Treatment Of Chronic Pain Syndromes Research Articles

Focused review: Botulinum toxin type A therapy in chronic pain disorders

Lang AM. Botulinum toxin type A therapy in chronic pain disorders. Arch Phys Med Rehabil 2003;84 Suppl 1:S69-73. This self-directed learning module highlights that the underlying problem in many types of muscle pain disorders is a distortion of critical structures that causes functional deficits and pain. An objective of treatment is to reverse this distortion, enabling repair of damaged tissues and strengthening of weakened muscles. Administering botulinum toxin type A (BTX-A; Botox) to reduce muscle tone and overactivity warrants consideration as part of an overall treatment approach that includes physical therapy to help restore normal muscle length and biomechanical balance to improve the prospect of ensuring long-term relief from associated pain. This article specifically focuses on pertinent review articles, results of controlled and open-trial data, and case reports to assess the role of BTX-A treatment in chronic pain disorders. Overall Learning Objective: To review the clinical trial data of the safety and efficacy of BTX-A for the treatment of chronic pain syndromes associated with muscle disorders.

Medication-assisted Spinal Manipulation

Background context: The acceptance of spinal manipulation as a reasonable method of treating certain patients with spinal pain over the past decade has led to a renewed interest and increased use of these techniques performed in conjunction with commonly used medications and procedures. Manual therapy is increasingly being used in conjunction with anesthetics, sedatives or analgesics as well as local, epidural and intra-articular injections.Purpose: This report provides a review of the literature and presents a description of current clinical practice methods for the application of the different techniques of medication-assisted spinal manipulation therapy followed by a discussion of the current clinical support and the published indications, contraindications and complications for each of these procedures. Study design/setting: This technical report integrates a literature review with information gathered through personal interviews, review of medicine-assisted manipulation courses and observations of clinical procedures. Methods: A PubMed search from 1966 to the present was performed to identify appropriate articles concerning the combination of spinal manipulation therapy with such medical procedures as the use of anesthetic, conscious sedation, local injection of analgesic, anti-inflammatory and proliferant agents and intra-articular injections. Additional articles and information were gathered through review of pertinent references, attendance of various technique specific seminars and communication with experts familiar with these procedures. Results: Four categories of medication-assisted manipulation were identified: manipulation under general anesthesia or sedation, manipulation under epidural anesthesia with or without epidural steroid injection, manipulation under joint anesthesia/analgesia, and manipulation with injectants, such as steroids or proliferant agents. The literature consists primarily of case reports and case series with two randomized controlled trials and one cohort study. Conclusions: Medicine-assisted spinal manipulation therapies have a relatively long history of clinical use and have been reported in the literature for over 70 years. However, evidence for the effectiveness of these protocols remains largely anecdotal, based on case series mimicking many other surgical and conservative approaches for the treatment of chronic pain syndromes of musculoskeletal origin. There is, however, sufficient theoretical basis and positive results from case series to warrant further controlled trials on these techniques.

Human pooled immunoglobulin in the treatment of chronic pain syndromes.

To examine the use of intravenous immunoglobulin (i.v.i.g.) in chronic pain. A prospective multiple-dose, open-label cohort study in 130 consecutive patients who suffered from 12 chronic pain syndromes. The largest symptom groups were (number of patients): Fibromyalgia (48); Spinal pain (20); Complex regional pain syndrome (CRPS, 11); Peripheral neuropathic pain (12); and Atypical odontalgia or atypical facial pain (11). All patients had insufficient pain relief with established treatments. Pain relief was recorded using average pain intensity values as documented in standardized diaries. A specific treatment protocol was developed, and patients were enrolled over a 36-month period. Overall, 20% of patients had>70% pain relief and 27.7% of patients reported relief between 25% and 70%. Six patients (4.6%) had moderately increased pain levels for a duration of up to 9 weeks. Good relief, of more than 70%, was found in all major symptom groups. Patients with pain of short duration (<2 years) reported high relief rates (33.8% of patients in this group reported relief of >70%). No serious adverse events were reported. conclusions: i.v.i.g. may be effective in patients suffering from chronic pain. Controlled studies are needed to evaluate the efficacy of i.v.i.g. in these patients. Patients with a good response to i.v.i.g. may be models for the study of neuroimmune interactions in chronic pain.

Bilateral Horner's Syndrome after a Stellate Ganglion Block

A stellate ganglion block (SGB) is a widely used procedure in the treatment of chronic pain syndromes in the facial and cervicobrachial regions as well as in nonpainful conditions. The complications of a stellate ganglion block include intra-arterial or intracranial injection of local anesthetic, Horner's syndrome, phrenic nerve block, recurrent laryngeal nerve paralysis, brachial plexus block, and pneumothorax. Horner's syndrome after the performance of a stellate ganglion block is a valuable sign of a successful block, but contralateral or bilateral Horner's syndrome remains an unusual and poorly explained phenomenon. We experienced a case of a 56 year-old female patient who had developed ipsilateral and contralateral Horner's syndrome after a stellate ganglion block. The ipsilateral Horner's syndrome was resolved after several hours but the contralateral side lasted for a week.

Radiofrequency lesions of the stellate ganglion in chronic pain syndromes: retrospective analysis of clinical efficacy in 86 patients.

Stellate ganglion (SG) blockade is used for the treatment of chronic pain syndromes in which the sympathetic nervous system is hypothesized to be involved. A possible treatment modality to achieve long-term pain reduction is blockade of the SG by means of a radiofrequency lesion (RF-SG). To evaluate the outcome of RF-SG as a therapy for different chronic pain syndromes, we reviewed 86 RF-SG procedures. Medical records containing treatment information were reviewed systematically. A systematic MEDLINE literature review search on SG blockade was also performed. In our clinic, 39.5% of 221 patients who received a prognostic SG block subsequently underwent RF-SG. Of these patients, 40.7% noted a more than 50% reduction of pain, 54.7% reported no effect on pain, and 4.7% showed worsening of pain. The mean follow-up interval was 52 weeks. The computer-assisted literature search resulted in 31 studies: 12 about complications and 19 about the efficacy of SG blockade. A review of these studies showed partial pain relief in 41.3% of patients, complete pain relief in 37.8%, and no pain relief in 20.9%. The efficacy of RF-SG blockade seems to be in line with that of other SG blockade procedures reported in the literature. Our retrospective study shows that an RF-SG block is most likely to be of benefit for patients suffering from complex regional pain syndrome type 2, ischemic pain, cervicobrachialgia, or postthoracotomy pain. Clinical efficacy remains to be proven in a randomized controlled trial, however.

Nerve blocks with 5% butamben suspension for the treatment of chronic pain syndromes

Background and Objectives. Butamben is a non-water-soluble local anesthetic that can be prepared as an aqueous suspension for nerve blocks. This report describes the use of 5% butamben suspension for the treatment of chronic pain of cancer and noncancer origin. Methods. The clinical courses of 75 consecutive patients were analyzed following 5% butamben nerve blocks (35 epidural blocks only, 33 peripheral nerve blocks only, and 7 had both epidural and peripheral nerve blocks). Epidural blocks were performed as a series of four with additional blocks offered if needed. Peripheral nerve blocks were done as a single block with repeat injections if needed. Injection volumes varied between 15 and 25 mL for epidural injections and 5 and 20 mL for peripheral nerve blocks. Successful therapy was defined as a ≥75% reduction in subjective pain assessments for ≥4 weeks or until death. Daily opioid requirements were also recorded. Results. Fifty-four of the 75 patients (72%) were successfully treated. This included 48 of 67 cancer patients (71.6%) and 6 of 8 noncancer patients (75%). Median duration of pain relief was 12 weeks (range, 1–96) in the cancer patients and 10 weeks (range, 6–166) in the noncancer patients. Mean reduction in opioid requirements in successfully treated cancer patients was 74 ± 5%. Pain on epidural injection occurred in half of the patients and was the most prevalent complication of treatment. Five patients had signs of intravascular injection. There were no serious long-term sequelae. Conclusions. When used as described in this report, 5% butamben suspension appears to be effective for treatment of chronic pain of both cancer and noncancer origin and has a low incidence of adverse sequelae.

Nerve Blocks With 5% Butamben Suspension for the Treatment of Chronic Pain Syndromes

Nerve Blocks With 5% Butamben Suspension for the Treatment of Chronic Pain Syndromes

Paracetamol and metamizol in the treatment of chronic pain syndromes

In a medline search (covering 1966 to Sept. 1996) 32 clinical studies were identified, in which the efficacy of paracetamol or matamizol per se, or in comparison to other analgesics, in various chronic pain states, such as migraine, dysmenorrhoea, arthritis and osteoarthritis pain and cancer pain had been examined. In patients with migraine (4 studies) several other analgesics (ibuprofen, mefenamic acid, flupirtin) were slightly more effective than paracetamol, however, the efficacy of paracetamol itself had not been assessed. In patients with chronic tension headache (1 study) paracetamol was superior to placebo, but less effective than naproxen. Pain of dysmenorrhoea was not, or only marginally improved by paracetamol in 3 studies, efficacy was reported in 1 study. Similarly, pain in rheumatoid arthritis was not significantly alleviated when paracetamol was given alone (3 studies) and marginally improved, when combined with naproxen and tested against naproxen alone (1 study). Some improvement by paracetamol of pain scores in patients with osteoarthritis (5 studies) requires further clinical confirmation. No studies were found, in which metamizol had been studied in chronic non-cancer pain. Paracetamol and/or metamizol have been included in 14 studies on cancer pain, most of these studies attempting to validate the WHO analgesic ladder for cancer pain treatment. However, except for one study, in which metamizol was comparable in efficacy to morphine, all other publications do not provide detailed information on the efficacy of individual analgesics. Therefore it is not possible at present, to assess the possible merits of paracetamol or metamizol in the treatment of cancer pain from published studies.

P-3-386 - The treatment of chronic pain syndromes by spinal cord stimulation with dual-lead systems

P-3-386 - The treatment of chronic pain syndromes by spinal cord stimulation with dual-lead systems

The accuracy of memory for pain: Not so bad most of the time

Although the clinical treatment of chronic pain syndromes requires systematic assessment of pain (based to some extent on patients' self-reports), it has become common to question the accuracy of autobiographical and retrospective accounts of pain severity. The authors' work suggests that self-reports of pain are generally accurate. In a research program sponsored by the National Center for Health Statistics, the authors found that the only influence on the accuracy of pain reports that could be documented empirically was pain at the time of recall on remembered pain episodes. With this exception, unreliability in pain self-reports may not be as attributable to the limitations of human memory and biases of self-report as generally assumed.

Treatment of Chronic Pain Syndromes

Treatment of Chronic Pain Syndromes

The future for antidepressants: treatment of pain.

Antidepressant drugs have been used successfully in the treatment of chronic pain syndromes. Clinical trials have supported the use of these drugs for pain and the depression that often accompanies pain syndromes. Although the exact mechanisms of action have not been clearly elucidated, it has been suggested that these agents have analgesic properties independent of their antidepressant effect on mood and behavior. Pain patients without concomitant depression experienced pain relief with antidepressant therapy; these patients represent the most convincing evidence that antidepressant drugs have a direct analgesic effect. Studies presented in this paper support the clinical efficacy of antidepressant medications in the treatment of patients suffering from headaches (migraine, tension, and mixed types), diabetic neuropathy, arthritis, and facial pain. These data also suggest that antidepressant drugs may be effective in the treatment of postherpetic neuralgia, back pain, and pain from mixed etiologies; however, data for these pain syndromes are less clear, and, thus, further testing is required.

Chronic Pain Syndrome

Chronic pain syndrome must be considered as a psychologic-physiologic disability. The understanding and treatment of chronic pain syndrome comprises a new medical disease model; however, some of the original symptoms are considered to have an underlying organic pathology. Recognition of the need for differentiation between the various forms of pain is paramount to the success of the treatment process. By applying different treatment modalities, we can best prevent acute pain from becoming chronic pain syndrome. Chronic pain syndrome must be treated differently from acute pain; To persist in treating chronic pain syndrome as an acute problem very often leads to unsuccessful treatment results. The appropriate use of medication is an important component in the multidisciplinary approach to chronic pain syndrome. Treatment of chronic pain syndrome has been most successful when a combination of all legitimate treatment modalities available were utilized.

CT-guided celiac plexus block with ventral approach

A modified procedure for infiltrating the coeliac plexus for the treatment of chronic pain syndromes is described. The injection of the analgesic is made through a fine needle introduced via a transabdominal approach under CT guidance. The advantages of this technique, compared with the dorsal approach, are a more accurate placement of the solution and the ability to carry out this procedure in very sick patients. No complications have been observed.

Treatment of chronic pain syndromes with iontophoresis of vinca alkaloids to the skin of patients : Neurosci. Lett. 31 (1982) 87–90

Treatment of chronic pain syndromes with iontophoresis of vinca alkaloids to the skin of patients : Neurosci. Lett. 31 (1982) 87–90

Treatment of chronic pain syndromes with iontophoresis of vinca alkaloids to the skin of patients

Repeated iontophoretic administration of the microtubule inhibitors vinblastic or vincristine to the segmentally related dermatomes of patients suffering from postherpetic, trigeminal and other neuralgias permanently alleviates chronic, autochthonoue pain. The beneficial effect of this therapy is probably due to transganglionic degenerative atrophy of primary central sensory terminals in the Rolando substance by blockade of retrograde axoplasmic transport in sensory nerves.

Comparison of Bupivacaine, Etidocaine, and Saline for Trigger-Point Therapy

Injections of local anesthetics, saline, "dry needling," or other stimuli at specific, tender loci (trigger or acupuncture points) are reportedly efficacious in treatment of chronic pain syndromes. In a randomized, double-blind crossover study, subjective responses of 15 patients with myofascial syndrome to trigger-point injections of either bupivacaine 0.5%, etidocaine 1%, or physiologic saline without preservative were compared. Responses in six pain-related categories were determined before treatment and 15 minutes, 24 hours, and 7 days after treatment. Trigger-point injections with bupivacaine and etidocaine were generally preferred over saline in several pain-tested categories. Implications and possible mechanisms are discussed.