The Clinical journal of pain
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Three patients with intractable chest wall pain due to diffusely metastatic thoracic neoplasm were successfully treated with intermittent interpleural steroid injections. Intermittent administration of 0.5% bupivacaine mixed with methylprednisolone suspension (Depo-Medrol) was effective in controlling intractable pain due to metastatic cancer. Pain relief with this technique lasted for periods in excess of 3 weeks between injections. Intermittent interpleural block may be a useful addition to the therapeutic armamentarium in dealing with chronic pain due to metastatic neoplasm.
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A 74-year-old woman with peripheral vascular disease suffered from rest pain in the right big toe and intermittent claudication. Because of concomitant venous congestion, a chemical lumbar sympathectomy was considered to carry an increased risk of leg edema. A continuous lumbar sympathetic block with local anesthetic abolished the pain in the toe without side effects. After this reversible block, a chemical lumbar sympathectomy was performed producing pain relief for 4 weeks when the patient was last seen.
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Median nerve somatosensory evoked potentials (SEPs) were monitored in patients with chronic pain before and after stellate ganglion blockade. A change caused by the syndrome or by the block would suggest that SEPs might be useful in the diagnosis and treatment of chronic pain. We observed 20 subjects. ⋯ Paired analysis within each group showed that the SEPs were not different from baseline (unaffected side before block) at any time throughout the study. We conclude that since SEPs are not changed by the reflex sympathetic dystrophy or stellate ganglion block, they would not be useful in the evaluation of pain or in determining the effectiveness of sympathetic block. Both the pain and the block appear to involve alteration of conducting pathways separate from those monitored by median nerve SEPs.
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This study investigated the psychometric properties of eight pain intensity measures used with chronic low back pain patients. All measures were similar in terms of scale distribution and rates of incorrect responses, with all scales apart from the Pain Rating Index significantly correlated. ⋯ The 101-point Numeric Rating Scale and the Box Scale had the strongest relationship, with loadings of 0.90. The Numeric Rating Scale and the Box Scale appear to be the scales of choice for the measurement of pain intensity in the low back pain patient.