Subsequent Pain Relief Research Articles

Constant Infusion of Morphine for Intractable Cancer Pain Using an Implanted Pump

✓ In the past, pain control for chronic pain syndromes using narcotic infusion has been carried out primarily via the intrathecal (subarachnoid) route. This report presents one of the first large series of terminally ill cancer patients with intractable pain treated with continuous epidural morphine infusions by means of implanted pumps and epidural spinal catheters. The purpose of the study was to demonstrate that the epidural route is effective with minimal complications, and that screening with temporary epidural catheter infusions results in a high rate of subsequent pain relief. A multidisciplinary team (neurosurgeon, anesthesiologists, psychiatrists, oncologists, and nurse clinicians) evaluated and treated all of the patients studied. Percutaneous placement of temporary epidural catheters for a trial assessment was performed by the anesthesiologists. Pain evaluations were conducted independently by psychiatrists using both verbal and visual analog scales. From 1982 to 1988, 41 (59.4%) of 69 patients...

Constant infusion of morphine for intractable cancer pain using an implanted pump

In the past, pain control for chronic pain syndromes using narcotic infusion has been carried out primarily via the intrathecal (subarachnoid) route. This report presents one of the first large series of terminally ill cancer patients with intractable pain treated with continuous epidural morphine infusions by means of implanted pumps and epidural spinal catheters. The purpose of the study was to demonstrate that the epidural route is effective with minimal complications, and that screening with temporary epidural catheter infusions results in a high rate of subsequent pain relief. A multidisciplinary team (neurosurgeon, anesthesiologists, psychiatrists, oncologists, and nurse clinicians) evaluated and treated all of the patients studied. Percutaneous placement of temporary epidural catheters for a trial assessment was performed by the anesthesiologists. Pain evaluations were conducted independently by psychiatrists using both verbal and visual analog scales. From 1982 to 1988, 41 (59.4%) of 69 patients evaluated for eligibility experienced good pain control during trial assessment and were subsequently implanted with Infusaid infusion pumps. Preinfusion pain analog values were 8.6 +/- 0.3 and postimplantation values at 1 month were 3.8 +/- 0.4 (p less than 0.001). Over this same 1-month period. requirements of systemic morphine equivalents decreased by 79.3% with epidural infusions as compared to preinfusion requirements (p less than 0.001). There were no instances of epidural scarring, respiratory depression, epidural infections, meningitis, or catheter blockage. One patient developed apparent drug tolerance and three patients required further catheter manipulations. This series strongly suggests that significant reductions in cancer pain can be obtained with few complications and a low morphine tolerance rate using chronic epidural morphine infusion. Anesthesiology and psychiatry input, along with temporary catheter infusion screening and quantitative pain evaluations using analog scales, are essential.

Managing temporomandibular joint syndrome

Pain in the temporomandibular joint is primarily responsible for the morbidity often associated with this syndrome. Of the 448 cases in this study, 48% presented as ear pain and 46% complained of either headache, sinus pain, or neck pain. Temporomandibular joint pain and mastication muscle tenderness elicited with palpation were frequent physical findings. In this review, temporomandibular joint syndrome was successfully managed in 75% of 448 cases with conservative treatment consisting of patient education, heat, massage, non-narcotic analgesics, and occlusal splints. Seventeen percent were referred to dentists for restorations or orthodontics. The success rate for the 6% who underwent diagnostic arthroscopy and/or open joint surgery with disc replacement was 67%. Therefore, patients with ear pain or head and neck pain require an objective evaluation of medical history and physical examination to obtain the correct diagnosis and subsequent correct treatment and pain relief. Early diagnosis helps to prevent changes in the joint that can become irreversible with intractable pain. Surgery is reserved for those patients who fail to respond to conservative management.

Long-term therapeutic effects of electro-acupuncture for chronic neck and shoulder pain--a double blind study.

Thirty-seven patients with chronic neck and shoulder pain were treated with a series of electro-acupuncture treatments. All patients had been unresponsive to previous conventional and placebo treatments for their pain. A double blind evaluation of acupuncture results and hypnotic profiles failed to demonstrate any correlation between the two. Twenty-four or 64.9% of our patients obtained significant long term improvement. An increase in regional microcirculation by peripheral sympathetic blockade from electro-acupuncture is thought to be responsible for the tissue healing and subsequent pain relief.

Presacral Neurectomy for Pelvic Pain in Infertility

Twenty patients have undergone presacral neurectomy at Yale-New Haven hospital over the past 7 years. The patients were separated into three subdivisions according to abnormal findings at the time of surgery: group I, endometriosis; group II, pelvic inflammatory disease (PID); and group III, those patients with neither endometriosis nor pelvic inflammatory disease but with pelvic pain and infertility. At the time of surgery, an attempt was made to correct and repair coexistent pelvic abnormalities. The groups were evaluated for relief of pain and subsequent viable intrauterine pregnancy. A control group of infertility patients complaining of pain who underwent infertility laparotomy without presacral neurectomy was used for comparison. Presacral neurectomy has traditionally been performed for pain associated with endometriosis and has resulted in subsequent pain relief and pregnancy rates of 30% to 60%. Pregnancy rates of 46% to 47% were found in the PID group, the endometriosis group, and the control group. In addition, 75% of the patients with either PID or endometriosis had significant relief of pain following presacral neurectomy as compared with only 26% of the control group undergoing only infertility laparotomy. It is concluded from these findings that presacral neurectomy plus reconstructive pelvic surgery is more effective than infertility laparotomy alone for the treatment of pelvic pain but that presacral neurectomy does not increase the subsequent incidence of pregnancy.