PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Intractable Pain”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 955 records · Page 53Linked to original sources
PubMed1987

Salmon calcitonin in cancer pain: comparison between two different treatment schedules.

The analgesic effect of salmon calcitonin (Calcitonina-Sandoz) was evaluated in an open study of thirty-four patients with bone metastases of a lung cancer. Two different administration protocols were used: eighteen subjects received sCT 400 IU/day for three consecutive days, while the remaining sixteen were given sCT 200 IU/day for six consecutive days. In both protocols salmon calcitonin was diluted in saline and infused intravenously in one hour. Bone, visceral and neuritic pain were evaluated by means of Huskisson's visual analog scale and Keele's pain scale. The analgesic efficacy of salmon calcitonin was also evaluated on the basis of daily consumption of analgesic drugs. Salmon calcitonin proved of extreme efficacy in the treatment of intractable pain from advanced malignancy. A higher and earlier analgesic activity was observed with sCT at the 400 IU daily dosage.

Bone Neoplasms↗
PubMed1984

Fat absorption after longitudinal pancreaticojejunostomy.

This study was undertaken to determine whether fat absorption is improved following longitudinal pancreaticojejunostomy. Ten consecutive patients with chronic pancreatitis underwent measurement of fat absorption (fecal fat, 14C-labeled phenylacetic dipalmitate oil absorption test) before and after operation. Fecal fat increased in 8 of 10 patients following side-to-side pancreaticojejunostomy. However, the average postoperative fecal fat increase of 4.3 gm was of no clinical significance. The observed mild postoperative decline in fat absorption was confirmed by the 14C-labeled phenylacetic dipalmitate test. An improvement in postoperative fat absorption following side-to-side pancreaticojejunostomy Roux-en-Y should not be expected. The primary indication for this procedure for patients with chronic pancreatitis continues to be intractable pain.

Adult↗
PubMed1994

Opiate and opioid use in patients with refractory headache.

Opiate and opioid analgesics are commonly used for pain in general and presumably for headache. Codeine, oxycodone and propoxyphene, among the most commonly prescribed, do carry some risk of abuse, and their efficacy in headache patients has not been well studied. In many patients with other kinds of pain, however, both of neoplastic and non-neoplastic origin, chronic opiate use has been demonstrated to be of benefit without adverse side effects. The type of headache patient with intractable pain who needs frequent opiate analgesic and who does not develop addiction or drug abuse is an important subject for research.

Adult↗
PubMedDate not supplied

A new approach to the failed, failed back syndrome.

A new screening test and operative technique for the relief of intractable pain in the failed back syndrome has been devised and has yielded a 72% success rate on short-term follow-up (9--30 months) in 26 patients. This syndrome is thought to represent pain emanating from permanently damaged nerve roots and not from the arachnoiditis that was always present. Multiple spinal nerve blocks are carried out sequentially in the foramina under local anesthesia and fluoroscopic control, and if fewer than three nerves are implicated in the causation of the major portion of the patient's pain syndrome, a microsurgical dorsal root rhizotomy in which not more than two contiguous roots are severed is performed. This procedure can be adopted despite severe adhesive arachnoiditis.

Arachnoiditis↗
PubMed2005

Methadone in the management of intractable neuropathic noncancer pain.

OBJECTIVE: To evaluate the role of methadone in the management of intractable neuropathic noncancer pain. METHODS: A case series of 50 consecutive noncancer pain patients who were seen at a tertiary care centre and treated with oral methadone for a variety of intractable neuropathic pain states. RESULTS: The mean age was 52.7 years and the mean duration of follow-up was 13.9 months. Post-discectomy nerve root fibrosis, complex regional pain syndrome, peripheral neuropathy and central spinal cord pain syndromes were the most common diagnoses. Over 90% had been treated with one or more tricyclic antidepressants and anticonvulsants and a similar number had received other adjuvant analgesics. All patients had failed treatment with one or more conventional opioid analgesics (mean 2.8) at a mean maximal morphine dose of 384 mg (or equivalents) per day. Twelve patients had failed spinal cord stimulation. Nineteen patients (38%) did not tolerate initial methadone titration or thought their pain was worse on methadone. Five patients (10%) declared initial benefit but required repetitive dose escalation and eventually became non-responders. Twenty-six patients (52%) reported mild (4), moderate (15), marked (6) or complete (1) pain relief and continued on methadone at a mean maintenance dose of 159.8 mg/day for a mean duration of 21.3 months. Fourteen patients (28%) reported improved function on methadone relative to previous treatments. CONCLUSIONS: Methadone appears to have unique properties including N-methyl-D-aspartate antagonist activity that may make it especially useful in the management of intractable neuropathic pain. This observation needs to be tested in randomized, controlled trials.

Analgesics, Non-Narcotic↗
PubMed1990

Treatment of painful neuromas with neurolytic blockade.

In 10 patients with intractable pain from neuromas that developed after amputations or other surgery, 20 neuromas were treated with neurolytic blockade. In all cases surgical treatment had been unsuccessful. The blockades were performed with phenol-glycerol. Nine patients became asymptomatic, with no relapse occurring thus far during an observation period of 8-22 months. In 1 patient with 3 neuromas, only one neuroma was completely asymptomatic after a single blockade. This treatment may offer an alternative when surgical treatment has not been successful.

Adult↗
PubMed1981

Carotid aneurysm presenting as pain in the neck.

A patient presenting with severe intractable pain in the right side of the neck and head was eventually found to have an aneurysm of the carotid artery. Resection of the aneurysm has abolished the pain.

Aneurysm↗
PubMed1997

Labour pain management in a parturient with an implanted intrathecal pump.

PURPOSE: We report the peripartum anaesthetic management for vaginal delivery of a chronic pain patient with an implanted intrathecal pump. This is the first report describing labour analgesia in a patient with such a device. As intrathecal systems become more popular for the management of nonmalignant pain, this situation is likely to be encountered with increasing frequency in the future. CLINICAL FEATURES: The patient was a nulliparous 23-yr-old with a history of chronic hereditary pancreatitis whose intractable pain had been managed with intrathecal morphine 3 mg.day-1 via an implantable pump for four years. Inadequate time between presentation and onset of labour prevented us from using this system. Intravenous patient controlled analgesia with fentanyl using a bolus of 25 micrograms and a lockout of five minutes was ineffective and epidural analgesia using bupivacaine was initiated and resulted in satisfactory analgesia. CONCLUSION: The presence of an existing intrathecal delivery system does not preclude the use of supplemental epidural analgesia during labour.

Adult↗
PubMed1982

Intraspinal narcotic tolerance: preliminary experience with continuous bupivicaine HCL infusion via implanted infusion device.

Spinal opiate receptor tolerance is the major limitation of continuous intraspinal narcotic analgesia delivered by implanted reservoir pump. Six intractable pain patients receiving continuous epidural morphine were given trials of low dose bupivicaine HCL in order to assess the effects on implanted reservoir function, analgesia, and safety. Daily infusion of 2.6-18.8 mg bupivicaine HCL had no consistent effect on flow rates. Subjectively, three patients had at least partial relief of pain while their intraspinal morphine doses were weaned. No sympathectomy was appreciated at these doses. The future of continuous intraspinal analgesia might require further advances in implantable infusion pump technology to allow manipulation of both daily infusion doses and multiple intraspinal analgesics. Further study is needed to assess the safety and effectiveness of higher continuous intraspinal bupivicaine doses for chronic pain relief.

Artificial Organs↗
PubMed2005

Sonographic diagnosis of right segmental omental infarction.

PURPOSE: The purpose of this study was to identify the characteristic features of omental infarction so that this entity can be differentiated from other acute conditions in the right lower quadrant of the abdomen. METHODS: A retrospective review was undertaken. We searched our hospital medical records and found 6 patients with the diagnosis of omental infarction in the last 3 years. Clinical, sonographic, and CT findings at the time of hospital admission and at follow-up were studied. RESULTS: In 5 of the 6 patients (83%) sonography demonstrated a moderately hyperechoic, noncompressible ovoid mass located in the omental fat between the umbilicus and the right colon corresponding to the point of maximal tenderness or to the site of a palpable lesion on physical examination. In 1 patient, sonography revealed no abnormalities. In all patients, the diagnosis of omental infarction was confirmed by CT. One patient underwent laparoscopy because of intractable pain; laparoscopy revealed a necrotic segment in the omentum, and pathologic analysis confirmed the original diagnosis. CONCLUSIONS: Omental infarction is a benign self-limited disease that can mimic acute abdomen. The diagnosis can be established preoperatively with sonography and CT, which may avoid unnecessary laparotomy.

Abdomen, Acute↗
PubMedDate not supplied

Percutaneous cervical cordotomy and the injection of the pituitary with alcohol.

The two techniques of percutaneous cordotomy and pituitary injection of alcohol have been considered as methods applicable to the relief of intractable pain in inoperatable cancer. Percutaneous cordotomy is best indicated for unilateral pain below the C5 dermatome and will produce absolute relief of pain until death in up to 90% of patients. The injection of alcohol into the pituitary gives some relief of bilateral pain in about 70% of patients. Twenty percent obtain complete freedom from pain for up to 4 months, and 20% have complete freedom from pain for over 4 months. Both methods require the use of an image intensifier X-ray machine and care in observing safety precautions is necessary for both techniques. The pituitary injection of alcohol is the simpler of the two techniques. It can relieve bilateral cancer pain and it may be used to relieve pain in the head and neck of cancer sufferers which cannot be relieved by other methods.

Cordotomy↗
PubMed1994

The Rashomon approach to dealing with chronic pain.

This paper discusses a kind of interview whose narrative structure has the interviewee-narrator assuming different personas during its course. In these kinds of interviews the narrator not only reflects on experience, but uses the interview situation to actively configure future experience, in this case to change a frustrating, overwhelming experience of mysterious, intractable pain into something more meaningful. The paper links narrative to experience by examining certain dialogic processes in narratives that engage in, as well as reflect on, practice, in this case, a kind of self-therapy.

Anecdotes as Topic↗
PubMed1997

[Malignant pleural mesothelioma in general practice; complex pain problems].

In three patients, men aged 67, 57 and 69 years, malignant pleural mesothelioma was diagnosed. All three had worked as coal miners and were presented with thoracic pain. They were among seven cases of malignant pleural mesothelioma diagnosed in a period of five years in one suburban general practice (adherence: 5600 patients) in the former mining area in the province of Limburg. The terminal phase of the disease was characterized by intractable pain. High doses of opioids and adjuvants were necessary to achieve acceptable pain relief. It is suggested that step one of the 'analgesic ladder for cancer pain management' of the WHO (non-opioids) should be followed soon by step three (strong opioids). Because the incidence of pleural mesothelioma is not yet decreasing, it is important to know that pain management remains a serious problem.

Aged↗
PubMed1977

Commissural myelotomy.

The effect of commissural myelotomy in 24 cases with intractable pain is described. The operative technique employed with the operating microscope or magnifying glasses and a special myelotome is outlined. The results suggest an outstanding advantage in patients with bilateral metastases from malignancies except intrapelvic metastases. Patients with lumbar arachnoiditis showed a total failure of pain relief after 2 to 5 years, in spite of good relief temporarily.

Female↗
PubMed2004

Utilization of zonisamide in patients with chronic pain or epilepsy refractory to other treatments: a retrospective, open label, uncontrolled study in a VA hospital.

OBJECTIVES: Zonisamide (1,2-benzisoxazole-3-methanesulfonamide) is a novel anti-seizure medication approved for use in the United States as adjunct therapy in the treatment of partial seizures in adults with epilepsy. It has also been used to treat other conditions including intractable pain. The aim of this study was to determine the usefulness of zonisamide in patients whose seizures were not controlled after having been treated with at least three other currently available anticonvulsant medications or in patients whose pain control was suboptimal despite the use of commonly used drug regimens. METHODS: This was a retrospective study documenting the efficacy of zonisamide in 48 consecutive patients who presented at an outpatient neurology clinic at a Veterans Administration hospital. The patients were diagnosed with refractory partial seizures (n = 21) or a variety of intractable neuropathic pain syndromes (n = 27). RESULTS: Sixteen out of 21 seizure patients (76%) experienced a 50% or greater reduction in seizure frequency when zonisamide (100-200 mg daily) was added to their existing anticonvulsant medication regimen. Of 27 patients with neuropathic pain, 17 (59%) responded to zonisamide, reporting subjective reduction in pain by at least 50%. The most common adverse events were gastrointestinal upset, somnolence, and one case of skin rash. CONCLUSIONS: In this study, zonisamide appeared to be an effective adjunct therapy in the treatment of partial seizures in adults who continued to experience frequent episodes while taking other anticonvulsant medications, and in adults whose neuropathic pain was not well controlled with analgesics. These promising results must be tempered by the fact that this investigation included a small patient population in an uncontrolled study design. Further research into the efficacy and tolerability of zonisamide in these areas is warranted.

Aged↗
PubMed2003

[Delirium is certainly not an unavoidable complication of pain control in the terminal phase of life].

In three terminal patients, a man aged 19 years who suffered from progressive osteosarcoma, a man aged 71 years with a small-cell pulmonary carcinoma, and a 68-year-old woman with cerebral metastases from a mammary carcinoma, delirium developed due to increased dosage of opioids for seemingly intractable pain (the first two patients) and dexamethasone (third patient). The delirium subsided after opioid rotation, administration of drugs for neuropathic pain, and treatment with an antipsychotic, respectively. This enhanced the patients' quality of terminal life and quality of dying. In terminal patients, analgesics-induced delirium must be considered, diagnosed and treated without delay.

Adult↗
PubMed1988

CSF morphine levels after lumbar intrathecal administration of isobaric and hyperbaric solutions for cancer pain.

The objectives of this study were to compare the pharmacokinetic properties and the duration of analgesia following intrathecal administration (L5-S1) of 2 mg morphine in 2 forms: (1) an isobaric (NaCl 0.9%) and (2) a hyperbaric solution (7% dextrose). The study was carried out on 5 cancer patients with severe, intractable pain in the lower half of the body. Samples of CSF were collected at the level of the 10th thoracic vertebra at regular intervals for 15 h after administration. Morphine concentrations were determined by HPLC. The pharmacokinetic properties of the solutions (I and II) were quite different. Peak levels (I) were reached in 5-15 min (30 and 60 micrograms/ml); they then fell rapidly during the 1st hour (7 and 11 micrograms/ml) with an elimination half-life of 10 and 15 min, followed by a change in slope (elimination half-life of 108 and 140 min). Peak levels (II) were reached in 4-5 h (0.8-3.3 micrograms/ml); they then fell progressively according to a single exponential function (elimination half-life: 144-246 min). The duration of analgesia for a dose of 2 mg was 30 h for solution 2 and 24 h for solution 1. The hyperbaric solution, which produced the same degree of analgesia as the isobaric solution, limited the cephalad diffusion of morphine and reduced or abolished the central depressant effects of the drug.

Chromatography, High Pressure Liquid↗