intractable pain: 1968-1973.

Dorsal column stimulators (DCS) have been implanted in 130 patients with various chronic pain syndromes at the University of California, San Francisco, between 1969 and 1973. Preoperative psychiatric evaluation and percutaneous dorsal column stimulation testing were of value in rejecting those patients most likely to have unsatisfactory long-term results with DCS. Best results occurred in patients with phantom limb or peripheral nerve pain and worst results in patients with paraplegic pain, documented arachnoiditis, pancreatitis and arthritis. The need is stressed for careful preoperative selection and for close, prolonged postoperative care in a situation permitting access to multidisciplinary facilities for patient care.

Adult↗
PubMed2000

[Ineffective and recurrent cases of thoracoscopic sympathectomy for hyperhidrosis and intractable pain].

We reported the cases of thoracoscopic sympathectomy, that is, six cases of hyperhidrosis, three of post herpetic neuralgia, and four of reflex sympathetic dystrophy, including recurrent or incompletely resected or ineffective ones. Recently this procedure for hyperhidrosis had been performed frequently because of its effectiveness, less pain, early discharge and cosmetic aspect. For an ineffective case of hyperhidrosis abdominal respiration which emphasized the exhalation and using an upper abdomen decreased the sweating. The balance of autonomic nerve system, toward parasympathetic dominant, was thought to be improved by conscious respiration. The decrease of sweating right after the operation in a case of incomplete resection indicated that intraoperative maneuver could restrict the sympathetic nerve. This procedure for a pain control could be less effective than that for hyperhidrosis, so an adequate preoperative informed consent was thought to be necessary.

Adolescent↗
PubMed1975

Percutaneous implantation of chronic spinal cord electrodes for control of intractable pain: preliminary report.

A percutaneous technique is described for implanting a dorsal or ventral column stimulator for pain control with minimal surgical trauma. If the patient does not respond to percutaneous on-surface spinal stimulation, a percutaneous cordotomy can be carried out, as the needle is already in the correct position. Stimulation of the cord at the C1-2 level can be used for treatment of trigeminal neuralgia.

Electric Stimulation Therapy↗
PubMed1975

Stimulation of the dorsal spinal cord for treatment of intractable pain: a preliminary report.

Electrical stimulation of the nervous system has been advocated as a means of alleviating pain in situations in which more conventional methods have been ineffective. A chronically implanted electrode on the dorsal surface of the spinal cord may prove to be a valuable adjunct to the neurosurgeon's armamentarium for pain control in selected individuals. The physiologic basis for this action is unclear but has been related to Melzack and Wall's gate control theory. This preliminary report deals with a series of patients treated with implanted dorsal cord stimulators.

Adult↗
PubMed1985

Chronic stimulation of the septal area for the relief of intractable pain.

Although brain stimulation techniques have changed the treatment of pain, their rationale has not yet been fully proved, and their clinical results are still frequently erratic or contradictory. In an attempt to provide alternate sites for stimulation, 10 patients were, in addition to conventional targets, chronically implanted at the septal area. Satisfactory relief of dysesthetic pain was induced by septal stimulation in 60% of the cases overall, without untoward effects. The follow-up ranged from 1 to 42 months. The available data conceivably suggest other mechanisms than the presumed exclusive activation of opiomimetic structures. They also seem to indicate that the septal area may be a suitable target for chronic stimulation.

Electric Stimulation Therapy↗
PubMed1986

Percutaneous radiofrequency lesioning of dorsal root ganglia for intractable pain.

A series of 26 patients with chronic pain were treated with percutaneous radiofrequency lesioning of the dorsal root ganglion. Ten patients had an excellent result, which persisted in 8 to the present time or death, and 5 had a good persistent result. A useful persisting result was therefore obtained in 13 patients with a further 2 patients having temporary benefit.

Adult↗
PubMed2005

A comparison of two invasive techniques in the management of intractable pain due to inoperable pancreatic cancer: neurolytic celiac plexus block and videothoracoscopic splanchnicectomy.

BACKGROUND AND AIMS: Pancreatic cancer is characterized by a constant deterioration in quality of life, excruciating pain and progressive cachexia. The aim of this study was to compare the effectiveness of two invasive methods of pain treatment in these patients: neurolytic coeliac plexus block (NCPB) and videothoracoscopic splanchnicectomy (VSPL) to a conservatively treated control group concerning pain, quality of life and opiates' consumption. PATIENTS AND METHODS: Fifty nine patients suffering from pain due to inoperable pancreatic cancer were treated invasively with NCPB (N=35) or VSPL (N=24) in two non-randomised, prospective, case-controlled protocols. Intensity of pain (VAS-pain), quality of life (FACIT and QLQ C30) and opioid intake were compared between the groups and to a control group of patients treated conservatively before the procedure and after 2 and 8 weeks of follow-up. The analysis was performed retrospectively using meta-analysis statistics. RESULTS: Both methods of invasive pain treatment resulted in significant reduction of pain (VSPL effect size=11.27, NCPB effect size=7.29) and fatigue (effect sizes, respectively, 1.23 and 3.37). NCPB improved also significantly physical, emotional and social well-being (effect sizes, respectively, 2.37, 4.13 and 7.51) which was not observed after VSPL. No influence on ailments characteristic for the disease was demonstrated. Mean daily opioid consumption was significantly decreased after both procedures. There was no perioperative mortality and no major morbidity. CONCLUSION: Both NCPB and VSPL provide significant reduction of pain and improvement of quality of life in inoperable pancreatic cancer patients. They present rather similar efficacy, but lower invasiveness of NCPB, in combination with its more positive effect on quality of life, pre-disposes it as being the preferred method.

Adult↗
PubMed1978

Brain stimulation for the suppression of the intractable pain.

Stimulation of the brain has been shown to effectively suppress the clinical pain states due to central nervous system lesions. The effective stimulation site is within the somatosensory system. Stimulation in the periventricular gray matter can produce profound analgesia and effective clinical relief of chronic pain states when they are due to lesions involving the peripheral structures. This system probably is effected by activating a descending tract in the dorsal lateral fasiculus of the spinal cord impinging upon neurons in lamina 5 and lamina 1 of the dorsal bone. Stimulation in this system has not been found to be effective in patients with central lesions, which might have been anticipated in view of the anatomical relationships presented.

Brain↗
PubMed2002

Surgical management of intractable pain in chronic pancreatitis: past and present.

The surgical management of pain in patients with chronic pancreatitis continues to provide a formidable challenge. Despite recent advances in the area of the pathophysiolgical cause of the symptoms of chronic pancreatitis there is still controversy as to the exact mechanisms that result in pain in both large and small duct disease. In addition, the surgical community has very polarized views as to the correct management of these patients. In this review we have set out to summarize the treatment options available and provide comparative data where available. Data were found following a computer search of the Medline database from 1966 to the present. The information extracted comprises mainly level two and level three data. There is a continuing lack of a "gold standard" in the surgical management of pancreatic pain. This is mainly due to the paucity of randomized controlled trials in the field of pancreatic surgery. With only four randomized controlled trials reported in the world literature it is difficult to state categorically what is the optimal treatment for this difficult group of patients. Until there is increased standardization in the reporting of both the physiological outcomes and quality-of-life issues in the surgical management of chronic pancreatitis this will continue to be the situation.

Chronic Disease↗
PubMed1998

Combined use of a true-bipolar sensing implantable cardioverter defibrillator in a patient having a prior implantable spinal cord stimulator for intractable pain.

Reported is a case involving a patient with a previously implanted spinal cord stimulator (SCS) who presented for an implantable cardioverter defibrillator (ICD). The SCS device was located in the left lower abdominal quadrant with a stimulation electrode array placed on the dorsal aspect of the spinal cord at the T-11 thoracic level. Interaction testing demonstrated that the biopolar sensing transvenous ICD system (Medtronic 7221 Cx PCD) did not detect the stimulator's output at burst rates ranging from 20-130 pulses/s, even with the ICD set to its maximum sensitivity of 0.15 m V and the stimulator programmed to the highest patient tolerated output combinations of 5 V, 0.45 ms in the bipolar configuration and 3 V, 0.45 ms in the unipolar (i.e., case-electrode) configuration.

Aged↗