Articles: back-pain.
-
Acta Neurochir. Suppl. · Jan 2011
Randomized Controlled TrialLong term intrathecal infusion of opiates for treatment of failed back surgery syndrome.
Failed Back Surgery Syndrome (FBSS) is a multidimensional painful condition and its treatment remains a challenge for the surgeons. Prolonged intrathecal infusion of opiates for treatment of noncancer pain also remains a controversial issue. The authors present a prospective study about the long-term treatment of 30 patients with nonmalignant pain treated with intrathecal infusion of morphine from February, 1996 to May, 2004. ⋯ There was improvement of the quality of life measured by SF-36 (30.8-49.6) and in all dimensions of the Treatment of Pain Survey, except for working capacity. The follow-up period ranged from 18 to 98 months (mean = 46.7 months). It was concluded that intrathecal infusion of morphine is a useful and safe tool for long-term treatment of chronic nonmalignant pain.
-
The HTA-report (Health Technology Assessment) deals with over- and undertreatment of pain therapy. Especially in Germany chronic pain is a common reason for the loss of working hours and early retirement. In addition to a reduction in quality of life for the affected persons, chronic pain is therefore also an enormous economic burden for society. ⋯ Despite the relatively high number of studies in Germany the HTA-report shows a massive lack in health care research. Based on the studies a further expansion of out-patient pain and palliative care is recommended. Further training for all involved professional groups must be improved. An independent empirical analysis is necessary to determine over or undertreatment in pain care.
-
Spinal cord stimulation (SCS) is thought to relieve chronic intractable pain by stimulating nerve fibers in the spinal cord. The resulting impulses in the fibers may inhibit the conduction of pain signals to the brain, according to the pain gate theory proposed by Melzack and Wall in 1965 and the sensation of pain is thus blocked. Although SCS may reduce pain, it will not eliminate it. ⋯ The concept of SCS has evolved rapidly following the technological advances that have produced leads with multiple contact electrodes and battery systems. The current prevalence of patients with chronic pain requiring treatment other than conventional medical management has significantly increased and so has been the need for SCS. With the cost benefit analysis showing significant support for SCS, it may be appropriate to offer this as an effective alternative treatment for these patients.
-
Zh Vopr Neirokhir Im N N Burdenko · Jan 2011
[Radiofrequency denervation of intervertebral joints in management of facet pain syndrome].
Back pain is very widespread and represents a socially significant problem of modern health care. During lifetime 90% of population experiences 1 or more episodes of back pain. This study focuses on assessment of effectiveness of radiofrequency denervation of intervertebral joints in management of patients with low back pain caused by facet pain syndrome. ⋯ In 112 (80%) patients pain regressed. Clinical series was analyzed using the scale for assessment of severity of lumbosacral spinal degenerative disease developed in Burdenko Neurosurgical Institute (Moscow, Russia). The performed study confirmed effectiveness of the assessed technique which allowed including of radiofrequency denervation of intervertebral joints in the algorithm of management of patients with degenerative changes in the lumbosacral spine as the surgical method used in case of ineffectiveness of conservative treatment.