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 1,009 records · Page 56Linked to original sources

PubMed1978

Treatment prostheses in TMJ dysfunction-pain syndrome.

Various types of acrylic resin therapeutic prostheses commonly used in the treatment of TMJ dysfunction-pain syndrome were described. Each design was related to recent data concerning optimum condylar positions in the fossae, the physiologic condylar suspension system, and individual treatment objectives for repositioning the mandibular condyles. For example, alteration of the vertical dimension of occlusion is a popular treatment procedure that is empirical in nature and is usually used without TMJ radiographs or a differential diagnosis. It can violate the physiologic requirements of the interocclusal distance or the speaking space and does not necessarily move the condyles forward as has been commonly thought. The dangers of empirical treatment procedures for a multicausal dysfunction syndrome have been pointed out. An example was cited where the mandible was moved forward for a long period of time with a repositioning prosthesis; this produced pathologic TMJ remodeling and continued pain. It was recommended that specific mandibular repositioning be based on the type of condylar displacement observed on the radiographs. Sometimes the condyles should be retruded, and other times they should be repositioned anteriorly or occasionally inferiorly on one side. Long-standing use of any acrylic resin repositioning prosthesis is contraindicated, particularly without close supervision. Acrylic resin anterior bite plates (with a minimum opening of 1 mm) were recommended for the relief of acute trismus or intractable pain. Usually the prosthesis is used in conjunction with heat and drug therapy. This type of prothesis can also be utilized to deprogram the muscles when a strong habit of eccentric occlusion develops as a result of missing teeth. (This should be confirmed by TMJ radiographs.) Occasionally atypical pain is present and a differential diagnosis can be established between TMJ dysfunction or neurologic etiology by the physiologic response to bite plate therapy. When it is necessary to reposition the mandibular condyles anteriorly the occlusion is adjusted to provide the planned anterior movement without increasing the vertical dimension of occlusion. A temporary acrylic resin prosthesis is used to retrain the muscle programming to the anterior therapeutic mandibular position. When the symptoms are relieved and the corrective condylar position is confirmed with TMJ radiographs, a more permanent repositioning prosthesis is made. The treatment of TMJ dysfunction-pain syndrome should be based on documented data including the pain history, TMJ radiographs, condylar position in the fossae, electromyographic evidence, and occlusal analysis. This information will help determine if the patient's centric relation is functional or dysfunctional and will indicate the recommended treatment procedures.

Acrylic Resins↗

PubMed1980

Control of dyskinesias due to sensory deafferentation by means of thalamic stimulation.

Intermittent stimulation of the parvocellular portion of the nucleus ventralis posterolateralis (V.P.L.) by means of chronically implanted electrodes and stimulus generator was performed in 124 patients for the control of chronic intractable pain. Among these, 11 showed spontaneous abnormal movements within the painful area: 6 post amputation "jumping stumps"; 4 pseudothalamic syndromes and 1 Von Benedikt's syndrome following a cerebrovascular accident. Electrical stimulation of the V.P.L. was able to control both pain and abnormal movements in all cases. The technique was applied with an equally good result in a case of choreoathetotic syndrome without pain but with severe sensory disturbances following a demyelinating process. Attempts made to control action tremor, parkinsonism and other dyskinesias not associated with sensory deafferentation in 12 cases failed. The same mechanism seems to be responsible for pain and dyskinesia in cases of sensory deafferentation, and thalamic stimulation might work as a substitute for sensory information delivered to the nucleus ventralis posterolateralis.

Amputation, Surgical↗

PubMed1988

Lateral percutaneous spinothalamic tractotomy.

The main elements of the percutaneous spinothalamic tractotomy technique by the lateral approach are presented and the results obtained in 163 consecutive patients are communicated. We emphasize the importance of its early use in cases of intractable pain avoiding drug addiction. The simplicity of the method permits a less strict selection of the patients compared with the classic open cordotomy.

Adolescent↗

PubMed1996

Ketorolac continuous infusion: a case report and review of the literature.

We report a case of intractable pain due to metastatic carcinoma that was effectively managed with a continuous intravenous (IV) infusion of ketorolac. Unlike previous reports of short-term continuous IV ketorolac for postoperative analgesia, this case is unique because of the etiology of the pain and the duration of treatment. The published literature on continuous administration of ketorolac by the intravenous, intramuscular, and subcutaneous routes is also reviewed.

Analgesics, Non-Narcotic↗

PubMed1980

Alterations of immunoreactive beta-endorphin in the third ventricular fluid in response to electrical stimulation of the human periaqueductal gray matter.

Immunoreactive beta-endorphin in the third ventricular fluid was measured in response to electrical stimulation of the periaqueductal gray matter in 8 patients with intractable pain during rostral mesencephalic reticulotomy for pain relief. In all patients, marked increase of immunoreactive beta-endorphin was observed. On the other hand, in cases of electrical stimulation of the zona incerta performed during stereoencephalotomy, in 5 patients with involuntary movement, immunoreactive beta-endorphin in the third ventricular fluid did not show any significant change. The authors conclude that the increase of immunoreactive beta-endorphin on electrical stimulation of the periaqueductal gray matter is not a nonspecific response to brain stimulation but a specific response in regard to cerebral localization of endorphins. Direct correlation between pain relief and periaqueductal gray stimulation is also questioned.

Adult↗

PubMed1987

The epidural opioid internalized system.

For several years opioids have been given epidurally with success to control chronic intractable pain. The authors report their 2-year experience with internalization of the epidural catheter and injection port in 18 patients at University Hospital, Saskatoon. In all, 21 devices were used. All patients had metastatic cancer; 16 are now dead. The need for other medications was eliminated with 9 and reduced with 12 devices. In the patients who died, the devices were effective for 82% of their remaining life-span. They were able to spend 46% of this time at home. Blockage of the epidural end of the device was the most common mechanical problem, followed by leakage from the port. One patient suffered meningitis after 11 days as a result of subarachnoid placement of the catheter but responded to removal of the device and antibiotic therapy. The authors have been impressed with the excellent pain relief afforded to many of these patients, and their ability to enjoy life free of the sedative effects of other methods of narcotic administration.

Adult↗

PubMed1975

Microsurgical approach to the cerebellopontine angle.

Various sections of the IXth, Vth, vestibular and cochlear nerves have been performed on twenty patients. The technique we used was an 'a minima' approach to the cerebellopontine angle. This operation is atraumatic and quick to perform, and the postoperative period is always excellent. It seems very useful for patients with Ménière's disease or intractable pains in the glossopharyngeal or trigeminal fields. It can be used for diagnosis if a small neurinoma in the cerebellopontine angle is suspected.

Aged↗

PubMed1981

Epidural morphine in terminal care.

Case histories of three patients with intractable pain, all of whom responded to epidural morphine, are presented. Drug tolerance appeared to develop in two patients who survived longer than 10 days. Nevertheless this method of pain relief may be a useful adjunct to terminal care and in certain circumstances may allow for easier management in the patient's own home.

Drug Tolerance↗

PubMed1995

Management of metastatic tumors to the spine using simple plate fixation.

Frequency of metastasis to the spine in the population of patients suffering from malignant disease is a significant clinical problem, as these patients present with intractable pain and neurologic impairment. The sequelae of metastatic tumors to the spinal column significantly decrease the quality of the patient's life. With the advent of modern chemotherapeutic regimens in metastatic disease, patients with metastatic tumors are living longer and more productive lives. The goal of surgical management of this problem is to increase the quality of the patient's life, and not longevity. The immediate technical goals are resection of the pathological segment, restoration of load bearing capacity for mobilization of the patient, and decompression of compromised neural structures, as well as maintenance of spinal stability to decrease pain and increase the patient's quality of life during the terminal stages. This is a series of 28 patients with metastatic tumors to the spine, with an average age of 61.5 years, ranging from 25-81 years of age. Within this population there were 11 different tumor types. The postoperative survivorship was an average of 6.4 months. Twenty patients in this series had an anterior procedure alone using a combination of Methylmethacrylate and inexpensive plate fixation. Six patients required an anterior/posterior procedure for circumferential spinal compression and instability. These techniques provide immediate spinal stability for rapid mobilization of the patient. Twenty-four patients in the series had significant pain relief, and 17 experienced neurologic improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Emergency intravenous sedation of the delirious, medically ill patient.

More than 2,000 medically ill patients with delirium have been treated by intravenous administration of a combination of haloperidol and lorazepam. The protocol was developed over 8 years at two major cancer centers in the United States and Canada. The addition of the potent benzodiazepine to the neuroleptic produces rapid and safe symptomatic sedation in emergency conditions and allows the use of lower doses of haloperidol. The combination was first attempted when doses of haloperidol as high as 350 mg failed to provide rapid emergency neurobehavioral control. All patients treated to date had cancer, and all were suffering multisystem organ failure. Hourly doses of each drug as high as 10 mg for as long as 15 days have been shown to be safe and effective in the most critically ill patient with delirium. Patients generally respond to the first one or two doses and, in most cases, less than 100 mg/day of each drug is required. The addition of the opioid hydromorphone makes the combination ideal for the treatment of intractable pain in terminally ill cancer patients. This polypharmacological approach is advocated as the method of choice for emergency sedation of the delirious patient as well as for palliative care.

Critical Care↗

PubMed1976

The Shiers arthroplasty of the knee.

Thirty-one patients with rheumatoid arthritis were reviewed after Shiers arthroplasty of the knee joint for which the main indication was intractable pain. Seven patients had the operation done to both knees. This review was done to assess the long-term results two to seven years later. All patients were clinically and radiologically assessed, and our results showed that pain and instability recurred within eighteen months. Thus it is likely that a prosthesis which allows rotation, and in which the bearing surfaces are metal on plastic, will replace the Shiers prosthesis.

Arthritis, Rheumatoid↗

PubMed2001

Palliative forequarter amputation for metastatic carcinoma to the shoulder girdle region: indications, preoperative evaluation, surgical technique, and results.

BACKGROUND AND OBJECTIVES: Uncontrolled metastatic carcinoma of the shoulder girdle is a difficult oncologic problem. This study reviews our experience with palliative forequarter amputation with emphasis on patient selection criteria, preoperative radiologic assessment, surgical technique, epineural postoperative analgesia, and clinical outcome. METHODS: Eight patients who underwent palliative forequarter amputation for metastatic carcinoma between 1980 and 1999 were analyzed retrospectively. Diagnoses included breast carcinoma (n = 3), squamous cell carcinoma (n = 2), hypernephroma (n = 2), and carcinoma of unknown origin (n = 1). All patients presented with severe, intractable pain and a useless extremity. Venography demonstrated obliteration of the axillary vein in each of the patients in whom this procedure was performed. Exploration of the brachial plexus confirmed tumor encasement and unresectability in all patients. Epineural catheters for bupivacaine infusion were placed for postoperative pain control. RESULTS: All patients experienced dramatic pain relief and improved mobility and overall function. Life-threatening hemorrhage and sepsis were alleviated. There were no instances of phantom limb pain or adverse psychological reactions, and no complications related to epineural analgesia. CONCLUSIONS: Palliative forequarter amputation is relatively safe and reliable and provides effective pain relief for selected patients with unresectable metastatic carcinoma to the axilla and bony shoulder girdle in whom radiotherapy and/or chemotherapy has not been effective. The triad of pain, motor loss, and an obliterated axillary vein is indicative of brachial plexus infiltration and unresectability.

Adult↗

PubMed2006

[A case of intractable lower limb pain treated successfully by spinal cord stimulation with an electrode inserted retrogradely].

We experienced a case of intractable lower limb pain successfuly treated by spinal cord stimulation with an electrode inserted retrogradely. The patient is a 32 year-old-man suffering from intractable lower limb pain on the area innervated by the sciatic nerve from unidentified cause for about 4 years. We tried various treatments such as epidural block, S 1 nerve-root block including thermocoagulation technique, opiate. Nevertheless, his pain became worse further. Therefore, 6 years after the onset of the symptom, we tried to stimulate electrically the nerve with an electrode inserted retrogradely. This method of spinal cord stimulation produced enough pain reduction. The method of retrograde insertion of an electrode for spinal cord stimulation seems to be a good way to treat intractable pain of the area innervated by a single spinal nerve.

Adult↗

PubMed1995

Autologous islet transplantation to prevent diabetes after pancreatic resection.

BACKGROUND: Extensive pancreatic resection for small-duct chronic pancreatitis is often required for pain relief, but the risk of diabetes is a major deterrent. OBJECTIVE: Incidence of pain relief, prevention of diabetes, and identification of factors predictive of success were the goals in this series of 48 patients who underwent pancreatectomy and islet autotransplantation for chronic pancreatitis. PATIENTS AND METHODS: Of the 48 patients, 43 underwent total or near-total (> 95%) pancreatectomy and 5 underwent partial pancreatectomy. The resected pancreas was dispersed by either old (n = 26) or new (n = 22) methods of collagenase digestion. Islets were injected into the portal vein of 46 of the 48 patients and under the kidney capsule in the remaining 2. Postoperative morbidity, mortality, pain relief, and need for exogenous insulin were determined, and actuarial probability of postoperative insulin independence was calculated based on several variables. RESULTS: One perioperative death occurred. Surgical complications occurred in 12 of the 48 patients (25%): of these, 3 had a total (n = 27); 8, a near-total (n = 16); and 1, a partial pancreatectomy (p = 0.02). Most of the 48 patients had a transient increase in portal venous pressure after islet infusion, but no serious sequelae developed. More than 80% of patients experienced significant pain relief after pancreatectomy. Of the 39 patients who underwent total or near-total pancreatectomy, 20 (51%) were initially insulin independent. Between 2 and 10 years after transplantation, 34% were insulin independent, with no grafts failing after 2 years. The main predictor of insulin independence was the number of islets transplanted (of 14 patients who received > 300,000 islets, 74% were insulin independent at > 2 years after transplantation). In turn, the number of islets recovered correlated with the degree of fibrosis (r = -0.52, p = 0.006) and the dispersion method (p = 0.005). CONCLUSION: Pancreatectomy can relieve intractable pain caused by chronic pancreatitis. Islet autotransplantation is safe and can prevent long-term diabetes in more than 33% of patients and should be an adjunct to any pancreatic resection. A given patient's probability of success can be predicted by the morphologic features of the pancreas.

Adolescent↗

PubMed1978

The incidence of psychosurgery in the United States, 1971--1973.

As part of the work of the APA Task Force on Psychosurgery, the author surveyed 1,901 neurosurgeons on how many psychosurgical procedures they performed in 1971, 1972 and 1973. A total of 1.481 questionnaires were returned: 195 neurosurgeons indicated they had performed a total of 476 procedures for intractable pain and 1.039 procedures for psychiatric conditions. Excluding the procedures reported by 4 neurosurgeons who performed more than 20 psychosurgical operations in any one of the three years, the number of psychosurgical operations in 575 for the three years, which the author suggests should allay fears about the abuse of psychosurgery.

Humans↗

PubMed1982

D-phenylalanine and other enkephalinase inhibitors as pharmacological agents: implications for some important therapeutic application.

A number of compounds have been shown to inhibit the degradation of enkephalins. As expected, these compounds produce naloxone reversible analgesia and potentiate the analgesia produced by enkephalins and by acupuncture. One of these, D-phenylalanine, is also anti-inflammatory. D-phenylalanine has proven to be beneficial in many human patients with chronic, intractable pain. It is proposed the enkephalinase inhibitors may be effective in a number of human "endorphin deficiency diseases" such as depression, schizophrenia, convulsive disorders and arthritis. Such compounds may alleviate other conditions associated with decreased endorphin levels such as opiate withdrawal symptoms.

Acupuncture Therapy↗

PubMedDate not supplied

Burst fracture of the spine involving vertebrae presenting no other lesions: the role of vertebroplasty.

We report our experience on percutaneous vertebroplasty performed on five patients who presented with history of trauma to the spine and secondary burst fracture, but with stable fractures, and on whom the medical and orthopedical therapies had been unsuccessful in the relief of the intractable pain and in the treatment of their functional status. Four cases have benefitted from the intervention, with complete disappearance of the symptomatology in two and incomplete in the other two. In one case, the improvement in the persistent painful symptoms was of no significance. Controls by computed tomography (CT). Which were performed after 3 months showed a satisfactory consolidation of the fractured vertebrae.

Adult↗

PubMed1976

Electrical stimulation in multiple sclerosis.

When electrodes were implanted in the spinal cord of a patient with MS--for dorsal column stimulation to relieve intractable pain--she regained considerable movement in her legs. Subsequently such stimulation has been employed in more than 70 other patients, and many have regained voluntary control over their arms, legs, and sphincters. The procedure is detailed and its implications are explored.

Activities of Daily Living↗