Pain
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Clinical Trial Controlled Clinical Trial
A prospective, longitudinal study on patients with trigeminal neuralgia who underwent radiofrequency thermocoagulation of the Gasserian ganglion.
Outcome after radiofrequency thermocoagulation in patients with trigeminal neuralgia was assessed in a prospective, longitudinal study. Forty-eight consecutive patients with chronic facial pain presenting for surgery to a neurosurgeon were studied. Patients were assessed preoperatively by an independent clinician both clinically, and with the use of two questionnaires: the McGill Pain Questionnaire (MPQ) and the Hospital Anxiety and Depression (HAD) scale. ⋯ Careful selection of patients for surgery using objective assessments will decrease morbidity and improve satisfaction. Physical morbidity and recurrence rates are insufficient to gauge outcomes. Psychological, sociological and patients' views must be included in evaluations.
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Randomized Controlled Trial Clinical Trial
Evaluation of the use of a pain diary in chronic cancer pain patients at home.
Systematic assessment of pain is the basis for adequate pain treatment. In the home situation, however, it is difficult to assess patients' pain intensity. A group of 159 cancer patients who had been admitted to a cancer hospital with pain caused by cancer, cancer therapy, or illness that persisted for at least 1 month received a pain diary. ⋯ When comparing pain scores obtained by patient interview with scores obtained by pain diary, results showed that Present Pain Intensity scores, rather than Average Pain Intensity scores, should be used in both the clinical and the home setting because patients' recall accuracy depends, in part, on the stability of the pain. Because the pain intensity scores fluctuate greatly during the day and over a period of time, the use of a pain diary is useful in the home setting. In 60% of the patients, completing the pain scores helped them to cope with the pain.
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The management of trigeminal neuralgia in older patients who do not want neurolytic block and/or surgical treatment may be problematic. This paper describes three patients who had first and/or second division trigeminal neuralgia. The analgesic effects of infraorbital nerve block using 0.5% bupivacaine or 1% mepivacaine dissipated within a few days, however, the effects of nerve blocks using 4% tetracaine dissolved in 0.5% bupivacaine continued for more than 3 months. Hypesthesia was observed in two patients within a week following the block, but sensory level returned to normal within 2 weeks and there were no further complications in any patient.
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The role of nerve growth factor (NGF) and glial-derived neurotrophic factor (GDNF) in sympathetic sprouting within the dorsal root ganglion was investigated. In nerve-intact rats, intrathecal NGF (1 mg/ml, 14 days) but not GDNF (1 mg/ml, 14 days) induced extensive sprouting of tyrosine hydroxylase immunoreactive (TH-IR) fibres and formation of pericellular TH-IR baskets within lumbar DRGs. TH-IR baskets were distributed equally to trkA-expressing and trkA-negative neuronal profiles. ⋯ Distribution of sympathetic sprouts within the DRG is independent of whether target neurons are injured or express trkA. Sequestration of NGF at the peripheral injury site does not influence basket formation within the DRG. It is likely that functional noradrenergic connections exist between sympathetic sprouts and sensory neuron cell bodies following exogenous NGF.
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Clinical Trial Controlled Clinical Trial
Assessment and treatment of neuropathic cancer pain following WHO guidelines.
Neuropathic pain syndromes are one of the major problems of cancer pain treatment. The present study surveys 593 cancer patients treated by a pain service following the WHO guidelines for relief of cancer pain. Of these, 380 presented with nociceptive, 32 with neuropathic and 181 with mixed (nociceptive and neuropathic) pain. ⋯ Analgesic treatment resulted in a significant pain relief in all groups of patients, as the mean pain intensity (NRS) decreased from 66 (nociceptive), 65 (mixed) and 70 (neuropathic) on admission to 26, 30 and 28 after 3 days and 18, 17 and 21 at the end of survey. The total outcome of pain treatment was not predicted by the designation to nociceptive, mixed or neuropathic pain. In conclusion, neuropathic cancer pain is not intractable and can be relieved in the majority of patients by treatment following the WHO guidelines.