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At least 649 records · Page 36Linked to original sources
PubMed2005

Palliative pain management: when both pain and suffering hurt.

Patients with advanced cancer frequently experience intractable pain without sufficient response to a conventional pharmacological approach. One reason for refractory pain at the end of life can be the bidirectional nature of pain and suffering. Three terminally ill patients were assessed using a multidimensional palliative pain concept, including sensory, affective, cognitive, and existential components. In these patients, resistant pain did not equal insufficient eradication of the nociceptive input, but also suffering. Unrelieved emotions, depressive or anxious symptoms, delirium, difficulties communicating, or chemical coping influenced the expression of pain, illuminating the phenomenon of somatization. Palliative pain treatment integrated analgesic treatments, psychological, rehabilitative, and existential interventions, in consideration of individual expectations and outcomes. With the disciplined assessment and alternative multidisciplinary palliative approach, the quality of life of three terminally ill cancer patients with intractable pain could be enhanced, and unnecessary interventions and escalation of medications avoided.

Adult↗
PubMed1997

Biofeedback for intractable rectal pain: outcome and predictors of success.

PURPOSE: A number of modalities have been used for the treatment of intractable rectal pain, with varying degrees of success. Electromyography (EMG)-based biofeedback therapy has been used in the treatment of this condition during the past six years. MATERIALS AND METHODS: Medical records of 86 patients who completed at least one session of biofeedback for rectal pain between February 1989 and August 1995 were retrospectively reviewed. All sessions were one-hour outpatient encounters with a trained biofeedback therapist. There were 31 male and 55 female patients with a median age of 68 (range, 12-96) years. Surgery (19.8 percent) or stress (15.1 percent) were frequently cited as precipitating factors for the development of rectal pain. Eleven patients completed only one session of biofeedback and were excluded from further analysis. Of the remaining patients, 28 complained of concomitant constipation. Assessment of the benefit of therapy was based on the patients' subjective reports of the level of symptoms, aided by a linear analog scale. RESULTS: Twenty six patients (34.7 percent) reported an improvement in symptoms. Outcome was not influenced by patients' ages (P = 0.63), duration of symptoms (P = 1.0), or a prior history of surgery (P = 0.14). Alleviation of symptoms was not significantly related to the presence of paradoxical puborectalis contraction demonstrated on either EMG (P = 1) or defecography (P = 0.12). Importantly, outcome was significantly improved in patients who completed the treatment schedule compared with those who self-discharged (P < 0.001). CONCLUSIONS: Although idiopathic rectal pain is difficult to treat, EMG-based biofeedback can produce alleviation of symptoms. However, success depends on patients' willingness to pursue a full course of therapy.

Aged↗
PubMed1987

Electrophysiological study of chronic intractable shoulder pain.

Electrophysiological criteria for carpal tunnel syndrome (CTS) may be defined by difference of the distal latencies between median and ulnar nerves in the same hand greater than 2 SD from the normal mean. Based on the data in 20 normal subjects (10 men and 10 women), the criteria for abnormality were distal sensory latency (DSL) over 0.9 msec and/or distal motor latency (DML) over 1.4 msec. Of 100 patients (24 men and 76 women) with chronic intractable shoulder pain (CISP) tested, 53 had electrophysiological CTS; 9 (17%) were men and 44 (83%) were women. Thirty-nine (74%) of these patients had bilateral CTS. Twenty of the 100 patients had nocturnal exacerbation (NE). Eighteen (90%) had CTS; one (6%) was a man and 17 (94%) were women. NE does not necessarily reflect the severity of CTS from statistical analysis. Electrophysiological evaluation is essential for middle-aged women with CISP, and nocturnal exacerbation may be pathognomonic for CTS in these patients.

Adult↗
PubMed2005

[Percutaneous cervical cordotomy in intractable cancer pain].

Percutaneous cordotomy by the lateral high cervical approach may be indicated in the treatment of intractable nociceptive or neuropathic cancer pain below the C5 dermatome. A description of the technique and two case studies are presented.

Cervical Vertebrae↗
PubMed1995

Epidural clonidine analgesia for intractable cancer pain. The Epidural Clonidine Study Group.

Although the vast majority of patients with cancer pain receive effective analgesia from standard therapy, a few patients, particularly those with neuropathic pain, continue to experience severe pain despite large doses of systemic or intraspinal opioids. Animal studies suggest intraspinal alpha 2-adrenergic agonists may be effective in such cases. Eighty-five patients with severe cancer pain despite large doses of opioids or with therapy-limiting side effects from opioids were randomized to receive, in a double-blind manner, 30 micrograms/h epidural clonidine or placebo for 14 days, together with rescue epidural morphine. Pain was assessed by visual analog score (VAS), McGill Pain Questionnaire, and daily epidural morphine use. Success was defined as a decrease in either morphine use of VAS pain, with the alternative variable either decreasing or remaining constant. Blood pressure, heart rate, and degree of nausea and sedation were monitored. Successful analgesia was more common with epidural clonidine (45%) than with placebo (21%). This was particularly prominent in those with neuropathic pain (56% vs. 5%). Pain scores were lower at the end of the treatment period in patients with neuropathic pain treated with clonidine rather than placebo, whereas morphine use was unaffected. Clonidine, but not placebo, decreased blood pressure and heart rate. Hypotension was considered a serious complication in 2 patients receiving clonidine and in 1 patient receiving placebo. This study confirms the findings from previous animal studies which showed the effective, potent analgesic properties of intraspinal alpha 2-adrenergic agonists and suggests that epidural clonidine may provide effective relief for intractable cancer pain, particular of the neuropathic type.

Adult↗
PubMed1996

Commissural myelotomy for intractable cancer pain: report of two cases.

PATIENTS: We describe two patients with cancer-related low back and bilateral lower extremity pain that failed pharmacologic treatment. RESULTS: In both cases, commissural myelotomy provided significant pain relief. The role of myelotomy in the management of cancer pain is discussed.

Carcinoma, Hepatocellular↗
PubMed2001

Treatment of refractory pain after brachial plexus avulsion with dorsal root entry zone lesions.

OBJECTIVE: Significant numbers of patients experience intractable pain after brachial plexus root avulsions. Medications and surgical procedures such as amputation of the limb are often not successful in pain treatment. METHODS: Forty-seven patients with intractable pain after traumatic cervical root avulsions were treated with dorsal root entry zone coagulation between 1980 and 1998. The dorsal root entry zone coagulation procedure was performed 4 months to 12 years after the trauma, and patients were monitored for up to 18 years (average follow-up period, 14 yr). RESULTS: Immediately after surgery, 75% of patients experienced significant pain reduction; this value was reduced to 63% during long-term follow-up monitoring. Nine patients experienced major complications, including subdural hematomas (n = 2) and motor weakness of the lower limb (n = 7). Improved coagulation electrodes with thermistors that could produce smaller and more-accurate lesion sizes, which were introduced in 1989, significantly reduced the number of complications. CONCLUSION: Central deafferentation pain that persists and becomes intractable among patients with traumatic cervical root avulsions has been difficult to treat in the past. Long-term follow-up monitoring of patients who underwent the dorsal root entry zone coagulation procedure in the cervical cord indicated that long-lasting satisfactory relief is possible for the majority of individuals, with acceptable morbidity rates.

Brachial Plexus↗
PubMed1992

Stereotactic mesencephalotomy for pain relief. A plea for stereotactic surgery.

Rostral mesencephalic reticulotomy (RMR) for pain relief was performed in 34 patients with intractable pain. Most of these patients have been followed for a long period of time postoperatively, the longest follow-up period being 11 years. Contrary to the commonly prevailed bias in the past that mesencephalotomy may be a surgical intervention with potential risk, these patients of RMR have continued to substantial improvement postoperatively in terms of their preoperative intractable painful dysesthesia after a long period of time. The results of pain relief for denervation pain as well as for nondenervation pain are surprisingly good even after unilateral procedures. There was no operative mortality. Postoperative disturbance of ocular motility has been reduced. RMR has its scientific basis in that the medial part of the reticular formation rather than the classical lateral spinothalamic tract has more significance in the central conduction of nociceptive impulses through the midbrain level, which was verified by intraoperative neuronal recording with a tungsten microelectrode. The present report emphasizes that stereotactic mesencephalotomy, if performed meticulously and precisely, is a safe surgical procedure for pain relief. Results of MRI and sensory manifestations of a patient 11 years after RMR are also presented.

Follow-Up Studies↗
PubMed1997

Functional magnetic resonance imaging: a potential tool for the evaluation of spinal cord stimulation: technical case report.

OBJECTIVE AND IMPORTANCE: The management of chronic pain of spinal origin continues to represent a challenge for neurosurgeons. Spinal cord stimulation for chronic intractable pain is an effective therapy in approximately 50% of patients. The present study uses a novel imaging approach, functional magnetic resonance imaging (fMRI), to examine the central effects of spinal cord stimulation. CLINICAL PRESENTATION: Three patients, each with a chronic history of intractable pain, were treated at the Toronto Hospital with a trial of dorsal column stimulation (DCS). For all patients, significant improvement in pain symptoms was achieved with DCS. INTERVENTION: fMRI on a 1.5-T conventional magnetic resonance system was used to study the effects of DCS in these patients. Images were collected while the stimulator was activated and deactivated. CONCLUSION: This report is the first to describe the cerebral effects of exogenous spinal cord stimulation with fMRI. fMRI allows for the objective examination of the effects of DCS and may provide an objective means of evaluating the efficacy of DCS as a therapy for intractable pain of spinal origin.

Adult↗
PubMed1977

Neurosurgical control of pain in the patient with cancer.

If properly evaluated, the majority of patients with intractable pain caused by visceral as well as somatic malignancy can obtain relief. Analgesics are of great value in some cases. They are especially indicated for patients who have conditions producing pain of short duration or for terminal patients. Radiotherapy may temporarily help most patients with intractable pain. Open or stereotactic surgical intervention and especially interruption of the ascending pain fibers within the spinal cord may give permanent relief to patients who have increasingly severe pain. At present the best results are obtained with percutaneous high cervical electrocoagulation of the spinothalamic tracts. Experience with electrical inhibition of pain based on the gate theory is limited. In the future, however, it may replace the present destructive approaches.

Brain↗
PubMed1977

[Treatment of chronic pain with intracerebral stimulators].

A new technique for the functional treatment of chronic intractable pain with a cerebral stimulation system under the patient's control is described. A four-pole electrode, diameter 0.65 mm (made by Medtronic), was implanted under stereotaxic control into nine patients. Stimulation was via a substernally implanted receiver connected to the intracerebral electrode. A pocket-sized stimulator with circular aerial, intermittently placed on the patient's skin, was activated by the patient whenever pain occurred. Pain suppression was achieved in all instances, best results being obtained with stimulation of the medial mesencephalic lemniscus, including the sensory-motor thalamic nuclei. The pain-suppressing effect lasted for up to seven hours, so that three stimulations for 30-40 minutes daily were sufficient, as demonstrated by an observation period of up to 21 months. The only complication was transitory oculomotor paresis. The described reversible non-destructive stereotaxic and functional technique of stimulation is preferable to the coagulation method in the treatment of chronic intractable pain.

Brain↗