pain-relief-12.matches: pain relief
Pancreatoduodenectomy for chronic pancreatitis: long-term results in 105 patients.

Sakorafas GH, Farnell MB, Nagorney DM, Sarr MG, Rowland CM.

Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA.

HYPOTHESIS: For patients with head-dominant, small-duct chronic pancreatitis who require operative intervention, pancreatoduodenectomy can be performed safely and affords satisfactory pain relief in most. DESIGN: Retrospective case series. Follow-up was complete in 86% of study subjects (average, 6.6 years). SETTING: Tertiary care center. PATIENTS: Among 484 consecutive cases of chronic pancreatitis treated surgically from January 1976 through April 1997, 105 (22%) in which pancreatoduodenectomy was performed were reviewed with regard to criteria for selection, operative procedure, postoperative course. and long-term outcome. MAIN OUTCOME MEASURES: The main outcome measure was degree of pain relief. Additionally, late mortality, cause of death, the presence of endocrine and exocrine insufficiency, and quality of life were recorded. RESULTS: There were 72 men (69%) and 33 women (31%) with a mean age of 51 years (range, 24-77 years). The cause of chronic pancreatitis was alcohol related in 58 patients (55%) and idiopathic in 41 (39%). Clinical manifestations included abdominal pain in 86 patients (82%), obstructive jaundice in 27 (26%), and vomiting in 11 (11%). Suspicion of malignant neoplasm was a concern in 67 patients (64%). Operative morbidity was 32%, and mortality, 3%. Mean hospital stay was 16 days (range, 12-82 days). Survival was significantly lower than that of age-matched controls. Among 66 patients with preoperative pain, pain relief was achieved in 59 (89%); it was complete in 44 patients (67%) and partial in 15 (23%). Operation resulted in a significant increase in patients with normal functional status (73 patients [81%] vs 51 [49%]; P<.001). Forty patients (48%) had diabetes. Steatorrhea was observed in 39 patients (43%), while weight maintenance or gain occurred in 59 (66%). CONCLUSIONS: Pancreatoduodenectomy achieves pain relief and good quality of life in a large percentage of selected patients with small-duct, head-dominant disease and is especially useful when a malignant neoplasm must be excluded. Morbidity and mortality are acceptable in experienced hands. Onset of diabetes and steatorrhea, while reflecting the natural course of the disease, is likely accelerated by pancreatoduodenectomy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10807274&dopt=Abstract pain, pain medicine, pain relief



pain-relief-31.matches: pain relief
Clinical effects of epidural block during labour. A prospective study.

Nel JT.

The aim of this study was to evaluate the clinical effects of epidural block for pain relief during labour in an obstetric unit which manages mainly high-risk pregnancies. In the majority of the 62 patients studied only 5 ml of a 0,5% solution of bupivacaine was sufficient for effective pain relief. In 75% of patients total pain relief was obtained. Complications of the procedure were hypotension in 32% of patients and bladder atony needing catheterization in 19%. The mean fall in blood pressure was greater in patients with pre-existing hypertension. The incidence of instrumental delivery was 40%, inadequate bearing-down effort being the indication in 54% of these cases. An abnormal fetal heart rate pattern on cardiotocography developed in 13 of 58 fetuses who were monitored internally, while in 3 cases an abnormal pattern because even more abnormal (in one-third of these cases this followed hypotension in the mother). The only statistically significant change in fetal heart rate patterns on cardiotocography was a decrease in the beat-to-beat variability. Epidural block is a very effective form of pain relief during labour but has potentially serious effects, especially in high-risk pregnancies. Precautions to minimize the risk of complications include the administration of intravenous fluid before the procedure and careful monitoring of the patient and her unborn baby. A cardiotocographic monitor is essential for the latter purpose.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=4035508&dopt=Abstract pain, pain medicine, pain relief



pain-relief-31.matches: pain relief
Epidural meptazinol for pain relief after lower abdominal surgery.

Rao U, Campbell IT, Catley DM, Sutherst JR.

A preliminary investigation is reported into the use of epidural meptazinol for pain relief in 20 patients after major lower abdominal (gynaecological) surgery. Analgesia was rapid in onset (15 minutes), had a median duration of 124 minutes (interquartile range 85-212 minutes) after a single dose of 30 mg and a median duration of 122.5 minutes (interquartile range 70-127 minutes) after a single dose of 60 mg. Overall pain relief, as judged by the patients themselves, was satisfactory in 19 out of the 20 cases. At 30 minutes and 45 minutes pain relief was significantly better with the 60 mg than the 30 mg dose (p less than 0.02). No drug-related adverse effects were observed during the study.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=4037268&dopt=Abstract pain, pain medicine, pain relief



pain-relief-12.matches: pain relief
Percutaneous radiofrequency ablation of osteoid osteoma.

Barei DP, Moreau G, Scarborough MT, Neel MD.

University of Ottawa, Ottawa Hospital, Ontario, Canada.

Osteoid osteoma is a benign bone tumor. Patients usually require surgical treatment for reliable pain relief. Difficulties with intraoperative localization of the tumor and anatomic locations that carry a high morbidity with en bloc resection complicate open surgery. Various methods have been developed to lessen the invasiveness of surgery including computed tomography-guided percutaneous radiofrequency thermal ablation. Eleven patients in three different centers were evaluated and diagnosed with osteoid osteoma based on typical histories, physical examinations, and imaging studies. All patients were treated with computed tomography-guided percutaneous radiofrequency thermal ablation after medical treatment failed. Excellent pain relief was reported in 10 patients. One patient suffered recurrence of a femoral neck lesion despite an initial 7-month period without pain. Patients were given a questionnaire to quantify the effectiveness of percutaneous radiofrequency ablation in terms of pain relief and return to function. The current study shows that percutaneous radiofrequency thermal ablation provides reliable, excellent pain relief and early return to function with minimal morbidity as compared with traditional open techniques. The authors suggest that this technique be used for all patients with extraspinal osteoid osteomas that are not immediately adjacent to neurovascular structures.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10810468&dopt=Abstract pain, pain medicine, pain relief



pain-relief-32.matches: pain relief
[Radiotherapy of metastatic bone tumor with a synthetic calcitonin derivative (Elcatonin) with irradiation]

[Article in Japanese]

Aoki Y, Akanuma T, Karasawa K, Minami M, Sakata K, Iio M.

Twenty cases of metastatic bone tumors were treated with Elcatonin together with irradiation, achieving pain relief in 47.3% of cases, improved bone scintigrams in 16.7% of cases and radiographic improvement of invaded bone in 7.7% of cases. It has reported that calcitonin is effective for pain relief in 50% of cases but for the radiographic improvement of bone lesions in only 0-10%. The life quality of patients with bone metastases is controversial since treatment techniques for advanced oncological patients has progressed remarkably. The pain relief obtained with calcitonin contributes significantly to improving the quality of life for such patients when administered in combination with conventional treatment modes.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2982331&dopt=Abstract pain, pain medicine, pain relief



pain-relief-32.matches: pain relief
[The study of neuro-adrenolysis of pituitary gland on cancer pain and experimental approach to reveal its mechanism of pain relief]

[Article in Japanese]

Sasaki K.

Neuro-adrenolysis of the pituitary gland by injection of pure alcohol was done to control intractable pain associated with wide-spread cancer, and pituitary functions were measured before and after the injection. Of a series of 46 patients undergoing a total of 57 neuro-adrenolysis of the pituitary gland, 22 (38.6%) of these procedures obtained complete pain relief 22 (38.6%) showed improvement, and the remaining 13 (22.8%) no effect. Hormonal changes of pituitary gland were not same among the cases and there was no correlation between hormonal changes and the occurrence of pain relief. Experimental study was done to investigate the effect of hypophysectomy and intracerebroventricular injection of AVP on pain threshold in rats. The study revealed that hypophysectomy and ventricular injection of AVP dose dependently raised pain threshold and these effects were inhibited by naloxone. These facts suggest that the analgesic effects of hypophysectomy and AVP injection into cerebral ventricle are mediated by beta-endorphin.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2985482&dopt=Abstract pain, pain medicine, pain relief



pain-relief-32.matches: pain relief
Effect of a rigid brace on back pain.

Willner S.

The effect of a rigid plastic delordosating brace - the Flexaform brace - was studied in 48 patients with low back pain. In spondylolisthesis the brace gave pain relief in 13 cases, and the remaining two cases reported improvement. In seven cases with spinal stenosis, only two cases were free from pain, four were improved, and in one case the pain was unchanged. In 26 patients with chronic low back pain of unknown etiology, 17 cases did not improve, five cases improved and complete loss of pain was seen in only four cases. When all three groups were combined, a correlation was seen between pain relief in the brace and pain relief in the supine position and in the forward bending position.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3157290&dopt=Abstract pain, pain medicine, pain relief