pain-relief-26.matches: pain relief
Postoperative pain therapy: a survey of patients' expectations and their experiences.

Owen H, McMillan V, Rogowski D.

Department of Anaesthesia and Intensive Care, Flinders Medical Centre, Bedford Park, Australia.

For 2 months elective surgical patients (n = 259) were asked preoperatively about their expectations of pain and pain relief. At both 24 and 72 h after their surgery they were asked about their pain and pain control. The analgesics they received were monitored for the first 72 h. The survey revealed that patients do not have the necessary knowledge about pain relief to contribute effectively in their own pain management. Analgesics administered intermittently were generally effective when given, however, the dosing interval was too long for the agents used resulting in frequent reports of poor pain relief. We conclude that patients need better education on postoperative pain control therapy. Medical staff could prescribe, and nursing staff administer, analgesics more effectively.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1697058&dopt=Abstract pain, pain medicine, pain relief



pain-relief-26.matches: pain relief
The incidence of cancer pain and improvement of pain management in Japan.

Hiraga K, Mizuguchi T, Takeda F.

National Cancer Centre, Tokyo, Japan.

A nation-wide survey (1987) of cancer pain and analgesic methods showed that the incidence of pain in the terminal stage was in the range of 68 to 72% without any significant difference between hospital groups. Irrespective of the stage of illness, a certain analgesic effect was obtainable with oral/parenteral use of opioids. As a result of a year-to-year comparison of pain in cancer clinics, it was found that the rate of complete pain relief has increased for all stages of illness, especially in the terminal stage. Here the rate of complete pain relief steadily increased from 37.8% in 1986 to 42.7% in 1987 and 48.6% in 1988. Propagation of WHO-advocated cancer pain therapeutics has led to an improvement of the rate of pain relief in the terminal stage. Marketing of MS Contin tablets resulted in a dramatic increase in the consumption of morphine, but there was no increase in the rate of pain relief due to poor measures to counter adverse reactions, and to administration of morphine in insufficient doses. The consumption of morphine for medical use increased year by year, but a greater number of doctors experienced in the use of opioids would further improve the management of pain. To realize that, it would be necessary to incorporate terminal care into medical education programmes as soon as possible. Further efforts will be required for extensive research and propagation of analgesic methods in various fields including education in medicine, science of nursing and postgraduate education.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1758814&dopt=Abstract pain, pain medicine, pain relief



pain-relief-26.matches: pain relief
A clinical survey of controlled-release morphine sulphate for cancer pain relief in a Japanese hospice.

Tsuneto S, Hayashi A, Miyazaki M, Kashiwagi T.

Hospice at Yodogawa Christian Hospital, Osaka, Japan.

Seventy-six cancer patients were studied on the use of controlled-release morphine sulphate (MS Contin) for cancer pain relief in the hospice of Yodogama Christian Hospital in Japan. The mean initial and maximum dosages were 81.4 mg and 178.6 mg respectively. While 46 patients (61%) did not need an increase in the initial dosage, 26 patients (34%) needed an increase ranging between 8 and 125%. Four patients (5%) required an increment of more than 500% of the initial dosage, because of apparent nerve involvement. This clinical survey showed that the total effectiveness was 92% and that 90% of the patients could experience control of pain with a daily dosage of 240 mg or less of MS Contin. Side effects observed were as follows: drowsiness 21%, nausea 11%, vomiting 8%, constipation 8%, confusion 7%, hallucination 3%. In conclusion, MS Contin offers effective cancer pain relief with minimal side effects in the majority of patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1758822&dopt=Abstract pain, pain medicine, pain relief



pain-relief-26.matches: pain relief
Bilateral versus unilateral percutaneous high cervical cordotomy as a surgical method of pain relief.

Amano K, Kawamura H, Tanikawa T, Kawabatake H, Iseki H, Iwata Y, Taira T.

Department of Neurosurgery, Tokyo Women's Medical College, Japan.

The present report is concerned with the results of bilateral percutaneous high cervical cordotomy (60 patients) compared with those of unilateral cordotomy (161 patients). The result of pain relief is classified into 4 grades based on Hitchcock's criteria; grade 1: complete pain relief, grade 2: almost complete pain relief with slight residual pain, grade 3: persisting pain, but tolerable, grade 4: persisting pain, untolerable. In cases of bilateral cordotomy (60 patients), 76% of the cases showed grade 1, 19% being grade 2, 3% being grade 3 and 2% being grade 4. On the contrary, the unilateral cordotomy (161 patients) showed less impressive results, particularly in grade 1, namely, grade 1 being 64%, grade 2 being 18%, grade 3 being 14% and grade 4 being 4%. Clinically acceptable results (grade 1 plus grade 2) were, therefore, obtained in bilateral cordotomy (95%) as compared with unilateral cordotomy (82%). The difference in pain relief between bilateral and unilateral procedure observed in the present investigation is contrary to that reported previously by others. The possible explanation for less impressive result in regard to grade 1 of unilateral cordotomy is that unilateral cordotomy was performed in this series to alleviate the major side of patient's pain, followed by latent pain on the other side postoperatively, which is not uncommon phenomenon in cancer pain. Whereas all of the bilateral cordotomies were done either for midline pain or bilateral pain, unilateral cordotomy gave satisfactory pain relief in some cases of midline pain. Midline pain, therefore, does not necessarily require bilateral cordotomies from a clinical point of view.(ABSTRACT TRUNCATED AT 250 WORDS)

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1792956&dopt=Abstract pain, pain medicine, pain relief



pain-relief-11.matches: pain relief
Value of bone scan imaging in predicting pain relief from percutaneous vertebroplasty in osteoporotic vertebral fractures.

Maynard AS, Jensen ME, Schweickert PA, Marx WF, Short JG, Kallmes DF.

Department of Radiology, University of Virginia Health Services, Charlottesville 22908, USA.

BACKGROUND AND PURPOSE: Patient selection for percutaneous vertebroplasty is often complicated by the presence of multiple fractures or non-localizing pain. Our purpose was to determine whether increased activity revealed by bone scan imaging is predictive of a positive clinical response to percutaneous vertebroplasty. METHODS: A retrospective chart review conducted at our institution yielded 28 vertebroplasty treatment sessions that had been performed after obtaining bone scan imaging for painful, osteoporotic compression fractures in 27 patients. Thirty-five compression fractures were treated during these 28 treatment sessions. In all cases, increased activity was revealed by bone scan imaging before treatment with vertebroplasty. Positive outcome was defined as subjective decrease in pain severity and/or increased level of patient mobility. RESULTS: Subjective pain relief was noted in 26 (93%) of 28 treatment sessions. In 14 (100%) of 14 cases with quantifiable pain levels, pain improved at least 3 points on a 10-point scale (range of improvement, 3-10 points; mean improvement, 7.4 points). Among the remaining 14 treatment sessions in which patients were unable or unwilling to quantify pain severity, the pain relief was described as complete or excellent pain relief in 11 (78%) of 14 cases. In 14 (100%) of 14 cases for which semiquantitative assessment of mobility was available, mobility improved at least one level (5-point graded scale; range of improvement, 1-4 points; mean improvement, 1.7 points). CONCLUSIONS: Increased activity revealed by bone scan imaging is highly predictive of positive clinical response to percutaneous vertebroplasty.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11110531&dopt=Abstract pain, pain medicine, pain relief



pain-relief-26.matches: pain relief
Brain stimulation.

Young RF.

Division of Neurological Surgery, University of California, Irvine Medical Center, Orange.

Electrical stimulation in the PAG has been shown to elicit profound analgesia in experimental animals that is at least in part due to the release of endogenous opioid substances. Electrical stimulation in the thalamic nuclei VPL and VPM inhibits the activation of spinal dorsal horn neurons by noxious stimuli. Acute electrical stimulation in these two targets relieves chronic pain in about 80% of patients. Chronic electrical stimulation by permanently implanted electrodes relieves pain in about 70% of patients with pain of peripheral or nociceptive origin but in only about 50% of patients with central pain resulting from deafferentation. Stimulating electrodes are implanted stereotactically by a burr hole under local anesthesia. Transient complications occur in 15% to 25% of patients and include infections, malfunctions of the stimulating hardware, pain at the implant sites, and mild temporary neurologic deficits. Permanent complications, including hemiparesis, intracranial hemorrhage, and death, occur in 1% to 2% of patients. Brain stimulation is recommended for the treatment of chronic pain in patients in whom other forms of treatment have failed. The technique is reasonably safe and provides pain relief for a group of patients who have exhausted all other therapeutic modalities. Unfortunately, not all patients receive effective pain relief with brain stimulation. Other stimulation targets such as the K-F nucleus in the parabrachial region of the brain stem are currently being explored in an attempt to provide pain relief to a greater proportion of patients. In addition, improvements in stimulation hardware have made the technique easier and more effective.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2136174&dopt=Abstract pain, pain medicine, pain relief



pain-relief-26.matches: pain relief
Test instrument for predicting the effect of rigid braces in cases with low back pain.

Willner SW.

Department of Orthopaedics, Malmo General Hospital, Lund University, Sweden.

The difficulty of predicting the acceptance and the result of wearing rigid braces has been identified before and is reported in the literature. Therefore a test instrument has been developed and tested. The intention is that the test instrument can imitate a rigid brace. Furthermore, different attributes of the rigid brace can be altered. Thus the range of the lordosis, the level of maximal dorsal support and the amount of abdominal support can be altered. By changing these parameters the maximal pain relief is sought. A good correlation between the result in the test instrument and the rigid brace manufactured according to the information from the former was seen (93%). No false negative results were seen. Thus, if no acceptance or pain relief was seen in the test instrument no pain relief could be expected in a rigid brace. Another purpose of this test instrument is to simplify the manufacture of the brace and to transfer easily the information gained from the test instrument to the brace with the aid of a so called measuring device.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2141399&dopt=Abstract pain, pain medicine, pain relief