pain-relief-29.matches: pain relief
Radiotherapy for pain relief in locally recurrent colorectal cancer.

Allum WH, Mack P, Priestman TJ, Fielding JW.

Queen Elizabeth Hospital, Birmingham.

Eighteen patients with local recurrence of colorectal cancer have been treated by external beam radiotherapy for pain relief. Seven received a fractionated course of 4500cGy and the remainder received single fractions of 1000cGy, a number being treated more than once. The median survival for all patients once recurrence had produced pain was 7 months. Treatment benefit was recorded in 71% treated by fractionated courses and in 66% by single fractions. The duration of pain relief was 3 months for each method. The repeatability of single fraction treatment indicates that this is a worthwhile alternative technique, particularly for those in poor general condition.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2445237&dopt=Abstract pain, pain medicine, pain relief



pain-relief-29.matches: pain relief
Changes in voluntary muscle strength, somatosensory transmission and skin temperature concomitant with pain relief during autotraction in patients with lumbar and sacral root lesions.

Knutsson E, Skoglund CR, Natchev E.

Department of Clinical Neurophysiology, Karolinska Hospital, Stockholm, Sweden.

Earlier clinical observations of rapid changes of certain neurological dysfunctions after autotraction treatment of patients with lumbar and sacral root affections have been evaluated by objective registration methods. Isokinetic recordings of maximal voluntary strength showed that in 6 out of 8 patients, weakness of the foot dorsal flexor muscles could be more or less completely restored after one session of autotraction resulting in pain relief. In a group of patients with clinical signs of impaired sensibility, the low or abolished SEP responses to nerve stimulation on the affected side were restituted in 4 out of 5 cases during autotraction. The asymmetric leg skin temperatures in 10 patients with sciatic pain levelled off in the 6 cases obtaining pain relief by the traction. The results suggest a causal relationship between pain relief and restitution of certain neurological deficits.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2837715&dopt=Abstract pain, pain medicine, pain relief



pain-relief-29.matches: pain relief
Effects of topical capsaicin on normal skin and affected dermatomes in herpes zoster.

Westerman RA, Roberts RG, Kotzmann RR, Westerman DA, Delaney C, Widdop RE, Carter BE.

Department of Physiology, Monash University, Clayton, Vic.

Hyperalgesia and allodynia, lasting for months or even years, occurs in the form of post-herpetic neuralgia in approximately 70% of adults previously infected with the varicella herpes zoster virus. The present study aimed at testing the analgesic desensitising actions and reversibility of repeated application of topical capsaicin on disordered polymodal nociceptors and peptidergic sensory fibres mediating warm and pain sensation. Cutaneous nociceptor desensitisation was measured using the Glasgow automated thermal threshold test (Medelec TTT). For normal subjects (n = 69) the mean forearm warm threshold was 0.15 +/- 0.07 degrees C and the cold threshold was 0.14 +/- 0.10 degrees C. A variable degree of partial desensitisation of herpes-affected skin was found in 15 patients with post-herpetic neuralgia before capsaicin treatment where the mean threshold elevation for warm detection was 1.19 degrees C and 0.7 degrees C for cold detection, compared with the corresponding normal skin. In preliminary studies of 15 patients with post-herpetic neuralgia, good pain relief averaging 30% or 77% occurred in the affected dermatome(s) after 3 to 4 weeks of 0.01% or 0.05% capsaicin cream respectively, applied 3-4 times daily. The warm thresholds, after chronic capsaicin treatment, increased between 0.1 and 7.60 degrees C, the average elevation being 3.69 degrees C. By contrast cold thresholds after capsaicin altered inconsistently and by only an average of 0.08 degrees C. The results suggest that elevation of the warm threshold may indicate the desensitisation achieved by capsaicin treatment of skin polymodal nociceptors. Cold detection, being dependent upon A-delta cold fibre function, is unaffected by capsaicin treatment. There was a poor correlation between pain relief and elevation of warm detection in response to capsaicin treatment. Generally, it was found that those patients with less initial desensitisation to warm detection as a consequence of post-herpetic neuralgia experienced better pain relief after capsaicin was applied. The method used permits determination of the minimum effective desensitising dose of capsaicin, enables patient compliance and progress to be monitored and should allow the prediction of patients likely to achieve the best response to treatment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3267488&dopt=Abstract pain, pain medicine, pain relief



pain-relief-29.matches: pain relief
Patient-controlled analgesia in pediatric surgery.

Rodgers BM, Webb CJ, Stergios D, Newman BM.

Department of Surgery, University of Virginia School of Medicine, Charlottesville 22908.

Patient-controlled analgesia (PCA) with a microprocessor-operated infusion syringe was first suggested for human use in 1965. Clinical studies from the United States and Europe have shown this form of analgesia to be well accepted by adults, but the use of this technology for children has not been studied. We evaluated PCA in 15 consecutive pediatric surgical patients between the ages of 11 and 18 years undergoing major thoracic or abdominal surgery. The patients and their parents were instructed in the use of the equipment prior to surgery and PCA was initiated after the patients left the recovery room. The mean duration of PCA was 2.6 days. No serious mechanical difficulties with the infusion apparatus were encountered. The acceptance of PCA was excellent with only two patients preferring some other method of analgesia. Pain relief was assessed twice daily by a registered nurse using a verbal-visual pain scale. On a 1 to 10 scale average pain relief was 7.2. Eight of the patients had had a previous operation, and seven of these reported that PCA was a better method of achieving pain control. A comparison of the 15 study patients with 15 previous patients with similar procedures indicated that PCA patients used less analgesia in the postoperative period, although they tended to use more in the first 24 hours. PCA is found to be a safe and effective means of analgesia in pediatric patients. Adequate pain relief was achieved with less analgesia and with less nursing attention. This technology is recommended for postoperative pediatric patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3357143&dopt=Abstract pain, pain medicine, pain relief



pain-relief-29.matches: pain relief
A statistical model for pain in patient-controlled analgesia and conventional intramuscular opioid regimens.

Ferrante FM, Orav EJ, Rocco AG, Gallo J.

Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.

A statistical model was developed: 1) to compare the efficacy of patient-controlled analgesia (PCA) and traditional intramuscular (IM) opioids for pain relief in 40 patients after total knee replacement and, 2) to evaluate pain cycles associated with each technique. Hourly visual analog pain scores were subjected to two-way analysis of variance (ANOVA) and time-series analysis. Hourly verbal analog pain scores were used to determine predominant pain levels. According to ANOVA, PCA was no more effective than were IM opioids. Time-series analyses documented a complete cycle of pain every 5.3 hours in patients receiving IM opioids but no pain cycle with use of PCA. Analysis of PCA verbal analog scores demonstrated self-administration of opioids to "moderate" levels of pain relief with use of PCA, not to complete analgesia. These results suggest that certain patients may not envision complete postoperative analgesia as being possible. Hence, they self-administer opioids for pain relief with PCA according to their expectations. Population characteristics may modify PCA efficacy. These characteristics should be delineated and the use of PCA targeted to appropriate patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3364765&dopt=Abstract pain, pain medicine, pain relief



pain-relief-12.matches: pain relief
Oral ibuprofen and diclofenac in post-operative pain: a quantitative systematic review.

Collins SL, Moore RA, McQuay HJ, Wiffen PJ.

Pain Research and Nuffield Department of Anaesthetics, University of Oxford, Oxford Radcliffe Hospital, The Churchill, Headington, Oxford, OX3 7LJ, UK

Surveys show consistently that pain is not treated well. Improvement depends on knowing which treatments are the most effective. We used systematic review to compare the relative efficacy of two common analgesics, ibuprofen and diclofenac, in post-operative pain. Studies were identified by searching MEDLINE (1966 to Dec 1996), EMBASE (1980 to Jan 1997), the Cochrane Library (Aug 1996), Biological Abstracts (Jan 1985 to Dec 1996) and the Oxford Pain Relief Database (1950 to 1994). We sought randomised, controlled, single-dose comparisons of oral ibuprofen or diclofenac against placebo. Summed pain relief or pain intensity difference over 4-6 h was extracted and converted into dichotomous information yielding the number of patients with at least 50% pain relief. This was then used to calculate the relative benefit and the number-needed-to-treat for one patient to achieve at least 50% pain relief. Thirty-four reports compared ibuprofen and placebo (3591 patients), six compared diclofenac with placebo (840 patients), and there were two direct comparisons of diclofenac 50 mg and ibuprofen 400 mg (130 patients). In post-operative pain, the numbers-needed-to-treat for ibuprofen 200 mg were 3.3 (95% confidence interval 2.8-4.0) compared with placebo, for ibuprofen 400 mg 2.7 (2.5-3.0), for ibuprofen 600 mg 2.4 (1.9-3.3), for diclofenac 50 mg 2.3 (2.0-2.7) and for diclofenac 100 mg 1.8 (1.5-2.1). Direct comparisons of diclofenac 50 mg with ibuprofen 400 mg showed no significant difference between the two. Both drugs worked well. Choosing between them is an issue of dose, safety and cost. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10700324&dopt=Abstract pain, pain medicine, pain relief



pain-relief-29.matches: pain relief
Surgical management of chronic pancreatitis: long-term results in 141 patients.

Mannell A, Adson MA, McIlrath DC, Ilstrup DM.

Department of Surgery, Mayo Clinic, Rochester, Minnesota.

The management of pancreatic pain is a controversial subject and the treatment recommended varies from one extreme to the other. Some authorities advise simply waiting for chronic pancreatitis to 'burn out', while others practise removal of the entire gland. In this paper we present 141 patients who underwent surgery for chronic pancreatitis at the Mayo Clinic. The main indication for operation was pancreatic pain and the choice of operation was based on anatomical abnormalities in the gland. The long-term results of the policy are reviewed (mean follow-up 8.5 years). Length of history, aetiology of disease, pancreatic dysfunction and pathology, time after operation and continued alcohol abuse were computer analysed for a statistically significant influence on pain relief, ability to work, pancreatic function and survival. There was one operative death (mortality rate 0.7 per cent). Continued drinking was not shown to affect postoperative pain relief but 10-year survival was significantly less in alcoholics than in those with non-alcoholic pancreatitis (P less than 0.02). Dilated ducts and duct calculi were associated with good results for pain relief although this association did not achieve statistical significance. Parenchymal calcification and time after operation did not influence the results of surgery. When the operation failed to relieve pain, spontaneous remission occurred in a few cases only. Seventy-seven per cent of patients had lasting relief of pain and operations selected on the basis of gross pathology were equally effective in relieving pain. Longitudinal pancreaticojejunostomy in those with dilated ducts and a Whipple operation for disease of the pancreatic head gave good results.(ABSTRACT TRUNCATED AT 250 WORDS)

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3390681&dopt=Abstract pain, pain medicine, pain relief