European journal of pain : EJP
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There is no reliable method to relieve both 'refractory' pain and spasticity in patients with multiple sclerosis (MS). This paper reports on the long-term use of continuous intrathecal bupivacaine infusion in such a patient. The patient under study was a 56-year-old woman affected for 18 years by MS, unsuccessfully treated with analgesics, baclofen, opioids, peripheral neurolysis (obturator nerves, lumbar plexus) and six intrathecal neurolyses of the L4-S3 nerve roots, each time with 1.5 ml of 50% phenol in glycerol. ⋯ The treatment was given for 712 days, at which point the patient died (unrelated to the treatment). Intrathecal infusion of bupivacaine relieved 'refractory' spasticity and pain in a MS patient in whom administration of intrathecal baclofen was contraindicated and neurodestructive procedures had been inefficient. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.
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Basic research indicates that systemic local-anaesthetic-type drugs that block sodium channels are effective in pain due to nerve damage. These drugs were first used as analgesics in the 1950s and they are still commonly used to try to relieve neuropathic pain and incident pain caused by cancer. As they are potentially toxic, these drugs should not be used without proven effectiveness. ⋯ Only minor dose-related adverse effects were reported in the 85 patients given mexiletine 225-750 mg. Local-anaesthetic-type drugs are effective in pain due to nerve damage, but there is little or no evidence to support their use in cancer-related pain. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.
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Projections from the locus coeruleus (LC) to the centrolateral thalamus (Cl) and the medial prefrontal cortex (PfCx) were studied using orthodromic and antidromic stimulation techniques. The LC is a major noradrenergic source in the central nervous system, and its descending projections provide an important source of pain suppression at spinal level. Previously, the author has described a cortico-thalamic loop involved in pain modulation. ⋯ The paper also describes the suppression of spontaneous and nociceptive-evoked activity in the PfCx and Cl following electrical stimulation in LC. It is proposed that the LC innervation could be associated with an ascending noradrenergic system acting upon a Cl-PfCx pain-modulation mechanism. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.
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In the present article, the relationships between pain, coping, functional capacity and psychological well-being are examined in a population of older patients (>/=60 years; n=202) treated for a variety of somatic complaints in a university-affiliated hospital. Results indicate that moderate to extreme pain is common in older patients and often occurs in several body regions simultaneously. Extreme pain in one or more body regions is associated with reduced daily functional capacity, lower values for life satisfaction and self-evaluated competence, and more negative attitudes towards the present and future. ⋯ Results of a hierarchical cluster analysis reveal interindividual differences in coping approaches among older patients suffering from extreme pain; they also emphasize the importance of cognitive strategies and life-review coping. Relevance for clinical practice with older pain patients is discussed. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.
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The present study has assessed the relationship between formalin-induced nociception and formalin-induced inflammation by comparing the dose-related effects of anti-inflammatory treatments on both nociceptive scores and plasma extravasation in the rat hind paw in response to high and low concentrations of formalin. The degree of plasma extravasation produced by 1% formalin did not differ significantly from that produced by the same volume of saline, and was not significantly affected by either of the anti-inflammatory agents. The 5% formalin injection produced significant plasma extravasation that was dose-dependently reduced by both dexamethasone and ibuprofen. ⋯ The present study suggests that there is a positive correlation between the nociceptive and inflammatory effects of formalin in the rat hind paw. However, only a high concentration of formalin, which produces significant plasma extravasation, is capable of demonstrating the antinociceptive effects of anti-inflammatory agents, and the effects are restricted to the late phase of the formalin test. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.