Journal of pain and symptom management
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J Pain Symptom Manage · Mar 1996
Randomized Controlled Trial Clinical TrialIntrathecal morphine for analgesia in children undergoing selective dorsal rhizotomy.
Selective dorsal root rhizotomy is performed for relief of spasticity in children with cerebral palsy. Postoperative pain relief can be provided by intrathecal morphine administered at the time of the procedure. We sought to define an optimal dose of intrathecal morphine in children undergoing selective rhizotomy, through a randomized, double-blinded prospective trial. ⋯ By 24 hr, there was no difference in cumulative dose among groups. Postoperative pain scores and the incidence of respiratory events, nausea, vomiting and pruritus were comparable among groups. These data suggest that intrathecal morphine at 30 micrograms.kg-1 provides the most intense analgesia at 6 hr following selective dorsal root rhizotomy, but was otherwise comparable to the 10 micrograms.kg-1 dose.
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J Pain Symptom Manage · Mar 1996
Randomized Controlled Trial Clinical TrialDay-to-day titration to initiate transdermal fentanyl in patients with cancer pain: short- and long-term experiences in a prospective study of 39 patients.
Initial dose finding in patients with cancer pain who are started on TTS fentanyl (Duragesic, TTS-F) is often unsatisfactory with currently recommended doses and intervals. Acknowledging that studies reveal a "psuedo steady state" 15 to 20 hr after application of TTS-F, we prospectively investigated an increased initial dose and day-to-day titration of TTS-F in 39 (evaluable) patients with uncontrolled cancer pain. Significant pain reduction (P = 0.001) was seen after 24 hr, and satisfactory analgesia was achieved within 48 h and maintained for the rest of the study. ⋯ Other side effects seemed to be less common compared with usual morphine treatment. TTS-F can be titrated effectively and safely on a day-to-day basis with an increased initial dose and adequate patient monitoring, thus avoiding more complicated approaches. TTS-F seemed to induce less constipation than might be expected.
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Two hundred patients with upper-abdominal malignancy were treated with oral morphine sulfate (OMS) during a 2-year period. Twenty-five of these patients experienced left-sided dragging pain and epigastric discomfort following a few months of adequate pain relief. An increase in the OMS did not relieve the pain. ⋯ All of these patients continued to receive OMS without reduction in dose. Three patients required repeat block after 90 days. This experience documents the value of unilateral celiac plexus block as an adjuvant technique for the management of pain due to upper abdominal cancer.
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J Pain Symptom Manage · Mar 1996
Case Reports Clinical TrialChronic opioid therapy for nonmalignant pain in patients with a history of substance abuse: report of 20 cases.
A history of substance abuse is considered by many to be a contraindication to chronic opioid therapy for nonmalignant pain. Twenty patients with a history of chronic nonmalignant pain and substance abuse treated with chronic opioid therapy for a period of more than 1 year were retrospectively evaluated to determine the factors associated with prescription abuse. The prevalence of six aberrant behavioral patterns was assessed to see if these correlated with a history of prescription abuse, as reported by the patient's pain clinic physician. ⋯ Those patients were more likely to be recent polysubstance abusers, or have a prior history of oxycodone abuse. None of them were active members of Alcoholics Anonymous. Signing an "opioids contract" was not in and of itself a predictor of successful outcome.
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J Pain Symptom Manage · Mar 1996
Clinical TrialNerve blocks with local anesthetics and corticosteroids in chronic pain: a clinical follow-up study.
During 4 years, 45 patients with various chronic pain conditions were treated with nerve blocks in our clinic. The blocks consisted of injections of local anesthetic and a corticosteroid on one or several occasions. At the end of this time period, the patients' pain was classified from their records as nociceptive, neurogenic, or unknown, according to International Association for the Study of Pain (IASP) criteria. ⋯ Only 6 of the 45 patients had pain relief for longer than 1 month. It is concluded that treatment with nerve blocks alone is not very effective as a long-term treatment for chronic pain. Further experimental and systematic clinical studies are necessary to define the ultimate place for nerve blocks in the treatment of chronic nonmalignant pain.