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Adequate Pain Control (adequate + pain_control)
Selected AbstractsAntiepileptic Drugs in the Management of Cluster Headache and Trigeminal NeuralgiaHEADACHE, Issue 2001Todd D. Rozen MD Cluster headache and trigeminal neuralgia are relatively rare but debilitating neurologic conditions. Although they are clinically and diagnostically distinct from migraine, many of the same pharmacologic agents are used in their management. For many patients, the attacks are so frequent and severe that abortive therapy is often ineffective; therefore, chronic preventive therapy is necessary for adequate pain control. Cluster headache and trigeminal neuralgia have several distinguishing clinical features. Cluster headache is predominantly a male disorder; trigeminal neuralgia is more prevalent in women. Individuals with cluster headaches often develop their first attack before age 25; most patients with trigeminal neuralgia are between age 50 and 70. Cluster headaches are strongly associated with tobacco smoking and triggered by alcohol consumption; trigeminal neuralgia can be triggered by such stimuli as shaving and toothbrushing. Although the pain in both disorders is excruciating, cluster headache pain is episodic and unilateral, typically surrounds the eye, and lasts 15 to 180 minutes; the pain of trigeminal neuralgia lasts just seconds and is usually limited to the tissues overlying the maxillary and mandibular divisions of the trigeminal nerve. Cluster headache is unique because of its associated autonomic symptoms. Although the pathophysiology of cluster headache and trigeminal neuralgia are not completely understood, both appear to have central primary processes, and these findings have prompted investigations of the effectiveness of the newer antiepileptic drugs for cluster headache prevention and for the treatment of trigeminal neuralgia. The traditional antiepileptic drugs phenytoin and carbamazepine have been used for the treatment of trigeminal neuralgia for a number of years, and while they are effective, they can sometimes cause central nervous system effects such as drowsiness, ataxia, somnolence, and diplopia. Reports of studies in small numbers of patients or individual case studies indicate that the newer antiepileptic drugs are effective in providing pain relief for trigeminal neuralgia and cluster headache sufferers, with fewer central nervous system side effects. Divalproex has been shown to provide effective pain control and to reduce cluster headache frequency by more than half in episodic and chronic cluster headache sufferers. Topiramate demonstrated efficacy in a study of 15 patients, with a mean time to induction of cluster headache remission of 1.4 weeks (range, 1 day to 3 weeks). In the treatment of trigeminal neuralgia, gabapentin has been shown to be effective in an open-label study. When added to an existing but ineffective regimen of carbamazepine or phenytoin, lamotrigine provided improved pain relief; it also may work as monotherapy. Topiramate provided a sustained analgesic effect when administered to patients with trigeminal neuralgia. The newer antiepileptic drugs show considerable promise in the management of cluster headache and trigeminal neuralgia. [source] Phenol Neurolysis for Severe Chronic Nonmalignant Pain: Is the Old also Obsolete?PAIN MEDICINE, Issue 4 2007Natan Weksler MD ABSTRACT Objective., Our purpose was to reassess the effectiveness of phenol 4% in aqueous solution for neurolysis in patients with severe chronic nonmalignant pain syndromes who did not achieve adequate pain control (visual analog scale [VAS] ,3) with conventional pain treatment. Design., Forty-two patients with severe nonmalignant pain persisting for 6 months or longer were followed for more than 6 months after phenol neurolysis in this prospective observational study. All patients had previously received narcotic drugs, with or without nonsteroidal anti-inflammatory agents or adjuvants, without adequate pain relief. An aqueous solution of phenol 4% was used for chemical neurolysis. A fluoroscopically guided technique was used for chemical lumbar sympathectomy, medial branch destruction, and sacroiliac injections. Anatomic-landmarks technique was used for intercostal neurolysis, greater occipital nerve destruction, genitofemoral neuroablation, and paracoccygeal infiltration. Results., Good pain relief (VAS ,3) was achieved in 35 patients after neurolysis with phenol, and the mean VAS decreased from 8.74 ± 1.08 (range 7,10) before treatment to 1.93 ± 2.41 after treatment (P < 0.0001). The mean VAS for assessment of the quality of pain relief after phenol neurolysis was 8.4 ± 2.39, ranging from 0 (no relief at all) to 10 (complete relief ). No major complications were seen. Conclusion., The use of phenol 4% in aqueous solution is an effective and safe technique for neurolysis. Because of the potential risk of flaccid paralysis, this technique should be used in selected cases, far removed from motor nerves and the spinal cord. [source] (231) Use of Transmucosal Fentanyl in Non-Malignant, Chronic PainPAIN MEDICINE, Issue 3 2001Forest Tennant Transmucosal fentanyl (TF) has recently become available for treatment of breakthrough pain in cancer patients who are already tolerant to opioids. In addition to cancer patients, there is a growing number of chronic pain patients who regularly use and are tolerant to opioids and require a breakthrough opioid for adequate pain control. This pilot study was done to determine if TF is effective and acceptable to non-malignant, chronic pain patients who are opioid tolerant and require a breakthrough opioid(s) for pain control. Sixty patients with chronic, non-malignant pain who were maintained on a long-acting opioid and who required breakthrough pain control were given TF in an initial dose of 400 or 600 mcg per single, transmuscosal administration. Among the study group 35 (58.3%) experienced chronic pain due to injuries to the spine and 25 (41.7%) were due to medical conditions other than cancer. After at least three months of usage, patients were asked if they desired to continue TF and the reason(s) why they believed it to be effective. Fifty-eight (96.7%) of these subjects perceived that TF was an effective breakthrough opioid and desired to continue it. The single, effective dosage ranged from 800 to 1600 mcg per administration, and the number of separate monthly dosages ranged from 2 to 360. The majority of patients used TF only for emergency, pain purposes but others preferred TF as their major breakthrough opioid and ceased use of other short-acting opioids including injectable meperidine. Reported reasons for widespread patient acceptance included TF's fast action, fewer bed-bound days, increased energy, decreased use of other opioids, less depression, and fewer emergency room visits. This pilot study indicates that TF is effective and desired as a preferential opioid for breakthrough pain by a high percentage of chronic, non-malignant pain patients. [source] Day-case sling surgery for stress urinary incontinence: feasibility and safetyBJU INTERNATIONAL, Issue 6 2005Subhasis K. Giri OBJECTIVE To prospectively assess the feasibility for discharge 10 h after a porcine dermal pubovaginal sling procedure (PVS), to examine the surgical factors (postoperative complications) affecting discharge, and to measure the short-term cure rate for stress urinary incontinence (SUI). PATIENTS AND METHODS Between June 2003 and December 2003, 40 consecutive patients with SUI and scheduled for treatment using a porcine dermal sling were enrolled in this prospective study. Patients were admitted with a planned overnight stay and returned to the ward with no urinary catheter. Outcome measures were bladder emptying efficiency (EE) at 10 h after surgery, time intervals to the first three spontaneous voids, EE of the first three voids, time required to achieve an EE of ,,75%, a visual analogue scale pain score, perioperative complications, and short-term cure rate of SUI. Patients were considered suitable for discharge from hospital when the EE was ,,75% or when they were self-catheterizing confidently with adequate pain control and no significant complication. All patients were followed for 6 months. RESULTS The median EE at 10 h was 61%; 16 patients (40%) achieved efficient emptying and were suitable for discharge 10 h after surgery. The median intervals to the first three spontaneous voids were 7, 10 and 17 h, and the median EEs for the first three voids 46%, 61% and 75%. The median visual analogue scale pain score was 3.5. Patients with intrinsic sphincter deficiency (ISD) were significantly less likely to achieve efficient emptying at 10 h (39% vs 70%). Overall SUI was cured or improved in 90% of patients at the 6-month follow-up. CONCLUSIONS In the present study only 40% of patients were suitable for day-case sling surgery. Early bladder emptying inefficiency was the main limiting factor. Exclusion of patients with ISD and possibly decreasing the EE threshold to 50% would improve the discharge rate. The short-term results of this PVS are similar to those obtained with the autologous fascial sling. [source] | ||||||||||