Neuromodulation : journal of the International Neuromodulation Society
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Objective and Importance. The subarachnoid infusion of narcotics by programmable devices in patients with chronic non-malignant pain can be a useful therapeutic method. However, certain side-effects, opioid tolerance or changes in the nature of the pain can lead to failure of the therapy. ⋯ The patient therefore needed alternative infusions of both drugs with changes of infusional parameters. Conclusion. The possibility of varying the infusion method of mixed drugs or alternating the drugs is fundamental for successful therapy since neuropathic pain must be considered a dynamic state.
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OBJECTIVES. The development of neurological sequelae subsequent to the placement of intraspinal drug delivery systems is particularly distressing. An attempt was made to determine the extent of this problem in both reported and in heretofore unreported cases. ⋯ Increased vigilance for early diagnosis may prevent the development of permanent paralysis. Gadolinium enhanced MRI scanning at the catheter tip is the imaging study of choice for diagnosis. Any patient developing a new area of pain, weakness or rapid escalation in intrathecal drug dose should be thoroughly assessed.
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Objective. This study examines, in a retrospective fashion, the effects of intraspinal infusion therapy in 36 patients with pain of non-cancer origin. In those cases where pain was recalcitrant to the infused opiate and/or had a neuropathic component, a local anesthetic, tetracaine, was added. ⋯ Conclusion. The results support the potential utility of infusion therapy in the treatment of non-cancer pain. This treatment, however, is not without problems and should be applied judiciously and in the context of evolving guidelines.
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Introduction and Methods. A prospective, open case study was performed on 37 patients, given intrathecal (IT) bupivacaine alone or bupivacaine/opioid combinations for refractory pain located in the extremities to explore the potential of this therapy for prophylaxis against post-amputation pain (PLP) and/or the treatment of severe, established PLP. Intrathecal infusions were administered before, during, and after amputation, as an attempt to prevent PLP ("prophylaxis group"; n = 21), or to relieve existing severe PLP after previous amputations ("treatment group"; n = 16). ⋯ Conclusions. Continuous IT infusion of bupivacaine with or without opioid gave satisfactory pain relief during the treatment in 95% of the patients. Continuous IT infusion of bupivacaine, alone or in combination with opioid, relieved severe preexisting PLP during the treatment in 100% of the treated patients, but did not prevent its recurrence after the end of the intrathecal treatment.