pain-relief-26.matches: pain relief
Palliative radiotherapy for symptomatic adrenal metastases.

Soffen EM, Solin LJ, Rubenstein JH, Hanks GE.

Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia.

To evaluate the role of palliative radiotherapy for adrenal metastases, a retrospective review was performed on 16 patients treated between 1972 and 1988 for palliation of symptomatic adrenal metastases. The median patient age was 56 years. In 15 cases lung cancer was the primary site (7 adenocarcinomas, 3 squamous cell carcinomas, 3 large cell carcinomas, and 2 small cell carcinomas) and in 1 case there was an unknown primary (squamous cell carcinoma). Ten of 16 patients were treated with 3000 cGy to opposed anterior and posterior fields (300-cGy fractions [four patients] and 250-cGy fractions [six patients]). The remaining six patients were treated with a variety of techniques, with total doses ranging from 2925 cGy to 4500 cGy. The patients were analyzed for response at their first follow-up visit (2 to 4 weeks after treatment). The overall response rate was 75% (12 of 16 patients). Six patients (38%) had complete pain relief without medication that lasted until death. Two patients had marked pain relief, but still required analgesics. Four patients had marked or moderate pain relief that did not continue through follow-up. Four patients had minimal to no response. All patients were observed until death, with a median survival time after irradiation of 3 months (range, 0.5 to 11 months). Although the prognosis for patients with adrenal metastases is poor, radiotherapy to symptomatic adrenal metastases can be administered with a high probability of achieving effective palliation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2155051&dopt=Abstract pain, pain medicine, pain relief



pain-relief-11.matches: pain relief
Personal control in pain relief during labour.

Wright ME, McCrea H, Stringer M, Murphy-Black T.

School of Health Sciences - Nursing, University of Ulster, Coleraine, Co. Londonderry, Northern Ireland. me.wright ulst.ac.uk

Personal control is a central feature of women's involvement in their childbirth experiences. To achieve this control tacit rules and guidelines are applied to define how women and the professionals who care for them should behave. This study investigated the extent to which women exercised control in pain relief during the first stage of labour by comparing (a) the rules which they held prior to childbirth (2-3 cm cervical dilatation) with those which they afterwards felt applied to their labour and (b) the rules held by the women before and after childbirth with those held by the midwives. In a quantitative study using a repeated measures design, a questionnaire was administered to 35 midwives and to 100 women prior to and within 24 hours following their delivery. Consistency of the women's scores before and after childbirth, indicated by few statistically significant differences, tended to confirm their rules on control of pain relief. Some of the rules were held even more strongly following childbirth. A surprising finding was the even stronger agreement by midwives with some of the rules. There was a definite trend for many of the rules held by the women prior to childbirth to increase following birth towards those of the midwives. This could be the result of the experience of childbirth per se but the possibility that it was contributed to by the influence of the midwives cannot be ruled out and warrants further research. An interesting hierarchy in the rules for compliance with professional care has been highlighted.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11115002&dopt=Abstract pain, pain medicine, pain relief



pain-relief-26.matches: pain relief
Subarachnoid and epidural calcitonin in patients with pain due to metastatic cancer.

Blanchard J, Menk E, Ramamurthy S, Hoffman J.

Nine patients with metastatic cancer who had pain refractory to traditional treatments received a subarachnoid injection of salmon calcitonin. Eight of the nine patients reported pain relief after subarachnoid injection varying from 1 hr to 5 days. Four of the responding patients subsequently received an epidural injection of salmon calcitonin, and two of these patients reported pain relief. Although many patients experienced pain relief, nausea and vomiting appeared to be a significant side effect, occurring in seven out of nine patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2324559&dopt=Abstract pain, pain medicine, pain relief



pain-relief-26.matches: pain relief
Perceptions of pain relief after surgery.

Kuhn S, Cooke K, Collins M, Jones JM, Mucklow JC.

Department of Clinical Pharmacology, North Staffordshire Health Authority, Stoke on Trent.

OBJECTIVE--To assess patients' satisfaction with postoperative pain relief. DESIGN--A descriptive and questionnaire study of patients' experience. SETTING--Two surgical and two gynaecological wards. PATIENTS--50 Patients admitted to hospital for cholecystectomy and 51 admitted for hysterectomy. MAIN OUTCOME MEASURES--Visual analogue scales with no divisions were completed by the patients immediately after each dose of postoperative analgesia was administered throughout their stay in hospital. A questionnaire completed on the fifth postoperative day recorded patients' recollections of their experience. Opinions were also sought from medical and nursing staff. RESULTS--During the first 24 hours after surgery recorded pain levels were 60% of the maximum and were not influenced by age, sex, or the type of operation performed. The median interval between the return of pain and a further injection of analgesic was 2 hours (interquartile range 1 to 3.5 hours). Expectations of pain relief were low, and for 70% of the patients the pain was at least as bad as they had expected. Only half of the medical and nursing staff questioned thought that postoperative analgesia should relieve pain completely; drugs were prescribed and administered with too little attention to the patient's response and too much concern about adverse effects and opioid dependence. CONCLUSIONS--The results suggest that the standard of postoperative pain relief is poor because of inadequate education of patients in what to expect (and demand), and of medical and nursing staff in how to prescribe and administer analgesia with reference to individual drug response.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2390548&dopt=Abstract pain, pain medicine, pain relief



pain-relief-26.matches: pain relief
[Pain problems in oncology]

[Article in German]

Senn HJ.

Medizinische Klinik C, Kantonsspital St. Gallen.

1. Not every cancer patient suffers from pain, but approximately 30-40% of regular inpatients and 60-70% in terminal stages do. 2. Not every pain syndrome in a cancer patient is tumor-derived: its role and potential cause need to be thoroughly investigated and treated. 3. Successful antineoplastic treatment is the best and most durable pain prophylaxis in advanced cancer patients. 4. Locally applicable pain treatments such as anesthesiologic, radiotherapeutic and surgical measures should be discussed on an interdisciplinary basis. 5. With chronic tumor pain and no further effect of antineoplastic and locally active treatments, pharmacologic analgesia is the most adequate method of effective pain relief. 6. Prophylactic prescription of effective analgesics in adequate doses and at regular intervals, according to accepted "pain-ladders", is the most successful method of effective and lasting pain relief. 7. Public and medical bias against adequate use of oral opiates in chronic cancer pain must be overcome. 8. Effective pain relief leads to improvement of life quality as well as social reintegration of late stage cancer patients. 9. The influence of psychosocial variables on pain perception and the outcome of analgesia should not be underestimated.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2392663&dopt=Abstract pain, pain medicine, pain relief



pain-relief-26.matches: pain relief
Foot salvage and improvement of microvascular blood flow as a result of epidural spinal cord electrical stimulation.

Jacobs MJ, Jorning PJ, Beckers RC, Ubbink DT, van Kleef M, Slaaf DW, Reneman RS.

Department of Surgery, Academic Hospital Maastricht, The Netherlands.

Epidural spinal cord electrical stimulation has been suggested as an alternative treatment in patients with limb-threatening ischemia in whom vascular reconstructive surgery is not possible anymore. We studied the effects of epidural spinal cord electrical stimulation on microcirculatory blood flow in 20 patients with ischemic rest pain and ulcers. Angiography showed occluded crural arteries technically unsuitable for reconstructive surgery. Intravital capillary microscopy was used to assess capillary density and diameter and red blood cell velocity before and after a 1-minute period of arterial occlusion. After epidural spinal cord electrical stimulation 18 patients claimed immediate pain relief, which was confirmed by intravital capillary microscopy. Capillary density increased from 10 to 19/mm2 (p less than 0.001), red blood cell velocity increased from 0.088 to 0.496 mm/sec (p less than 0.001), and peak red blood cell velocity after arterial occlusion increased from 0.092 to 0.548 mm/sec (p less than 0.001). Two patients had no immediate pain relief; they did not show improvement of microcirculatory perfusion, and amputation was necessary. During the follow-up period (3 months to 3 years, mean 27 months), six other patients had recurrent ischemic pain, and amputation was necessary. In 12 patients pain relief continued, and ischemic ulcers healed; capillary microscopy confirmed improved microcirculatory blood flow. Microcirculatory parameters were significantly higher in respondents than in nonrespondents (p less than 0.001). Life-table analysis revealed a cumulative foot salvage of 80% and 56% after 1 and 2 years, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2398593&dopt=Abstract pain, pain medicine, pain relief



pain-relief-27.matches: pain relief
Long-term pain relief produced by intrathecal morphine infusion in 53 patients.

Onofrio BM, Yaksh TL.

Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.

The present report details the characteristics of the analgesic effects of morphine administered chronically by infusion pumps implanted in 53 patients suffering from terminal metastatic disease. The median postimplant survival time in these patients was 4 months. Patients (mean age 58 years) were characterized according to the duration of pain before pump implantation (mean 16 months), prior consumption of systemic opioids (mean one to six daily analgesic equivalents of morphine), and their response to a trial intrathecal dose of morphine (1 to 2 mg). The median infusion dose at 2 weeks was 3.8 mg/day. The analgesic index, calculated as (quality of pain relief x duration of pain relief in hours)/morphine dose in mg, that was observed after the trial dose of morphine was determined for each patient. A close correlation was observed between the acute (2-week) infusion dose necessary to produce pain relief and the analgesic index such that the infusion dose = -8.0 x log (analgesic index) + 17.1. By 16 weeks, the mean spinal morphine dose for the group had increased by a factor of about 2.5; however, significant variation in the dose incrementation was documented. The maximum increase was observed in patients with a low analgesic index, and this rapid incrementation was usually correlated with an unsatisfactory overall outcome. Evidence that long-term infusion continues to yield analgesia was evidenced in six cases where there was an unanticipated loss of drug infusion and a corresponding increase in parenteral narcotic consumption. These data indicate the long-term efficacy and safety of spinal opioid infusion in patients with terminal cancer, and emphasize the advantage of assessing the sensitivity of the patient to spinal opioids by a standardized trial injection prior to pump placement as a prognostic indication of outcome.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1688618&dopt=Abstract pain, pain medicine, pain relief