Articles: pain-management.
-
The optimal management of pain in the elderly cancer patient is founded on astute assessment of pain and other symptoms, development of a pain diagnosis derived from the clinical evaluation, treatment of underlying causes where possible, and the expert application of analgesic techniques. Analgesic techniques themselves are multimodal. Pharmacologic approaches are the mainstay, but an individual patient may benefit from the use of anesthetic, neuroaugmentative, surgical, physiatric, or psychological methods, as well. Guidelines for the assessment and integrated management of these patients are suggested, with specific emphasis on the use of pharmacologic therapy.
-
Prompted by clinical failures of percutaneous radiofrequency neurotomy in the treatment of back pain and neck pain, we performed a study to determine the shape and size of lesions made by radiofrequency electrodes. Experimental lesions were made in egg white and fresh meat at temperatures recommended in clinical practice. The cardinal finding was that lesions do not extend distal to the tip of the electrode. ⋯ Consequently, if electrodes are directed perpendicularly onto a nerve, the nerve may not be encompassed by the lesion generated. Some of the clinical failures of percutaneous medial branch neurotomy ("facet rhizotomy") may be due to this phenomenon. We suggest modified techniques for medial branch neurotomy in which the electrodes are introduced parallel to the target nerve whereupon it is more readily encompassed by the radial spread of the lesion.
-
Anasth Intensivther Notfallmed · Apr 1987
[Diagnostic and therapeutic blockade of the celiac ganglia].
Neurolytic celiac plexus block is the therapy of choice for visceral upper abdominal pain that is resistant to therapy. In order to ensure that the treatment is indicated a temporary block for diagnostic purposes (application of a local anesthetic) has to be carried out. A diagnostic block can be performed as a blind puncture according to anatomic criteria if new computed tomograms are available providing the necessary information on the patient's anatomy. ⋯ The location, angle and depth of the puncture can be calculated by the computer tomograph. Of 14 patients in whom we performed a CT-guided block of the celiac ganglion, 10 were free from pain afterwards or showed considerably reduced pain symptoms. The side effects that could be observed were but slight and passed after a few days.
-
Journal of neurosurgery · Mar 1987
Clinical Trial Controlled Clinical TrialPain relief by electrical stimulation of the periaqueductal and periventricular gray matter. Evidence for a non-opioid mechanism.
Pain relief following stimulation of the periaqueductal gray matter (PAG) or periventricular gray matter (PVG) in man has been ascribed to stimulation-induced release of endogenous opioid substances. Forty-five patients were studied and followed for at least 1 year after placement of chronic stimulating electrodes in the PAG or PVG to determine if pain relief due to stimulation could be ascribed to an endogenous opioid mechanism. Three criteria were assessed: the development of tolerance to stimulation; the possibility of cross-tolerance to morphine; and reversibility of stimulation-induced pain relief by the opiate antagonist naloxone. ⋯ The pain-relieving effect of PAG-PVG stimulation was reversed to an approximately equal degree by naloxone and placebo. The authors do not believe that, in most patients, pain relief elicited by PAG-PVG stimulation depends on an endogenous opioid mechanism. It appears that other, non-opioid mechanisms are primarily responsible for such pain relief.
-
Med. Clin. North Am. · Mar 1987
ReviewAntitumor and antinociceptive approaches to control cancer pain.
Patients with cancer pain often present with specific clinical syndromes that allow specific anti-tumor approaches. If these approaches are not feasible, neurosurgical procedures for pain relief should be considered. ⋯ The most durable pain procedure is cordotomy, while intraspinal narcotics offer a rational treatment alternative in selected patients. Spinal and plexopathy syndromes that are amenable to more specific anti-tumor therapy should be looked for, since newer surgical approaches offer the prospect of both pain relief and tumor control.