Articles: chronic-pain.
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Intrathecal morphine (ITM) is commonly used for the treatment of cancer pain. There is reluctance for its use in France to treat chronic noncancer pain. In order to appreciate its popularity, efficacy, dose escalation with time, and long-term tolerance, we carried out a retrospective study in the neurosurgery departments of university teaching hospitals in France involved in intrathecal drug therapy. ⋯ Side effects imputable to morphine included; constipation, somnolence, decreased libido, weight gain, amenorrhoea, vomiting, nightmares, and itching. No development of tolerance or addiction were recorded. We conclude that in well selected cases ITM should be considered as a possible therapeutic option in the treatment of intractable chronic benign pain.
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The objective of this paper is to assess the outcome of implanted multiple thoracolumbar lead spinal cord stimulation (SCS) in mechanical back pain without prior spinal surgery. These results are compared with intrathecal opioid drug delivery (ITDD). An anonymous third party patient questionnaire study of pain relief, function and psychosocial quality of life measures (recorded on 11-point numerical rating scales) for 12 patients with SCS and 13 with ITDD was used. ⋯ The majority of psychosocial quality of life measures were significantly more improved in the ITDD group compared with the SCS group (p < 0.05). We conclude that multiple-lead SCS improves mechanical back pain in patients unresponsive to more conservative measures. However, ITDD provides significantly more improved quality of life measures, with a trend towards greater pain reduction than SCS.
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This report outlines a case of refractory insomnia temporally related to migration of cervical spinal cord stimulator leads. To our knowledge this association is previously unreported. ⋯ A brief review of insomnia and its complex relationship to chronic pain is presented. We hope that this case will stimulate further discussion and possibly bring to light new insights into spinal cord stimulation and insomnia and alert others to this possible clinical association of symptoms.
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It is known that, in spite of meeting appropriate clinical criteria for spinal cord stimulation (SCS) and having undergone flawless procedures, a significant number of patients who fail the therapy continues to exist. It is the purpose of this article to focus on the development of psychosocial indicators of success for SCS, if any. Referring to specialist literature authors present a review of what is known, what is not known, and what remains controversial on this topic. ⋯ To improve treatment outcomes of SCS, seems to be essential to perform psychosocial evaluations on all persons clinically indicated for SCS to exclude those patients, who most probably, on a psychosocial level, will fail the procedure. To maximize treatment efficacy, authors believe spinal cord stimulation for chronic pain control must be part of a comprehensive program. An accurate preoperative psychosocial assessment and a course of psychological assistance both before and after therapy seems to be crucial for improving outcomes.
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Baseline and 12-month follow-up data from a prospective controlled study on patients treated with SCS for neuropathic limb pain (NLP) are analyzed critically. The outcome on pain, use of medication, and quality of life are reported and compared with the literature. Patients enrolled from April 1999 to December 2001 were part of a quality system study by the Dutch Working Group on Neuromodulation. ⋯ The difference between baseline and 12-m follow-up is statistically significant for all measures. We conclude that the outcome measures indicate that SCS significantly reduces pain and enhances quality of life in patients having NLP not responding to other adjuvant therapy. Recommendations are proposed to make studies more comparable.