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 127 records · Page 7Linked to original sources

[Intractable pain after lumbar intervertebral disc surgery (author's transl)].

A joint follow-up study of 3238 cases from 15 neurosurgical departments analyzed complications following lumbar disc surgery. One hundred cases of intractable pain were evaluated and correlated with the pre-, intra-, and postoperative findings of all patients with complications following lumbar disc surgery. The 100 cases with intractable pain are divided into 67 cases without and 33 cases with reoperation; these two groups are treated separately. In patients with intractable pain the following findings were more frequent and may be considered as risk factors: long preoperative period of complaints, discrepancy between sensory findings and level of operation, pronounced osteochondritic changes, extensive surgical intervention, and complaints without adequate neurologic findings. The poorest results after lumber disc surgery are discussed and compared with the literature.

Humans↗

Effects of stereotactic lesions of the pulvinar and lateralis posterior nucleus on intractable pain and dyskinetic syndromes of man.

In a series of 18 patients suffering from intractable pain or different types of dyskinetic syndromes, 28 stereotactic lesions of the pulvinar, associated with six lesions of the laterlis posterior nucleus, have been performed. The evaluation of long-term results in intractable pain reduces the therapeutic benefit of the stereotactic pulvinolysis. Concerning dyskinetic syndromes, the pulvinar does not seem to play an important role in spasticity, while its role in other dyskinetic syndromes can be questionable.

Adolescent↗

Long-term intraventricular infusion of morphine for intractable pain in cancer of the head and neck.

The authors' experience with seven patients with intractable pain that was treated by continuous intraventricular infusion of morphine through an implanted Infusaid pump is reported. The pain was caused by head and neck cancer in six patients and was associated with postpolio syndrome in one. The average follow-up was 7 months. Pain was effectively managed through intraventricular administration of a combination of morphine and mild oral narcotic analgesics. Complications included one case of transient respiratory depression, one pump pocket infection, and one pump failure. The morphine dose required to maintain analgesia increased over time in all patients treated. This is a safe and effective method of pain management in patients with head and neck cancer. It is useful as well in patients who have intractable pain that cannot be managed through an intrathecal route because of a contraindication to lumbar puncture or an inaccessible subarachnoid space.

Head and Neck Neoplasms↗

Intractable pain with breast cancer.

This study examines retrospectively the cause, clinical features, natural history and results of treatment of intractable pain associated with breast cancer in 210 patients. The three chief types of pain were that due to skeletal metastases or brachial plexus neuropathy and pain of psychogenic origin. Onset at the time of cancer diagnosis characterized the psychogenic pain, whereas pain from metastases first occurred after a median latency of 3.7 years. Treatment was custom-tailored to the specific patient and pain problem, with several factors taken into account. The onset of intractable pain due to metastatic disease indicated a short survival (median, 9 months).

Bone Neoplasms↗

Tolosa Hunt Syndrome--intractable pain treatment with acupuncture?

PURPOSE: The Tolosa Hunt Syndrome (THS) is a painful granular inflammation of the cerebral vessels followed by pain and disorders of the extrabulbar muscles. The therapy consists of corticosteroids and analgetics. There was a 70 year old woman who suffered from painful paresis of the abducent and oculomotor nerves following an infection with Borrelia Burgdorferi--but without ocular symptoms. The treatment with corticosteroids reduced the palsy but she complained of excessively painful attacks in the region of the first branch of the trigeminal nerve. Opiold analgetic therapy did not bring about any relief. Acupuncture is an irritative method with a physical effect on the nervous system: its pain-reducing effect is caused by the activation of transmitters like endorphins in thalamus and brain stem. Knowing this effect, the THS patient, after informed consent, was treated with acupuncture. To measure the extent of pain, a visual analog scale (0: no pain - 10: maximum pain) was used. Acupuncture was performed according to the empirical rules of the Traditional Chinese Medicine (TCM), during a period of 10 weeks and 12 weeks. There was a significant pain relief after acupuncture from VAS 10 to VAS 5. The effect vanished during the next four months. After a second series of 12 sessions pain reduction was reported from VAS 10 to 4. One year after the last Tolosa Hunt Syndrome - intractable pain pain strength ranged between VAS 4 - 6. Therefore acupuncture seems to be a good additional method for reduction of intractable pain.

Acupuncture Therapy↗

Combined stereotaxic surgery for relief of intractable pain.

We have carried out 43 of our standard combined stereotaxic thalamotomies in 37 patients with intractable pain. Our standard targets in thalamotomy for pain relief consisted of pulvinar, dorsomedial, centromedial, parafascicular and limitans nuclei. 91% of all the cases had excellent or good results. Six patients had bilateral thalamotomy because of severe relapse. Five patients developed mental disorientation and confusion after operation, but in a week returned to a normal state. One of the 37 patients died. Autopsy revealed cardiac infarction. On the basis of our results we consider the use of our standard targets to be most suitable for relieving intractable pain.

Adult↗

Intraventricular administration of morphine in patients with neoplastic intractable pain.

Since February 1981, eight patients with neoplastic intractable pain have been treated by intracerebroventricular administration of small doses of morphine. Morphine was injected into the cerebrospinal fluid through a ventricular reservoir either by direct puncture or by self-administration. Clinical results were very good, and there were no deleterious effects.

Adult↗

Chronic stimulation of the Kölliker-Fuse nucleus region for relief of intractable pain in humans.

Chronic electrical stimulation in the periventricular or periaqueductal gray matter regions and the thalamic somatosensory relay nuclei (ventralis posteromedialis and ventralis posterolateralis) provides long-term pain relief in about 50% of patients with intractable pain refractory to other conservative and/or surgical measures. To enhance the success of electrical stimulation in relief of pain, alternative brain and brain-stem targets have been sought. A series of laboratory studies indicated that the Kölliker-Fuse nucleus and the parabrachial region may provide appropriate alternatives to the "classic" targets. This report describes six patients with intractable chronic pain of nociceptive or central origin, in whom an electrode was stereotactically implanted in the region of the Kölliker-Fuse nucleus. Kölliker-Fuse nucleus stimulation alone or in combination with stimulation in the periaqueductal/periventricular gray matter region or the somatosensory thalamic nuclei provided excellent pain relief in three of the six patients.

Adult↗

Ventilatory response to intractable pain.

Fifty-two patients, admitted to a pain relief unit, had a cannula placed in the radial artery to measure the paO2, paCO2 and pH of arterial blood every 2 h, for periods ranging from 12 to 24 h. The patients were divided into 3 groups: 14 had low back pain, 21 patients had pain from cancer, and 17 had pain from other causes. Twenty were male and 32 were female with a mean age of 53 years (range 16-82 years). The mean paO2 of these groups was within normal limits. The mean paCO2 and pH for the 3 groups were, low back pain paCO2 4.1 kpa, pH 7.42, others, paCO2 4.2 kpa, pH 7.42. The finding of a normal pH associated with a low paCO2 suggests that patients were "reset" to a low paCO2. Treatment, which was most commonly nerve blocks, resulted in marked pain relief in 30 patients. Ten of these patients were available for follow-up at least 1 week later (4 from the low back pain group, 6 from the cancer group), and in every patient, after pain relief, there was a rise in paCO2 which was statistically significant (P less than 0.001) and was not accompanied by a fall in pH. This suggests that intractable pain is accompanied by chronic hyperventilation and that the relief of pain is accompanied by a decrease in ventilation.

Adolescent↗

Illness behaviour syndromes associated with intractable pain.

One hundred patients, referred for the management of intractable pain, completed a 52-item Illness Behaviour Questionnaire (IBQ). Responses were scored on 7 scales: general hypochondriasis, disease conviction, psychological versus somatic perception of illness, affective inhibition, affective disturbance, denial, and irritability. IBQ scale profiles were subjected to numerical analysis and 6 taxonomic clusters were identified. Patients in groups 1-3 were characterized by a relatively non-neurotic, reality-oriented attitude to illness, as indicated by low scores on the first three scales. Patients in groups 4-6 manifested greater evidence of 'abnormal illness behaviour', and presented syndromes resembling 'hysteria', 'conversion reaction', and 'hypothchondriasis' respectively.

Adult↗

Common factors contributing to intractable pain and medical problems with insufficient drug uptake in areas to be treated, and their pathogenesis and treatment: Part I. Combined use of medication with acupuncture, (+) Qi gong energy-stored material, soft laser or electrical stimulation.

Most frequently encountered causes of intractable pain and intractable medical problems, including headache, post-herpetic neuralgia, tinnitus with hearing difficulty, brachial essential hypertension, cephalic hypertension and hypotension, arrhythmia, stroke, osteo-arthritis, Minamata disease, Alzheimer's disease and neuromuscular problems, such as Amyotrophic Lateral Sclerosis, and cancer are often found to be due to co-existence of 1) viral or bacterial infection, 2) localized microcirculatory disturbances, 3) localized deposits of heavy metals, such as lead or mercury, in affected areas of the body, 4) with or without additional harmful environmental electro-magnetic or electric fields from household electrical devices in close vicinity, which create microcirculatory disturbances and reduced acetylcholine. The main reason why medications known to be effective prove ineffective with intractable medical problems, the authors found, is that even effective medications often cannot reach these affected areas in sufficient therapeutic doses, even though the medications can reach the normal parts of the body and result in side effects when doses are excessive. These conditions are often difficult to treat or may be considered incurable in both Western and Oriental medicine. As solutions to these problems, the authors found some of the following methods can improve circulation and selectively enhance drug uptake: 1) Acupuncture, 2) Low pulse repetition rate electrical stimulation (1-2 pulses/second), 3) (+) Qi Gong energy, 4) Soft lasers using Ga-As diode laser or He-Ne gas laser, 5) Certain electro-magnetic fields or rapidly changing or moving electric or magnetic fields, 6) Heat or moxibustion, 7) Individually selected Calcium Channel Blockers, 8) Individually selected Oriental herb medicines known to reduce or eliminate circulatory disturbances. Each method has advantages and limitations and therefore the individually optimal method has to be selected. Applications of (+) Qi Gong energy stored paper or cloth every 4 hours, along with effective medications, were often found to be effective, as Qigongnized materials can often be used repeatedly, as long as they are not exposed to rapidly changing electric, magnetic or electro-magnetic fields. Application of (+) Qi Gong energy-stored paper or cloth, soft laser or changing electric field for 30-60 seconds on the area above the medulla oblongata, vertebral arteries or endocrine representation area at the tail of pancreas reduced or eliminated microcirculatory disturbances and enhanced drug uptake.(ABSTRACT TRUNCATED AT 400 WORDS)

Acupuncture Therapy↗

Clinical pharmacokinetics applied to patients with intractable pain: studies with pethidine.

The minimum effective analgetic blood concentration (MEAC) of pethidine following intravenous administration was identified in 3 patients with intractable pain. In two patients this value remained the same whether the pethidine was given intravenously, orally or rectally. In the third patient, whose eneral bioavailability was only 20%, the MEAC was not obtained. However, intramuscular administration reliably achieved the MEAC and was useful clinically. During the study period of 3-12 months, the individual patient's MEAC remained similar. Two patients developed dependence on, and tolerance to, pethidine but neither the dependence nor the tolerance appeared to be related to the MEAC. These studies confirm the importance of clinical pharmacokinetic measurements in the investigation and treatment of patients with intractable pain.

Administration, Oral↗

Childhood hospitalization and chronic intractable pain in adults: a controlled retrospective study.

Three groups of patients have been studied in order to elucidate the relationship between childhood hospitalization and chronic intractable pain in adults. The groups were: patients referred to a pain clinic, psychiatric patients with a depressive illness, and patients attending a rheumatology clinic. The findings suggest that early hospitalization is related to the genesis of both depressive illness and intractable pain: in the former occurring in the preschool years and in the latter, during school age. The significance of these relationships is discussed.

Adolescent↗

Parafascicular-center median nuclei stimulation for intractable pain and dyskinesia (painful-dyskinesia).

Medial thalamus stimulation was used to treat chronic intractable pain associated with dyskinesia. Relief from both the pain and the motor disorder occurred concomitantly. However, maximum pain reduction was attained at a relatively faster rate than maximum reduction from the motor disability. It is postulated that pathologic changes in the center median nucleus secondary to lenticulo-striate-internal capsular lesions account, in part, for both the pain and the dyskinesia. Electrical stimulation of the center median(n) parafascicular nuclear complex presumably simultaneously activates both the neurohumeral and tertiary sensory pain inhibitory system for pain control, and the suprasegmental gamma system for motor control.

Adult↗

Thalamic relay nucleus stimulation for relief of intractable pain. Clinical results and beta-endorphin immunoreactivity in the cerebrospinal fluid.

Deep brain stimulation (thalamic relay nucleus, periaqueductal gray and internal capsule) was applied to various cases of intractable pain, and the resulting degree of pain reduction and alteration in beta-endorphin immunoreactivity in the cerebrospinal fluid (CSF) were compared. The following results were obtained. (1) The studies on intractable pain revealed that the levels of beta-endorphin immunoreactivity in the CSF were lower than those in the control group. (2) Thalamic relay nucleus stimulation proved effective not only for deafferentiation pain, but also for somatogenic pain. No relationship was, however, noted between pain reduction and the rate of increase of beta-endorphin immunoreactivity in the CSF. (3) The incidence of stimulation tolerance following prolonged stimulation of the thalamic relay nucleus can be reduced to a minimum by administration of L-DOPA. It is concluded that the increase in beta-endorphin in the CSF is not the direct and major cause of pain reduction during treatment by thalamic relay nucleus stimulation. It may be assumed that neuronal facilitation on the monoaminergic descending pain inhibitory system plays a role in reducing pain.

Adult↗

Management of intractable pain: the scope and role of nerve blocks: review of one year's experience.

This paper presents the first one year's experience of nerve blocking procedures carried out for the relief of intractable pain. The control of pain is complex and has led to the development of Pain Clinics employing the skills of different specialties. The scope and organisation of such a clinic developed at Auckland Hospital is outlined. Some 103 patients were referred with intractable pain from cancer, musculo-skeletal disorders, neurogenic causes and ischaemic causes and ischaemic problems. Of these, 55 percent derived complete relief. Breakdown of results demonstrate that over 70 percent of patients in the groups of pain of neurogenic and ischaemic origin had complete relief of pain. Recognised complications of major nerve blocking procedures were encountered in a small percentage of patients, but these caused no great concern. Nerve blocks have a definite place in the treatment of chronic pain and form an important adjunct to the overall management.

Anesthetics, Local↗