PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Intractable Pain”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 631 records · Page 35Linked to original sources
PubMed1996

Prospective outcome evaluation of spinal cord stimulation in patients with intractable leg pain.

STUDY DESIGN: The results of spinal cord stimulation were prospectively evaluated using both subjective patient self-report measures and objective physical functional testing. OBJECTIVES: The purpose of this study was to evaluate prospectively the effects of spinal cord stimulation implantation, performed with the patient awake and providing feedback, in patients with primary reports of intractable leg pain. SUMMARY OF BACKGROUND DATA: Spinal cord stimulation has been used for treating chronic pain of many types. However, even among those with intractable lower extremity pain, the outcome results have shown great variability. METHODS: The surgical procedure was performed with the patient awake and providing feedback to ensure optimal pain relief from the lead placement. The study group comprised 40 patients, ranging in age from 28 to 86 years. The average symptom duration was 65.4 months, and the average number of prior lumbar spine surgeries was 2.3 (range, 1 to 8). The primary data collection periods were preoperative, 6 weeks after, and 12 and 24 months after surgery. RESULTS: Statistically significant improvement in isometric lower extremity function was demonstrated 6 weeks after the spinal cord stimulation implantation. In the more painful leg, the performance increased from 457.5 ft-lb-sec to 629.8 ft-lb-sec (P < 0.01). The performance remained significantly improved at the 12- and 24-month follow-ups. Significant improvement was demonstrated on the physical scale of the Sickness Impact Profile at 6 weeks. At 24 months, all three scales (physical, psychological, and other) as well as the total score were significantly improved. Statistically significant decreases in pain, assessed by changes in visual analog scale scores, were noted in the legs, when walking, and in overall lifestyle. The use of narcotic medication decreased at all follow-up periods. At least 66% of the patients who were taking narcotics before spinal cord stimulation were taking reduced amounts or no narcotics 2 years later. At the time of the 24-month follow-up, at least 70% of patients reported that the procedure helped them, and would recommend it to someone with similar symptoms. CONCLUSIONS: Spinal cord stimulation implantation can result in improved physical function and decreased pain in patients who are carefully screened and in whom the implantation is performed with the patient awake to help ensure optimal pain-relieving lead placement.

Adult↗
PubMed1984

[Our experiences of PISCES (percutaneously inserted spinal cord electrical stimulation) in SMON and other neurologic disorders].

Percutaneously inserted spinal cord electrical stimulation (PISCES) was carried out in eleven intractable pain cases and in one spastic paraplegic case. The causes of intractable pain constitute subacute myelo-optic neuropathy (SMON) 6 cases, cerebrovascular disease 2 cases, multiple sclerosis (MS) 1 case, Charcot-Marie-Tooth (CMT) 1 case and transverse myelitis (TM) 1 case. The cause of spastic paraplegia was due to the ossification of posterior longitudinal ligament (OPLL). A trial stimulation was performed about two weeks before planning a permanent implantation of PISCES system. For the trial stimulation, epidural electrodes were percutaneously inserted with a guide of fluoroscopy in a X-ray room. The conditions of stimulation were adjusted to give an optimal electric dysesthesia. We employed pulse width 0.1-1.0 msec, pulse rate 1-120 Hz and pulse amplitude 0-10 Volt. If an excellent effect was obtained by trial study, we proceeded to the chronic implantation of PISCES system which were composed of epidural electrodes, a subcutaneous receiver and a surface antenna. The procedure of implantation was carried out in an operating room under local anesthesia. In our series, seven subjects (58%) experienced a rewarding effect by the trial stimulation and three underwent the permanent implantation of PISCES. We summarized the clinical courses of these three cases which were OPLL, CMT and SMON. Compared with the other methods for pain relief, PISCES is most characteristic in its safety and simplicity. To date, PISCES has been applied to various disorders; such as ataxia, spasticity, intractable pain, neurogenic bladder and peripheral vascular disease. But its efficacy has not been established in all these disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

Thoracoscopic splanchnicectomy for pain control in patients with unresectable carcinoma of the pancreas.

BACKGROUND: Intractable pain is the most distressing symptom in patients suffering from unresectable pancreatic carcinoma. Palliative interventions are justified to relieve the clinical symptoms with as little interference as possible in the quality of life. The purpose of this study was to examine the efficacy and safety of thoracoscopic splanchnicectomy for pain control in patients with unresectable carcinoma of the pancreas. METHODS: Between May 1995 and April 1998, 24 patients (14 men and 10 women) with a mean age of 65 years (range, 30-85) suffering from intractable pain due to unresectable carcinoma of the pancreas underwent 35 thoracoscopic splanchnicectomies. All patients were opiate-dependent and unable to perform normal daily activities. Subjective evaluation of pain was measured before and after the procedure by a visual analogue score. The following parameters were also evaluated: procedure-related morbidity and mortality, operative time, and length of hospital stay. RESULTS: All procedures were completed thoracoscopically, and no intraoperative complications occurred. The mean operative time was 58+/-22 min for unilateral left splanchnicectomy and 93.5+/-15.6 min for bilateral splanchnicectomies. The median value of preoperative pain intensity reported by patients on a visual analogue score was 8.5 (range, 8-10). Postoperatively, pain was totally relieved in all patients, as measured by reduced analgesic use. However, four patients experienced intercostal pain after bilateral procedures, even though their abdominal pain had disappeared. Complete pain relief until death was achieved in 20 patients (84%). Morbidity consisted of persistent pleural effusion in one patient and residual pneumothorax in another. The mean hospital stay was 3 days (range, 2-5). CONCLUSIONS: We found thoracoscopic splanchnicectomy to be a safe and effective procedure of treating malignant intractable pancreatic pain. It eliminates the need for progressive doses of analgesics, with their side effects, and allows recovery of daily activity. The efficacy of this procedure is of major importance since life expectancy in these patients is very short.

Adult↗
PubMed1989

Multidimensional analysis of peak pain symptoms and experiences.

Peak pain symptoms and experiences were explored within a group of 243 intractable pain patients seen consecutively at a pain clinic. Using a 5-point scale, patients rated the frequency with which 99 symptom adjectives occurred when their pain was at its worst. Key cluster analysis identified 11 reliable, conceptually clear symptom clusters: Four affective symptom categories, Angry Depression, Diminished Drive, Intropunitive Depression and Anxiety, describing emotional states concomitant with peak pain; two somatic symptom categories, Ecto-Pain and Endo-Pain, describing surface and deep bodily pain, respectively; and five additional symptom categories including Cognitive Dysfunction, Sleep Disturbance, Fatigue, Withdrawal and Disequilibrium. Among the affective symptom clusters, symptoms of Angry Depression were reported to occur frequently by 32% of the patients while only 11% reported the frequent occurrence of Intropunitive Depression. For the somatic symptom clusters, 25 and 52% reported the frequent occurrence of Ecto-Pain and Endo-Pain, respectively. Pain reports measured by Ecto-Pain and Endo-Pain were nearly independent of all other symptom categories. The results suggest that the experiential context of pain differs widely among intractable pain patients. The study derived a Pain Symptom Checklist to measure each symptom cluster as one way to identify coping styles among chronic pain patients.

Adult↗
PubMed1980

Somatosensory evoked potentials and noxious stimulation in patients with intractable, noncancer pain syndromes.

Investigations of the evoked potentials (EPs) to noxious laser stimulation have indicated consistent strong linear relationships between subjective response (R), stimulus intensity (S), and EP amplitude (A). Thirty patients with chronic intractable benign pain syndromes (CIBPS) were tested to determine whether their patterns differed from previous studies with normal volunteers. Nearly half of the CIBPS patients were found to be relatively insensitive to acute pain stimuli. A large number were also found to show negative relationships between S and A. These differences from control subjects were considered of potential importance in their implications concerning the nature of chronic pain and its differences from the acute pain process.

Adult↗
PubMedDate not supplied

Subcutaneous neuromodulating implant targeted at the site of pain.

INTRODUCTION: Primary afferent stimulation for the control of chronic pain frequently offers the optimal compromise for the control of intractable pain. We describe a new access route directly to the site of pain (target) in the form of subcutaneous targeted neurostimulation (STN) via a percutaneous permanent neurostimulating implant. CASE REPORT: We present 3 cases with chronic intractable pain where STN via a permanent neurostimulating implant was introduced successfully. STN for 1-2 hours daily produced pain relief lasting between 12 to 24 hours, which argues that subcutaneous neurostimulation instead of stimulation of peripheral nerves is sufficient in selected cases. The effects of subcutaneous stimulation do not correlate with transcutaneous electrical nerve stimulation applied externally over the same area. CONCLUSION: The introduction of an STN directly to painful areas, therefore bypassing the spinal cord and peripheral nerves, is a novel and simple procedure that is effective, in this small series, for control of intractable pain consistent with neuropathic pain.

Adult↗
PubMed1986

Totally implantable spinal cord stimulation for chronic pain: design and efficacy.

Neurostimulators used to treat chronic, intractable pain have evolved from technical developments in pacemaker technology. A totally implantable spinal cord stimulation (SCS) system was designed based on elements of a widely used cardiac pacemaker. This paper reports on the transformation of pacemaker technology for neurostimulation applications and presents results of using this system for the treatment of 90 patients with chronic, intractable pain of the low back and/or legs. Significant reduction in pain levels resulted from use of a totally implantable spinal cord stimulation system. Seventy percent of the patients experienced good or excellent pain relief at an average of 14.5 months after implant. Patients who used an automatic ON/OFF cycling mode of stimulation reported greater pain relief than patients who were stimulated continuously.

Adult↗
PubMed1983

[Current role of acupuncture in analgesic therapy].

After a brief introduction dealing with the great development of acupuncture in management of various painful conditions in the West today, its increased importance, use and role in acute and chronic pain, benign and intractable pain, are discussed. Recent acquisitions about known and yet unknown neurophysiological parameters (evoked cns potentials, endorphines, action of acupuncture in "regulation" of many functions--so called homeostasis--milieu) in connection with good pain relief properties of acupuncture, are referred. The main methods of acupuncture in pain treatment (acupuncture as reflexotherapy--so called electroacupuncture and the very effective auriculotherapy, in comparison with traditional acupuncture as "regulating" method of homeostasis and others minor methods, with our casuistry and positive results in 724 cases of various pain conditions are stressed. Own conclusions about the positive results and the great significance of physician-patient relations in delicate field of pain therapy are referred.

Acupuncture Therapy↗
PubMed1998

Spinal cord stimulation revisited.

The proportion of patients with intractable pain successfully managed with spinal cord stimulation (SCS) remains disputed. We analyze 27 consecutive patients with intractable pain treated with SCS using identical hardware (Itrel II System; Medtronic Neurological, Inc Minneapolis, MN, USA) by a single satisfactory diagnosis 1992 through 1995. A rigid selection protocol was used: 1. A satisfactory diagnosis of the pathologic process resulting in pain was made. 2. A corrective surgical procedure was judged not feasible by surgeons experienced in the particular pathology, e.g., vascular peripheral nerve, spine. 3. Lack of satisfactory response to noninterventional pain management modalities by an interdisciplinary pain clinic. 4. Independent psychological evaluation, including a structured interview was performed by a psychologist specialized in chronic pain management. In the last eight cases, a battery of self-report tests designed to assess psychosocial and behavioral consequences of the chronic pain problem were administered as well. All cases were of nonmalignant pain, except for one patient. Thirteen cases were diagnosed with failed back surgery syndrome (FBSS), one older patient with lumbosacral radiculopathy who refused decompression, one cervical radiculopathy and Klippel-Feil syndrome, six with reflex sympathetic dystrophy (RSD), two with peripheral vascular ischemic disease, one with post-thoracotomy pain syndrome, one with leg pain following resection of angiolipoma, one with traumatic superficial peroneal neuropathy, and one with Pancoast's tumor. Fifteen patients were female and twelve were male. All were Caucasian. Their ages ranged from 27 to 84 years (mean:48). The average follow-up was 21 months (range: 48-6). All patients underwent a three day trial screening with Pisces-Quad/Resume epidural leads connected to a temporary external stimulator. An Itrel II System pulse-generator was internalized in each of the 24 patients who had successful trial (three cervical and twenty-one thoracic-lumbar). There was no morbidity. Pain reduction was sustained in 22 out of the 24 patients who continue to use the stimulator. The same number would choose to receive in an electrical stimulator again. Normalization or improvement in Quantitative Sudomotor Axon Reflex Test (Q-SART) and Thermography was documented in the patients with RSD. We conclude that rigid selection protocol can maximize the proportion of patients with intractable pain who are successfully treated with SCS. Strict neurosurgical technique eliminates infection risk. Hardware selection minimizes incidence of malfunction.

Adult↗
PubMed1993

Intractable chest pain in cardiomyopathy: treatment by a novel technique of cardiac cryodenervation with quantitative immunohistochemical assessment of success.

A novel method of cardiac denervation by cryoablation has been developed experimentally. The technique uses liquid nitrogen delivered under pressure to ablate the principal sources of cardiac innervation--namely, the adventitia surrounding the aorta, pulmonary arteries, and veins. The technique has been verified experimentally both in vivo by physiological means and in vitro by quantitative immunohistochemistry and the measurement of myocardial noradrenaline concentrations. A 35 year old woman presented with intractable precordial pain, normal epicardial coronary arteries, and hypertrophic cardiomyopathy. Her symptoms were refractory to maximal medical treatment and she was thought to be unsuitable for either conventional myocardial revascularisation, autotransplantation, or allografting with the concomitant risk of transplant coronary artery disease. She therefore underwent cardiac denervation by the method developed in the laboratory. There was quantitative immunohistochemical evidence of extrinsic cardiac denervation associated with a considerable improvement in her symptoms. This improvement persisted during a follow up period of over 16 months.

Adult↗
PubMed1991

Chronic use of opioids in intractable facial pain. A case report.

The use of opioids in chronic non-malignant pain conditions is largely rejected by the health authorities. Their concern is mostly due to the potential problems of addiction and other adverse effects of opioids. However, in certain pain conditions opioids may be the only effective remedy. This article presents some guidelines for the use of narcotics for non-cancer pain. A case is presented in which methadone in small doses in combination with an antidepressant was the first drug capable of alleviating the patient's suffering. The drug was effective during a period of 9 months.

Administration, Oral↗
PubMed1988

Behavioral treatment of intractable chest pain in a patient with vigorous achalasia.

Chest pain is a major symptom of patients diagnosed with esophageal motility abnormalities. Motility disorders of the esophagus are also associated with elevated scores on measures of somatic anxiety and depression. In spite of this relationship between psychological characteristics and esophageal motility disturbances, few attempts have been made to treat complaints of chest pain in patients with esophageal motility disorders using psychological methods. This report describes the successful use of a behavioral pain management program for the treatment of persistent chest pain in a patient diagnosed with vigorous achalasia who was previously treated with pneumatic dilatation and a long Heller myotomy. This is the first report on the use of psychotherapy in treating chest pain associated with vigorous achalasia, and suggests that, in the etiology and treatment of chest pain in patients with esophageal motility disturbances, psychological influences may be more important than has generally been recognized. No long-term relationship between esophageal motility disturbances and complaints of chest pain was found.

Adult↗