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At least 19 recordsLinked to original sources
PubMed1979

Spinal epidural neurostimulation for treatment of acute and chronic intractable pain: initial and long term results.

Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Hashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post-traumatic and postamputation neuroma. Long term follow-up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.

Acute Disease↗
PubMed1977

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↗
PubMed1975

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↗
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↗
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↗
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↗
PubMed1978

Local anaesthetic nerve block in the treatment of intractable pain from osteoarthritis of the hip.

Previous workers have advocated hip nerve block, with local anaesthetic, in the treatment of intractable pain from osteoarthritis of the hip. In a pilot study we obtained some degree of pain relief in only six of 13 patients. A further double-blind, controlled, randomized trial was undertaken in 31 patients, comparing 0.5% Marcain and normal saline. There was no significant improvement in pain or hip movements in either group over a six-week period.

Aged↗
PubMedDate not supplied

Ablation of the brachial plexus. Control of intractable pain, due to a pathological fracture of the humerus.

A case report is presented which illustrates the difficulties in providing control of intractable pain from pathological fractures of the humerus. Relief from large and frequent doses of systemic analgesics was found to be inadequate. Control was achieved using brachial plexus block with bupivacaine combined with absolute alcohol. The decision to partially ablate the plexus is considered to be justified by the improved quality of life which the patient enjoyed.

Brachial Plexus↗
PubMed1978

Cyclobenzaprine in intractable pain syndromes with muscle spasm.

The effectiveness of cyclobenzaprine hydrochloride, a new tricyclic skeletal muscle relaxant, was shown in patients with long-term intractable pain of cervical and lumbar origin aggravated by skeletal muscle spasm and tenderness. The investigation was double-blind and randomized, comparing cyclobenzaprine hydrochloride (10 mg three times a day) with diazepam (5 mg three times a day) and with placebo. After two weeks of treatment, the 16 patients in the cyclobenzaprine group showed an overall improvement in pain variables as did the 16 patients in the diazepam group. No serious adverse reactions to cyclobenzaprine were observed in the study. However, dry mouth due to cyclobenzaprine's anticholinergic action and mild degrees of drowsiness were encountered more often than with diazepam or placebo.

Adult↗
PubMed1977

Anterior commissurotomy for intractable pain.

Anterior commissurotomy for the relief of intractable lower half and midline pain has been found to be a very satisfactory procedure in a small group of severely incapacitated patients. The presumed anatomic rationale for undertaking the procedure has not been confirmed by postoperative sensory examinations. Alternative explanations for its effectiveness remain conjectural. The operative procedure is described.

Adult↗