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Results for “Intractable Pain”

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At least 775 records · Page 43Linked to original sources

PubMed1986

Long-term, intermittent percutaneous administration of epidural and intrathecal morphine for pain of malignant origin.

Eight patients with intractable pain of malignant origin were treated by the surgical implantation of externalized catheters for percutaneous injection of morphine into the spinal epidural or the cerebral intraventricular space. Follow-up ranged from 48 hr to 1 yr. Four catheters (50%) malfunctioned mechanically and were repaired. Two were imputed in systemic infection and were removed. One patient developed paradoxical responses and discontinued catheter use. Every patient enjoyed excellent relief for a significant time with full preservation of mental capacities. The attractive simplicity of this morphine delivery system deserves further study.

Adult↗

PubMedDate not supplied

Long-term peripheral nerve stimulation for painful nerve injuries.

BACKGROUND: Although peripheral nerve stimulation (PNS) has been used in the treatment of pain since 1965, only a few follow-up studies have been published. The aim of the present retrospective study was to carefully assess the long-term efficacy and safety of PNS in the treatment of painful nerve injuries. METHODS: Patients suffering from intractable pain due to peripheral nerve injuries underwent PNS after careful selection. Long-term results were evaluated based upon patients' reports of pain intensity on a visual analog scale (VAS) and their consumption of analgesics. Two categories of results were chosen: good, referring to 50% or more relief of pain with abstinence from analgesic medications; and poor, with less than 50% improvement. RESULTS: Of 154 referred patients, 46 (26 women and 20 men) were found suitable for PNS. Four etiologic factors were identified, the most common being nerve lesion following an operation in the region of the hip or knee. Other etiologies included entrapment neuropathy, pain following nerve graft, and painful neuropathy following a traumatic injection. The follow-up period was 3-16 years. Of the 46 patients who underwent surgery, the results were classified as good in 36 (78%) patients and as poor in 10 (22%) patients. Overall, pain intensity dropped from a VAS of 69 +/- 12 before surgery to 24 +/- 28 postoperatively (P < 0.001). CONCLUSIONS: PNS can produce good pain relief in the majority of carefully selected patients suffering from isolated painful neuropathies.

Adult↗

PubMed1976

What is a pain center?

The authors present the concept that a multi-disciplinary interdepartmental pain center should include: 1) an initial out-patient pain clinic, 2) an inpatient pain service for diagnosis of pain problems and treatment of patients with intractable pain, including pain from cancer, 3) a psychotherapeutically-oriented chronic benign Pain Unit, 4) facilities for clinical and basic pain research, and 5) affiliations for an adequate teaching program.

California↗

PubMed1994

[Use of a disposable infusion device for continuous epidural block].

We analyzed 130 patients with intractable pain who were treated with continuous epidural block therapy using a disposable microinjector to evaluate its efficacy and utility. The mean treatment period was 4.3 +/- 0.4 weeks. After the treatment, the mean visual analog scale (VAS) improved to 3.3 +/- 0.2, from the pretreatment value of 6.5 +/- 0.1. Among the intractable pain conditions, postherpetic neuralgia (PHN) and pain in the neck, shoulder and upper limbs were relieved markedly, while cancer pain was difficult to reduce. These data show that continuous epidural block therapy using the disposable microinjector is particularly useful in PHN, in which sympathetic nerve block is the essential treatment. The pain in the neck, shoulder and upper limbs was relieved with continuous somatic nerve block.

Aged↗

PubMed1995

Transcranial magnetic coil stimulation of motor cortex in patients with central pain.

We report two patients with deafferentation pain secondary to central nervous system lesions who were evaluated by noninvasive magnetic coil stimulation of the motor cortex followed by electrical motor cortex stimulation with epidural electrode array implantation. Magnetic coil stimulation was very useful to estimate the effect of electrical stimulation. Our first patient was a 52-year-old man who experienced a left putamenal hemorrhage at the age of 48. Two years later, he had paresthesias and intractable pain in the extremities and face on the right side. Pain was resistant to barbiturates but responded to magnetic coil stimulation of the motor cortex. Electrical motor cortex stimulation provided excellent relief from the pain. The second patient was a 43-year-old man who was suffering from congenital cerebral palsy for which left thalamotomy was performed two times, at the ages of 9 and 13. He began to experience intractable pain on the right side 20 years later. Although barbiturate administration was effective for pain relief, neither magnetic coil stimulation nor electrical stimulation of the motor cortex gave relief from pain.

Adult↗

PubMed1991

Spinal cord compression complicating subarachnoid infusion of morphine: case report and laboratory experience.

The intraspinal administration of morphine has been employed increasingly in the management of intractable pain of malignant as well as benign origin. We have encountered a previously unreported clinical complication: spinal cord compression by an inflammatory tissue mass surrounding a subarachnoid infusion catheter administering morphine, leading to paraplegia. The patient was referred to our institution after catheter and pump implantation for chronic, intractable pain associated with pre-existing lumbar arachnoid fibrosis, after multiple myelograms and surgeries. The patient may, therefore, have had an underlying propensity to foreign body reactions. We have encountered a similar phenomenon, however, in a canine laboratory model. The pathological features in both our patient and our laboratory preparation, with inflammatory tissue masses around the tip of the catheter but not around proximal subarachnoid segments, suggest an effect related to infusion, as opposed to infection or the presence of the catheter. We review the pathological features in both settings and the pertinent literature.

Adult↗

PubMed1975

Neurophysiological characterization of the anterolateral spinal cord neurons contributing to pain perception in man.

These studies have examined threshold, frequency, and refractory period characteristics of a neural population in the anterolateral quandrant (ALQ) of the spinal cord of man, stimulation of which produces pain. Subjects were 18 conscious humans undergoing percutaneous anterolateral cordotomy for relief of intractable pain. Pain could be produced by ALQ stimulation in all subjects. Pain thresholds ranged from 120 to 1000 muA (at 50 pulses/sec; 0.2 msec pulses), but the majority of thresholds were below 300 muA. A linear relationship was found between stimulation frequency and percentage of subjects reporting pain. This relationship ranged from 5 to 25 pulses/sec with 100% reporting pain at 25/sec and 0% at 5/sec. In 2 of 3 subjects, increases in stimulation frequency up to 500/sec did not produce pain when stimulation intensity was below threshold at 50/sec. The neuronal refractory period for pain in these subjects ranged between 1.0 and 2.0 msec, but the majority of relative refractory periods fell between 1.0 and 1.5 msec. The threshold, frequency, and refractory period data obtained in this study are similar to those found for wide dynamic range cells in the ventral half of the dorsal horn in the monkey and suggest that activation of these cells is a sufficient condition to produce pain in man.

Animals↗

PubMed1991

Stereotaxic placement of a ventricular catheter and reservoir for the administration of morphine sulfate.

Patients with intractable pain due to cancer present a unique challenge to both medical and nursing personnel. This case study illustrates a unique home hospice managed pain control regime that has been implemented for a terminal cancer patient with intractable pain. A ventricular catheter attached to a reservoir was stereotaxically implanted for the administration of preservative-free morphine sulfate. The presentation will include the history of intraspinal morphine, the surgical placement of the ventricular access devise, and the procedure for intraventricular morphine administration. Also, the preoperative nursing assessment and patient family education will be discussed. Education of hospice nurses in the technique of injection, postoperative pain assessment, monitoring of side effects and discharge planning will conclude the presentation.

Adult↗

PubMed2000

Surgical options in the patient with chronic pancreatitis.

There are a number of indications for surgical intervention in chronic pancreatitis, but the most common is intractable pain. Many surgical procedures can be applied in the patient with chronic pain, and the variety of procedures reflects the fact that no single procedure is ideal for all patients. Duct drainage procedures are safe and have a significant response rate, but only about one third of patients experience long-lasting complete relief of pain. Procedures that combine resection and duct drainage are generally more effective, with long-term success rates in the 80% range. The development of the Frey and Beger procedures, two methods for pancreatic head resection that preserve the anatomy of the stomach, duodenum, and bile duct, represents an advance in surgical therapy of chronic pancreatitis. Total pancreatectomy with islet autotransplantation is a procedure that may be appropriate in certain subsets of patients. Thoracoscopic splanchnicectomy is a new, minimally invasive procedure, still in evaluation, which may become a very valuable method when the sole indication for surgery is intractable pain.

Chronic Disease↗

PubMed1995

Treatment of hyperesthetic neuropathic pain in diabetics. Decompression of the tarsal tunnel.

OBJECTIVE: The authors evaluated the causal relationship between entrapment of the posterior tibial nerve and neuropathic pain and describe the results of nerve decompression in a selected group of patients with intractable pain. SUMMARY BACKGROUND DATA: Painful metabolic neuropathy has, until recently, been thought to be an irreversible and essentially untreatable complication of diabetes. Recent studies have shown that metabolic deterioration is only one component of the disease process. METHODS: A group of patients with intractable painful neuropathy and a positive percussion sign underwent posterior tibial nerve decompression. RESULTS: Nerve decompression relieved the pain in the majority of treated patients. Return of other sensory function also was noted. CONCLUSIONS: Painful diabetic neuropathy of the lower extremities is potentially reversible. It appears to be caused partially by nerve entrapment and can be reversed by decompression.

Adult↗

PubMed2005

Outcome of pancreaticoduodenectomy for chronic pancreatitis.

BACKGROUND AND PURPOSE: Some patients with chronic pancreatitis may require surgery, mainly because of disabling medically intractable pain, suspicion of malignancy or complications related to chronic pancreatitis. This study analyzed the efficacy of pancreaticoduodenectomy (PD) for patients with chronic pancreatitis in terms of pain relief, control of local complications and pancreatic endocrine/exocrine function. METHODS: This retrospective analysis included 24 consecutive patients with chronic pancreatitis who received PD from April 1995 to March 2003. There were 21 men and 3 women. The age of the patients ranged from 21 years to 73 years, with a mean age of 44 years. Alcohol abuse, found in 14 patients (58.3%), was the most common predisposing factor. Local complications included stenosis of the pancreatic duct in 15 patients, biliary obstruction in 9, duodenal obstruction in 4 and left-sided portal hypertension in 1. The surgical indications were recurrent intractable pain (n=16), local complications (n=18), and suspicion of malignancy (n=6). Endocrine pancreatic function was assessed by the need to treat diabetes mellitus with dietary modification, oral hypoglycemic agents or insulin. Pancreatic exocrine function was assessed based on clinical symptoms. Pain severity was evaluated using a scoring system based on the use of analgesic medication. The mean duration of follow-up in 22 of 24 patients was 31 months, with a range of 4 to 90 months. RESULTS: Preoperatively, pancreatic exocrine insufficiency was detected in 3 patients (3/24, 12.5%), exocrine insufficiency in 5 (5/24, 20.8%) and intractable abdominal pain requiring morphine injection in 16 (16/24, 66.7%). After PD, 4 patients had 5 complications, resulting in a morbidity rate of 17% and a mortality rate of 4%. Postoperative diabetes mellitus developed de novo in 3 patients (3/20, 15%) and postoperative pancreatic exocrine insufficiency was detected in 14 patients (14/22, 63.6%). Complete pain relief after surgery was noted in 12 patients (12/14, 85.7%). CONCLUSIONS: In selected patients with chronic pancreatitis, PD is a safe procedure and can effectively relieve pain and control local complications. Deterioration of pancreatic endocrine function after PD was mainly related to disease progression. Pancreatic resection plays an important role in progressing pancreatic exocrine function.

Adult↗

PubMed1996

Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis.

OBJECTIVE: The authors performed an initial clinical evaluation of laparoscopic pancreatectomy with splenectomy for chronic pancreatitis. SUMMARY BACKGROUND DATA: Severe intractable pain is the most common indication for resection in chronic pancreatitis. Localized accentuation of the pathology, usually in the head of the organ, is the basis for localized proximal resection, often with preservation of a rim of pancreas and the duodenum, although some favor total pancreatectomy. The reported results for distal pancreatectomy have been variable. Distal resections are limited to those patients in whom the gross pathology is maximal in the left hemipancreas. METHODS: A consecutive series of five patients with intractable pain due to chronic pancreatitis have been treated with laparoscopic 70% distal pancreatectomy and splenectomy using a 5-port technique. RESULTS: The procedure was completed in all with an average operating time of 4.5 hours and a mean intraoperative blood loss of 400 mL. There was one minor pancreatic leak, which resolved spontaneously. The median postoperative hospital stay was 6 days. CONCLUSIONS: Laparoscopic distal pancreatectomy for chronic pancreatitis is feasible, the procedure appears to be safe, and it is accompanied by an accelerated recovery.

Adult↗

PubMed1997

Outcome of surgery for chronic pancreatitis.

BACKGROUND: In patients with chronic pancreatitis, surgery is indicated for the management of intractable pain or for the treatment of complications. METHODS: Sixty-three consecutive patients (49 men and 14 women of median age 40 (range 20-72) years) who had undergone surgery over an 8-year interval for chronic pancreatitis were studied. The mortality and morbidity rates associated with surgery were assessed and quality of life was reviewed based on relief of symptoms, analgesic use, employment and long-term sequelae. RESULTS: Forty-four patients (70 per cent) had alcoholic chronic pancreatitis. In 60 patients the principal indication for surgery was intractable pain. Eighteen patients had a duodenum-preserving resection of the pancreatic head (Beger operation); the other surgical procedures were Whipple resection (15), left-sided resection (13), total pancreatectomy (seven), pseudocystjejunostomy (five), pancreaticojejunostomy (one) and bypass procedures (four). The median inpatient stay was 12 days; 23 patients had postoperative complications including one death (2 per cent). There was improved pain control (P < 0.001), a reduction in opiate analgesia use, increase in percentage weight gain (P < 0.01 at 2 years) and return to employment following surgery. Although there was an increase in diabetes mellitus and need for enzyme supplementation these were easily controlled. CONCLUSION: Surgery is an effective treatment in carefully selected patients with chronic pancreatitis but must be tailored to the pattern of disease in each individual.

Adult↗

PubMedDate not supplied

Patient satisfaction with spinal cord stimulation for predominant complaints of chronic, intractable low back pain.

BACKGROUND CONTEXT: Results of subsequent surgical intervention in patients with intractable pain after lumbar spine surgery are typically worse than for initial surgery, particularly in those with predominant complaints of back pain rather than lower extremity pain. Spinal cord stimulation (SCS) has been found to yield good results in patients with primary complaints of intractable lower extremity pain. Technological advances have broadened the indications for this treatment. PURPOSE: The purpose of this study was to evaluate patient satisfaction after SCS in the treatment of patients with predominant complaints of chronic, intractable, low back pain. STUDY DESIGN/SETTING: Data were collected from retrospective chart review and patient follow-up questionnaire. Patients were treated at a spine specialty center. PATIENT SAMPLE: The study group consisted of the consecutive series of our first 41 patients who underwent SCS for predominant complaints of low back pain. The mean symptom duration was 82.9 months, and the mean age was 47.9 years (range, 28-83 years). All but three patients had previously undergone lumbar spine surgery (mean, 2.3 prior surgeries). OUTCOME MEASURES: At the time of follow-up (5.5-19 months after SCS implantation), patients completed questionnaires assessing their satisfaction with their outcome, if they would have the procedure again knowing what their outcome would be and if they would recommend SCS to someone with similar problems. In determining outcome, a negative response was assigned for patients who had the device removed. A worst-case analysis was also conducted in which a negative response was assigned for patients lost to follow-up or who failed to respond to a particular question. Data were also collected on complications and re-operations. METHODS: All trial stimulation procedures were performed under local anesthetic with the patient providing feedback concerning pain relief achieved with various lead placements and settings. If one lead did not provide acceptable relief in all the areas needed, placement of a second lead was pursued. If the patient failed to maintain acceptable pain relief (> or =50% pain relief) during a multiday trial period, the leads were removed. If adequate relief was maintained during the trial period, the receiver was implanted. RESULTS: Responses to the follow-up questionnaire indicated that 60% of patients considered themselves improved from their preoperative condition and the remaining 40% did not; 78.1% of patients would recommend SCS to someone with similar problems, 69.0% were satisfied, 75.0% would have the procedure performed again if they had known their outcome before implantation. Among the 36 patients in whom the system was implanted, it was later removed in 4 because of lack of sufficient pain relief. Other re-operations included repositioning of the leads to regain pain relief in the areas needed, replacement of a malfunctioning unit and revision of lead extension wires. CONCLUSIONS: In this retrospective study, the majority of patients were satisfied with the results of SCS and would have the procedure again knowing what their outcome would be. These results suggest that further investigation of SCS is warranted in this difficult to treat patient population presenting with predominant complaints of chronic, intractable, axial low back pain.

Adult↗

PubMed2004

Judgments of laypersons and general practitioners on justifiability and legality of providing assistance to die to a terminally ill patient: a view from New Zealand.

As part of a larger study, four decisions related to a vignette scenario of the elective death of a terminally ill patient suffering intractable pain are examined (doctor supplying information and drugs, assisting patient to take the drugs, or administering a lethal injection). Judgments on justifiability and legality of actions were obtained from laypersons and general practitioners (GPs) in Auckland, New Zealand. The results show that over 72% of laypersons and over 30% of GPs judged all four actions justified. Despite illegality a significant number of laypersons and some doctors were unsure of the legal status of actions. The current law in New Zealand prohibiting physician-assisted death may not reflect judgments by the majority of laypersons or 30% of general practitioners on the justifiability of elective death options for a terminally ill patient with intractable pain. Judgments on justifiability may be related to confusion over the legality of actions.

Adolescent↗

PubMed2003

Molecular mechanism of neuropathic pain.

Pain is the most common clinical symptom for which people seek medical care. Although effective therapy for inflammatory pain is possible, current therapy for neuropathic pain is still inadequate. Even the strongest painkiller, morphine, is reported to be ineffective against neuropathic pain in the clinic. The lack of effective therapeutic agents for neuropathic pain is due to the fact that its underlying mechanisms are still not fully understood. Recently, pain researchers have been trying to identify the cellular and molecular processes that lead to neuropathic pain. Understanding the molecular mechanisms of neuropathic pain would certainly provide a hope for the future development of effective therapies for this intractable painful disease.

Analgesics↗

PubMed1983

Intraventricular morphine for control of pain in terminal cancer patients.

Satisfactory control of intractable pain has been achieved in 17 terminal cancer patients by injecting small doses of morphine into the lateral cerebral ventricle via an Ommaya reservoir. Pain relief together with a favorable behavioral response was obtained without interference with other sensory modalities, noticeable physical changes, or side effects annoying or severe enough for the patient to discontinue therapy. Eleven patients developed tolerance, but this phenomenon does not require withdrawal of treatment. Chronic intraventricular morphine administration can be safely performed on an outpatient basis, and results in control of midline, bilateral, and diffuse pain associated with orofacial and disseminated cancer. However, this experience is preliminary and further clinical trials are needed to determine the place of this method of therapy in the management of chronic pain.

Aged↗

PubMed1992

Reflex sympathetic dystrophy of the stump in below-knee amputees.

OBJECTIVE: To document the occurrence of reflex sympathetic dystrophy of the stump in two patients with below-knee amputation. DESIGN: A retrospective survey emphasising two clinical case reports. SETTING: Department of orthopaedic rehabilitation at a teaching rehabilitation hospital. PATIENTS: Lower limb amputees (n = 164) were accepted for prosthetic rehabilitation. Twenty-one amputees were regarded as rehabilitation failures; in two below-knee amputees intractable pain was the major problem. RESULTS: Clinical manifestations, radiological, and scintigraphic findings in the two amputees with intractable pain met the criteria for diagnosis of reflex sympathetic dystrophy. CONCLUSIONS: Reflex sympathetic dystrophy of the stump should be suspected in below-knee amputees whenever severe pain persists over a period of 3 to 4 months following amputation.

Amputation Stumps↗