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PubMed2000

CT-guided celiac plexus block for intractable abdominal pain.

Treatment of intractable abdominal pain due to inoperable intraabdominal malignancy is important, and the ineffectiveness of pharmacological agents has led many investigators to recommend chemical neurolysis of the celiac ganglions as a treatment. The author describes the technique and results of celiac plexus neurolysis under CT-guidance with various approach routes, including anterior, posterior and transaortic routes. Twenty-eight patients, ranging in age from 36 to 82 years, have been treated with this procedure. All had inoperable or recurred intraabdominal malignancies and suffered from intractable upper abdominal pain and/or back pain. The author performed the procedure using absolute alcohol by an anterior approach (n=18), posterior approach (n=6) and transaortic approach (n=4). Pain was rated according to a visual analog scale before and after the procedure to gauge treatment success. No major complications occurred. Mild hypotension occurred in five patients (18%) and transient diarrhea in six patients (21%). Twenty-one (75%) of the 28 patients had some relief of pain and 17 of these patients (61%) had good relief of pain after the procedure. The results support that CT-guided celiac plexus block with alcohol is a safe and effective means of pain control in patients with intraabdominal malignancy.

Abdominal Pain↗
PubMed2004

Successful use of ketamine for intractable cancer pain.

UNLABELLED: GOALS AND WORK: Despite medical awareness, intractable pain is a serious problem in cancer and occurs in up to 2% of advanced cancer patients. However, few data are available concerning the optimal treatment of such patients. The emergence of intractable pain may notably be due to the activation of N-methyl-D-aspartate (NMDA) receptors located in the central nervous system. NMDA antagonists might thus be an interesting approach in such pain syndromes. PATIENTS AND METHODS: Twelve patients with intractable cancer pain received a test dose of 5-10 mg of ketamine, a strong NMDA antagonist, in order to determine their response and tolerance to the drug. Continuous intravenous infusions of ketamine associated with morphine were then administered. MAIN RESULTS: The acute test dose was successful in all cases (VAS <3/10 after 5 min). The prolonged use of ketamine allowed us to reduce the total daily dose of morphine required (range: 200-1,200 mg) by 50% and allowed eight patients to go home with a portable pump with morphine and ketamine during a relatively long period of time (range: 7-350 days, median: 58 days). Side effects were moderate (dizziness) and they were limited to the test phase. CONCLUSION: Our data suggest the importance of NMDA receptors in the genesis of chronic cancer pain and indicate that NMDA antagonists should be further studied for the management of cancer pain and, in particular, intractable pain.

Adult↗
PubMed1979

Intractable facial pain.

Case histories of 225 patients with intractable pain attending the Pain Clinic of a large metropolitan teaching hospital were retrospectively analysed. The 29 cases of intractable facial pain were investigated to determine if there were any clinical or historical factors which might indicate intractability and thus speed diagnosis of such cases in future. Significant factors were age, duration of pain, number of surgical interventions and psychiatric factors. Patients with intractable facial pain are more likely to be over 40 years of age, to have pain of long duration, to have had one or more operations, and to require psychiatric assistance than patients with non-intractable facial pain. Temporomandibular joint dysfunction pain and atypical facial pain merged in the intractable state and differ from intractable neuralgias with respect to sex ratio and psychiatric assistance. The incidence of intractable facial pain in South Australia was eight cases per million population per year. Compared to those with intractable pain at other body sites, patients with intractable facial pain have unilateral pain, do not suffer major impairment to their daily lives and are not concerned with monetary compensation. Patients with intractable pain are more likely to show a pattern of organic preoccupation, non-acceptance of reassurance and disease conviction. These findings, together with some current psychiatric aspects of intractable pain, including the concept of illness behaviour, are discussed. It is suggested that early psychiatric assessment will improve management but it is realised that although it is not possible to apply some of the factors studied to each patient, the findings may alert the clinician to potential intractability.

Age Factors↗
PubMed1996

Does electroconvulsive therapy (ECT) have any role in the management of intractable thalamic pain?

Three patients with intractable thalamic pain unresponsive to a range of previous treatments received a course of six bilateral electroconvulsive therapy (ECT) treatments over 2 weeks. There was no evidence of any improvement in the intensity of the pain, pain relief or mood as measured on visual analogue scales and with standard measures. Propofol was used as the anaesthetic induction agent. Two patients showed wide changes in blood pressure during ECT but all three patients showed prompt recovery. In the light of the negative findings of this study and those of a previous study of the use of unilateral ECT in similar patients it is concluded that ECT is not an effective treatment for post-stroke thalamic pain.

Adult↗
PubMedDate not supplied

Alcohol-induced adenolysis of the pituitary gland: a new approach to control of intractable cancer pain.

In exploring new modalities to control or ameliorate unbearable intractable pain associated with invasive cancer, the authors studied the effectiveness and safety of a new method involving the destruction of the pituitary by injection of absolute alcohol into the gland. Of a series of 24 patients undergoing pituitary adenolysis for control of cancer pain, 13 patients experienced complete and lasting relief and 10 showed significant improvement. The authors hope that the encouraging results obtained in this preliminary study will stimulate other investigators also to employ the transnasal, transphenoidal approach to alcohol-induced hypophysectomy for the control of intractable pain due to advanced cancer.

Adult↗
PubMed1999

Spinal Cord Stimulation: Indications, Mechanism of Action, and Efficacy.

Unrelieved pain is costly to the economic fabric of our society; its direct costs to patients and their families is staggering. Spinal cord stimulation for the treatment of chronic pain is cost-effective when used in the context of a pain treatment continuum. Many theories on the mechanism of action of spinal cord stimulation have been suggested, including activation of gate control mechanisms, conductance blockade of the spinothalamic tracts, activation of supraspinal mechanisms, blockade of supraspinal sympathetic mechanisms, and activation or release of putative neuromodulators. Whatever theory or theories of mechanism are correct, spinal cord stimulation has efficacy in the treatment of failed back surgery syndrome, complex regional pain syndromes, intractable pain due to peripheral vascular disease, and intractable pain due to angina.

Journal Article↗
PubMed1996

Childhood sex abuse in women with chronic intractable back pain.

This study explores the relationship between chronic intractable pain and histories of childhood sexual abuse in 112 women sampled from a large university campus health center. Fifty-nine (59) women with chronic back pain were sampled and compared with 53 control subjects obtained simultaneously from the same clinical population. Results noted that women with chronic intractable back pain had a significantly higher percentage of childhood sexual abuse experiences than controls. A new chronic back pain checklist was used.

Adult↗
PubMed1981

Intractable facial pain and illness behaviour.

Management of intractable facial pain (IFP) patients is time consuming and potentially frustrating. Earlier identification of IFP patients may be helped by considering such cases in terms of their illness behaviour rather than a large rang of other diagnostic labels. A group of 24 IFP patients, with diagnoses including temporomandibular joint dysfunction pain, atypical facial pain and facial neuralgia, completed a questionnaire designed to measure illness behaviour. Compared to a control group of patients with minor odontogenic pain, IFP patients were more somatically preoccupied, could not accept reassurance from a doctor as easily, and were less likely to acknowledge psychological aspects of illness. These attitudes, similar to those reported by other intractable pain patients, are unlikely to be related to degree of organic pathology or chronicity of pain. Use of a discriminant function resulted in three-quarters of the total sample being correctly separated into the two clinical groups on the basis of their IBQ scores.

Adult↗
PubMed2006

Reduction of intractable deafferentation pain by navigation-guided repetitive transcranial magnetic stimulation of the primary motor cortex.

The precentral gyrus (M1) is a representative target for electrical stimulation therapy of pain. To date, few researchers have investigated whether pain relief is possible by stimulation of cortical areas other than M1. According to recent reports, repetitive transcranial magnetic stimulation (rTMS) can provide an effect similar to that of electrical stimulation. With this in mind, we therefore examined several cortical areas as stimulation targets using a navigation-guided rTMS and compared the effects of the different targets on pain. Twenty patients with intractable deafferentation pain received rTMS of M1, the postcentral gyrus (S1), premotor area (preM), and supplementary motor area (SMA). Each target was stimulated with ten trains of 10-s 5-Hz TMS pulses, with 50-s intervals in between trains. Intensities were adjusted to 90% of resting motor thresholds. Thus, a total of 500 stimuli were applied. Sham stimulations were undertaken at random. The effect of rTMS on pain was rated by patients using a visual analogue scale (VAS) and the short form of the McGill Pain Questionnaire (SF-MPQ). Ten of the 20 patients (50%) indicated that stimulation of M1, but not other areas, provided significant and beneficial pain relief (p<0.01). Results indicated a statistically significant effect lasting for 3 hours after the stimulation of M1 (p<0.05). Stimulation of other targets was not effective. The M1 was the sole target for treating intractable pain with rTMS, in spite of the fact that M1, S1, preM, and SMA are located adjacently.

Adult↗
PubMed1983

Illness behaviour and personality in intractable facial pain syndromes.

Management of intractable facial pain is often referred to a specialised Pain Relieving Clinic, especially in light of the evidence that psychological factors play a part in the maintenance of the pain. A group of 60 patients so referred were divided into two groups according to diagnosis. The 32 diagnosed as suffering from trigeminal neuralgia were found to be more likely to deny non-pain problems, less irritable, but less convinced that there was a physical disease process responsible for their pain, than the 28 patients with non-neuralgic facial pain. Personality factors did not discriminate between the two groups. The relevance of the difference between these two groups to our understanding of pain is discussed, as is the special place of pain in the face.

Face↗
PubMed1992

[Continuous subarachnoid analgesia for management of intractable cancer pain].

Four patients with severe and intractable cancer pain were treated with continuous subarachnoid analgesia (CSA). All patients underwent placement of a 32-gauge subarachnoid catheter attached to an infusion pump allowing continuous administration of local anesthetic agent and morphine. CSA produced good pain relief except in one patient. There was no severe complication, but itching developed in one patient. At present, CSA is not a routine treatment, because it may lead to severe complications. CSA produces excellent pain relief without disturbing consciousness and is recommended for the treatment of severe and intractable cancer pain.

Aged↗