pain-relief-29.matches: pain relief
Intraventricular morphine produces pain relief, hypothermia, hyperglycaemia and increased prolactin and growth hormone levels in patients with cancer pain.

Su CF, Liu MY, Lin MT.

Department of Surgery, National Defense Medical Center, Taipei, Taiwan, Republic of China.

The effects of analgesic, thermoregulatory and endocrine functions of administering morphine sulphate (0.3 mg) into the lateral cerebral ventricle via an Ommaya catheter were assessed in eight patients with cancer pain. Satisfactory control of intractable pain was obtained in these patients, without any change in other sensory modalities. The delay in the onset of pain relief and the duration of analgesia ranged, respectively, from 20 to 40 min and from 12 to 16 h after drug injection. In addition, intraventricular administration of morphine caused a reduction in rectal temperature in these patients at an ambient temperature of 24 degrees C. The hypothermia in response to the injection of morphine was due to cutaneous vasodilation and sweating. There was no change in metabolism or in respiratory evaporative heat loss after morphine injection. Further, 10 to 20 min after intraventricular administration of morphine, the blood levels of prolactin, growth hormone and glucose were elevated in these patients. The changes in temperature and endocrine levels lasted for 1-3 h. In addition to the pain relief, these side-effects of morphine treatment were short-lasting and disappeared as the morphine treatment continued. The results indicate that activation of opiate receptors in the brain produced pain relief, hypothermia (due to cutaneous vasodilation and sweating), and increased blood levels of prolactin, growth hormone and glucose in patients with cancer pain.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3430186&dopt=Abstract pain, pain medicine, pain relief



pain-relief-29.matches: pain relief
Long-term results by epidural spinal electrical stimulation (ESES) in patients with inoperable severe lower limb ischaemia.

Jivegard L, Augustinsson LE, Carlsson CA, Holm J.

Department of Surgery I, University of Goteborg, Sahlgrenska Hospital, Sweden.

Arterial reconstruction is the treatment of choice for patients with severe lower limb ischaemia, but may at times be technically impossible. Thirty-two consecutive patients with impending (n = 24) or already established (n = 8) distal arteriosclerotic or diabetic lower limb gangrene, in whom vascular surgery was either technically impossible or had failed, were treated with epidural spinal electrical stimulation (ESES) for 27 +/- 16 (S.D.) months. All patients had severe rest pain, which was reduced by ESES in 91% of the cases. Improved ulcer healing was noted in 58% of the patients who had skin ulceration. Eighty-three percent of those patients who did not have established gangrene when ESES was started, retained their leg after 1 year, and 54% after 3 years. These results suggest that ESES often provides pain relief and improves skin healing in patients with impending arteriosclerotic or diabetic gangrene in whom vascular surgery is impossible or has failed. Epidural spinal electrical stimulation (ESES) does not affect the progression of established gangrene but may provide pain relief. The observed outcome of severe limb ischaemia in this study could be used to compare with those after arterial reconstruction performed in patients with poor run-off vessels, and may allow us to examine the natural history of this disease when adequate pain relief is provided. The results reported here and the previously reported enhancement of cutaneous blood flow in severely ischaemic extremities by ESES may suggest, that ESES enhances limb salvage by improving skin blood flow.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3509725&dopt=Abstract pain, pain medicine, pain relief



pain-relief-29.matches: pain relief
Neurolytic celiac plexus block for pancreatic cancer pain.

Brown DL, Bulley CK, Quiel EL.

Neurolytic celiac plexus block (NCPB) is an effective method for relief of the pain of pancreatic cancer, but many physicians are reluctant to use the technique because of the perception that the incidence of complications is high. We analyzed the incidence of complications and the quality of pain relief obtained during the use of NCPB in 136 patients with pancreatic cancer. Eighty-five percent of the patients had good pain relief that, in 75% of cases, lasted through the patients' remaining life. No permanent neurologic complications resulted, although two patients had a pneumothorax. Radiographically guided needle placement did not affect quality of pain relief or the incidence of complications. This neurolytic pain block is effective, has a low incidence of neurologic complications, and deserves more widespread use in patients with pancreatic cancer.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3619093&dopt=Abstract pain, pain medicine, pain relief



pain-relief-29.matches: pain relief
Results of treatment of recurrent dorsoradial wrist neuromas.

Mackinnon SE, Dellon AL.

Dorsoradial wrist neuromas diagnosed and treated by traditional techniques remain the most difficult for which to achieve satisfactory pain relief. Between 1981 and 1985, 52 patients with dorsoradial wrist neuromas were treated by neuroma resection and implantation of the nerves innervating the neuroma into the brachioradialis muscle. Critical to this treatment schema was preoperative use of nerve blocks to diagnose overlapping patterns of the cutaneous nerves in this region. Of patients for whom this technique was the first surgical treatment of their neuroma (primary group), 100% achieved good to excellent pain relief. Among patients in whom the neuroma had been operated on once previously (first recurrence group), 88% achieved good to excellent pain relief with the technique described in this article. Of patients treated who had had 3 or more previous "neuroma" operations (multiple recurrence group), this technique resulted in excellent pain relief in 56%. Factors contributing to a poorer result in the multiple recurrence group included duration of pain longer than 24 months and the patient's unemployment. The diagnostic and surgical approach detailed in this article has yielded clinical results that recommend this approach not only as the primary treatment of choice but also as the treatment to help patients with pain from recurrent dorsoradial neuromas. The apparent susceptibility of the superficial branch of the radial nerve (SBRN) to form painful neuromas has been well documented. Once established, the neuroma appears particularly resistant to treatment. Based on experimental and cadaveric studies, we have formulated a treatment plan for patients with dorsoradial wrist neuromas.(ABSTRACT TRUNCATED AT 250 WORDS)

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3631861&dopt=Abstract pain, pain medicine, pain relief



pain-relief-12.matches: pain relief
Outcome of pancreaticoduodenectomy with pylorus preservation or with antrectomy in the treatment of chronic pancreatitis.

Jimenez RE, Fernandez-del Castillo C, Rattner DW, Chang Y, Warshaw AL.

Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.

OBJECTIVE: To compare the short- and long-term results of pancreaticoduodenectomy with pylorus preservation (PPPD) or with antrectomy (Whipple procedure) in the treatment of selected patients with chronic pancreatitis. BACKGROUND: PPPD may be preferred over Whipple because of its purported nutritional advantages and the reduced likelihood of postgastrectomy syndromes. METHODS: A retrospective review was performed of 72 consecutive patients undergoing pancreaticoduodenectomy for chronic pancreatitis between 1991 and 1997. RESULTS: PPPD was performed in 39 patients and Whipple in 33. The two patient populations had similar characteristics. Short-term complications included (PPPD vs. Whipple): pancreatic or biliary fistulas (5.1% vs. 15%), delayed gastric emptying (33% vs. 12%), cholangitis (2.6% vs. 6.1%), and death (0 vs. 3%). Delayed gastric emptying was not associated with other complications and resulted in longer hospital stays for PPPD than for Whipple patients (15 vs. 12 days). The duration of follow-up averaged 41 +/- 24 months. Long-term weight status was similar, with body-mass indices of 22.1 and 22.9 after PPPD and Whipple, respectively. Postoperative enzyme supplementation (63% vs. 77%) and new-onset diabetes (10% vs. 12%) did not differ significantly between the PPPD and Whipple groups. Dumping, bile gastritis, or peptic ulcer disease occurred in three patients after PPPD and in three after Whipple. Complete or partial pain relief was attained in 60% and 70% of patients after PPPD and Whipple, respectively. Multivariate analysis of preoperative variables revealed that site-specific pathology in the head of the pancreas was the only independent factor associated with successful pain relief after pancreatic resection. CONCLUSION: PPPD results in higher frequencies of postoperative delayed gastric emptying compared with the Whipple procedure. Both operations achieve comparable long-term nutritional results, cause new insulin dependence in surprisingly few patients, and provide equivalent pain relief to 65% of selected patients. Patients with disproportionate pathology in the head of the pancreas have a higher likelihood of successful pain relief.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10714621&dopt=Abstract pain, pain medicine, pain relief



pain-relief-2.matches: pain relief
Are single fractions of radiotherapy suitable for plantar fasciitis?

Schwarz F, Christie DR, Irving M.

School of Health Sciences, Bond University, Gold Coast, Queensland, Australia.

The use of radiotherapy for plantar fasciitis has never been reported in Australasia and is scarcely found in the English language medical literature, but it is commonly used in Europe, especially in Germany. In Europe, treatment courses consisting of multiple small fractions have been associated with high levels of pain relief. In the present report, the use of single fractions or radiotherapy was evaluated by reviewing seven consecutive patients referred for treatment and by applying objective and subjective criteria for pain relief. One patient died of unrelated causes soon after treatment and one declined to receive radiotherapy. Four patients each received a single dose of 8 Gy resulting in complete pain relief. One patient was treated with 8 Gy and 12 weeks later was retreated achieving partial pain relief. A follow-up interview was conducted after a mean of 15.6 months, ranging from 1.5 to 30 months. No acute or late effects occurred; however, the possibility that delayed effects may yet occur, particularly carcinogenesis, cannot be excluded. Radiotherapy for this common condition should be investigated further as it might be safer and more effective than other methods currently in use.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15230750&dopt=Abstract pain, pain medicine, pain relief



pain-relief-2.matches: pain relief
Continuous epidural infusion for postoperative pain relief: a comparison of three regimens.

Sakura S, Uchida H, Saito Y, Asano M, Kosaka Y.

Department of Anesthesiology, Shimane Medical University, Izumo, Japan.

We evaluated the postoperative pain relief and side-effects of continuous epidural infusion of three analgesic regimens following major thoracic and/or abdominal surgery. One hundred and twenty patients were randomly divided into three treatment groups: (1) 0.25% or 0.5% bupivacaine at a rate of 3-7 ml.hr(-1), (2) 0.01% morphine at a rate of 1-2 ml.hr(-1), (3) a combination of 0.125% or 0.25% bupivacaine and 0.0025% or 0.005% morphine at a rate of 2-4 ml.hr(-1). The study continued for the first 48 postoperative hours. The effect of pain relief was evaluated by assessment of the further requirement for parenteral analgesics. Sixty-four percent of the patients given bupivacaine, 56% of the patients given morphine and 80% of the patients given the combination required no supplemental analgesics. Continuous epidural infusion of bupivacaine was associated with hypotension (21%) and with numbness and weakness of hands or legs (18%). Continuous epidural infusion of morphine was associated with pruritus (18%) and with peristaltic depression (12%). The combination regimen was associated with pruritus (17%) and with drowsiness (14%). We conclude that the combination of bupivacaine and morphine significantly provides superior analgesia with less deleterious complications compared with either bupivacaine or morphine alone.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15235998&dopt=Abstract pain, pain medicine, pain relief