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Results for “Intractable Pain”

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At least 973 records · Page 54Linked to original sources

PubMed2000

The future of peripheral nerve neurostimulation.

Electrical stimulation of selected peripheral nerves for treatment of intractable pain has been used inconsistently over the past 30 years due to difficulties in clarifying appropriate indications, utilizing approved device technology, and standardizing the surgical techniques. Circumferential electrodes treating mononeuropathies have given way to paddle electrode techniques and, most recently, the application of percutaneous wire electrode methods will allow for minimally invasive peripheral nerve stimulation for certain intractable CRPS and other painful monoeuropathies.

Electric Stimulation Therapy↗

PubMed1987

A new permanent exteriorized epidural catheter for narcotic self-administration to control cancer pain.

The lack of an available exteriorized permanent epidural catheter led to the application of the Broviac catheter technology to the development of an epidural catheter. The resulting three-piece silicone-rubber catheter system allows specific spinal-level location of the catheter tip from a lumbar entry site, and exteriorization for ease of self-administration. Fifty-five cancer patients with metastatic disease and intractable pain received 58 catheters. No catheter infections were found during 3891 catheter-days of use, and only 18 minor side effects were noted, with no respiratory depression observed. Hospitalizations for pain control was decreased by 90% after catheter placement. Therefore, the authors recommend early placement of this silicone-rubber epidural catheter to control pain unrelieved by oral analgesics.

Catheterization↗

PubMedDate not supplied

Celiac plexus block: evaluation of injectate spread by three-dimensional computed tomography.

We describe a case of pancreatic cancer in which the spread pattern of injectate during neurolytic celiac plexus block was evaluated by three-dimensional helical computed tomography. Three-dimensional images provide excellent visualization of the spread patterns of injectate in a target site, which appears to provide patients with effective relief from intractable pain.

Autonomic Nerve Block↗

PubMed1989

Nociceptive flexion reflexes during analgesic neurostimulation in man.

Nociceptive flexion reflexes of the lower limbs (RIII responses) have been studied in 21 patients undergoing either epidural (DCS, n = 16) or transcutaneous (TENS, n = 5) analgesic neurostimulation (AN) for chronic intractable pain. Flexion reflex RIII was depressed or suppressed by AN in 11 patients (52.4%), while no modification was observed in 9 cases and a paradoxical increase during AN was evidenced in 1 case. In all but 2 patients, RIII changes were rapidly reversible after AN interruption. RIII depression was significantly associated with subjective pain relief, as assessed by conventional self-rating; moreover, in 2 patients it was possible to ameliorate the pain-suppressing effects of AN by selecting those stimulation parameters (intensity and frequency) that maximally depressed nociceptive reflex RIII. We recorded 2 cases of RIII attenuation after contralateral neurostimulation. AN appeared to affect nociceptive reflexes rather selectively, with no or very little effect on other cutaneous, non-nociceptive responses. Recording of RIII reflexes is relatively simple to implement as a routine paraclinical procedure. It facilitates the objective assessment of AN efficacy and may help to choose the most appropriate parameters of neurostimulation. In addition, RIII behavior in patients could be relevant to the understanding of some of the mechanisms involved in AN-induced pain relief.

Adult↗

PubMed2001

[Analgesic effect of neurolytic celiac plexus block guided by ultrasonography in advanced malignancies].

OBJECTIVE: To investigate the analgesic effect of celiac plexus block with anhydrous alcohol in patients suffering form advanced abdominal malignancies. METHODS: Ultrasonographically demonstrated and guided, 20 to 50 ml of anhydrous alcohol is injected into the celiac plexus and superior mesenteric plexus by fine needle of 22G. The injecting angle between the needle and the aorta is 20 to 30 degree. The injecting fields mainly located around the celiac plexus and the dorsal part of tumor are also injected. Sometimes if the tumor is rather large, an appropriate amount of alcohol was injected inside too. RESULTS: Twenty-eight cases of advanced abdominal malignancies were treated, among whom 96.4% achieved analgesic effect of different degree, 53.6% (15 cases) achieved the period of pain relief over three days, and 42.8% (12 cases) achieved partial relief. The analgesic effect is correlated with the amount of alcohol injected, i.e. no complete relief was observed in the four patients who received less than 12 ml, while two out of six could get transient complete relief in those who received 15 to 28 ml. In the group of 30 to 50 ml, 72.2% (13 cases) could get complete pain relief. Nine cases with big tumor received injection in side the tumor, with six tumors resulting in shrinkage or necrosis, significant pain relief also achieved in these cases. Complications occurred in nine cases (32.1%), with four cases of postural hypotension, two cases of vomiting, two cases of hiccup and one case of diarrhea. CONCLUSION: Neurolytic celiac plexus block guided by ultrasonography is a safe and effective modality in the management of intractable pain resulted from advanced abdominal malignancies.

Abdominal Neoplasms↗

PubMed1991

Hemorrhoidectomy during pregnancy: risk or relief?

Acute hemorrhoidal crisis can occur in the pregnant female. When medical therapy fails to relieve pain, operative intervention may be necessary. The surgeon, however, may be reluctant to operate due to potential complications to the mother and fetus. From July 1983 to July 1989, hemorrhoidectomy was performed in 25 of 12,455 pregnant women (0.2 percent) who delivered in our institution. Twenty-two women were in their third trimester, 80 percent were multiparous, and each had a remote history of hemorrhoidal symptoms, including intermittent pain, bleeding, and protrusion. Closed hemorrhoidectomy was performed under local anesthesia. The surgery was directed at removing only symptomatic disease, which included three quadrants in 14 patients, two quadrants in seven patients, and one quadrant in four patients. All patients experienced relief of intractable pain the day after surgery, except one patient who required a hemostatic packing during the immediate post-operative period. There were no other maternal or fetal complications. Subsequent follow-up for anorectal disease ranged from 6 months to 6 years. Six (24 percent) patients required additional hemorrhoid treatment. Hemorrhoidectomy in selected pregnant patients is safe in our experience.

Adult↗

PubMed1991

Autotransplantation of dispersed pancreatic islet tissue combined with total or near-total pancreatectomy for treatment of chronic pancreatitis.

Chronic pancreatitis is difficult to treat in patients with a nondilated duct. Patients experiencing intractable pain unresponsive to or judged untreatable by lesser procedures must decide between total pancreatectomy and resultant diabetes or a continuation of their pancreatitis. From 1977 through 1990, 26 patients underwent extensive pancreatectomy and dispersed pancreatic islet tissue autotransplantation for treatment of chronic pancreatitis pain and prophylaxis of surgical diabetes. Of these 26 patients, total (Whipple) or near-total (greater than 95%) pancreatectomy was performed in 24 patients. Of these 24 patients, pain relief could be assessed in 21 patients at 5 to 155 months (mean, 5.7 years), and 19 patients (90%) reported partial or complete remission. Of the patients who underwent total or near-total pancreatectomy, islets were injected intraportally in 22 patients and into the renal subcapsule in two patients. The latter two patients have required insulin since surgery. Of the other 22, one patient died from a complication of the pancreatectomy. Nine of the 21 evaluable recipients of intraportal islet autografts were insulin independent for at least several months after surgery. Five patients are currently insulin independent at 6 years, 4 years, 1.5 years, 9 months, and 5 months after surgery. Of the other four patients, one patient died insulin independent at 6 years, and three patients required insulin beginning 8 to 18 months after surgery. Insulin independence correlated with the number of islets recovered, which in turn correlated inversely with the degree of pancreatic fibrosis. Of our four most recent patients, three patients had mildly to moderately fibrotic glands, and higher numbers of islets were obtained. After total (Whipple) pancreatectomy, these three patients are insulin independent. A liver biopsy was performed in one patient 8 months after total pancreatectomy and islet autotransplantation; numerous clusters of islet cells staining strongly for insulin and glucagon were detected within portal triads on both wedge and needle biopsy specimens. Morbidity related to the intraportal-dispersed pancreatic islet tissue transplantation was low (no disseminated intravascular coagulation, significant portal hypertension, or hepatic dysfunction). Islet autotransplantation can be an effective and safe adjunct to extensive pancreatic resection for those patients who risk surgical diabetes for relief of their chronic pancreatitis pain.

Abdominal Pain↗

PubMedDate not supplied

Patient-administered sphenopalatine ganglion block.

BACKGROUND AND OBJECTIVES: Pain resulting from head and neck cancer can be severe and difficult to manage. Avoiding hospitalization for as long as possible with a reasonable level of comfort requires a number of therapeutic modalities. The usefulness of self-administered sphenopalatine ganglion block was evaluated in a patient with lethal midline granuloma requiring large doses of morphine. METHODS: A 30-year-old woman with intractable pain from lethal midline granuloma was taught to self-administer 4% lidocaine, 1.5 mL topically into each nostril three times per day. RESULTS: A 3-month follow-up examination showed substantial pain relief and reduction in morphine requirement. No adverse side effects or complications developed. CONCLUSIONS: In certain patients, sphenopalatine ganglion block can be effectively self-administered at home to manage chronic pain.

Administration, Intranasal↗

PubMed2002

[Successful intravenous administration of low dose ketamine for pain caused by erythromelalgia: report of a case].

A 15-year-old female complained of reddening, edema, and pain in her hands and feet. The symptoms were relieved upon cooling. From these findings, a diagnosis of erythromelalgia was made. Because none of the oral medication prescribed by dermatologist was effective, the patient was consulted to our department. A low dose of ketamine, a drug considered to be effective for intractable pain, was administered intravenously and the pain subsided significantly. Furthermore, the pain became completely controllable with a combination of intramuscular ketamine injection and other oral medication.

Adolescent↗

PubMed1992

[Epidural administration of bupivacaine in glycerine solution can prolong analgesia].

Glycerine has long been used with phenol as a drug depot in control of intractable pain. However, through our literature review, glycerine has never been used to prolong the pharmacological effects of a local anesthetic, such as bupivacaine. Our study is an attempt to use the same mechanism to further extend the pharmacologic effects of a popular long lasting anesthetic in a commonly used technique. Fifteen adult patients with cancer pain received 0.125% bupivacaine via a chronically implanted epidural catheter. In a blind study of pain control: Group I, consisting of 8 patients, received 5 ml 0.125% bupivacaine in normal saline; group II, consisting of 7 patients, received the same amount of the same strength anesthetic dissolved in 50% glycerine. The pharmacological effect was assessed by evaluation of intensity and duration of sensory as well as motor blockade. Our preliminary experimental experience revealed that significant prolongation (11.8 +/- 2.3 h vs 7.6 +/- 1.8 h, p less than 0.01) of analgesia was observed with the glycerine solution as compared to the saline solution. There was no motor blockade or other adverse effects or complications. This markedly prolonged analgesic effect is attributed to the slow release of the local anesthetic agent from the glycerine base which functions as a drug depot. Other clinical applications of this novel approach in pain relief are currently under investigation.

Adult↗

PubMed1981

Pain due to lesions of central nervous system removed by sympathetic block.

Eight patients were studied in whom a lesion within the central nervous system caused constant pain and hyperpathia. Blockade of the sympathetic supply to the periphery was carried out in each patient by stellate ganglion block or intravenous infusion of guanethidine 15 mg in 30 ml saline into a limb on the affected side. On almost every occasion the pain and hypersensitivity were reduced, sometimes completely. Thus chronic pain and hyperpathia arising from a lesion in the central nervous system may be abolished by blocking the sympathetic supply to the periphery; this effect may be achieved when not all the peripheral nerves of the affected region have had their sympathetic nerve supply blocked. Such blockade may be worth repeating in the hope of achieving lasting relief of the intractable pain.

Adult↗

PubMed1992

Topical capsaicin in painful diabetic neuropathy. Controlled study with long-term follow-up.

OBJECTIVE: We conducted an 8-wk controlled study with topical 0.075% capsaicin in subjects with chronic severe painful diabetic neuropathy who were unresponsive or intolerant to conventional therapy. Capsaicin is an alkaloid found in capsicum peppers and produces desensitization to noxious thermal, chemical, and mechanical stimuli when applied topically. RESEARCH DESIGN AND METHODS: In 22 randomly assigned subjects, either capsaicin or vehicle cream was applied to painful areas 4 times/day. Pain measurements were recorded at baseline and at 2-wk intervals for 8 wk. RESULTS: Capsaicin treatment was more beneficial than vehicle treatment in the overall clinical improvement of pain status, as measured by physician's global evaluation (P = 0.038) and by a categorical pain severity scale (P = 0.057). Decrease in mean pain intensity by a visual analogue scale was 16% in capsaicin-treated and 4.1% in vehicle-treated subjects. Mean pain relief on visual analogue scale was 44.6 and 23.2%, respectively. In a follow-up open-label study, approximately 50% of subjects reported improved pain control or were cured, and 25% each were unchanged or worse. A burning sensation at the application site was noted by some subjects but both its magnitude and duration decreased with time. CONCLUSIONS: Results from this preliminary study suggest that topical 0.075% capsaicin may be of value in subjects with diabetic neuropathy and intractable pain.

Administration, Topical↗

PubMedDate not supplied

Genu amoris.

Intractable pain in a patient with chondromalacia patellae was found to be related to an unusual type of repetitive trauma.

Adult↗

PubMed1987

Long-term results of pancreatojejunostomy in patients with chronic pancreatitis.

During a 10 year period, 69 patients with pancreatic duct dilation of 7 mm or more and intractable pain from chronic pancreatitis underwent Roux-Y drainage either as a lateral pancreatojejunostomy on 48 occasions or as a caudal pancreatojejunostomy in 21 cases. Nine patients (three with caudal pancreatojejunostomy and six with lateral pancreatojejunostomy) were lost to follow-up within the first postoperative year. The residual 60 patients undergoing 64 procedures were followed for an average of 69.3 months (range 10 to 144 months). Four patients with recurrent pain after caudal pancreatojejunostomy were converted to a lateral pancreatojejunostomy, with resolution of pain. Long-term pain relief occurred significantly more often in patients undergoing lateral pancreatojejunostomy than in those who received a caudal pancreatojejunostomy (66 versus 34 percent, p less than 0.01). Accordingly, caudal pancreatojejunostomy has little place in the surgical management of these patients. Since no differences existed in the two surgical populations, long-term pain relief in chronic pancreatitis appears more favorably influenced by the choice of an appropriate surgical procedure, rather than resulting solely from progressive destruction of the gland, as has been claimed. Although successful results in patients with lateral pancreatojejunostomy could not be correlated with anastomotic suture technique (one layer versus two layers or capsule versus mucosa-to-mucosa, p greater than 0.05), the creation of a pancreatojejunal anastomosis of more than 6 cm was found to be critical for success (p less than 0.001). Restoration of either exocrine or endocrine function should not be anticipated after otherwise successful lateral pancreatojejunostomy. However, if ductal dilatation can be demonstrated, recurrent pain after lateral pancreatojejunostomy is best managed by repeat lateral pancreatojejunostomy rather than resection.

Chronic Disease↗

PubMed1987

[Treatment of the pain syndrome in cancer patients by peridural administration of low doses of opiates].

Peridural injections of morphine were given to 180 incurable cancer patients suffering chronic pain. The effectiveness of the said procedure as well as its side-effects were assessed. A relationship between the external respiration parameters, on the one hand, and drug dosage and time postinjection, on the other, was studied. The data obtained point to the effectiveness of the said method and suggest that it be used as a universal procedure for the treatment of intractable pain in incurable patients.

Adult↗

PubMed2000

Asleep-Awake-Asleep general anesthesia for open cervical rhizotomy: case report and description of the technique.

The authors describe the technique of Asleep-Awake-Asleep anesthesia for open dorsal rhizotomy in a 78-year-old female patient, admitted to the hospital with intractable pain in the distribution of C2 dermatome following a road traffic accident. The patient was anesthetised and the rhizotomy performed using the intradural approach. Anesthesia was conducted by Total Intravenous Anesthesia using a Target Controlled Infusion system. The patient was awakened twice intraoperatively to verify success of the rhizotomy. Complete pain relief was obtained and maintained at 1 year follow-up.

Accidents, Traffic↗

PubMed2006

Analgesic activity of high-dose intravenous calcitonin in cancer patients with bone metastases.

We undertook a prospective, nonrandomized study with the objective to evaluate the efficacy of salmon calcitonin (sCT) in controlling pain secondary to bone metastases. Our study population consisted of 45 cancer patients with bone metastases (26 men) with a mean age of 64 years (range, 48-70) who had completed chemotherapy, hormonal therapy and radiation therapy at least 30 days prior to enrollment in the study, and had intractable pain despite the use of common analgesics (acetaminophen, nonsteroidal anti-inflammatory agents, opioids) and bisphosphonates. The study medication was a 300-IU dose of sCT administered intravenously daily for 5 consecutive days and repeated every two weeks until no response was noticeable. The analgesic efficacy of sCT was evaluated by means of Huskisson's visual analogue scale and Keele's pain scale; the daily consumption of analgesic drugs and performance status were also monitored. None of the patients managed to completely discontinue the use of other analgesics, but 5 patients (11% of the total number) had an analgesic response that lasted 4 weeks and less than 5% of the patients continued to respond for 6 weeks. No significant side effects were observed. Our data show that intravenous calcitonin administered in a relatively high dose has a very limited therapeutic potential as an adjuvant analgesic for a short period of time in selected cancer patients with bone metastases.

Aged↗

PubMed1979

[Stereotaxia in phantom-limb-neuralgia and causalgia (author's transl)].

Intractable pain is an important indication for stereotactic operations in deep structures of the brain. The targets are situated in primary and secondary sensomotoric regions of the thalamus, dependent or independent on cortical areas. In clinical practice it is necessary to combine two or three targets in the thalamic nuclei. In more than 25% the destruction of parts of the emotional pain-perception is necessary (ncl. dorso-medialis). The results os stereotactic operations in 32 patients with causalgia and phantom-limb-neuralgia are analysed.

Causalgia↗