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Results for “Intractable Pain”

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At least 739 records · Page 41Linked to original sources

PubMed2004

Percutaneous vertebroplasty for treatment of thoracolumbar spine bursting fracture.

OBJECTIVE: Percutaneous vertebroplasty can be very beneficial for patients with vertebral osteoporotic compression fractures. To the best of our knowledge, however, there has been no mention in any literature regarding the use of percutaneous vertebroplasty for the treatment of spinal burst fracture. METHODS: A preliminary study was conducted on 6 patients with traumatic burst fractures of vertebrae treated with percutaneous vertebroplasty starting in June 2000. Fractures involving the anterior and middle columns of the vertebrae and the canal were mildly compressed by the retropulsed bone fragment. However, there was no obvious neurologic deficit in these patients. They initially underwent conservative treatment and thoracolumbar spinal orthosis (TLSO) brace for at least 3 months, but the intractable pain caused patients to be bedridden for prolonged periods of time and limited daily activity. As a result, the patients underwent percutaneous vertebroplasty with polymethylmethacrylate (PMMA) for treatment of spinal burst fractures. RESULTS: Six male patients (mean age: 38.2) who suffered from burst fractures of vertebrae with disabling back pain refractory to analgesic therapy and TLSO brace were treated in this study. The duration of conservation treatment period was 3.5 months to 8 months (mean: 5.2 months). There was no motility. However, 4 vertebrae (66.7%), on radiographs revealed evidence of PMMA leakage through the endplate fracture site into either the disc space or the paravertebral space, without any evident clinical symptoms. No intracanal leakage was seen, and no patient needed a secondary surgical intervention. Pain decreased from 84.3 +/- 5.4 mm at baseline to 34.7 +/- 4.4 mm at the third postoperative day, 30.2 +/- 5.8 at 3 months and 24 +/- 3.5 mm at 12 months. The reduction in pain from baseline to the 3-day and 3 month mark was statistically significant (p < 0.05). The mobility was at least 2 levels of improvement (mean improvement 2.7 points) at 12-months postoperative. CONCLUSION: In highly selective patients, percutaneous vertebroplasty can be an alternative method for the treatment of spinal burst fractures and the prevention of complications from major surgical procedures. However, this procedure still has potential risks and should be employed with extreme caution to prevent extravasation of PMMA into the spinal canal.

Adult↗

PubMed2002

Pain management problems in patients' terminal phase as assessed by nurses in Finland.

BACKGROUND: This study is part of a larger questionnaire survey concerned with the views of nursing staff on physical, emotional and spiritual support for terminally ill patients and decision making on the transition to the terminal phase of treatment. AIM: This article discusses the results concerning the prevalence of physical pain in patients and with problems in pain management. METHODS: A total of 328 nurses working on the inpatient wards of 32 municipal health centres in finland took part. Data were collected with multiple-choice items and one open-ended question, which were part of a larger structured questionnaire. The data were analysed by means of the SPSS statistical software and content analysis. FINDINGS: Dying patients often suffered from pain, which was most commonly because of cancer. Intractable pain was common. The problems of pain management concerned attitudes and qualifications related to treating pain, the assessment of the pain, pain management per se and the organization of pain management. CONCLUSION: The study highlights the need to increase pain education, discussion and agreement on the principles of pain management in municipal health centres in Finland.

Adult↗

PubMed1996

Prognostic value of psychological testing in patients undergoing spinal cord stimulation: a prospective study.

OBJECTIVE: Associations between psychological and physical states are understood to exist, and the development of standardized psychological tests has allowed quantitative evaluation of this relationship. We tested whether associations exist between psychological test instruments and patients selected for therapeutic trials of spinal cord stimulation (SCS) for chronic, intractable pain. METHODS: Fifty-eight patients selected for SCS were tested prospectively with a battery of standardized psychological tests: Minnesota Multiphasic Personality Inventory with Wiggins content scales, Symptom Check List-90, and Derogatis Affects Balance Scale. Associations between treatment outcomes and preoperative test scores and clinical variables were tested by univariate and multivariate statistical analyses, in which the dependent variables were as follows: 1) the outcome of a therapeutic trial of stimulation (whether the patient derived sufficient reported pain relief with a temporary electrode to proceed with a permanent implant), and 2) long-term outcome of treatment with the permanent implant, as determined by disinterested third-party interview. RESULTS: Significant associations (P < or = 0.01) were observed between the outcome of the therapeutic trial of stimulation and psychological test results; patients with low "anxiety" scores on the Derogatis Affects Balance Scale and with high "organic symptoms" scores on the Wiggins test were significantly more likely to proceed to permanent implants, as determined by multivariate statistical models. There was an elevation in the Minnesota Multiphasic Personality Inventory hypochondriasis scale in these patients by univariate (P = 0.02), but not by multivariate, models. The multivariate model also identified young age, reproduction of leg pain by straight leg raising, and bilateral leg pain as favorable prognostic factors. The only association with favorable long-term outcome of implantation of a permanent device, by univariate analysis, was an elevated "joy" score on the Derogatis Affects Balance Scale. Multivariate analysis revealed no statistically significant predictors of long-term outcome. CONCLUSION: Because our study population was selected on the basis of recognized prognostic factors and long clinical experience, it may not be possible to generalize our findings to the overall pain clinic referral population. In the subpopulation we have chosen for SCS trials, psychological testing is of modest value and explains little of the observed variance in outcome. We find little evidence for selecting patients for SCS on the basis of psychological testing. Because self-reported outcome measures may themselves reflect the patient's psychological state, these findings should be considered carefully, in overall clinical context. A prospective study with additional objective outcome measures is underway, which will address some of these issues.

Adaptation, Psychological↗

PubMed1999

Impairments of attention after cingulotomy.

BACKGROUND: Outcome studies have generally not indicated significant cognitive disturbances after cingulotomy. There is now considerable evidence that the cingulate may play an important role in emotional behavior and attention. OBJECTIVE: To characterize impairments of attention associated with bilateral lesions of the anterior cingulate cortex produced by cingulotomy. METHODS: Twelve patients who underwent cingulotomy for treatment of intractable pain were administered tests of attention, executive functions, response intention and production, and a broad range of other neurocognitive functions before surgery and again 3 and 12 months after surgery. Data from this within-subjects repeated-measures design were analyzed by multivariate analysis of variance procedures. RESULTS: After cingulotomy, patients initially had executive and attentional impairments. By 12 months, these had resolved into more circumscribed deficits, with greatest impairments on tasks requiring intention and spontaneous response production, and milder impairments of focused and sustained attention. Other aspects of attention and other cognitive functions were generally unaffected. CONCLUSION: The anterior cingulate cortex modulates response intention and focused attention.

Adult↗

PubMed2006

Ziconotide.

Ziconotide, an intrathecal analgesic for the management of chronic intractable pain, binds with high affinity to N-type calcium channels in neuronal tissue and obstructs neurotransmission. In three pivotal, well designed trials of 5-6 or 21 days' duration, titrated ziconotide was significantly more effective than placebo in treating chronic malignant or nonmalignant pain as assessed by mean percentage improvements from baseline in Visual Analogue Scale Pain Intensity scores. Improvements in secondary endpoints (e.g. proportion of patients who responded or achieved pain relief and the change in opioid use) generally support the efficacy of ziconotide over placebo. Ziconotide maintains its analgesic efficacy in preliminary results from long-term, open-label trials (data available for up to 12 months). Most ziconotide-related adverse events are neurological, mild to moderate in severity, resolve over time and reverse without sequelae on drug discontinuation. Low initial doses of ziconotide and gradual titration to onset of analgesia reduces the incidence and severity of adverse events. No evidence of respiratory depression has been reported with intrathecal ziconotide.

Animals↗

PubMed2006

Ultrasonic interventional analgesia in pancreatic carcinoma with chemical destruction of celiac ganglion.

AIM: To detect the therapeutic effects of chemical destruction of celiac ganglion in patients with pancreatic carcinoma with intractable pain. METHODS: Ninety-seven cases with advanced pancreatic carcinoma received chemical destruction of celiac ganglion-5 mL pure alcohol injection around celiac artery under ultrasonic guidance. The changes of visual analogue scale (VAS), serum substance P (Sub P), beta-endopeptide (beta-EP) and T-lymphocyte subtypes level were compared between pre- and post-therapy. RESULTS: Successful rate of puncture was 98.7%, with one failure. No serious complications such as traumatic pancreatitis, pancreatic fistula, abdominal cavity hemorrhage or peritoneal infection occurred. VAS, serum Sub P and beta-EP level significantly changed after treatment (8.0+/-2.3 vs 4.6+/-2.1, 254.1+/-96.7 vs 182.4+/-77.6, 3.2+/-0.8 vs 8.8+/-2.1, P<0.01, P<0.05, P<0.01) with complete relief rate 54.2%, partial relief rate 21.9%, ineffective rate 12.5% and recurrent rate 10.7%. The T-lymphocyte subtypes level remarkably increased when compared with that of pre-therapy (46.7+/-3.7 vs 62.5+/-5.5, P<0.01). CONCLUSION: Our study suggests that chemical destruction of celiac ganglion under ultrasonic guidance is highly safe, and can evidently relieve cancer pain and improve the cellular immunity in patients with advanced pancreatic carcinoma.

Adult↗

PubMed2004

Results of arthroscopic acromioplasty for chronic rotator cuff lesion.

The influence of acromioplasty in long standing rotator cuff deficiency with intractable pain was retrospectively evaluated in a consecutive series of 13 patients who were followed for a mean period of 19 months (range, 12 to 42 months) after arthroscopic acromioplasty. The Constant score improved from 59.3 (range, 39.9 to 90.3) preoperatively to 98.7 (69.1 to 122.7) postoperatively. Pain and motion improved significantly whereas strength did not improve. Arthroscopic acromioplasty in painful chronic rotator cuff avulsion was found to be an effective means to control pain and improve motion; it can be recommended when conservative treatment has failed.

Acromion↗

PubMed1980

Hypnosis as an adjunct in management of pain.

Hypnosis in the management of intractable pain is a valuable but frequently overlooked tool for the practicing physician. Two cases are presented which illustrate some of the benefits and limitations of hypnosis in pain management. Hypnosis is most effective when the patient is motivated, and pain is a strong motivating force. Secondary gain from the pain and underlying psychiatric illness must be considered when seemingly routine pain problems do not respond to hypnosis. Hypnosis may be equally effective for pain of organic or psychogenic origin. Ancillary benefits from hypnosis may include a diminution of secondary anxiety and depression. The technic is impractical for some patients because of the time requirements, but proper patient selection can obviate much of this objection. Self-hypnosis and/or the supervised use of a relative as a substitute for the physician enhances effectiveness. Training in hypnosis for adjunctive use in the management of pain is available to primary care physicians.

Humans↗

PubMed1981

Chronic pain: modern concepts in management.

Chronic intractable pain is one of the major contributors to overwhelming social and industrial disruption in contemporary society. Taditional medical techniques have proven inadequate in dealing with the vast array of psychosocial problems associated with the chronic pain syndrome, as instanced by the proliferation of the alternative therapies now available. The multidisciplinary pain clinic has emerged as one solution.

Ambulatory Care Facilities↗

PubMedDate not supplied

[MRI guided stereotactic thalamotomy for the treatment of the neurogenic pain].

INTRODUCTION: Medial thalamotomy is one of the first stereotactic operations to have been used for neurogenic pain, has a low complication rate and no risk of the development of iatrogenic neurogenic pain. It represents selective local relief for all types of pain, without causing somatosensorial deficit. PATIENTS AND METHODS: We did 39 posteromedial thalamotomies in patients with persistent intractable pain due to various disorders. The pain was assessed pre- and postoperatively on the VAS (Visual Analogic Scale). RESULTS: Half of the patients operated on had relief of pain after thalamotomy. In 84% (n = 39) of our cases this relief occurred on the second day, in 70% (n = 35) after three months, in 63% (n = 27) after six months, in 64% (n = 25) after nine months, in 62% (n = 23) of the patients after 12 months, and in 62% (n = 22) after 24 months. Three patients had temporary complications and one a permanent complication, but this did not make him an invalid. CONCLUSION: Posteromedial stereotactic thalamotomy under MR guidance can provide safe, effective treatment for persistent, intractable pain.

Adult↗

PubMed1995

Gamma Knife thalamotomy for the treatment of persistent pain.

Twenty patients who suffered persistent intractable pain from a variety of disorders underwent medial thalamotomy with the Leksell Gamma Knife. The lesions were directed at the intralaminar nuclei, the lateral portion of the medial dorsal nucleus, the centromedian and the parafascicular nuclei. Lesions were made with radiation doses from 140 to 180 Gy using a 4-mm beam collimator helmet and either a single isocenter (1 patient), two isocenters (17 patients) or three isocenters (2 patients). Two thirds of the patients experienced either excellent or good pain relief in a follow-up period between 1 and 22 months. One patient showed temporary complications which resolved, and 2 other patients also suffered complications which currently are improving. One patient died due to radiation necrosis following a bilateral thalamotomy. Gamma Knife thalamotomy may offer a potentially safe and effective alternative for the treatment of certain difficult persistent pain problems.

Chronic Disease↗

PubMed1989

[Therapy refractory pain of malignant origin].

In 50 patients with intractable pain due to malignancy an intrathecal application of morphine was performed. The follow-up extended in 28 patients till their death. Overall 46% of the patients had a profit of the therapy for the whole remaining life, 25% at least half of it. The main indication to intrathecal infusion of morphine is in multiloculare and midline pain especially in advanced cancer stage.

Adult↗

PubMed1982

The role of the human caudate nucleus in acupuncture analgesia.

The role of the caudate nucleus in acupuncture analgesia was studied in 17 patients receiving caudate stimulation through chronic implanted electrodes to relieve intractable pain caused by late malignancy. Electrical stimulation of the head of the caudate nucleus provided relief from intractable pain in all 17 patients. The pain and pain tolerance threshold were elevated, the alteration in skin galvanic activity, respiratory movement and fingertip plethysmography elicited by a given painful stimulus were depressed. The analgesia required a period of induction and persisted for some time after cessation of stimulation; it showed no obvious segmental topography. These characteristics are similar to those observed in acupuncture analgesia. The effect of caudate stimulation was similar to that of electric needling in depressing the late component of the somatosensory evoked potentials (SEPs) recorded over the scalp and from the centrum medianum of the thalamus. Evoked potentials could be recorded from the caudate nucleus when an acupuncture point was electrically stimulated. The evoked potential record was a complex wave of positive and negative components, the peak latencies of main components being 100-180 msec for positive wave and 148-332 msec for negative wave components. The present study supports the supposition that the caudate nucleus may play a role in acupuncture analgesia. The possibility that the effect of caudate stimulation is brought on by inhibiting the activity of the medial thalamus is discussed.

Acetylcholine↗

PubMed1982

Intrathecal and intraventricular morphine for pain in cancer patients: initial study.

Intractable pain in six cancer patients was treated with lumbar intrathecal morphine (two patients) and intraventricular morphine (four patients). Daily percutaneous injections of morphine through Ommaya reservoirs were made. Initially, 1 mg of lumbar intrathecal morphine resulted in pain relief for 10 to 14 hours, and 2.5 to 4.0 mg of intraventricular morphine gave relief for 12 to 24 hours. This treatment was continued for 3 to 7 months in three of the adults. Morphine requirements gradually increased. Side effects were minimal, and there were no complications.

Adult↗

PubMed1991

Intrathecal phenol rhizotomy for management of pain in recurrent unresectable carcinoma of the rectum.

The medical records of 11 patients with recurrent unresectable adenocarcinoma of the rectum who had intrathecal phenol block for the management of intractable pain were reviewed. There were seven patients with pelvic and four with combined pelvic and perineal recurrences. Five patients had sacral involvement by tumor. Six patients had received prior irradiation. Three patients had good, three had fair and five patients had poor results after phenol rhizotomy. Patients with good results had relief for a median of three months. The over-all survival rate after phenol injection was three months. Phenol rhizotomy is indicated for the relief of intractable pain secondary to recurrent unresectable carcinoma of the rectum in carefully selected patients.

Adenocarcinoma↗

PubMed2003

Is there still a role for open cordotomy in cancer pain management?

For a small number of cancer patients, good pain control remains difficult to achieve despite adequate assessment and medical management. In nine cases, effective control of intractable pain from malignant pelvic disease was achieved by open thoracic cordotomy. The technique was well tolerated, with no major complications. Eight of the nine patients decreased their median daily oral morphine requirement from 560 mg (range 360-2600 mg) to 160 mg (range 40-1000 mg). Maximal survival time post-cordotomy was 830 days, with a median of 107 days. No patient experienced recurrent pain in the initially painful site. For patients with intractable pain associated with advanced pelvic malignancy, the use of an open cordotomy should be considered when satisfactory pain control is not achieved by medical or minimally invasive methods.

Adult↗

PubMed1996

Spinal cord stimulation for chronic pain in peripheral neuropathy.

BACKGROUND: Spinal cord stimulation (SCS) has been used for the relief of chronic, intractable pain for over 2 decades. Recent technologic improvements in hardware have resulted in improved clinical outcome. We report our experience with epidural spinal cord stimulation for pain control of peripheral neuropathy for the past 15 years. METHODS: An analysis of our series of 276 patients revealed 30 patients diagnosed with peripheral neuropathy. The mean age of the 16 men and 14 women in the study was 62.4 years. The anatomic sources of pain included thorax, as well as upper and lower limbs. Causes of intractable pain included postherpetic neuralgia, intercostal neuralgia, causalgic pain, diabetic neuropathy, and idiopathic neuropathy. RESULTS: Nineteen patients reported relief of pain on trial stimulation and had their systems permanently implanted. At an average of 87 months' follow-up, 14 of these patients achieved long-term success in control of chronic pain (47% of all patients included in this study). Six patients reported excellent pain relief (> 75% pain relief), eight described good results (> 50% pain relief), and six had poor pain relief (< 50% pain relief). CONCLUSION: SCS is an effective therapy for pain syndromes associated with peripheral neuropathy. Causalgic and diabetic neuropathic pain seem to respond relatively well. whereas postherpetic pain and intercostal neuralgia syndromes seem to respond less favorably to the long-term beneficial effects of SCS. This information will be useful in the selection of patients with peripheral neuropathic pain who could be helped by SCS.

Adult↗

PubMed1991

Intractable muscle pain syndrome, osteomalacia, and axonopathy in long-term use of phenytoin.

Muscle pain syndrome is a complicated situation in that even an extensive work-up may overlook the primary etiology. A patient with multiple medical problems, including a history of partial gastrectomy due to trauma, a below-knee amputation from arteriosclerotic disease, and chronic phenytoin therapy for a seizure disorder, developed intractable, generalized muscle pain, with total dependency in mobility and self care. He was admitted to an acute care hospital and was eventually discharged with a diagnosis of occult malignancy. After being referred to our amputee clinic for prosthetic management, the patient was admitted for inpatient rehabilitation. Electrodiagnostic studies and muscle biopsy revealed typical neuropathic findings and nonspecific myopathic changes. Laboratory studies showed a vitamin D deficiency with secondary hyperparathyroidism. Discontinuation of phenytoin and treatment with calcium and vitamin D resulted in rapid relief of muscle pain and marked improvement in mobility and self care. This case illustrates an unusual combination of phenytoin-induced axonopathy and osteomalacia that incapacitated an otherwise functional person with below-knee amputation.

Aged↗