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At least 919 records · Page 51Linked to original sources
PubMed1979

The albatross syndrome--how to prevent it.

While no single test or historical feature will allow the physician to predict the patients who will have poor results from ulcer surgery, certain factors may alert the physician to a possible poor result and encourage careful re-evaluation of the need for surgery. Any patient with intractable pain should be assessed carefully in an attempt to establish the cause of the intractability, and this assessment should include endoscopy. The endoscopist may help to identify those patients with structural disease that is too minimal to explain the intractable complaints. Careful attention should also be given to the evaluation of the patient's personality, work record, and relationship to spouse, family, and friends. Patients who have previously been disabled by other medical problems such as low back injury should be approached with caution. While newer procedures in ulcer surgery may alter the incidence of standard postgastrectomy complications it will not alter the incidence of the albatross syndrome, which is more directly related to the selection of the patient rather than the selection of the surgeon or surgical procedure.

Adult↗
PubMed1990

[Neuropathic pain unrelieved by morphine, alleviated by haloperidol].

Neuropathic pain, originating in damaged nerve and not peripheral nociceptors, is often resistant to treatment by opiates given by the oral, parenteral or spinal routes. This failure to obtain satisfactory pain relief is generally ascribed to psychological factors or to individual peculiarities in drug metabolism or kinetics. Currently, psychotropic and antidepressant drugs are among the first choices in treating painful conditions due to partial nerve lesions. We present a 56-year-old man who suffered intractable pain confined to his left knee following emergency L2-3 vertebral decompression, after collapse due to metastatic disease. 12 mg of morphine and 10 of diazepam given together intravenously did not lessen pain. Acute, solitary spinal nerve root injury was hypothesized. 2 mg of haloperidol injected IV gave complete relief of pain without hypotension or deep sedation. There is no definite explanation for the resistance of neuropathic pain to opiates.

Haloperidol↗
PubMed1988

Nonsurgical management of pain secondary to peripheral nerve injuries.

Physicians and surgeons dealing with peripheral nerve injuries have long been plagued by the chronic intractable pain which often follows these injuries. Early recognition of the associated problems and prompt intervention by a multidisciplinary team approach to the pain is essential. Although the techniques reviewed here were presented as separate choices, the treatment of the patient should employ a combined approach of good surgical repair, positive encouragement, non-addicting medications, appropriately timed nerve blocks, aggressive physical and occupational therapy, and electrical stimulation techniques as the patient's physical recovery permits. The importance of early psychological assessment and intervention in this complex phenomenon cannot be overemphasized. Together these techniques may succeed in reducing the morbidity associated with peripheral nerve injuries.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1984

Relief of cancer pain in man: alcohol-induced neuroadenolysis vs. electrical stimulation of the pituitary gland.

To explore new methods for the control of intractable pain caused by advanced cancer, the analgesic effect of electrical stimulation of the pituitary gland was investigated in 25 patients. The results were compared with a control study and with the effects of alcohol-induced pituitary neuroadenolysis (NALP) in the same patients. The pain score (0: no pain at all, 4: extreme pain) in the control study was 3.88 +/- 0.33. After electrical stimulation of the pituitary gland it was 1.24 +/- 1.61; and after NALP it was 1.0 +/- 1.60. The pain scores after electrical stimulation and NALP were significantly lower (P less than 0.01) than those in the control study; but there was no significant difference when the two were compared with each other. The duration of pain relief following NALP (59.65 +/- 68.72 days) was significantly longer compared with that recorded following electrical stimulation (2.97 +/- 2.58 days). Autopsy examinations of 3 patients who expired from their malignancies revealed that the pain relief was unrelated to the degree of necrosis induced in the pituitary by alcohol. Naloxone administration did not inhibit the analgesic effect of either NALP or electrical stimulation. The advantages and disadvantages of electrical stimulation, the pain relief mechanism activated by this method, and potential clinical applications are also discussed.

Adult↗
PubMed1990

Eosinophilic meningitis: cause of a chronic pain syndrome.

Three tourists developed eosinophilic meningitis after visiting the Fijian Islands. Two had a severe and long lasting illness with chronic intractable pain. In one patient electrophysiological studies and MRI scan of the brain were abnormal and provided evidence of both radicular and cerebral parenchymal involvement by the most likely causative agent, Angiostrongylus cantonensis.

Adult↗
PubMed1990

Palliative care in a cancer center: results in 1984 versus 1987.

We reviewed the charts of 48 consecutive patients treated by our Palliative Care Team (PCT) during 1984 and compared these results with 50 consecutive patients treated during 1987. The composition of the PCT did not change between 1984 and 1987. The median equivalent daily dose of parenteral morphine (MEDD) before referral, after initial treatment by the PCT, and at the maximum prescribed by the PCT were 43 mg, 48 mg, and 96 mg in 1984, respectively, versus 60 mg (p less than 0.03), 60 mg (p less than 0.03), and 120 mg (p less than 0.12) in 1987, respectively. Seventeen of 43 patients were receiving mild narcotics in 1984 versus 7 of 48 patients in 1987 (p less than 0.01). Parenteral narcotics were used initially in 2% of patients in 1984 versus 46% of patients in 1987 (p less than 0.001). Poor pain control after the initial treatment was observed in 42% of patients in 1984 versus 26% in 1987 (p less than 0.01). Our results suggest that patients are being treated more aggressively by their physicians before referral to the PCT in 1987, that our PCT is using more aggressive initial treatment than in 1984, and that, notwithstanding these changes, there is still a significant proportion of patients in whom pain cannot be controlled before death. These results suggest that more research is necessary to better define intractable pain syndromes and develop adequate treatments for them.

Alberta↗
PubMed1976

Clinical evaluation of acupuncture in 129 patients.

The scope of effectiveness of acupuncture in relieving pain was tested in an Acupuncture Clinic for nonemergency care: 129 patients were treated, mainly for intractable pain associated with a wide variety of conditions. Only mechanical stimulation was used. Acupuncture anesthesia was not evaluated. Response was excellent or good in 87 patients. Acupuncture was most effective in conditions attributable to musculoskeletal or visceral muscle spasm. In some situations it inhibited pain recurrence, such as menstrual cramps in subsequent periods. It did not mask pathology: pain recurred promptly if underlying stimulus persisted. Relief of pain was usually immediate; side effects were negligible. Neurophysiologic principles appear to offer a basis for explaining the mechanism of action. Acupuncture is sufficiently promising as an adjunct to standard medical methods to deserve clinical and theoretical investigation.

Acupuncture Therapy↗
PubMed1983

Lateral retinacular release for intractable lateral retinacular pain.

Lateral retinacular release was performed in a series of patients with intractable lateral retinacular pain characterized by tenderness localized in some portion of the lateral retinaculum. Patients with other patellofemoral problems were excluded. Of 14 knees, 79% responded favorably. Lateral retinacular release may be best indicated in patients with less severe malalignment of the patella and intractable pain in the lateral retinaculum.

Adolescent↗
PubMed2005

Intradiscal electrothermal annuloplasty.

Low back pain is a common problem, and although the majority of cases of low back pain resolve, a subset of patients will continue to have intractable pain despite appropriate conservative treatments. Intradiscal electrothermal annuloplasty is a minimally invasive spinal procedure that has been proposed to treat provocation discography-proven internal disk disruption syndrome. The early uncontrolled and nonrandomized intradiscal electrothermal annuloplasty literature suggests it may provide some relief in a small proportion of strictly defined patients; however, more recent randomized, placebo-controlled trials have not substantiated these initial findings. This article will review the published literature, indications, contraindications, safety, and efficacy of the intradiscal electrothermal annuloplasty procedure for the treatment of chronic, intractable, axial back pain.

Contraindications↗
PubMed1992

A simplified method of laparoscopic presacral neurectomy for the treatment of central pelvic pain due to endometriosis.

OBJECTIVE: To describe optimal procedures and preliminary results for videolaparoscopic presacral neurectomy as part of the surgical treatment of endometriosis associated with intractable dysmenorrhoea. DESIGN: Observational study with follow up for at least one year. SETTING: Subspecialty practice: Endometriosis Clinic and Centre for Special Pelvic Surgery. SUBJECTS: Eighty five women (18-45 years) with endometriosis and intractable pain, referred because medical and surgical management had failed. Subjects without a central (midline) component to their discomfort were excluded. INTERVENTIONS: Excision and vaporization of endometriotic pathology was followed by presacral neurectomy. OUTCOME MEASURES: During surgery, severity of endometriosis was assessed using revised American Fertility Society scoring. Overall pelvic pain and dysmenorrhoea relief were determined by office visit, telephone interview and questionnaire at a minimum of one year postoperatively. RESULTS: There were no operative complications and all women left hospital within 24 h of surgery. Overall pain relief was reported by 49 (94%) of 52 patients followed. The other three subjects noted no pain abatement. Dysmenorrhoea was reduced in 48 (92%) whereas four (8%) women claimed no relief. CONCLUSIONS: Laparoscopic presacral neurectomy is an option for treating dysmenorrhoea and pelvic pain in selected women, but is indicated only if medical management has failed. Videolaparoscopic presacral neurectomy using the CO2 laser is safe in trained hands. Pain relief achieved is within the range reported for laparotomy.

Adolescent↗
PubMed1997

[Intrahepatic pressure, oxygen partial pressure and pain in chronic pancreatitis].

We investigated the relationship between pain, intraductal and parenchymal pancreatic pressures and oxygen partial pressure in 39 patients who underwent surgery for chronic pancreatitis with intractable pain. Acute pain was correlated with parenchymal pressure; correlation between pain and oxygen pressure could not be found. Since no strong correlation exists between pain and parenchymal pressure, we hypothesise that pressure and parenchymal factors contribute to the pathogenesis of pain in chronic pancreatitis.

Abdomen, Acute↗
PubMed2004

[Cancer pain management in children].

Pain is one of the most common and frightening symptoms of children with cancer and their families. If current pain management techniques are utilized, the majority of children can achieve adequate analgesia. It is the rare pediatric patients who develop intractable pain. The World Health Organization (WHO) has established principles of pain management for children with cancer.

Analgesics, Opioid↗
PubMed1989

Subpial spinal evoked potentials in patients undergoing junctional dorsal root entry zone coagulation for pain relief.

Seven patients with complete avulsion of the brachial plexus underwent junctional coagulation lesions of the dorsal root entry zone (DREZ) for relief of intractable pain in the paralyzed arm. Intra-operative monitoring by recording spinal cord somatosensory evoked potentials (SEP) resulting from tibial nerve stimulation was done using subpial recording electrodes situated dorsal to the posterior median sulcus at the C4 and T2 segment. SEP on the normal side showed an initial positive wave and two negative waves followed by a group of high frequency waves of relatively high amplitude which continued into high frequency, low amplitude potentials. The conduction velocity of the fastest spinal evoked potential components were, on average, 86 m/s. Recordings from the side of avulsion revealed a steep positive potential of high amplitude which appeared in five patients prior to the creation of the DREZ lesion. This effect was assumed to be secondary to spinal cord damage caused by avulsion. During the DREZ coagulation the SEP from the unaffected side did not change. On the side of DREZ coagulation the velocity of the fastest fibres decreased. Four patients reported sensory deficits after the operation, which were transient in three. In one of these patients, the first two negative potentials disappeared. In the fourth patient, who had permanent sensory deficits, the positive steep potential appeared after generation of the lesion. Our results point to the usefulness of the subpial SEPs monitoring during microneuro-surgical procedures on the spinal cord to provide further insight into evoked electrical activity of the normal and injured spinal cord, and to minimize post-operative neurological morbidity.

Action Potentials↗
PubMed1994

Clinical evaluation of pain treatment with electrostimulation: a study on TENS in patients with different pain syndromes.

OBJECTIVE: We evaluated the clinical efficacy and the unwanted side effects of transcutaneous electrical nerve stimulation (TENS) in a consecutive group of patients with intractable pain due to different pain syndromes. METHODS: Two hundred eleven patients with different pain syndromes, coded according to the International Association for the Study of Pain (IASP), were treated with TENS, using a standardized protocol. After a 6-month treatment period, an independent investigator estimated the effect of TENS in retrospect through assessment of patient files, standardized questionnaires, and diaries. In addition, a physical examination to determine the IASP code was performed, and unwanted side effects were evaluated. RESULTS: TENS showed a favorable response in the majority of patients with pain caused by peripheral nerve damage (53%), anginal pain resulting from ischemic heart disease (75%), and pain of the musculoskeletal system due to mechanical degenerative causes (69%). TENS employed in patients with prominent psychological and social distress, and for pain caused by central and autonomic dysfunction, alleviated pain in only 10-25% of the patients. Side effects occurred in 35% during the initial period of the treatment and were usually able to be resolved, especially with thorough supporting instructions during the initial treatment period. CONCLUSIONS: In this study, the beneficial effect of TENS appeared to be related to the etiology of the underlying pain. The effect of TENS was maintained for > 6 months in the majority of patients with an immediate favorable response. Supporting instructions are crucial for long-term success.

Adolescent↗
PubMed1996

Functional neurosurgery with the Leksell Gamma knife.

Sixty patients underwent a total of 64 separate Gamma Knife radiosurgical procedures for treatment of a variety of functional disorders between July 1992 and February 1995. Thirty-four patients with intractable pain received unilateral (32 patients) or bilateral (2 patients) lesions in the intralaminar thalamus. Twenty-nine patients with facial pain, including 19 with typical trigeminal neuralgia. 8 with facial pain due to tumors involving the trigeminal nerve and 2 with other forms of facial pain, were also treated. Five patients with Parkinson's disease underwent pallidotomy (2) or thalamotomy (3) with the Gamma Knife and 2 patients with non-Parkinson's tremor were also treated with gamma-thalamotomy. The rate of improvement or resolution of the functional disorders was similar to that seen with other forms of surgical therapy. No immediate complications were seen, but 4 patients who underwent thalamotomy for pain developed delayed transient complications and 1 death was seen following bilateral thalamotomy.

Aged↗
PubMed1986

Adolescent chronic pain: the ability to cope.

The study investigated differences in mother-child interaction, child personality, and family characteristics between adolescents who were coping with chronic benign intractable pain and adolescents who were not. Both groups experienced a similar amount and intensity of pain. Behavioural observations indicated that non-copers engaged in significantly more negative behaviour than the copers. In addition, non-copers tended to express more pain and were on-task less often than the copers. Mothers of non-copers more frequently discouraged coping behaviour. No differences between the two groups were evident on the family or personality measures. The data are consistent with clinical impressions that parental behaviour interacts with child coping.

Activities of Daily Living↗
PubMed1990

The role of spinal opioids in the management of cancer pain.

Spinal opioids have dramatically influenced the way intractable pain of malignant origin is managed. To provide optimal pain relief, spinal opioids must be used in the context of a comprehensive cancer pain management treatment plan. The choice of epidural versus subarachnoid route of administration, as well as the specific opioids administered, require assessment of the individual needs of the patient. Factors likely to influence patient selection, including physiologic and behavioral abnormalities that may interfere with the patients' ability to assess pain relief, must be considered. During therapy, side effects must be anticipated and treated aggressively to assure patient comfort and safety. Although the chronic administration of opioids and other drugs into the epidural or subarachnoid space is in its infancy, advances in the pharmacology of spinal drugs and the development of new delivery system technology will probably expand the options available for the relief of cancer pain.

Analgesia, Epidural↗