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Results for “Intractable Pain”

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At least 883 records · Page 49Linked to original sources

PubMed1999

Low-dose ketamine in the management of opioid nonresponsive terminal cancer pain.

Two patients with far-advanced cancer, near death, who were experiencing excruciating and intractable pain that was poorly responsive to rapidly escalating doses of morphine and hydromorphone were treated with low-dose intravenous ketamine (0.1-0.2 mg/kg). This intervention eliminated the need for any further opioid use, providing profound analgesia and a sense of calm during the last hours and days of these patients' lives. These case reports add to the small but growing body of clinical literature suggesting that ketamine may have a significant place in the care of patients with pain that is poorly responsive to opioids, or who experience dose-limiting adverse effects, near the end of life. This is an important matter to disseminate in order to reassure the public that we do have the tools necessary to keep the promise that no one need die with uncontrolled pain. This therapeutic approach may also serve to reassure concerned physicians that their efforts to assure pain relief may not be misconstrued as hastening death.

Adolescent↗

PubMed1978

Single neuron analysis of the human midbrain tegmentum. Rostral mecencephalic reticulotomy for pain relief.

Rostral mesencephalic reticulotomy (RMR) has been performed since 1973 for relief of intractable pain. The target area is in the midbrain reticular formation (MRF) bordering the periaqueductal gray matter at the superior collicular level. The target of RMR is 13--16 mm posterior to the midpoint of the AC-PC line and 5--8 mm below the AC-PC line. The laterality of the target is measured from the center of the aqueduct, ranging 5 to 8 mm from the midline. The rationale for this procedure is based upon the previous findings that the brain stem reticular formation plays a more important role above the spinal cord level than the lateral spinothalamic tract in the central conduction of nociceptive impulse. In the present study, intraoperative single neuron recording was made with tungsten microelectrodes from the human midbrain tegmentum in response to peripheral pinprick stimulation. These nociceptive neurons were classified into three groups in regard to the unit latency from the peripheral pinprick stimulation.

Aged↗

PubMed1988

[Eight-MHZ RF hyperthermia in urological malignancies].

Eight-MHz radiofrequency hyperthermia (H) using Thermotron-RF8, and its combination with irradiation (RH), anticancer drugs (CH) or anticancer drugs plus irradiation (CRH), were carried out for a total of 93 urological malignancies: 19 cases of renal cancer, 3 of renal pelvic cancer, 4 of ureteral cancer 39 of bladder cancer, 8 of prostatic cancer, 14 of metastatic lesion of urological cancers and 6 of other urological cancers. All had failed in previous treatments, or had not undergone surgery because of their poor general condition. Nine cases, including 1 of renal cancer, 1 of ureteral cancer, 4 of bladder cancer, 2 of prostatic cancer and 1 of metastatic lesion of bladder cancer, were treated with (H). Fifty cases, including 4 renal cancer cases, 20 bladder cancer cases and 6 prostatic cancer cases, were treated with (RH). Eight of the 19 cases of renal cancer were treated with mitomycin C-microcapsule (MMC-mc) embolization prior to radiohyperthermia (CRH). The remaining 6 cases of renal cancer received embolization with MMC-mc followed by RE-heating (CH). Eighteen of the 48 cases of urothelial cancer or its metastasis, including 1 of renal pelvic cancer, 15 of bladder a cancer and 2 of metastatic lesion of bladder, received a combined treatment of intravenous THP-adriamycin, one of the derivatives of adriamycin and RE-heating (CH). In the remaining 2 cases, one received (CH), and the other received (CRH). Hyperthermia was given twice a week for a total of 10 sessions in 5 weeks. Intratumoral temperature was kept above 42.5 degrees C for 30 to 40 minutes during a one-hour heating. Complete tumor regression was obtained in 9 bladder cancer cases. Partial tumor regression, defined as a regression of 50% or more, was obtained in 17 cases. A pain relief was attained in 18 of 23 patients with intractable pain due to local tumor infiltration. As side effects, mild skin burns were observed in 21 cases. Ten obese cases, having subcutaneous tissue 15mm thick or more, developed fat tissue induration after treatment.

Adolescent↗

PubMedDate not supplied

The dilemma of painful old os calcis fractures.

This study of 16 patients (17 amputations) draws attention to intractable pain as a rare, but not previously emphasized, sequela of os calcis fracture. The fracture remained painful despite, in many cases, exhaustive measures to relieve symptoms. The majority of patients still had pain even after amputation and revision, suggesting the development of a regional (phantom) pain syndrome. Patients should be advised that severe os calcis fractures may not heal sufficiently to stabilize the foot for 18-24 months. Patients who continue to complain of pain following treatment of a fracture of the os calcis should be carefully evaluated in a pain management clinic. Since in some patients the pain may not be entirely organic in origin, amputation would not solve the problem. In the present series amputation did not always relieve pain and also made prosthetic fitting difficult.

Adult↗

PubMed1983

Dorsal root entry zone lesions (Nashold's procedure) for pain relief following brachial plexus avulsion.

Brachial plexus avulsion is an important cause of severe intractable pain, particularly in young motor cyclists. The pain usually develops soon after the injury. In a minority of cases severe pain persists and is refractory to management. Nineteen patients are reviewed in whom dorsal root entry zone lesions have been produced for pain relief. The operative technique is described. Early post-operative motor or sensory disturbance in the ipsilateral leg have been temporary side effects, with mild persisting deficits in a minority. Sixteen cases have had significant persisting pain relief. The maximum follow-up period is 2 1/2 years.

Accidents, Traffic↗

PubMed1989

Schools of thought on pain.

Through an analysis of the way pain specialists speak about pain and deal with pain patients, the prevailing approaches to pain in eight academic pain centers in the Netherlands have been traced and studied. Major categories for distinguishing between the diverse approaches to pain are: theoretical statements about pain, definitions of pain patients, statements about therapy, and about recovery. On the basis of these categories, five ideal typical schools or approaches have been deduced. After a brief description of these schools, according to the above categories, and from the point of view of an ideal typical adherent (actor) of each school, I proceed to an in-depth inquiry into the major basic assumptions of these approaches with respect to their portrayal of man and the role of medicine. Finally, envisaging the phenomenon of pain within the context of everyday life, a new model is proposed for understanding the experience of pain; this also sheds light on the medical problem of patients with 'intractable' pain.

Adaptation, Psychological↗

PubMed1983

Thalamic stimulation for chronic pain.

Electrical stimulation of the thalamus was found to be effective for the treatment of chronic intractable pain of various etiologies. Diencephalic recordings revealed spontaneous focal electrical discharge patterns with relatively low activation thresholds. Localization of the optimum thalamic discharge site is used as a guide for the electrode implant to be used for chronic stimulation. The thalamic sites which most frequently displayed the low threshold spontaneous focal discharge activity were the CM-Pf complex and related intralaminar nuclear structures. Generation of diencephalic pain-reverberating circuits was discussed in relation to explaining the pain syndromes herein described. The applied electrical stimulation is thought to electrophysiologically 'jam' the low threshold discharging systems and thereby alleviate pain.

Adult↗

PubMed2006

Peripheral nerve field stimulation in chronic abdominal pain.

INTRODUCTION: Spinal Cord Stimulation (SCS) has become an accepted therapeutic modality for the treatment of intractable pain syndromes, primarily used today in the settings of failed back surgery syndrome, neuropathic back and limb pain. The use of spinal cord stimulators for peripheral nerve field electrostimulation is becoming increasingly recognized as a safe, effective alternative for chronic pain conditions that are refractory to medical management and do not respond to traditional dorsal column stimulation. Advances in technology have allowed for minimally invasive percutaneous placement of multipolar leads with complex programmable systems to provide patient- controlled relief of pain in precisely targeted regions. With these improvements in hardware, the use of Peripheral Nerve Field Stimulation (PNFS) appears to have an untapped potential for providing patients with pain relief for a wider range of underlying conditions than was previously believed possible. We present three cases, each with a different etiology of chronic abdominal pain: one with inguinal neuralgia, one with chronic pancreatitis, and one with pain following liver transplant. Each patient was refractory to conventional medical approaches. For all three patients, PNFS provided significant relief from pain, enabling patients to decrease or discontinue their opioid medications and to enjoy significant improvement in their quality of life. We conclude that PNFS is a safe, effective and minimally invasive treatment that may be used successfully for a wide variety of indications including chronic abdominal pain.

Abdominal Pain↗

PubMed1985

Management of pain in the terminally ill by administration of epidural narcotics.

Fifteen patients with chronic malignant intractable pain were given epidural narcotics for periods of up to 280 days. The majority were treated at home. The patients self-administered the narcotics through an indwelling epidural catheter that had been tunneled and brought out onto the anterior abdominal wall. The results are presented together with the problems encountered.

Administration, Oral↗

PubMed2005

Acute response to intracisternal bupivacaine in patients with refractory pain of the head and neck.

Continuous intracisternal infusion of bupivacaine for the management of intractable pain of the head and neck is effective in controlling pain in this patient group. With the catheter tip being located at the height of the C1 vertebral body, autonomic regulatory information may also be influenced by the infusion of bupivacaine. By combining direct sampling of cerebrospinal fluid (CSF), via a percutaneously placed catheter in the cisterna magna, with a noradrenaline and adrenaline isotope dilution method for examining sympathetic and adrenal medullary activity, we were able to quantify the release of brain neurotransmitters and examine efferent sympathetic nervous outflow in patients following intracisternal administration of bupivacaine. Despite severe pain, sympathetic and adrenal medullary activities were well within normal range (4.2 +/- 0.6 and 0.7 +/- 0.2 nmol min(-1), respectively, mean +/-S.E.M.). Intracisternal bupivacaine administration caused an almost instantaneous elevation in mean arterial blood pressure, increasing by 17 +/- 7 mmHg after 10 min (P < 0.01). Heart rate increased in parallel (17 +/- 5 beats min(-1)), and these changes coincided with an increase in sympathetic nervous activity, peaking with an approximately 50% increase over resting level 10 min after injection (P < 0.01). CSF levels of GABA were reduced following bupivacaine (P < 0.05). CSF catecholamines and serotonin, and EEG, remained unaffected. These results show that acutely administered bupivacaine in the cisterna magna of chronic pain sufferers leads to an activation of the sympathetic nervous system. The results suggest that the haemodynamic consequences occur as a result of interference with the neuronal circuitry in the brainstem. Although these effects are transient, they warrant caution at the induction of intracisternal local anaesthesia.

Adult↗

PubMed1996

Cancer pain.

An accurate assessment and where possible a precise diagnosis of the underlying mechanism in necessary for the effective management of pain in cancer. The majority of patients respond to oral analgesics, and the range of drugs required is not vast. Adjuvant analgesic drugs will be needed for the treatment of bone pain, visceral pain and neuropathic pain. For the remaining patients who present with difficult and occasionally intractable pain, a multidisciplinary approach using drug and non-drug measures will usually allow significant relief of symptoms.

Analgesics↗

PubMed2005

[Pulsed radiofrequency treatment of severe radicular pain].

UNLABELLED: Radiofrequency (RF) lesions have been used for over 25 years in the treatment of intractable pain of spinal origin. The conventional idea is that the heat generated in the tissue surrounding the electrode tip leads to destruction of nerve fibers. In case of mechanical back pain, an electrode positioned adjacent to the medial branch of the dorsal root may reduce the input of noxious nerve stimuli and alleviate pain. For treatment of patients with severe radicular pain the authors often apply pulsed radiofrequency current. This technique enables the application of a relatively high voltage near the dorsal root ganglion, avoiding the deleterious thermal effect of the current. It was found to exert a beneficial effect in cases of intractable radicular pain. This study reports the result of pulsed RF in 28 patients suffering from severe radicular pain treated by pulsed radiofrequency current with follow-up at periods of 3, 6 and 12 months after treatment. There were 20 cases of low back pain and 8 with neck pain, with an average age of 56.7 years. The first follow-up after 3 months revealed the following results: excellent results in 2 cases (7.1%), good results in 12 cases (42/9%), fair in 9 (32/1%) and 5 (17/9%) reported that their condition have not changed. Results after 6 and 12 months were excellent in 2 (both groups), good in 7 and 6 respectively, 11 fair (both groups) and unresponsiveness to treatment was noticed in 8 patients after 6 and 9 after 12 months. Significant reduction was found in the Visual Analog Scale for pain from an average of 8.8 to 4.2 after 3 months, 4.8 after 6 months and 4.9 after 1 year. CONCLUSION: Pulsed RF treatment is a safe and simple procedure to control radicular pain in the cervical and lumbar regions. Following the current study the authors stress the need for further prospective, double-blind studies for better investigation of this technique.

Electric Stimulation Therapy↗

PubMed2006

Does laparoscopy used in open exploration alleviate pain associated with chronic intractable abdominal wall neuralgia?

BACKGROUND: This study aimed to assess the efficacy of diagnostic laparoscopy and open exploration of trigger points (scar revision and neurectomy) in the treatment of intractable chronic abdominal wall pain. METHODS: This prospective nonrandomized study enrolled 24 patients (21 women) with an average age of 59 +/- 11 years. Abdominal wall pain was diagnosed by excluding other causes of pain and using multiple injections of bupivacain. The patients' demographic data and long-term postoperative course (37 +/- 13 months) were carefully recorded. RESULTS: Using laparoscopy, intraabdominal adhesions close to trigger points were found and lysed in 15 patients (63%). Next, a subcutaneous nerve resection was performed. After 1 month, 33% of the patients were completely pain free, and 42% reported alleviation of pain. After 3 years, chronic abdominal pain was totally healed in 25%, diminished in 50%, and unchanged or increased in 25% of the patients. A total of 23 patients (96%) reported that surgery was beneficial for their intractable pain. CONCLUSIONS: Laparoscopy used in open exploration is beneficial for 75% of carefully selected patients with chronic abdominal wall pain.

Abdominal Pain↗

PubMed1986

Dorsal root entry zone radiofrequency lesion for pain relief in brachial plexus avulsion.

Brachial plexus root avulsion is one of the important causes of intractable pain in young individuals following road traffic accidents. A procedure using radiofrequency coagulation lesion of the substantia gelatinosa of Rolando (Nashold's procedure) was performed in seven patients with excellent relief of pain in two, good relief in three and poor result in two patients.

Brachial Plexus↗

PubMed1982

Transsphenoidal stereotaxic cryohypophysectomy for the management of pain in disseminated prostatic carcinoma.

Nineteen adult males with disseminated carcinoma of the prostate gland associated with intractable pain were subjected to a transsphenoidal stereotaxic cryohypophysectomy. Growth hormone (GH) assays following insulin-induced hypoglycemia were obtained once during the preoperative and twice during the postoperative period. In the postoperative assays, a 73% or greater suppression of GH levels correlated with significant clinical remission and extended survival. In all patients who had as much as 73% reduction in GH level, pain relief occurred within 4 days or less after surgery. This study shows that subtotal hypophysectomy may be adequate to achieve satisfactory clinical remission and pain control. GH assay is a useful index of the adequacy of hypophysectomy.

Adult↗

PubMed1994

[Home therapy approach in cancer patients--pain control (case 3-1)].

We present a case study of 34 years old female patient who had intractable pain in terminal stage of lung cancer. She complained severe persistent shooting pain in left lateral pectoral region, where was a wound of thoracotomy. She was given several analgesics orally in order of their efficacy, but could not get sufficient pain relief. From the nature of the pain that she had, neurological findings, and the result of thermography examination, we decided that the pain was associated with the failure of sympathetic nervous system. Then, she was admitted to our hospital and received the thoracic epidural block after epidural catheterization. But she could not get continuous pain relief. For the purpose of her return to the home therapy, we tried to administer MS Contin to her. Subsequently, she took a turn for the worse and died due to respiratory dysfunction in our hospital in the middle of her pain treatment.

Adult↗

PubMed1990

Pancreatic denervation for pain relief in chronic alcohol associated pancreatitis.

To denervate the pancreas of sensory afferents, 15 patients with intractable pain of chronic alcohol induced pancreatitis underwent left transthoracic splanchnicectomy with concomitant bilateral truncal vagotomy. All were malnourished and 11 were addicted to opiates. No respite had been obtained from 33 previous operative procedures. Each patient experienced almost immediate pain relief. Five, however, later had return of pain, but only to the right epigastrium. These five then underwent right transthoracic splanchnicectomy, after which four noted complete and apparently permanent disappearance of pain. In those 14 with a successful outcome there has been a 29 per cent mean increase in body weight, break of hard drug addition in ten of the 11 so afflicted, and return to gainful work or a relatively normal lifestyle in all 14 at a mean follow-up of 16 months. Although 11 of the 14 do have delayed gastric emptying, only one has required a drainage procedure. There have been no other late complications. This approach for control of incapacitating pain in chronic pancreatitis is both safe and simple and at the same time it appears to be reasonably reliable.

Adult↗

PubMed2003

[A case of intractable bone fracture pain due to metastasis of carcinoma treated with continuous epidural infusion using ropivacaine].

A 62-yr-old man presented with intractable pain due to sciatic and iliac bone fractures with metastasis of carcinoma. We treated this symptom using epidural infusion of ropivacaine over 8 weeks. He developed no complications related to epidural infusion of ropivacaine. Continuous epidural infusion of ropivacaine is useful for the management of pain from invasive carcinoma.

Amides↗