pain-relief-21.matches: pain relief
Acupuncture and subtypes of chronic pain: assessment of long-term results.

Carlsson CP, Sjolund BH.

Department of Anaesthesiology, Malmo General Hospital, Sweden.

OBJECTIVE: To determine patients' opinions of pain relief for a longer time after one treatment period of acupuncture for chronic pain. PATIENTS AND SETTING: Two hundred and eleven patients had acupuncture treatment for chronic pain at the Pain Clinic of Malmo University Hospital during 1983-5. Their mean duration of pain was 10.4 years prior to treatment. INTERVENTION: The patients were treated with needle acupuncture with a combination of local and distal points every 1-2 weeks. Both manual and electrical stimulation was utilized. The mean number of treatments was 7.8. DESIGN: In 1988, all patient documents were screened, and the pain conditions were classified as nociceptive, neurogenic, or psychogenic. Of the 211 treated patients, initial results could be evaluated from the clinic records in 202 cases. Eighty-five of these patients (42.1%) experienced pain relief immediately after the treatment period. These patients were sent a 1-page questionnaire by mail in 1988. OUTCOME MEASURES: Pain relief over defined time periods (yes/no); do more work at home or at workplace (yes/no); analgesic consumption. RESULTS: Only 35 patients (17.3% of all patients) still experienced pain relief 6 months after treatment. Among those with nociceptive pain, 70 of 142 (49%) had experienced initial pain relief, while those with neurogenic or psychogenic pain experienced relief in only 11 of 34 and four of 26 of the cases, respectively. Pain relief for > 6 months was experienced by 33 of 142 of the cases with nociceptive pain, but by only two of 34 of those with neurogenic pain, and by none of those with psychogenic pain. CONCLUSION: Only patients with nociceptive pain can be expected to get pain relief for > 6 months after one treatment period of acupuncture, and of these only a small proportion will be helped.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7858358&dopt=Abstract pain, pain medicine, pain relief



pain-relief-21.matches: pain relief
Long-term results following proximal row carpectomy.

Tomaino MM, Delsignore J, Burton RI.

Department of Orthopaedic Surgery, University of Pittsburgh, PA.

The functional outcome, patient satisfaction, and x-ray film status for 23 wrists were examined an average of 6 years following proximal row carpectomy. Surgery was performed for Kienbock's disease, scapholunate dissociation with periscaphoid arthritis, and scaphoid nonunion not suitable for bone grafting. Twenty patients were satisfied with functional performance and pain relief. Wrist flexion-extension arc averaged 74 degrees, or 61%, of the opposite wrist at a later examination. Grip strength, corrected dor dominance, averaged 79% of the opposite side, reflecting an average improvement of 15 kg force. Radiocarpal arthritis developed in three wrists, but only one required arthrodesis for pain relief. The majority of patients experienced satisfactory pain relief, functional wrist motion, and effective grip strength following proximal row carpectomy. The results did not decline at an average of 6 years after surgery.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7963335&dopt=Abstract pain, pain medicine, pain relief



pain-relief-21.matches: pain relief
[Objective and subjective response in stage D2 prostate cancer patients with cancer pain]

[Article in Japanese]

Yoshida M, Hirasawa K, Kasuya Y, Tanaka Y, Homma Y, Higashihara E, Kawabe K, Aso Y.

Department of Urology, Faculty of Medicine, University of Tokyo.

Fourty-eight patients with stage D2 prostate cancer, initially treated with endocrine therapy at the University of Tokyo between 1981 and 1990, were followed up and analysed. For the assessment of a subjective response, pain score, narcotic score, and performance stages (PS) were used. Of the fourty-eight patients, twenty-one suffered from cancer pain due to bone metastases. These patients showed significantly (p < 0.01) more lesions of bone metastases and higher PS, compared with patients without cancer pain. The progression free survival of these patients was significantly (p < 0.01) lower than that of patients without cancer pain, although the actuarial survival was not significant. In twenty-one patients with cancer pain, the objective and subjective response rates to endocrine therapy were 75% and 86%, respectively. The duration of pain relief was 1.25-54 (median 19) months. Those rates to anti-cancer chemotherapy in refractory patients (8 patients) previously treated with endocrine therapy were both 25% and those to additional administration of flutamide (FUL) or diethylstilbestrol (DES) in refractory patients (6 patients) were 33% and 100%, respectively. Although the duration of pain relief was 0.78-8 (median 2) months, the additional administration of DES or FLU led to pain relief and improved quality of life (QOL) in all 6 patients. Endocrine therapy such as LH-RH agonist and non-steroidal pure anti-androgen, which has no severe side effects, would be of great usefulness in stage D2 prostatic cancer patients with pain on the basis of efficacy and safety.(ABSTRACT TRUNCATED AT 250 WORDS)

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8170080&dopt=Abstract pain, pain medicine, pain relief



pain-relief-21.matches: pain relief
NSAID use and efficacy in the emergency department: single doses of oral ibuprofen versus intramuscular ketorolac.

Wright JM, Price SD, Watson WA.

Department of Medicine, School of Medicine, University of Missouri-Kansas City.

OBJECTIVE: To compare the clinical efficacy of single doses of intramuscular ketorolac and oral ibuprofen in the emergency department (ED) treatment of acute pain. DESIGN: A retrospective analysis of data collected during a prospective survey of pain management efficacy. The design was noninterventional, and therapy was selected by the treating physician independent of the trial. SETTING: Urban teaching hospital adult patient emergency department. PARTICIPANTS: A convenience sample of ED patients in acute pain. INTERVENTIONS: Patients received ibuprofen 800 mg po (n = 95), or ketorolac 60 mg im (n = 30) as a single dose. Therapy was selected by the treating physician and was not influenced by the study. RESULTS: Data collected were a 100-mm visual analog pain scale at patient arrival and discharge, verbal description of pain relief, patient demographics, pain management data, and discharge diagnosis. Baseline pain intensity was higher in patients receiving ketorolac (77 mm median) than in those receiving ibuprofen (65 mm, p = 0.02). Pain relief was similar (p = 0.29) with either treatment when assessed by visual analog scale or patient definition of pain relief. CONCLUSIONS: A single dose of either nonsteroidal antiinflammatory drug produced similar pain relief in the general ED population during clinical treatment of pain. Ketorolac should not necessarily be considered a more effective analgesic than ibuprofen in these commonly used doses.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8193414&dopt=Abstract pain, pain medicine, pain relief



pain-relief-21.matches: pain relief
Caudal epidural blocks for elderly patients with lumbar canal stenosis.

Ciocon JO, Galindo-Ciocon D, Amaranath L, Galindo D.

Department of Internal Medicine/Geriatrics, Cleveland Clinic Florida, Fort Lauderdale 33309-1743.

OBJECTIVE: To determine the efficacy of caudal epidural blocks (CEB) in relieving pain and the duration of pain relief with CEB in elderly patients suffering from degenerative lumbar canal stenosis (LCS). DESIGN: This study was a descriptive, prospective study with a 10-month follow-up. PARTICIPANTS AND SETTING: Thirty patients, 76 +/- 6.7 years of age, with leg discomfort with or without back pain and with LCS documented by magnetic resonance imaging (MRI) within 1 year of the study, were recruited from the outpatient clinic of the Cleveland Clinic Florida. None of the subjects had received CEB or surgery for their leg discomfort and none had relief of pain by analgesics alone. MEASUREMENTS AND INTERVENTIONS: Subjects received a total of three doses of 0.5% Xylocaine with 80 mg Depo-Medrol into the caudal epidural space through the sacral hiatus at weekly intervals. The Roland 5-point pain rating scale was utilized before and at 2-month intervals up to 10 months after the CEB was administered. MRI was used to identify the degree of LCS. RESULTS: The degree of LCS on admission was moderate in 66.7% (n = 20) of the patients, mild in 23.3% (n = 7), and severe in the remaining 10% (n = 3). Patients had LCS involving 2.4 +/- 0.49 lumbar vertebrae. The degree of LCS is directly correlated with the pain level before CEB. After CEB, the pain level changed from 3.43 +/- 0.82 to 1.5 +/- 0.86 (P < 0.0000), with a significant relief of pain up to 10 months (the end of observation). The duration of pain relief ranged from 4 to 10 months (P < 0.0001). CONCLUSION: CEB offers significant pain relief and appears to be a reasonable therapeutic option among elderly patients with LCS. This alternative seems particularly important among patients with poor response to drug therapy and who are either poor surgical risks or who have refused surgery.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8201143&dopt=Abstract pain, pain medicine, pain relief



pain-relief-22.matches: pain relief
[Palliative radiotherapy for bone pain in hormone refractory prostate cancer]

[Article in Japanese]

Kawakami S, Kawai T, Yamauchi T, Yonese J, Ueda T, Ishibashi K.

From 1970 to 1992, 23 patients were treated with irradiation for palliation of pain caused by bone metastases from hormone refractory adenocarcinoma of the prostate at Cancer Institute Hospital. External beam irradiation was delivered to painful bony metastatic sites using linear accelerator. Numbers of irradiated sites were 1, 2, 3 in 6 patients, 4 in 3 patients and 5 or 7 in one patient. To evaluate the pain relief at the irradiated sites, severity and frequency of pain were measured quantitatively before and 1 month after the treatment. Overall efficacy of palliation was evaluated by summing up results of the irradiated sites in each patient. Pain relief was obtained in all the irradiated sites. Minimal relief, partial relief and complete relief of pain were achieved in 10%, 15% and 75% of the 60 irradiated sites, respectively. No significant dose-response relationship was observed. Complete pain relief was attained less frequently at the sites with severe and constant pain that those with moderate and intermittent pain. Minimal, partial and complete palliation of pain was attained in 9%, 17% and 74% of 23 patients, respectively. In patients with highly extensive bone metastases, many irradiated sites, or many irradiated bones, complete palliation was difficult to obtain. Recurrence of pain was observed in one site. In other 59 irradiated sites, pain relief lasted until patient's death or throughout the follow-up period (maximum 51 months, median 9 months). We concluded that external beam irradiation is an effective palliation therapy for pain of bone metastases from hormone refractory prostate cancer and will play a considerable role in the management of advanced disease.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7504756&dopt=Abstract pain, pain medicine, pain relief



pain-relief-22.matches: pain relief
Pain relief following tennis elbow release.

Newey ML, Patterson MH.

Princess Royal Hospital, Haywards Heath, Sussex, UK.

We studied the outcome of tennis elbow release in 27 patients at an average of 29.6 months after surgery. We found that 44% of patients had obtained complete pain relief, 37% of patients experienced occasional pain and 19% of patients still experienced moderate pain. Pain relief was significantly better in those patients with the shorter duration of preoperative symptoms. We therefore conclude that surgery for tennis elbow should be employed at an earlier stage than is currently practised.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7515435&dopt=Abstract pain, pain medicine, pain relief