Journal of pain and symptom management
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J Pain Symptom Manage · Apr 1992
Case ReportsResponse of central pain syndromes to intravenous lidocaine.
In this study, 8 patients with central pain syndromes, 6 with hemispheric lesions, and 2 with spinal cord lesions were treated with a 1 mg/kg dose of intravenous lidocaine. Patients first received the same volume of normal saline, in single-blind fashion, to monitor placebo effects. Of the 8 patients, 7 responded to lidocaine, and only 1 responded to normal saline. ⋯ In addition, 3 patients had pain relief that lasted for 8-20 wk. These findings, which are in agreement with two previous open-label studies, suggest that a single dose of a local anesthetic, lidocaine, can provide lasting pain relief for patients with central pain syndromes. This analgesic action may be central, and possibly supraspinal, at least in patients with hemispheric lesions.
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J Pain Symptom Manage · Apr 1992
Randomized Controlled TrialA randomized double-blind crossover trial of intravenous lidocaine in the treatment of neuropathic cancer pain.
In a randomized, double-blind, crossover study, we evaluated the effect of intravenous lidocaine (5 mg/kg body weight over 30 min) on the neuropathic pain of advanced cancer patients. Pain intensity, assessed by a visual analogue scale, did not show any significant difference between lidocaine and placebo infusion. The blinded choice of patients and investigators also suggested no significant improvement from lidocaine when given by this regimen. Intravenous lidocaine does not appear to have a significant analgesic effect on neuropathic cancer pain.
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Alternative routes of drug delivery have particular relevance for use in chronic pain. When the pain experience is constant or nearly constant, a continuous infusion of drug is an ideal way to achieve effective pain relief. Early experience with the transdermal application of fentanyl in chronic cancer pain suggests that it is a safe, noninvasive, effective method of managing pain. ⋯ The system was able to be maintained through a variety of concomitant events. This experience demonstrated the safety and clinical effectiveness of transdermal fentanyl. The transdermal therapeutic system (fentanyl) is a promising advance in achieving noninvasive, continuous drug administration for the management of chronic cancer pain.
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The transdermal therapeutic system (TTS) is a novel technique of drug administration that can mimic long-term continuous intravenous infusions in maintaining stable drug plasma concentrations. Fentanyl, a potent lipid-soluble synthetic opioid, has been incorporated into such a system and has undergone preliminary clinical trials in postoperative patient populations to assess analgesic efficacy and incidence of undesirable side effects (pruritus, nausea and vomiting, urinary retention, respiratory depression). In general, when applied 2 hr preoperatively, a TTS (fentanyl) patch (in different doses) provides moderate-to-good analgesia for a variety of surgical procedures for periods of up to 3 days. ⋯ The incidence of side effects such as nausea and vomiting varies between studies but can be as high as 70%. Clinically significant respiratory depression is rare but was reported in several of the studies. TTS (fentanyl) is a simple and useful technique for the control of postoperative pain.
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J Pain Symptom Manage · Apr 1992
ReviewThe role of patient-controlled analgesia in the management of cancer pain.
The technology of patient-controlled analgesia (PCA) has gained wide acceptance for use in cancer pain management. Assessment of technological innovations is necessary in order to evaluate the most appropriate use from the perspective of the individual patient and broader health policy perspective. This paper reviews the literature related to PCA use in chronic cancer pain, appropriate and inappropriate uses of PCA, as well as several professional issues and directions for future PCA use. Professional dialogue regarding the standard of PCA care is necessary for optimum use of this technology for relief of chronic pain.