pain-relief-20.matches: pain relief
Superior hypogastric plexus block for chronic pelvic pain in the presence of endometriosis: CT techniques and results.

Wechsler RJ, Maurer PM, Halpern EJ, Frank ED.

Department of Radiology, Jefferson Medical College, Philadelphia, PA 19107-5091, USA.

PURPOSE: To evaluate the use of superior hypogastric plexus block with computed tomographic (CT) guidance in patients with endometriosis and chronic pelvic pain. MATERIALS AND METHODS: Seven blocks were performed on an outpatient basis in five women with endometriosis and pelvic pain. In the first four patients, one or two 20-gauge, 15-cm needles were placed anterior to the spine at the common iliac bifurcation from a posterior approach. In the fifth patient, the block was performed from an anterior approach with a single needle. RESULTS: One procedure resulted in mild pain relief, three in considerable pain relief, one in complete midline pain relief with no change in the lateral pain, and one in complete pain relief. One procedure was terminated because anesthetic was injected into the peritoneal cavity. There were no other complications. CONCLUSION: CT-guided superior hypogastric plexus block is easily performed and can be used to assess whether chronic pelvic pain can be attenuated by blocking the superior hypogastric plexus.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7784552&dopt=Abstract pain, pain medicine, pain relief



pain-relief-20.matches: pain relief
Spinal cord stimulation in the treatment of paraplegic pain.

Cioni B, Meglio M, Pentimalli L, Visocchi M.

Istituto di Neurochiurgia, Universit a Cattolica, Rome, Italy.

Twenty-five patients suffering from intractable pain due to a chronic spinal cord lesion underwent a percutaneous test of spinal cord stimulation. At the end of the test period, 40.9% of the patients reported a mean of 65% pain relief and these patients were selected for ongoing stimulation. At a mean follow-up time of 37.2 months the success rate, based on the number of patients with more than 50% pain relief, had fallen to 18.2%. Pain relief rates were analyzed in relation to quality of pain, neurological status, level and extent of the lesion, and electrode level to identify prognostic factors that could improve the clinical usefulness of spinal cord stimulation. Patients experiencing painful spasms or a constrictive type of pain and with incomplete thoracic lesions were found to be the best candidates for spinal cord stimulation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7815131&dopt=Abstract pain, pain medicine, pain relief



pain-relief-11.matches: pain relief
Evaluation of outcomes in patients following surgical treatment of chronic exertional compartment syndrome in the leg.

Howard JL, Mohtadi NG, Wiley JP.

Faculty of Medicine, Department of Surgery, University of Calgary Sport Medicine Centre, University of Calgary, Alberta, Canada.

OBJECTIVE: To evaluate outcomes in patients who had a fasciotomy performed on their leg(s) for chronic exertional compartment syndrome (CECS). DESIGN: A retrospective descriptive cohort study. SETTING: Tertiary care sport medicine referral practice. PATIENTS: A consecutive series of 62 patients surgically treated for CECS from January 1991 to December 1997. MAIN OUTCOME MEASURES: A questionnaire was designed and developed to assess pain (using a 100 mm visual analogue scale), level of improvement, level of maximum activity, satisfaction level, and the occurrence of reoperations. RESULTS: Fifty patients had anterior/lateral compartment involvement, 8 patients had deep posterior compartment involvement, and 4 patients had anterior/lateral/deep posterior compartment involvement. The demographics of the 39 respondents and 23 nonrespondents were similar. The mean percent pain relief of respondents was 68% (95% CI [confidence interval] = 54% to 82%). There was no relationship between percent pain relief and the documented immediate post exercise compartment pressures. A clinically significant improvement was reported by 26 of 32 (81%) anterior/lateral compartment patients and 3 of 6 (50%) patients with deep posterior compartment involvement. Patient level of activity after fasciotomy was classified as equal to or higher than before the operation with a lesser degree of pain by 28 of 36 (78%) patients, while 8 of 36 (22%) patients reported lower activity levels than before the operation. Of the patients reporting lower activity, seven were due to exercise related pain in the post operative leg(s) and one was due to lifestyle changes. Thirty of 38 patients (79%) were satisfied with the outcome of the operation. Four of 62 patients (6%) failed the initial surgical procedure and required revision surgery for exercise-induced pain. In addition, one of these individuals also had a sympathectomy and another had a neurolysis performed at the time of revision surgery. Three of the 62 (5%) patients had subsequent operations for exercise-induced pain on different compartments than the initial surgical procedure. One individual had an unsuccessful operative repair of a posttraumatic neuroma. Postoperative complications were reported by 5 of 39 (13%) patients in the additional comments section of the questionnaire. CONCLUSIONS: The majority of patients surgically treated for CECS experience a high level of pain relief and are satisfied with the results of their operation. The level of pain relief experienced by patients is not related to the magnitude of the immediate post exercise compartment pressures. Despite the possibility that some patients have less favorable outcomes, experience complications, or need subsequent operations, fasciotomy is recommended for patients with CECS as there is no other treatment for this condition.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10959927&dopt=Abstract pain, pain medicine, pain relief



pain-relief-21.matches: pain relief
Outcome assessment following limited wrist fusion: objective wrist scoring versus patient satisfaction.

Tomaino MM, Miller RJ, Burton RI.

Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania.

Eighteen nonrheumatoid patients were reviewed an average of 4.4 years following limited wrist fusion to evaluate whether patient satisfaction or objective wrist scoring more closely correlated with functional outcome. Range of motion, grip strength, pain relief, radiographs, and patient satisfaction were assessed by examination and interview, and each wrist was scored based on a clinical scoring system described by Cooney. Twelve patients (67%) were very satisfied with their results, and six (33%) were dissatisfied. Thirteen (72%) experienced good pain relief, 12 of whom denied functional restrictions. Six patients (33%) reported suboptimal wrist function, and four indicated they had inadequate pain relief. Despite high levels of satisfaction in 12 patients, the objective wrist scores were only fair and poor. These low wrist scores unreliably reflected functional outcome. Patient self-assessment of wrist performance, however, was uniformly predictive. Pain relief was more critical to patient satisfaction than residual range of motion. Therefore, compared to objective wrist scoring, consideration of patient satisfaction may allow more accurate prediction and assessment of functional outcome following limited wrist fusion. Satisfactory postoperative function appears to be more dependent on pain relief than residual motion.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10147142&dopt=Abstract pain, pain medicine, pain relief



pain-relief-21.matches: pain relief
Survey of postoperative pain in University Hospital Kuala Lumpur.

Vijayan R, Tay KH, Tan LB, Loganathan.

Department of Anaesthesiology, University Hospital, Kuala Lumpur, Malaysia.

One hundred and eighty-three patients undergoing surgery were interviewed twenty-four hours following surgery to assess the quality of pain relief they received in the immediate postoperative period. Interviews were conducted using a standard questionnaire for all patients. They were asked to (1) rate the quality of pain relief they obtained on a Visual Pain Analogue Scale (VPAS-0 being no pain and 10 being the worst imaginable pain); (2) state whether they were happy and satisfied with the pain relief they received; (3) if dissatisfied, they were asked to give their reasons. 37.7% (69 patients) had moderate to severe pain--pain score greater than 6 on the VPAS. Most of these patients had undergone abdominal or major orthopaedic surgery. 32.7% (60 patients) were unhappy with their postoperative pain control. The main reasons for complaint from the patients were that analgesic injections were either not given promptly or were not given at all. The survey also highlighted the inadequate under-administration of narcotic injections in the postoperative period despite orders being written up. It showed there is an urgent need for setting up an Acute Pain Service for better postoperative pain control. An anaesthesiology based Acute Pain Service was started in October 1992.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7701371&dopt=Abstract pain, pain medicine, pain relief



pain-relief-21.matches: pain relief
The interpretation of pain relief and sensory changes following sympathetic blockade.

Dellemijn PL, Fields HL, Allen RR, McKay WR, Rowbotham MC.

Dr Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.

A comparative study of the effects of sympathetic blockade by stellate ganglion block (SGB) and intravenous phentolamine infusion (PhI) was carried out in 24 patients with presumed sympathetically maintained pain of an upper extremity. A total of 15 SGBs and 16 PhIs were performed, with seven patients undergoing both procedures. All patients developed a Horner's syndrome with SGB and nasal stuffiness and cardiovascular changes with PhI. Similar pain relief was obtained with SGB and PhI in six of the seven who underwent both procedures. Pre-procedure patient characteristics including age, sex, duration of pain, historical and physical examination features suggestive of the reflex sympathetic dystrophy syndrome, and sensory disturbances such as allodynia and hyperpathia did not predict pain relief from either procedure. Changes in skin temperature following the sympatholytic procedure did not correlate with pain relief. For PhI, pain relief correlated with the magnitude of decrease in systolic blood pressure. After SGB, changes in quantitative thermal sensory testing (QST) suggestive of a partial deficit in thermal sensation correlated with pain relief. In 20 normal controls, water bath immersion to cool the hand passively by 7 degrees C and warm the hand passively by 4 degrees C had small and selective effects on thermal QST thresholds, but did not produce a general impairment in thermal sensation. In conclusion, the diagnosis of sympathetically maintained pain based on the history and physical examination alone cannot be made with confidence and therefore a sympatholytic procedure is necessary. When SGB produces pain relief but PhI does not, systemic absorption of local anaesthetic and/or sensory blockade by spread to somatic nerves may be the reason. Thus, PhI appears to be a less sensitive but more specific test than SGB. These two procedures provide complementary information and both may be needed to establish the diagnosis of sympathetically maintained pain.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7820581&dopt=Abstract pain, pain medicine, pain relief



pain-relief-21.matches: pain relief
[Treatment of lumbar facet joint syndrome by CT-guided infiltration of the intervertebral joints]

[Article in German]

Schleifer J, Fenzl G, Wolf A, Diehl K.

Radiologische Abteilung, Knappschaftsklinik Puttlingen/Saar.

INTRODUCTION: Lumbar facet joint syndrome is a common condition, involving about 79% of patients suffering from low back pain. Denervation by scalpel or electrofrequency is a well-known method of treating it. An alternative method for longer lasting pain relief is CT-guided intraarticular infiltration of facet joints with local anaesthetics and cortisone. METHODS: In 62 patients with facet syndrome a total of 205 joints were infiltrated, CT monitoring being used in all cases. Each facet joint was infiltrated with 0.3 ml bupivacaine and 0.8 ml methylprednisolone. The patients were divided into three groups. Group 1 consisted of 24 persons who had undergone lumbar disc surgery, group 2 of 23 patients with spondylarthrosis of the facet joints, and group 3 of 15 patients who had undergone lumbar disc surgery but had additional spondylarthrosis. Very good results were defined as pain relief for longer than 4 weeks, good results as pain relief for up to 4 weeks and poor results as brief pain relief or none at all. In 27 patients facet infiltration was performed for the purpose of diagnosis. RESULTS: Results were significantly in group 2 than in group 1 (Fisher's exact test P < 0.012). In group 3 results were better than in group 1, but worse than in group 2. These differences were not statistical by significant (Table 3). Seven patients in the diagnostic group had no pain relief, and facet syndrome was excluded. CONCLUSIONS: CT-guided facet joint infiltration is a good method for treatment and diagnosis of lumbar facet joint syndrome. It can be repeated and has no severe side effects. The best results were seen in patients with spondylarthrosis of the facet joints. After lumbar disc surgery the pain relief was shorter, though it also yielded good results. For patients with unspecific low back pain, facet joint injections are a very good diagnostic method, allowing definite exclusion of lumbar facet syndrome.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7846279&dopt=Abstract pain, pain medicine, pain relief