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At least 145 records · Page 8Linked to original sources
PubMed1999

Managing intractable pain with an intrathecal catheter and injection port: technique and guidelines.

The objective of our study was to describe an effective technique for the management of chronic intractable pain in patients with intermediate life expectancy or as a long-term screening device prior to implantable pump therapy. In the study, an InDura intraspinal catheter is connected to a BardPort, which is accessed transdermally. We describe our surgical technique, recommended dosage calculations, cost comparison to an implantable infusion pump, and our experience with 13 cases. In our series of 13 patients, there was one seroma and one dural leak. There were no infections, and all were functioning well in the 12 cancer patients until their deaths. One case was converted to an implantable pump. There were no malfunctions or infections of the intrathecal infusion system in the 12 cancer patients. This intrathecal drug infusion system should be considered in the treatment armamentarium for chronic intractable pain and cancer pain.

Adult↗
PubMed1985

Intrathecal morphine for intractable pain secondary to cancer of pelvic organs.

Sixty-two patients with intractable pain secondary to cancer of the pelvic organs were managed with intrathecal injections of morphine. Forty-six patients experienced pain relief from an initial test dose that ranged from 0.5 to 2.0 mg. In order to provide long-term pain relief, these 46 patients were further treated with repeated single injections (14 patients), external catheter (28 patients), or implanted pump (4 patients). Twenty-four of the 46 patients received pain relief without developing tolerance or side effects or experiencing mechanical failure of the application systems. When side effects developed, they were generally itching, sphincter disorder and somnolence. No serious respiratory depression was noted. Intrathecal morphine offers a hopeful alternative to systemic narcotics or ablative neurosurgical procedures in the management of terminal cancer pain.

Humans↗
PubMed2001

Thoracoscopic splanchnicectomy for control of intractable pain due to advanced pancreatic cancer.

BACKGROUND: Severe upper abdominal pain is a dominant and distressing feature of advanced pancreatic cancer. This study was performed to evaluate pain intensity and to determine the ways in which pain may interfere with the common daily activities of patients with intractable pain before and after thoracoscopic splanchnicectomy. METHODS: Twenty-six left-sided thoracoscopic splanchnicectomies were performed. To assess pain severity and the impact of pain, all patients completed a short questionnaire using the 0-10 Numeric Rating Scale. The Pain Management Index was used to describe and compare the adequacy of analgesic management. Patients were evaluated 1 day prior to operation and for 6 months after the procedure. RESULTS: Pain was reduced significantly after the operation (p < 0.001), and all patients enjoyed consistent pain relief during the postoperative follow-up. The degree to which pain interfered with their daily function decreased significantly (p < 0.001) after surgery. The adequacy of the analgesic management improved, and none of the patients required opioids. CONCLUSIONS: Unilateral left thoracoscopic splanchnicectomy is a simple, minimally invasive, effective, and safe procedure that can be recommended as the method of choice for the management of intractable upper abdominal pain due to advanced pancreatic cancer.

Adult↗
PubMed1990

Deep brain stimulation for control of intractable pain in humans, present and future: a ten-year follow-up.

Deep brain stimulation with chronically implanted electrodes has provided satisfactory control of pain in patients with intractable chronic pain syndromes, which have been refractory to medication and other conventional modalities of management. In this series the authors present their experience with 48 patients who have been followed for periods ranging from 6 months to 10 years. Long-term pain control was achieved in 30 patients (63%). Both the periventricular gray and specific sensory thalamic nuclei have been used as targets. Our results indicate that there is an initial 2-year fall-off of pain control caused by idiopathic tolerance, with stable results thereafter, regardless of site of the implant. This is suggestive of some biochemical modification of tissues around the electrode. Patients with failed-back syndrome secondary to multiple disc operations fared well; those with pain secondary to progressive neurological disorders or cancer had only short-term pain relief, and those with thalamic pain, cauda equina injury, or phantom limb pain usually had a poor result. Deep brain stimulation, in selected patients, appears to provide long-term pain control safely with few side effects or complications.

Adult↗
PubMed1989

[Treatment of intractable pain in ORL cancer].

Numerous effective treatments are available to relieve the intractable pain of terminal E.N.T. cancers when aetiological therapies are no longer of any use. These treatments must be prescribed as a progressive therapeutic scale ranging from analgesics, and notably morphine which remains the basic drug, to the classical or stereotactic surgical operations. To these must now be added other routes of administration of morphine (e.g. intraventricularly) which in some cases give unexpected results.

Humans↗
PubMedDate not supplied

Treatment of intractable painful diabetic neuropathy with intravenous lignocaine.

OBJECTIVE: Lignocaine is a cardiac antiarrhythmic agent occasionally used to treat neuropathic pain. This study was designed to examine the effectiveness of intravenous lignocaine in patients with intractable painful diabetic neuropathy. RESEARCH DESIGN AND METHODS: Fifteen patients with painful diabetic peripheral neuropathy, who had appeared to respond to previous lignocaine infusions, completed a double-blind, placebo-controlled crossover trial of two doses of intravenous lignocaine (5 and 7.5 mg/kg) versus saline. Infusions were administered in random order over 4 h at four weekly intervals. The effect of treatment on pain perception was assessed using the McGill Pain Questionnaire (MPQ), a daily pain diary, hours of sleep, fasting blood glucose, and use of other pain-relieving medication. RESULTS: Both doses of lignocaine significantly (P<.05 to P<.001 for the different measures) reduced the severity of pain compared with placebo. This reduction was present at both 14 and 28 days after the infusion. The qualitative nature of the pain was also significantly (P<.05 to P<.01) modified by lignocaine compared with placebo for up to 28 days. The preceding dose 4 weeks earlier significantly (P<.01 and P<.001) affected the response to the next dose. There were no significant effects of treatment on the other measures of response. There were no significant side effects of the treatment. CONCLUSIONS: This study shows that intravenous lignocaine ameliorates pain in some diabetic participants with intractable neuropathic pain who have failed to respond to or are intolerant of available conventional therapy.

Adult↗
PubMed1992

Response of intractable pain to continuous intrathecal morphine: a retrospective study.

We have treated 37 patients with intractable pain (35 with cancer-related pain) by continuous intrathecal morphine infusion via implanted pump. These patients were carefully selected according to specific criteria, and each demonstrated a significant reduction in pain following a test dose of intrathecal morphine. All patients had good pain relief from intrathecal morphine infusion, even with pain located in cervical dermatomes. Systemic narcotics could be withdrawn from most patients. Significant side effects were rare and typically self-limited. Many patients required gradually increasing doses, seemingly related to disease progression. Two patients with non-malignant pain have had variable dose requirements over 28 and 44 months without clear tolerance. In these patients we observed a reduction in side effects associated with systemic opioids when continuous intrathecal opioid infusion was instituted. Intrathecal opioid administration may have fewer complications than ablative pain relief procedures. In properly selected patients, this method offers an effective alternative for pain relief.

Adolescent↗
PubMed1978

Mesencephalotomy for intractable pain due to malignant disease.

40 mesencephalotomies were carried out on 38 patients with intractable pain secondary to malignant disease. In 2 patients with bilateral pain, a bilateral mesencephalotomy was required. Most of the patients had pain in the head, neck or upper trunk secondary to carcinoma of the nasopharynx, jaw, tongue, or neck.

Female↗
PubMed1981

Intractable pain--the present position.

The broad changes that have occurred in the treatment of intractable pain are considered. There is a new understanding of the anatomy and physiology of pain pathways and pain appreciation. Thus gate control theory, the spinal laminae, and the descending inhibitory pain pathway through the raphe nuclei are discussed in relation to the recent discovery of the opioid (enkephalin) systems. Out of this arises the stimulation methods of pain relief--transcutaneous neural stimulation, periaqueductal stimulation, and acupuncture. These are valuable in patients with a normal expectation of life. For patients with a shortened expectation of life other methods, especially destructive ones, are valuable (though in all types of chronic pain drug therapy is still the most used method). Basic changes in techniques and the equipment used to bring this about are detailed broadly. In particular, the use of the image intensifier X-ray machine and the stimulation and destruction available from the modern lesion generator when used in combination provide accuracy and safety. Techniques and methods are constantly altering and examples of this are given. All this costs money in time, personnel, and equipment; the costings of the Liverpool Centre for Pain Relief are given. Finally, the Pain Relief Foundation is in being in Liverpool in the grounds of Walton Hospital. This has been made possible by a large 'seed' donation by the Wolfson Foundation.

Electrocoagulation↗
PubMed1978

High cervical percutaneous cordotomy in intractable pain.

The authors report on 200 cervical percutaneous cordotomies in 146 patients who were suffering from intractable pain. In order to assess the success rate and the incidence of relapse, the neurological findings immediately post-operatively were compared with the results of a later follow-up. The prospect of success in the treatment of pain appears to depend on the anatomical representation in the spino-thalamic tract of the region of the body which is involved. The incidence of complications and the mortality are compared with the observations of other authors and with the results of open cordotomy.

Aged↗
PubMed2000

Attempted gene therapy for intractable pain: dexamethasone-mediated exogenous control of beta-endorphin secretion in genetically modified cells and intrathecal transplantation.

For optimal neural transplantation using gene engineering, it might be important to control the expression of the transfected gene extrinsically as required. This strategy could be very useful for the treatment of intractable pain that responds to opioids. For this purpose, we established a genetically modified embryonal carcinoma cell line (P19) in which the expression of beta-endorphin (beta-EP) could be controlled by the addition of dexamethasone. To obtain extrinsic control, we transfected the cells with pMAMneo containing mouse MMTV-LTR as a promoter and cDNA of the artificial beta-EP. The upregulation of beta-EP, through the activation of MMTV by the administration of dexamethasone, was confirmed in vitro. Then we transplanted these cells into the subarachonoid space in rats and evaluated the analgesic potential of these cells in vivo by hot plate test and formalin test. In the rats that received beta-EP-producing cells, we observed prominent analgesic effects after the transplantation for a month. The administration of naloxone blocked these effects. Intraperitoneal injection of 100 mg/kg dexamethasone further enhanced these effects by up to two times. These data indicate obvious analgesic effects of the cells after the transplantation and the possible exogenous upregulation of transfected beta-EP gene expression in vivo. The application of this technique might provide a new therapeutic approach to various neurological diseases.

Animals↗
PubMed1970

Intrathecal cold saline for the relief of intractable pain.

Cold saline was injected intrathecally for the relief of intractable pain in terminal cancer patients. Worthwhile relief was obtained in five out of seven patients. The procedure should be considered in the management of such cases when neurosurgical procedures have failed or are contraindicated and when patients have become addicted to, or their pain is unrelieved by, narcotics. There is still uncertainty as to whether cold or hypertonicity is the operative factor; we are more in favour of the latter view.

Adult↗
PubMed1982

Experience with transcutaneous electrical nerve stimulation for relief of intractable pain in cancer patients.

Sixty patients with intractable cancer pain were subjected to transcutaneous electrical stimulation for pain control. Evaluation, after two weeks of treatment, revealed: 17 (28.3%) excellent response, 22 (36.2%) fair and 21 (35.0%) no relief. Re-assessment after 3 months revealed 9 (15%) excellent responses, 11 (18.3%) fair and 40 (67%) failures. Extremity and trunk pains appeared to be most rewarding to patient pain, so far as pain relief is concerned. Perineal and pelvic pains were most difficult to control, only 5 of 12 (41%) cases obtained some short term relief. Pain location and sources correlated with treatment results.

Abdomen↗
PubMed1977

[The treatment of intractable pain by transdermal electrostimulation (author's transl)].

Various kinds of electric currents were examined with regard to their efficacy in the relief of pain when applied transdermally. The most suitable form of current was applied to 39 cases (who had been especially selected in a negative sense) suffering from intractable pain. About half were patients with malignant disease encroaching or causing pressure on nerves or plexuses. The other half consisted of patients suffering from intractable neuralgia totally resistant to all forms of therapy. A diagram of the pulsating direct current is shown. Results were as follows: no effect in nine cases; 5 cases obtained moderate relief of pain for up to 12 hours; the remaining 25 patients reported complete relief of pain already after the first application of current lasting from 12 hours to 3 weeks and--after a series of sessions (3 to 17 treatments)--of up to 12 months. Two of these patients were supplied with a unit for home treatment after their relatives had been trained in the use of the instrument. In these two cases, however, a large number of treatment sessions became necessary. These results warrant continued study of cases of this kind and call for a study of the basic mechanisms possibly underlying these effects. If the present results are confirmed, it is planned to introduce battery-powered miniaturized sets, which patients may use themselves after fixation of electrodes.

Adult↗
PubMed1977

Phosphorus-32 for intractable pain in carcinoma of prostate. Analysis of androgen priming, parathormone rebound, and combination therapy.

Thirty-three patients with intractable pain caused by diffuse osteoblastic metastases from carcinoma of the prostate were treated with phosphorus-32 (32P) therapy either androgen priming, parathormone rebound, or a combination of both priming methods. Significant response to pain was achieved in 12 of 19 patients receiving testosterone-potentiated therapy, 0 of 5 patients treated with parathormone alone, and 6 of 9 patients receiving a combination of both priming modalities. It is concluded that androgen priming alone is the simplest and most effective method to be used when 32P therapy is being considered for palliative control of pain in patients with carcinoma of prostate.

Aged↗
PubMed1984

Use of intraventricular and intrathecal morphine in intractable pain associated with cancer.

The use of the intraventricular or subarachnoid administration of morphine in the treatment of intractable pain secondary to cancer is described. The drug, in doses ranging from 0.33 to 4.00 mg, was administered by the percutaneous injection of an Ommaya reservoir or by a spinal tap. The duration of analgesia ranged from 36 to 150 hours. The indications for and side effects of this type of therapy are considered.

Aged↗
PubMed1991

Clinical application of a patient-controlled apparatus for ventricular administration of morphine in intractable pain: report of 28 cases.

The authors developed a patient-controlled apparatus (L-224) for ventricular administration of pain-relieving medication and utilized it in the treatment of 28 patients with intractable pain. The initial dose of morphine hydrochloride was 1 mg, which afforded pain relief for an average of 170 hours. At an average dose of 1.8 mg, the average time of pain relief obtained was 137 hours. Therefore, they conclude that L-224 is a satisfactory apparatus for the ventricular administration of pain medication; it is patient controlled, safe, and reliable in clinical application.

Adult↗