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At least 901 records · Page 50Linked to original sources
PubMed1979

[Pain due to bone metastasis in hormonodependent cancer. Treatment by intrasellar injection of alcohol (author's transl)].

Pain due to bone metastasis in hormonodependent cancer (of the breast or the prostates more particularly) can be relieved by surgery directed at the endocrinic system. The most efficient techniques are hypophysectomies and hypophysiolysis (or neuroadenolysis). The intrasellar injection of alcohol through the transnasal-transsphenoidal route is a fairly simple procedure which can be carried out on such fragile patients without too much risk. The authors here report the first results obtained with this procedure in 12 pateints. Full sedation of pain is achieved in 30 to 40 p. cent of the cases. The duration of analgesia varies and pain frequently returns. One of the advantages of this procedure lies in the fact that such an injection may be repeated if necessary. The intrasellar injection of alcohol is but one of the many techniques available to practitioners working in the field of intractable pain.

Aged↗
PubMed2002

Palliation by coeliac plexus block for upper abdominal visceral cancer pain.

Palliation of cancer related pain is one of the major concerns of patients suffering from cancer of the upper abdominal organs. The non-availability of imaging techniques to guide needle placement prompted us to use a blind technique of neurolytic coeliac plexus block. Thirty consecutive patients with intractable pain, due to documented inoperable upper abdominal visceral cancers, underwent neurolytic coeliac plexus block by blind percutaneous retrocrural unilateral neurolysis. The severity of pain was documented on a 0-10 visual analogue scale (VAS) performed pre-block and post-block at 1 day, 1 week, 1 month and 3 months. Pain relief was graded as excellent if the score was 0-2, good when VAS was 3-5, satisfactory whenVAS was 6-7 and unsatisfactory if VAS was 8-10. Excellent pain relief was obtained in 26/30 patients (86.6%). Relief from pain diminished with time and after 3 months, 16/30 patients (53.35) graded their pain relief as excellent. Transient but severe hypotension complicated 73% of blocks. Despite the proximity of vital structures, blind unilateral retrocrural neurolytic coeliac plexus blockade is a safe and effective means to relieve the terminal pain associated with upper abdominal visceral cancer. It deserves more widespread use in patients with upper abdominal cancer. Results of the present study are encouraging and relevant for clinicians working in developing countries.

Abdominal Neoplasms↗
PubMed1996

Retrolabyrinthine selective posterior root section of the trigeminal nerve for the treatment of trigeminal neuralgia.

Patients frequently consult otolaryngologists for the treatment of trigeminal neuralgia. Retrolabyrinthine selective posterior root section of the fifth cranial nerve effectively and permanently eliminates pain from areas supplied by this nerve without the production of annoying anesthesia dolorosa. The procedure is performed by the neurotologist and causes minimum morbidity. The results of this surgery in 106 patients are reviewed and demonstrate that the procedure provides lasting relief from intractable pain from a variety of conditions whose innervation is the Vth cranial nerve as well as trigeminal neuralgia. The surgical technique and long-term results are described.

Adult↗
PubMed1983

[Sonographically guided and intraoperative alcohol block of the celiac ganglia in conservatively uncontrollable cancer-induced epigastric pain].

Preliminary results of sonographically controlled alcohol injection into the region of the coeliacal ganglion for treatment of medically intractable pain in inoperable pancreas carcinoma (6 patients) are compared with results of a similar treatment using a surgical approach (10 patients). Both procedures resulted in up to total pain relief and marked reduction of consumption of analgetics. Neurolysis of the coeliacal ganglion by means of sonographically guided alcohol injection seems to be a useful treatment to reduce pain in inoperable pancreas carcinoma.

Biopsy, Needle↗
PubMedDate not supplied

Continuous spinal anesthesia for cancer and chronic pain.

BACKGROUND AND OBJECTIVES: The use of spinal opioids for intractable pain is limited by development of tolerance and opioid resistance of some types of pain. METHODS: The literature regarding clinical experience with spinal mu opioid agonists for chronic and cancer pain was reviewed. Experimental use of intrathecal non-mu opioid agonists and non-opioid agonists and antagonists was also reviewed. RESULTS: Intrathecal mu agonists, particularly morphine, are effective for most patients with cancer pain, though in some patients rapid tolerance or marked resistance develop. Varied results are seen among chronic pain patients. Delta opioid agonists and a variety of non-opioid agonist analgesics are effective in standard analgesic testing paradigms, and some agents are effective in clinical trials. NMDA and NK-1 receptor antagonists are effective in models that produce sensitization of spinal dorsal horn neurons. CONCLUSIONS: A number of new agents appear to have promise as intrathecal drugs for patients with intractable chronic and cancer pain.

Anesthesia, Spinal↗
PubMed2001

Interventional neurophysiology for pain control: duration of pain relief following repetitive transcranial magnetic stimulation of the motor cortex.

The chronic electrical stimulation of a motor cortical area corresponding to a painful region of the body, by means of surgically-implanted epidural electrodes is a validated therapeutical strategy to control medication-resistant neurogenic pain. Repetitive transcranial magnetic stimulation (rTMS) permits to stimulate non-invasively and precisely the motor cortex. We applied a 20-min session of rTMS of the motor cortex at 10 Hz using a 'real' or a 'sham' coil in a series of 14 patients with intractable pain due to thalamic stroke or trigeminal neuropathy. We studied the effects of rTMS on pain level assessed on a 0-10 visual analogue scale from day 1 to day 12 following the rTMS session. A significant pain decrease was observed up to 8 days after the 'real' rTMS session. This study shows that a transient pain relief can be induced in patients suffering from chronic neurogenic pain during about the week that follows a 20-min session of 10 Hz-rTMS applied over the motor cortex.

Adult↗
PubMed1986

Pain cocktails: survey of formulations used in US hospitals.

Brompton's cocktail is an oral formulation used widely for intractable pain associated with cancer. In the United States, however, formulations are not standard, and questions concerning the efficacy and safety of some ingredients have been raised. Hospitals were surveyed to determine the formulation of Brompton's cocktail used, how the cocktail is compounded, and who is responsible for deciding on the pain cocktail formula. Controversy surrounding the use of cocaine as an ingredient is discussed, and problems with dating of formulations are described. P & T Committees are encouraged to review the literature concerning pain cocktail formulations and reevaluate the use of pain cocktails within their own institutions.

Analgesics↗
PubMed1985

[The study of neuro-adrenolysis of pituitary gland on cancer pain and experimental approach to reveal its mechanism of pain relief].

Neuro-adrenolysis of the pituitary gland by injection of pure alcohol was done to control intractable pain associated with wide-spread cancer, and pituitary functions were measured before and after the injection. Of a series of 46 patients undergoing a total of 57 neuro-adrenolysis of the pituitary gland, 22 (38.6%) of these procedures obtained complete pain relief 22 (38.6%) showed improvement, and the remaining 13 (22.8%) no effect. Hormonal changes of pituitary gland were not same among the cases and there was no correlation between hormonal changes and the occurrence of pain relief. Experimental study was done to investigate the effect of hypophysectomy and intracerebroventricular injection of AVP on pain threshold in rats. The study revealed that hypophysectomy and ventricular injection of AVP dose dependently raised pain threshold and these effects were inhibited by naloxone. These facts suggest that the analgesic effects of hypophysectomy and AVP injection into cerebral ventricle are mediated by beta-endorphin.

Adolescent↗
PubMed1979

Analgesia and haloperidol: a hypothesis.

We have previously reported 10 patient histories involving various intractable pain syndromes where the administration of Haloperidol either eliminated the need for narcotic analgesics or resulted in a significant reduction in narcotic dosage. We are presently undertaking a controlled double-blind evaluation of Haloperidol as an adjunctive treatment for intractable cancer pain. Based upon the reported clinical observations, these findings are discussed from the following aspects: 1. The isomeric similarity of Haloperidol to Meperidine. 2. Dose response between Haloperidol and analgesic effect. 3. The clinical literature regarding the use of Haloperidol for the effective withdrawal or maintenance of narcotic addicts. 4. The analgesic property as it relates to the opiate receptor.

Analgesics↗
PubMed1978

Percutaneous epidural stimulation of the spinal cord for relief of pain. Long-term results.

Percutaneous epidural stimulation of the spinal cord was carried out in 20 patients with intractable pain. The procedure proved simple, and no major complications were encountered. The long-term results were comparable to the results obtained after a dorsal column stimulator implant by laminectomy. The percutaneous technique allowed extended trial stimulation without committing the patient to a major operation. Those patients in whom stimulation did not alleviate pain could be identified during a 2-week observation period, and the system could be removed easily. Seven patients were placed on chronic autostimulation and only one of those failed to experience continuing pain relief throughout the follow-up time of up to 2 years. It is concluded that percutaneous epidural stimulation constitutes a valid alternative to dorsal column stimulator implantation.

Adult↗
PubMed1994

Medial thalamotomy with the Leksell Gamma Knife for treatment of chronic pain.

The authors describe 10 patients who underwent stereotactic medial thalamotomy with the Leksell Gamma Knife for treatment of chronic intractable pain. The pain was related to structural spinal disorders (4), postherpetic neuralgia (2), spinal cord injury (1), thalamic syndrome (1), anesthesia dolorosa of the face (1), and brainstem infarction (1). All patients had undergone extensive treatment with a variety of modalities prior to gamma thalamotomy. Nine patients underwent unilateral and one patient bilateral lesions. Magnetic resonance imaging (MRI) was used for target localization and the lesions were directed toward the intralaminar nuclei, the lateral portion of the medial dorsal nucleus, the centrum medianum and parafascicular nuclei. The lesions were made with radiation doses of 160-180 Gy using a 4 mm beam collimator and either a single isocenter (1 patient) or two isocenters (9 patients). Follow-up MRI scans in all patients showed well localized lesions. Three patients experienced excellent pain relief, four had good pain relief and three were failures. No complications were seen in any of the patients. In the past gamma thalamotomy was used mainly for treatment of pain related to malignancies but our results indicate that it may also be a safe and effective treatment for pain of nonmalignant origin as well.

Aged↗
PubMedDate not supplied

Chronic stimulation via percutaneously inserted epidural electrodes.

Thirty-one patients suffering from intractable pain associated with chronic low back syndrome, cancer, and other disorders have been studied after an average of 6 months of treatment by electrical stimulation of the spinal cord applied using electrodes inserted through a Touhy needle into the epidural space. As judged by three different subjective rating methods, epidrual stimulation successfully relieved otherwise intractable chronic pain in from 23 to 26 of the 31 patients. Reported improvements in the ability to perform various everyday activities, and elimination of drug usage by many patients, corroborated this finding.

Adult↗
PubMedDate not supplied

Chronic dorsal column stimulation via percutaneously inserted epidural electrodes. Preliminary results in 31 patients.

31 patients suffering from intractable pain associated with chronic low back syndrome, terminal cancer, and other disorders have been studied after an average 6 months' treatment by electrical stimulation of the spinal cord applied via electrodes inserted through a Tuohy needle into the epidural space. As judged by three different subjective rating methods, epidural stimulation successfully relieved otherwise intractable chronic pain in from 23 to 26 of the 31 patients. Reported improvements in the ability to perform various everyday activities, and elimination of drug usage by many patients, corroborate this finding. The side effects of stimulation, both as reported subjectively and as measured objectively by sensory testing, were not clinically significant. Spontaneous electrode displacements, leading to loss of analgesia and requiring minor surgery for repositioning, were encountered frequently, as were lead wire failures necessitating replacement. The partially implanted, externally powered stimulation system presently in use also suffers from problems of reliability and convenience to the patient.

Electric Stimulation Therapy↗
PubMed1996

Evaluation of laser and radiofrequency induced dorsal root entry zone lesion for pain control in rats.

BACKGROUND: Dorsal root entry zone (DREZ) lesions have been believed to be effective for control of intractable pain. These lesions are usually made using radiofrequency (RF) technique. Theoretically, laser can provide very fast, precise, reproducible and easy control of photothermal effect, possibly achieving better pain control than RF. The objective here was to learn more about the effect of pain control among the RF, carbon dioxide (CO2) laser and potassium titanyl phosphate (KTP) laser in rats. METHODS: The adult rat was anesthetized and the dorsal spinal cord from C5 to T1 was exposed under a microscope. The DREZ lesions were created in each group of eight including sham, RF thermocoagulation, CO2 laser and KTP laser. The latency of pain withdrawal in the fore-paw by a hot-plate test was recorded before the DREZ lesions and three weeks afterward. RESULTS: The data showed that RF, CO2 and KTP laser could significantly reduce pain in rats (p < 0.05, one-way ANOVA and Dunnett's test). Latencies of pain withdrawal in the fore-paw by the hot-plate test before, and three weeks after, DREZ lesions were 13.9 +/- 1.4 sec and 65.2 +/- 4.9 sec in the RF group, 15.9 +/- 1.4 sec and 59.0 +/- 5.9 sec in the CO2 laser group, and 14.1 +/- 0.9 sec and 64.8 +/- 5.7 sec in the KTP group, respectively. CONCLUSIONS: The density of opioid receptor in DREZ lesions cord showed no significant change three weeks after operation in the sham and CO2 laser groups. It was concluded that DREZ lesions caused by RF, CO2 laser and KTP laser can achieve pain control significantly in the rats. The effect of KTP laser was close to RF, followed by CO2 laser.

Animals↗
PubMed2002

Spinal cord stimulation in postherpetic neuralgia and in acute herpes zoster pain.

UNLABELLED: We studied the effects of spinal cord stimulation (SCS) on postherpetic neuralgia (PHN). Data of 28 patients were prospectively investigated over a median period of 29 (quartiles 9--39) mo. In addition, four patients with acute herpes zoster (HZ) pain were studied simultaneously. After intractable pain for more than 2 yr, long-term pain relief was achieved in 23 (82%) PHN patients (median, 70 yr) during SCS treatment confirmed by a median decrease from 9 to 1 on the visual analog scale (P < 0.001). In five cases with serious comorbidity, the initial pain alleviation could not be stabilized. Spontaneous improvement was always confirmed or excluded by SCS inactivation tests at quarterly intervals. Eight patients discontinued SCS permanently because of complete pain relief after stimulation periods of 3--66 mo, whereas 2 reestablished SCS because of recrudescence after 2 and 6 mo. Considerable impairments in everyday life, objectified by the pain disability index, were also significantly improved (P < 0.001). In 4 patients with acute HZ pain, SCS was promptly effective and after periods of 2.5 (quartiles 2--3) months the pain had subsided. SCS seems to offer a therapeutic option for pharmacological nonresponders. IMPLICATIONS: In many patients with postherpetic neuralgia and acute herpes zoster pain is not satisfactorily alleviated with pharmacological approaches. We report on 23 of 28 patients with postherpetic neuralgia and 4 of 4 with acute herpes zoster whose chronic pain was improved by electrical spinal cord stimulation.

Acute Disease↗
PubMed1982

Stereotaxic rostral mesencephalotomy in treatment of malignant faciothoracobrachial pain syndromes. A survey of 14 treated patients.

Stereotaxic rostral mesencephalotomy was performed 19 times in 14 patients suffering from intractable pain syndromes due to malignant diseases. The satisfying results in terms of pain relief during a necessarily short follow-up period (mean 4.9 months) are outlined. Undesired side effects were mainly confined to oculomotor disorders, which partly subsided over the months following the operation. Some technical aspects of the procedure and the pertinent literature are briefly discussed.

Adult↗
PubMed1985

[Epidural spinal cord stimulation: its efficacy and mechanisms].

Pain-alleviating effects of epidural spinal cord stimulation (ESCS) were assessed in patients with chronic intractable pain including cancer pain, and some aspects concerning its mechanisms were discussed. The temporary ESCS with percutaneously inserted electrodes was employed in 105 patients, and the implantable systems for long-term use in 19 patients. The ESCS had satisfactory effects especially in patients suffering from cancer pain, causalgia, facial and nape pain. The conditioning stimuli applied to the cervical dorsal cord exhibited interactions with the segmentally evoked spinal cord potential (SCP). The N1 wave of the SCP was inhibited up to 120 ms, while the P2 wave was facilitated for more than 100 ms, suggesting that the presynaptic inhibitory action at the dorsal horn is responsible for mechanism of the ESCS. CSF concentration of norepinephrine was significantly decreased by the ESCS therapy, indicating the existence of the relationship between norepinephrinergic descending inhibitory system and the ESCS in pain-alleviating mechanism.

Adult↗