Cessation Of Pain Research Articles

Frequency of Health Risk Assessment Activities at U.S. Worksites

Data from the National Survey of Worksite Health Promotion Activities include information about health risk assessment (HRA) activities available at private sector worksites in the United States. HRA activities were found at 29.5% of all worksites. Of those worksites, 24% provided HRA questionnaires and 77.4% provided periodic health/physical examinations. Screening tests provided as part of the health/physical exams included blood pressure screening (55.4%), cancer screening (19.5%), blood tests for cholesterol (28.3%) and sugar (39%), and tests of physical fitness (15.1%). In most cases, the frequency increased as worksite size increased, regional variations were small, and there was significant variation among different industry types. HRA activities were overrepresented at worksites where the majority of workers were women, over 30 years of age, not blue collar, and not represented by a union. On-site health personnel increased the likelihood of the presence of HRA activities. At 85% of the worksites with HRA activities all permanent employees were eligible. The full costs of screening were paid by 87.9% of the worksites, activities were held on company time at 74.5%, and time off to participate was available at 78.2% of worksites. The most commonly mentioned benefit of HRA activities was improved employee health (47.1%). Other health promotion activities frequently found in association with HRA activities were smoking cessation (54.1%), care and prevention of back pain (50.8%), and stress management (49.6%).

Management of primary and metastatic renal cell carcinoma by transcatheter embolization with iodine 125.

The long-term results of the management of metastatic renal cell carcinoma by a radioactive interstitial implant seated by a transcatheter embolization technique were evaluated in 85 patients at risk at 2 years and 37 at 5 years. The 2-year survival rate was 33% and the 5-year survival rate was 32%. Patients with isolated skeletal metastases showed the best survival rate (2-year survival rate, 69%; 5-year survival rate, 60%). Isolated pulmonary, other parenchymal, and central nervous system (CNS) metastases showed a lower 2-year survival rate of 15%. Regardless of the site of metastases and the size of the primary, histologic grade appeared to have a substantial impact on the survival of our patients. The beneficial results of interstitial radiation therapy are attributed to reduction of tumor burden and possibly the stimulation of the host immune response that may initiate remission. The noticeably better results in patients with osseous metastases are attributed to the resolute treatment of all osseous metastases by additional interstitial iodine 125 (125I) infarct implants. Conversely, the poor results in patients with CNS and other parenchymal metastases may be based on the inability to treat such metastases with 125I interstitial infarct implants. In addition to clinical observations of weight gain and the cessation of pain and hematuria if present, remissions are heralded by normalization of the erythrocyte sedimentation rate, disappearance of tumor markers if present, and rise of beta interferon levels. The technique is advocated for the management of inoperable renal cell carcinoma with distant metastases.

Whippleʼs Procedure Plus Intraoperative Pancreatic Duct Occlusion for Severe Chronic Pancreatitis

The present investigation provides follow-up data (up to 36 months) of exocrine and endocrine pancreatic function, inflammatory activity, pain, and body weight in 23 chronic pancreatitis patients submitted to Whipple's procedure plus intraoperative Ethibloc occlusion of the remaining pancreatic duct system between January 1983 and February 1984. Clinically, Whipple's procedure plus intraoperative pancreatic duct occlusion resulted in almost complete and continuous cessation of pain as well as significant (p less than 0.05) increase in body weight. With regard to exocrine pancreatic function (Secretin-Pancreozymin test, plasma amino acid consumption test, Pankreolauryl test, fecal chymotrypsin determination), intraoperative pancreatic duct occlusion was shown to induce high-grade insufficiency and thus exocrine parenchymal atrophy in all patients. Simultaneously, the inflammatory process (represented by serum levels of trypsin, lipase, and pancreatic isoamylase) was terminated in all 23 patients. Endocrine pancreatic function, evaluated by serum levels of insulin and C-peptide measured under fasting conditions and subsequent maximal combined beta-cell stimulation as well as corresponding integrated hormone releases, was reduced by partial pancreas resection by about 50%, while there was no further impairment during the 36-month follow-up period in consequence of additional intraoperative pancreatic duct occlusion. Altogether, Whipple's procedure plus intraoperative Ethibloc occlusion of the residual pancreatic duct system seems suitable for termination of the inflammatory process and thus preservation of residual endocrine pancreatic function in chronic pancreatitis.

Activity of blood coagulation factor XIII as a prognostic indicator in patients with Henoch-Schönlein purpura. Efficacy of factor XIII substitution.

Determination of coagulation Factor XIII (F XIII)-related parameters in 21 patients with Henoch-Schönlein purpura documented a significant decrease of F XIII activity as well as of the F XIII-related antigenic determinants. Subgroup analysis with regard to the clinical symptoms showed an even further decrease of these parameters in patients with gastrointestinal complications. Stimulated by these findings a substitution therapy with a F XIII concentrate was initiated in those patients whose F XIII activity in plasma remained low and who developed severe abdominal pain accompanied by persisting gastrointestinal bleeding. This therapeutic approach not only corrected the laboratory data, but more important led to a cessation of pain and bleeding. A rapid decrease of F XIII levels after transfusion below 40 U/ml was indicative of relapse of abdominal symptoms, while increasing values were associated with the recovery of the patients. F XIII activity determinations appear to have a predictive value in patients with Henoch-Schönlein purpura, and the administration of F XIII concentrates may contribute to the improvement of gastrointestinal complications.

Dorsal Periaqueductal Gray‐Matter Stimulation in Humans

Seven patients suffering intractable pain from head and neck cancer (age 48-73, mean 57.5 years) underwent acute stimulation of dorsal periaqueductal gray matter (PAG) with immediate cessation of pain. Two patients received chronic PAG stimulation with relief of pain during stimulation. The effect was not reversed by naloxone and there were no changes in CSF peptides.

Endodontics

It is known that pets with broken teeth or teeth with other diseases of the pulp suffer considerable pain and frequent infection. To ignore these problem teeth would not only be inhumane, it would risk chronic infection, abscessation, and tooth loss. Although extraction of these teeth is sometimes necessary, the procedure is often difficult to perform and painful for the animal. The resultant tooth loss is cosmetically displeasing and, frequently, there is compromise in function. The endodontic treatment of these teeth, on the other hand, is relatively easy to perform. It almost always results in immediate cessation of pain and will usually allow the tooth to remain functional for the lifetime of the pet.

Treatment of Interstitial Cystitis with the Neodymium-Yag Laser

AbstractFive patients with severe interstitial cystitis that had not responded to conventional means of therapy were treated with the neodymium-YAG laser» Of the 5 patients 4 demonstrated cessation of severe bladder pain and frequency of urination within several days after therapy. These patients also were studied objectively by measuring bladder capacity, which was found to be increased overall Complication rates from this modality of therapy were extremely low. The patients have been followed for 3 to 15 months after treatment and to date have had no recurrent symptoms of severe interstitial cystitis, although some have had mild recurrent voiding symptoms.

Carotid-dural arteriovenous fistula during use of an oral contraceptive

Most spontaneous carotid-cavernous fistulas occur in patients over age 45 with a 2:1 predilection to occur in women. Under age 45 the syndrome typically afflicts pregnant postpartum or postabortal women. In the case reported in this article the symptoms were coincidental with the use of an oral contraceptive (OC). Headache frequently unilateral is an almost constant complaint. A 20-year old college student reported right frontotemporal head pain for 3 months. The most severe headaches were bilateral and sometimes accompanied by nausea but were never associated with diplopia scotomas blurred vision conjunctival injections tearing or rhinorrhea. The young woman had experienced infrequent muscle contraction headaches since age 16 but the present headaches differed in both frequency and quality. 6 months before seeing a neurologist she began use of an OC containing 0.5 mg of norgestrel and 0.05 mg of ethinyl estradiol. Headaches could not be correlated with any phase of the OC cyle. Neurological examination was normal. There was no evidence of endocrinologic dysfunction other than depression of luteinizing hormone and follicle stimulating hormone levels and a mildly elevated prolactin level (30 ng/ml) as would be expected of a person using an OC. A right carotid angiogram demonstrated a wedge-shaped blush posterior to the dorsum sellae at the basal venous plexus fed by the meningohypophyseal branch of the intracavernous segment of the right internal carotid artery which filled when the cavernous segment of the right internal carotid artery was first opacified. Venous drainage proceeded via the basilar plexus to the cavernous sinus anteriorly via the superior ophthalmic vein into the facial vein and caudally into the pterygoid plexus. Left carotid and vertebral circulations were normal. Left carotid and vertebral were normal. The OC was stopped and within 3 weeks the headache disappeared. 3 months later the prolactin level was normal. 6 months later a right carotid angiogram was normal. The headache has not recurred in 4 years; she has not become pregnant. The mechanism by which pregnancy and parturition predispose a woman to develop carotid-cavernous shunts is unknown. The close temporal relationship of stopping OC use and cessation of head pain is felt to be more than a chance occurrence.

Administration of Levodopa for Relief of Herpes Zoster Pain

Forty-seven outpatients with herpes zoster, seen within five days of onset of the eruption, received ten days' administration of oral levodopa and benserazide or placebo in a double-blind controlled study. Both the total patient group and high-risk group, eg, those with either ophthalmic zoster or those older than 65 years, were analyzed. Both groups were comparable in terms of demographic and pathological criteria. Vomiting was the only side effect observed in both groups. A significant decrease in intensity of pain was seen in the group receiving levodopa from the third day, and complete cessation of both pain and sleep disturbances was more frequent in the patients. Two months later, postherpetic neuralgia was also less frequent in the group that received levodopa.

ACYCLOVIR THERAPY FOR MUCOCUTANEOUS HERPES SIMPLEX INFECTIONS IN IMMUNOCOMPROMISED PATIENTS

11 of 24 immunocompromised patients with mucocutaneous herpes simplex virus (HSV) infections were given intravenous acyclovir in a randomised double-blind placebo-controlled study. Patients receiving acyclovir experienced no major adverse effects. The median times to cessation of new lesion formation, lesion crusting, lesion healing, cessation of pain, and termination of viral shedding were shorter in the acyclovir-treated group than in the placebo group. The time-to-event probability curves for the acyclovir and placebo groups were significantly different for cessation of pain (p = 0.032) and termination of viral shedding (p = 0.004). The median times to termination of viral shedding were also statistically different (p = 0.045). Acyclovir seems to be a non-toxic and effective treatment for mucocutaneous HSV infections in immunocompromised patients.

Treating bruxism with the habit-reversal technique

The habit-reversal technique developed by Azrin and Nunn (1973, 1977) was used in treating four clients with bruxism. Following a single treatment session, marked reductions in the frequencies of this behavior were obtained in each case. Subsequently, relaxation and stress management techniques were conducted with two of these clients who had facial pain. These procedures were associated with decreased pain ratings and medications for one client and a further decrease in bruxism and cessation of pain for the second. These results remained consistent over 6- and 12-month follow-ups. Each of the components of habit-reversal appeared to be related to its effectiveness, and methods for performing component analyses of this technique are described.

Primary Dysmenorrhea Treated With Indomethacin

Primary dysmenorrhea is a difficult entity to treat, and therapy is usually directed at relieving symptoms. There is some indication that this disorder is caused by an increase in prostaglandin F2alpha. Therefore, logically the treatment may include antiprostaglandin agents. We have studied 32 women with the diagnosis of primary dysmenorrhea in a randomized double-blind fashion using a placebo and indomethacin. Both agents were taken three times a day over four cycles, and therapy was begun two days before the usual onset of pelvic pain. Only two of 16 patients in the placebo group were significantly improved in the four-month treatment cycles while all 16 in the treatment group showed some improvement, 11 having cessation of pain. In the six months following the study period, all patients were given indomethacin. The original treatment group did not change significantly. However, all in the placebo group when switched to indomethacin had some relief, 12 of the 16 showing complete cessation of pain. Gastric irritation was the main side effect and was present in 18% of the treatment group and 12% in the placebo group. Indomethacin appears to effectively relieve primary dysmenorrhea and does not appear to be associated with a high incidence of side effects.

Long-Term Follow-up of Patients With Austin Moore Prostheses

A retrospective study of the long-term follow-up of patients with Austin Moore prostheses is presented. Sufficient data were present to evaluate 78 hips postoperatively at six months, and 1, 5, 10, and 15 years when applicable. The average age of patients at the time of operation was 56.1 years. Most preoperative diagnoses resulted from previous operative procedures which had failed (there were only six fresh fractures). The operative technic is discussed. Postoperatively, cessation of pain is relatively early and the return of function increases linearly but at a slower rate. The importance of partial weight-bearing for four to six months postoperatively as well as daily physical therapy is emphasized. The mean amount of settling of the prostheses (total in the femur and acetabulum) was 1.63 cm in all patients. We believe that certain postoperative principles are applicable to all types of reconstructive surgery of the hip.

VASCULAR COMPRESSION OF LOWER CRANIAL NERVES: OBSERVATIONS USING MICROSURGERY, WITH PARTICULAR REFERENCE TO TRIGEMINAL NEURALGIA

A new finding made possible by the use of the operating microscope in neurosurgery is discussed. Nineteen patients with trigeminal neuralgia have been explored, and in 14 of these vascular compression of the fifth nerve at its entry zone to the pons has been found. Relief of this vascular compression has caused cessation of pain in all these patients. In addition, one patient with hemifacial spasm, and one patient with glosso pharyngeal neuralgia, are reported; each of these also had vascular compression of the appropriate nerve causing the symptoms.

Management of preinfarction angina: Evaluation and comparison of medical versus surgical therapy in 43 patients

Short-term results of aggressive surgical management were compared with results of medical management in forty-three patients with preinfarction angina admitted to the coronary-care unit (CCU) over an 18 month period. These patients were selected from 1,609 consecutive admissions to the CCU because they met strict criteria for preinfarction angina: severe chest pain at rest, ST-segment elevation or depression during pain which subsided rapidly after cessation of pain, and normal serum enzymes (CPK, SGOT, and LDH). Twenty-three patients had coronary angiography, done with operating room and pump standby. One patient, who had total occlusion of the left main coronary artery, died during the study. Twenty-one of the remaining patients were considered surgical candidates, and were treated immediately after angiography with 1 to 3 vein bypass grafts. There was one late postoperative death and, of the 20 survivors, 2 had ECG evidence of acute myocardial infarction and one had mild angina at time of discharge. In contrast, of the 21 patients treated medically, 13 sustained acute MI, resulting in 8 instances of congestive heart failure and 4 cases of ventricular fibrillation. Four patients died in cardiogenic shock. With the use of rigid criteria, a small subgroup of patients with variant angina at high risk of developing AMI has been identified and categorized as having preinfarction angina. Our experience suggests that aggressive surgery immediately following coronary angiography offers a lower incidence of MI, morbidity, and death than does medical management.

Continuous electrocardiographic recordings and serial changes of various serum enzymes in a patient with variant form of angina pectoris.

A patient with a variant form of angina pectoris was subjected to continuous electrocardiographic recordings. This case was different from the variant form of angina pectoris as described by Prinzmetal et al., in that the ST segment elevation in the leads reflected the ischemic area during his chest pain, not only at rest, but also at the time of effort. With the cessation of pain, the ST segment rapidly returned to the appearance prior to the onset of an attack. This case also demonstrates the interesting serial changes of electrocardiograms taken by continuous electrocardiographic recordings during anginal attacks. The serial alteration of various serum enzymes in this case remained within the normal range except for the slightly transient increase of SCPK activity. In this case, practolol therapy was effective in alleviating the anginal attacks.

Enovid therapy (norethynodrel with mestranol) for fibrocystic disease

This investigation was undertaken to evaluate the results of norethynodrel with mestranol (Enovid therapy) for women suffering from symptoms due to a fibrocystic disease of the breast. The patients ranged in age from 16 to 69 years old and, in practically every instance, the disease involved both breasts. Over half of the patients had had symptoms for more than 3 years. The average dose was 5 mg. of Enovid three times a day and, in some instances with patients who had severe symptoms, the dose was 10 mg. three times a day. The dose fluctuated, depending upon the manner in which the patient tolerated the medication and, in many instances, it was necessary to reduce the dose which was altered to the patient's ability to withstand same. Objective remissions were observed in 76 of the 110 patients and the response was considered excellent in 54 patients. Sixty-eight of the patients enjoyed some subjective response and, in 53 of the patients, the response was considered excellent. This consisted of cessation of pain, disappearance of areas of firmness, and diminution of tenderness. In 5 per cent of the patients, after softening of the breast tissue had occurred, a solitary nodule could be detected which was surgically excised and found to be benign. No effect of the Enovid therapy could be noted upon histologic study of the nodule. Complications were minimal: the most frequent one was weight gain which could be treated by the administration of a diuretic agent. Thrombophlebitis was encountered in only one patient who had given a history of previous thrombophlebitis.

Hernia due to banding of the abdominal muscles.

SUPERIMPOSED parallel slits between bands of the internal oblique and transversus abdominis muscles occasionally open to allow formation of a hernia at the level of the semicircular line of Douglas, which enters a shallow subaponeurotic space lateral to the rectus sheath and deep to the aponeurosis of the external oblique. Zimmerman et al1noted this and described its anatomical peculiarities. Four cases, with incarceration and strangulation, show this hernia to be dangerous and misleading. Report of Cases Case 1. —A 23-year-old man, loading heavy oil drums, suddenly noticed tender, firm swelling in the left lower abdominal wall. Sharp pain rendered him helpless, and after some delay he was brought to the hospital with an oblique, oval, exquisitely tender mass, midway between the umbilicus and anterior superior iliac spine (Fig 1). During examination it quickly disappeared, with immediate cessation of pain. Because considerable time had lapsed, exploration was advised. Upon

Superior mesenteric embolectomy

This paper reports a successful superior mesenteric embolectomy. The possibility of successful surgical treatment makes its recognition particularly important. In any patient with a known history of cardiovascular disease who...

Femoral Cortical Drilling for the Relief of Pain Due to Degenerative Arthritis of the Hip

A review of the literature concerning the femoral cortical drilling or forage procedure was presented. Nine patients (ten hips) had immediate cessation of pain, but at the end of two years there was only one good result. Five patients had further operative procedures at the end of one year. The femoral cortical drilling procedure in our hands failed to relieve pain in degenerative hip disease.