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At least 793 records · Page 44Linked to original sources
PubMed2006

Prospective measurement of function and pain in patients with non-neoplastic compression fractures treated with vertebroplasty.

BACKGROUND: There has been an increasing number of reports regarding the benefits of vertebroplasty for the treatment of vertebral compression fractures. In this investigation, validated outcome tools were utilized to document the impact of vertebroplasty on pain and function. METHODS: Fifty patients were recruited at a tertiary university hospital. Patients had been treated for intractable pain due to osteoporotic compression fracture(s) for at least four weeks. The vertebroplasty procedures were performed by a radiologist. The subjects were followed prospectively for one year and received conservative treatment in conjunction with the vertebroplasty. Validated outcome tools, including a visual analog scale, the Oswestry scale, and the Roland-Morris functional activity questionnaire, were used to evaluate changes in pain and functional capabilities. RESULTS: Fifty patients, thirty-one women and nineteen men (mean age, 68.6 years), were followed prospectively for one year. One hundred and three fractures (fifty-nine thoracic and forty-four lumbar) were treated. The visual analog scale showed the greatest improvement between the baseline score (mean, 7.76) and the score at one month (mean, 2.9), and the score remained improved at one year (mean, 2.9). The Oswestry and Roland-Morris questionnaires demonstrated significant (p < 0.0001) functional improvement between the baseline and one-month scores. With the numbers available, there were no significant changes in any variable from one month to one year (p > 0.05). CONCLUSIONS: Vertebroplasty is an effective treatment for patients with intractable pain due to osteoporotic vertebral compression fractures. Improvement in pain scores and functional capabilities that were found at one month were maintained at one year.

Adult↗
PubMed2001

Atlanto-axial subluxation syndrome and management of intractable headache, neck pain and shoulder pain with auricular stimulation: a clinical case report.

Atlanto-axial subluxation syndrome is a condition that is easily overlooked, misdiagnosed and mismanaged. Anatomy, neurovascular involvement and description of clinical manifestations are reviewed. Bi-Digital O-Ring Test is employed to establish an accurate diagnosis and its value and accuracy described briefly. Bi-Digital O-Ring Test has been an important diagnosis confirmation method (reconfirmed by CT or MRI in over 95% of more than 850 clinical cases) in this author's practice of spinal disorder and intractable pain management. A newly described device, the KIM-STIM, offers auricular stimulation of multiple points, using electrical microcurrent. Each unit is individually custom-molded to the patient's ear, and fitted with multiple electrodes. It was found to be very effective in managing the majority of intractable pain, especially pain requiring multiple daily treatments in order for the patient to live and function normally. The KIM-STIM device allows the patient to self-manage the pain, by day or night, thus allowing for a reduction or elimination of medication intake and diminishing the necessity for frequent doctor visits.

Acupuncture Points↗
PubMed1997

Pain relief in chronic pancreatitis with epidural buprenorphine injection.

BACKGROUND: The management of intractable pain in chronic pancreatitis is difficult. A novel method for its relief is described. METHODS: Twelve patients were given a mixture of buprenorphine (0.3 mg) and blood (10-15 mL) into the epidural space. RESULTS: All patients had pain relief lasting up to six months. CONCLUSION: Epidural buprenorphine injection is a simple, safe and effective method for pain relief in chronic pancreatitis.

Adolescent↗
PubMed1996

[Intrathecal administration of morphine and bupivacaine in the treatment of severe pain in chronic pancreatitis].

A 25-year-old male with idiopathic chronic pancreatitis suffered from severe pain not reacting to medical therapy. Intractable pain persisted after the following procedures: subtotal resection of the pancreas, interpleural administration of bupivacaine, epidural administration of bupivacaine, and thoracoscopic sympathectomy. Eventually, adequate pain relief was achieved with intrathecal administration of morphine and bupivacaine. An infusion pump, externally controlled by radiotelemetry, was implanted subcutaneously for intrathecal drug administration. With this pump the patient was fully ambulant. Intrathecal administration of morphine and bupivacaine through an implanted pump is a possible new technique for pain management in chronic pancreatitis.

Adult↗
PubMedDate not supplied

Effects of neurolytic concentrations of alcohol and phenol on Dacron and Gore-Tex vascular prosthetic grafts.

BACKGROUND AND OBJECTIVES: Neurolytic nerve block, using either alcohol (A) or phenol (P), is frequently used to treat intractable pain. However, these agents may disrupt the integrity of prosthetic vascular grafts. To investigate this possibility, the tensile strength of Dacron (Meadox Medicals, Oakland, NJ) and Gore-Tex (W.L. Gore Associates, Flagstaff, AZ) vascular grafts was determined after in vitro exposure to various clinically used concentrations of A or P. METHODS: Segments of Dacron and Gore-Tex graft were placed in the following solutions: saline (S), 6% and 9% P, and 25%, 50%, 75%, and 100% A, and stored at 23 degrees +/- 1 degree C for 72 hours. Axial maximum load (in kilonewtons, KN) and strain (in mm/mm) were determined with an Instron universal testing machine (Instron Corporation, Camden, MA). Samples from the S, 9% P, and the 100% A groups were evaluated using a scanning electron microscope. RESULTS: Dacron tensile strength decreased a maximum of 23% after exposure to 50%, 75%, and 100% A. Dacron strain capacity decreased after exposure to A (50%, 75%, 100%) and P (6%, 9%). Scanning electron microscope of both P and A showed significant degradation. No changes were found in the Gore-Tex group after exposure to P or A, however, scanning electron microscope of the 100% A sample showed moderate fiber degradation. CONCLUSIONS: The study shows that Dacron woven grafts are degraded by concentrations of A of at least 50%, and to a lesser extent, concentrations of at least 6%, while Gore-Tex had only minimal changes. While neurolytic block offers distinct advantages in patients with terminal cancer pain, the findings suggest that the use of more conservative modalities, such as oral medication regimens, be considered for the treatment of intractable pain in patients with vascular prosthetic grafts that are proximate to the proposed site of neurolysis.

Blood Vessel Prosthesis↗
PubMed1985

Sensory and motor responses to deep brain stimulation. Correlation with anatomical structures.

Motor and sensory responses induced by trial stimulation were examined before stereotaxically implanting a permanent stimulating electrode for pain relief in 11 patients with intractable pain of central origin. The total number of points eliciting a response when stimulated was 70. The points of stimulation were determined as exactly as possible from Schaltenbrand and Bailey's Atlas. Motor responses were detected upon stimulating 21 points, the majority of which were in the posterior third of the posterior limb of the internal capsule (IC). Stimulation of these 21 points was accompanied by pain relief in only two points (10%). Warm (22) or cool sensations (three) were provoked in the most posteromedial portion of the posterior limb of the IC, nucleus reticularis pulvinaris, and area triangularis, and seven (28%) of these 25 sensations were accompanied by pain relief. A burning sensation was found upon stimulation of 12 points, with stimulation in the mesencephalic lateral tegmental field eliciting the most severe burning pain. A tingling sensation was elicited at 12 points, in a distribution similar to that of the warm sensation. Five (42%) of these 12 points provided pain relief. The best stimulating point for pain relief is not in the center of the posterior limb of the IC, directly lateral to the posterior commissure, but rather in its most posteromedial part; that is, at the nucleus reticularis pulvinaris or area triangularis.

Adult↗
PubMed1989

Continuing challenges in the management of cancer pain.

Four issues concerning the mechanisms of cancer pain are highlighted in this article. First is the need for a common language-a staging system-for assessing cancer pain. The author discusses the recently proposed Edmonton Staging System for Cancer Pain which classifies patients according to seven prognostic factors. The other issues addressed include: Optimal use of narcotic analgesics and adjuvant drugs; and intractable pain syndromes. All are areas of pain management where we are falling short.

Analgesics, Opioid↗
PubMed2003

Nerve blocks and neuroablative surgery for chronic pancreatitis.

Surgical decompressive procedures for "large-duct" chronic pancreatitis have been notably successful in relieving pain. However, management of patients with intractable pain from "small-duct" chronic pancreatitis has been difficult, often resulting in narcotic addiction and/or malnutrition from major pancreatic resection. In view of the disappointing results from extensive pancreatic resections in these cases, denervation of pancreatic sympathetic pain afferents has been suggested as an alternative. Although denervation procedures have been attempted at multiple anatomical levels, results have unfortunately been mixed. The observed variability in results has been attributed to poor patient selection, incomplete understanding of neurophysiology of pancreatic pain, and perhaps inadequate knowledge of pancreatic neuroanatomy. At present, the preferred form of neural ablation is splanchnicectomy. However, a consistent and reliable method for identifying candidates for splanchnicectomy is critical, as it is clinically difficult to distinguish true pancreatic pain from other nociceptive conditions masquerading as pancreatic pain. Differential epidural anesthesia (DEA) is a promising, safe test for initial evaluation and patient selection, although it is not as precise as sometimes claimed. Patients responding to sympathetic block during DEA seem to be the best candidates for operative sympathetic ablation. At the moment, the optimal surgical approach to splanchnic ablation, which offers the least morbid technique, most favorable results, and an attractive risk-benefit ratio, is bilateral thoracoscopic splanchnicectomy. More experience and longer follow-up will be necessary to evaluate this approach.

Afferent Pathways↗
PubMed1998

Neurolytic thoracic paravertebral block in cancer pain. A clinical report.

BACKGROUND: Paravertebral block has successfully been used in the treatment of acute and chronic pain. The duration of paravertebral block could theoretically be prolonged by using neurolytic agents. METHODS: We retrospectively analyzed the results of neurolytic paravertebral blocks performed in 7 patients suffering from intense cancer-related thoracic pain. Thirty-seven spinal nerve roots were blocked during 20 visits. Nerve roots were identified by eliciting paresthesia radiating to the painful area. Each root was blocked separately. After test block using 0.5% bupivacaine, the paravertebral blocks were performed with 1-4 ml of 7% phenol in aqua. RESULTS: No technical failures or complications were recorded in the patient files. Pain relief lasted over 2 months after 4 visits (20%), from 1 week to 1 month after 5 visits (25%), and less than 1 week after a single visit (5%). After 9 visits (45%), the results were poor with no significant pain relief. CONCLUSION: Neurolytic paravertebral block with phenol doses used in our patients appears to have only limited use. Some patients with pain restricted to a small number of thoracic segments may benefit from its use. Because of complication risks, this technique should be limited to intractable pain in cancer patients with poor prognosis.

Acute Disease↗
PubMed1997

Pain characteristics help to predict the analgesic efficacy of radiotherapy for the treatment of cancer pain.

It is recognised that radiotherapy provides relief for intractable pain in approximately 50% of patients with cancer pain. Unfortunately, traditional explanatory variables, such as age, gender, histology or radiation dose, do not help to predict which individuals will benefit from palliative radiotherapy. A non-randomised prospective clinical trial was conducted on 51 patients to evaluate the value of pain characteristics as new explanatory variables for predicting the efficacy of palliative radiotherapy for providing cancer pain relief. Two new explanatory variables were identified: the presence of radiating pain and the pain score before radiotherapy.

Female↗
PubMed1993

Subarachnoid adrenal medullary transplants for terminal cancer pain. A report of preliminary studies.

BACKGROUND: The prolonged use of opioids to treat intractable pain with currently available therapeutic modalities is often unsatisfactory, usually because of tolerance or complications. Extensive studies carried out in the authors' laboratories have indicated that the transplantation of adrenal medullary tissue into the spinal subarachnoid space can significantly reduce pain in animal pain models, most likely via release of opioid peptides and catecholamines. The current study was undertaken to assess the feasibility and efficacy of subarachnoid adrenal medullary transplantation in alleviating terminal cancer pain in humans. METHODS: Two milliliters of human adrenal medullary tissue were prepared in the laboratory and then transplanted via lumbar puncture into the subarachnoid space in five patients suffering from terminal cancer pain. Pain scores (VAS), functional activity, and opioid intake were assessed and recorded before and after the transplantation procedure. In addition, CSF samples were collected before and (when possible) at fixed intervals after transplantation for biochemical and cytologic analysis. RESULTS: Four of the five patients demonstrated progressive decreases in pain scores after the transplant procedure, with concomitant reductions in opioid intake. Three of these four patients remained pain free, two for over 10 months, while the other had a recurrence of her pain after surgery for spinal cord compression secondary to metastases 10 weeks after transplant. The fifth patient had no pain reduction by 1 month after the procedure, and refused further followup. After the transplants, spinal CSF samples revealed increased concentrations of met-enkephalin in three of the five patients, and increased concentrations of catecholamines in the four patients in whom they were determined. CONCLUSIONS: The results obtained in this study indicate that subarachnoid adrenal medullary transplantation may provide a unique and effective approach to the management of intractable chronic pain in humans.

Adrenal Medulla↗
PubMed1991

[Intercostal nerve cross-anastomosis and DREZ-tomy in a patient with brachial plexus avulsion].

An 18-year-old male with a right brachial plexus injury caused by a motorcycle accident was admitted on October 13, 1988. A detailed examination revealed that the brachial plexus was totally injured. The axon reflex test suggested that the lesion sites were postganglionic in the C5 and C6 nerves, and preganglionic in the C7, C8 and Th1. On December 14, 1988, intercostal nerve cross-anastomosis was performed in the hope that a lost motor function of the right upper extremity could be restored as a first step. An electromyogram 6 months after this anastomotic operation demonstrated synkinesis between the biceps brachialis and the intercostal muscles during deep inspiration. Fifteen months after this operation, active voluntary muscle discharges which were higher than before in amplitude, were provoked. The right elbow flexion was gradually restored independently of respiration. On the other hand, intractable pain with a persistent severe tingling sensation appeared approximately one week after the injury on the lesioned upper extremity. The pain rapidly increased in severity. The DREZ-tomy from C5 to Th1 was performed on March 7, 1989. This has brought complete relief of the intractable pain. A brief discussion was given concerning some aspects of the brachial plexus avulsion and DREZ-tomy.

Adolescent↗
PubMed1991

Intrathecal narcotics for relief of pain from head and neck cancer.

We describe our experience with nine patients with head and neck pain of malignant origin who were treated with continuous low-dose intrathecal morphine via a lumbar catheter and implantable subcutaneous drug delivery pump. All patients had failed prior attempts at oral narcotic pain control due to either poor pain control or intolerable side effects. Using a visual analogue scale where the most severe pain is rated as 10 and no pain is rated as 0, the mean visual analogue scale was reduced from 7.6/10 (range, 5 to 10/10) before implantation to 1.9/10, 2.0/10, and 0.5/10 at 1 week, 1 month, and 2 months after implantation, respectively. Complications were acceptable. We conclude that intrathecal administration of morphine is a safe and effective means of pain control. This method deserves serious consideration in patients with intractable pain secondary to head and neck malignancy.

Analgesia↗
PubMed1995

A day-care pain clinic--its possibilities and limitations in the treatment of cancer patients.

A day-care unit was established to extend facilities of the pain clinic. During its first 2 years of operation 79 patients with cancer-related pain have been treated. Most patients were admitted because of intractable pain but also suffered other symptoms mainly concerning the gastrointestinal and respiratory tract. For more than half of the patients and their families, psychosocial problems were also an important issue. The central aim of the pain management programme is to improve the quality of life of patients with cancer-related pain through appropriate drug based or anesthetic interventions. Control of other symptoms and counseling for both patient and family are an integral part of the holistic approach. The first initial clinical experiences show that the day-care unit provides a noticeable improvement in patient care and constitutes an excellent link between the out- and inpatient therapeutic possibilities.

Adult↗
PubMed1994

Consensus conference on the neurosurgical management of pain.

On the recommendation of the American Association of Neurological Surgeons Section on Pain, a satellite conference was organized for the 1993 annual meeting to work toward a consensus regarding the indications, expected outcomes, and potential complications of neurosurgical procedures for intractable pain. Twenty-two experts in the field attended this 2-day conference to consolidate our understanding of the role of neurosurgical procedures in pain management and to review critically the methodologies for clinical studies. With the support of the Section on Pain, this consensus development process will continue in order to refine the application and study of neurosurgical procedures for pain.

Algorithms↗
PubMed1977

Use and misuse of intra-articular corticosteroids in treatment of temporomandibular joint pain.

In certain cases of intractable pain in the temporomandibular joint after conservative treatments have been unsuccessful, a single intra-articular injection of up to 40 mg of prednisolone trimethylacetate has been shown to be useful for permanent relief. This treatment has most success in patients over the age of 30 years; the older the patient the greater likelihood of clinical improvement. It is not to be recommended in the younger age groups. There is no evidence that a single intra-articular injection of any such corticosteroid causes damage that can be detected radiographically to an apparently sound articular surface. But it is still possible that multiple injections can cause damage, and they should not be used for any age group. In some cases where there is radiographic evidence of articular erosion before treatment, an advance of the lesion with reduction of the size of the mandibular condyle can be expected but is consistent with a reduction of the symptoms. The final result may be said to resemble a pharmacologically-achieved arthroplasty. Judgment of the success of the treatment by symptomatic assessment has proved to be entirely satisfactory, since the majority of patients have been grateful for the initial and continued relief of their pain and dysfunction. They have, in fact, avoided surgery to their joints and have no untoward side-effects.

Adult↗
PubMed1996

Community attitudes on the family of issues surrounding the death of terminal patients.

In two studies, respondents made recommendations for the medical treatment of a terminally ill elderly woman. The woman was or was not experiencing intractable pain, and had requested either heroic medical efforts or euthanasia. Respondents' recommendations were influenced by both the specific wishes of the patient and the pain the person was experiencing. However, participants were not completely swayed by the patient's wishes: only about half of the sample recommended euthanasia even when the patient was in intractable pain and had requested death; also, many subjects would not resuscitate the patient whose heart or lungs failed, even though she had requested heroic measures. Respondent attitudes toward euthanasia predicted recommendations in the expected directions. We suggest that there is less dissent on the issues that arise for medical treatments at the end of life than has been widely assumed.

Advance Directives↗