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Intractable Pain (intractable + pain)

Distribution by Scientific Domains

Medical Sciences	91%

Selected Abstracts

PHYSIOLOGIC ABNORMALITIES AS BIOLOGIC MARKERS IN SEVERE, INTRACTABLE PAIN

PAIN MEDICINE, Issue 2 2002
Article first published online: 4 JUL 200
Forest Tennant, MD, Dr PH; Laura Herman RN BSN FNP Veract Intractable Pain Centers, 338 S. Glendora Ave., West Covina, CA 91790 It is recognized that biologic markers of severe, intractable pain (SIP) can help distinguish degrees of pain and assist in monitoring treatment effectiveness. Fifty (50.0%) adult ambulatory SIP patients, at the time of referral described their pain as constant, excruciating, produced a bed or house-bound state, and was uncontrolled by non-opioid medications and low dosages of the weak opioids, hydrocodone or codeine. Patients were treated with a long-acting opioid preparation consisting of methadone, oxycodone, morphine, or transdermal fentanyl in addition to a short-acting opioid for breakthrough pain. These patients were screened before treatment and after three months of opioid treatment by: (1) blood pressure; (2) pulse rate; (3) morning cortisol and pregnenolone serum concentrations; and (4) erythrocyte sedimentation rate (ESR). The percentage of patients with physiologic abnormalities before and after three months of treatment were as follows: (1) hypertension above 140/90 mm/Hg; 28 (56.0%) vrs 14 (28.0%); (2) tachycardia above 84/minute; 21 (42.0%) vrs 9 (18.0%); (3) elevated serum cortisol concentration; 12 (24.0%) vrs 2 (4.0%); (4) low serum cortisol serum concentration; 7 (14.0% vrs 1 (2.0%); (5) low pregnenolone serum concentration; 18 (36.0%) vrs 3 (6.0%); and (6) elevated ESR; 10 (20.0%) vrs 3 (6.0%) (p<.05). Mean blood pressure, pulse rate, ESR, and serum concentrations of cortisol and pregnenolone in patients who demonstrated a physiologic abnormality all positively and significantly (p<.05) altered these markers toward normal. This study indicates that some physiologic abnormalities, particularly those related to pituitary-adrenal over-stimulation with excess output of catecholamines and glucocorticoids, may serve as biologic markers which can help to identify SIP and monitor treatment effectiveness. [source]

Opioids for Intractable Pain: The Good, the Bad and the Ugly

PAIN MEDICINE, Issue 2 2005
MPH Editor-in-Chief, Rollin M. Gallagher MD
No abstract is available for this article. [source]

T-type calcium channels: an emerging therapeutic target for the treatment of pain

DRUG DEVELOPMENT RESEARCH, Issue 4 2006
Terrance P. Snutch
Abstract It has become generally accepted that presynaptic high voltage,activated N-type calcium channels located in the spinal dorsal horn are a validated clinical target for therapeutic interventions associated with severe intractable pain. Low voltage,activated (T-type) calcium channels play a number of critical roles in nervous system function, including controlling thalamocortical bursting behaviours and the generation of spike wave discharges associated with slow wave sleep patterns. There is a growing body of evidence that T-type calcium channels also contribute in several ways to both acute and neuropathic nociceptive behaviours. In the one instance, the Cav3.1 T-type channel isoform likely contributes an anti-nociceptive function in thalamocortical central signalling, possibly through the activation of inhibitory nRT neurons. In another instance, the Cav3.2 T-type calcium channel subtype acts at the level of primary afferents in a strongly pro-nociceptive manner in both acute and neuropathic models. While a number of classes of existing clinical agents non-selectively block T-type calcium channels, there are no subtype-specific drugs yet available. The development of agents selectively targeting peripheral Cav3.2 T-type calcium channels may represent an attractive new avenue for therapeutic intervention. Drug Dev. Res. 67:404,415, 2006. © 2006 Wiley-Liss, Inc. [source]

Blocking the R-type (Cav2.3) Ca2+ channel enhanced morphine analgesia and reduced morphine tolerance

EUROPEAN JOURNAL OF NEUROSCIENCE, Issue 12 2004
Kazuaki Yokoyama
Abstract Morphine is the drug of choice to treat intractable pain, although prolonged administration often causes undesirable side-effects including analgesic tolerance. It is speculated that voltage-dependent Ca2+ channels (VDCCs) play a key role in morphine analgesia and tolerance. To examine the subtype specificity of VDCCs in these processes, we analysed mice lacking N-type (Cav2.2) or R-type (Cav2.3) VDCCs. Systemic morphine administration or exposure to warm water swim-stress, known to induce endogenous opioid release, resulted in greater analgesia in Cav2.3,/, mice than in controls. Moreover, Cav2.3,/, mice showed resistance to morphine tolerance. In contrast, Cav2.2,/, mice showed similar levels of analgesia and tolerance to control mice. Intracerebroventricular (i.c.v.) but not intrathecal (i.t.) administration of morphine reproduced the result of systemic morphine in Cav2.3,/, mice. Furthermore, i.c.v. administration of an R-type channel blocker potentiated morphine analgesia in wild-type mice. Thus, the inhibition of R-type Ca2+ current could lead to high-efficiency opioid therapy without tolerance. [source]

Chronic, painful lower extremity wounds: postoperative pain management through the use of continuous infusion of regional anaesthesia supplied by a portable pump device

INTERNATIONAL WOUND JOURNAL, Issue 3 2010
Christy L Scimeca
Reducing and preventing postoperative pain are currently a topic of great interest. There are different modalities for providing analgesia that can provide an alternative or adjunct to opioid therapy. One mode of therapy involves the use of portable pain pump devices that can deliver continuous local anaesthesia directly to the site of interest. A considerable amount of attention in literature has been dedicated to using regional anaesthesia postoperatively for various surgical applications. However, to our knowledge, little or no work has been published concerning the use of infusion of regional anaesthesia in the treatment of painful lower extremity wounds. We present a case report of a 55-year-old gentleman with a complex past medical history, 2-year history of opioid dependency and a 2-week history of intractable pain associated with the combination of debilitating painful diabetic neuropathy and painful lower extremity wounds. After surgical debridement of the lower extremity wounds, substantial analgesia was achieved postoperatively through the implantation of a portable direct infusion pump device. The device supplied 2 ml/hour of 0·25% bupivacaine and resulted in a reduction in pain within the first hour of implantation. Although the device achieved maximal analgesia at 6 hours, we found that this could have been likely reduced through the use of a 5-ml bolus dose of 0·25% bupivacaine at the time of implantation. The device provided sufficient analgesia to the patient without any observed adverse effects, and showed significant potential in avoiding an increase in his requirement for other systemic analgesia including opioids. [source]

Palliative forequarter amputation for metastatic carcinoma to the shoulder girdle region: Indications, preoperative evaluation, surgical technique, and results

JOURNAL OF SURGICAL ONCOLOGY, Issue 2 2001
James C. Wittig MD
Abstract Background and Objectives Uncontrolled metastatic carcinoma of the shoulder girdle is a difficult oncologic problem. This study reviews our experience with palliative forequarter amputation with emphasis on patient selection criteria, preoperative radiologic assessment, surgical technique, epineural postoperative analgesia, and clinical outcome. Methods Eight patients who underwent palliative forequarter amputation for metastatic carcinoma between 1980 and 1999 were analyzed retrospectively. Diagnoses included breast carcinoma (n,=,3), squamous cell carcinoma (n,=,2), hypernephroma (n,=,2), and carcinoma of unknown origin (n,=,1). All patients presented with severe, intractable pain and a useless extremity. Venography demonstrated obliteration of the axillary vein in each of the patients in whom this procedure was performed. Exploration of the brachial plexus confirmed tumor encasement and unresectability in all patients. Epineural catheters for bupivacaine infusion were placed for postoperative pain control. Results All patients experienced dramatic pain relief and improved mobility and overall function. Life-threatening hemorrhage and sepsis were alleviated. There were no instances of phantom limb pain or adverse psychological reactions, and no complications related to epineural analgesia. Conclusions Palliative forequarter amputation is relatively safe and reliable and provides effective pain relief for selected patients with unresectable metastatic carcinoma to the axilla and bony shoulder girdle in whom radiotherapy and/or chemotherapy has not been effective. The triad of pain, motor loss, and an obliterated axillary vein is indicative of brachial plexus infiltration and unresectability. J. Surg. Oncol. 2001; 77:105,113. © 2001 Wiley-Liss, Inc. [source]

Peripheral Nerve Stimulation in Treatment of Intractable Postherpetic Neuralgia

NEUROMODULATION, Issue 4 2007
Alexander E. Yakovlev MD
ABSTRACT Objective., This case report presents an application of peripheral nerve stimulation to a patient with intractable postherpetic neuralgia that conventional treatment failed to ameliorate. Methods., The patient underwent an uneventful peripheral nerve stimulator trial with placement of two temporal eight-electrode percutaneous leads (Octrode leads, Advanced Neuromodulation Systems, Plano, TX, USA) into the right subscapular and right paraspinal area of the upper thoracic region. Results., Upon experiencing excellent pain relief over the next two weeks, the patient underwent implantation of permanent leads two weeks later and reported sustained pain relief. Conclusion. Peripheral nerve stimulation offers an alternative treatment option for intractable pain associated with postherpetic neuralgia, especially for elderly patients where treatment options are limited due to existing comorbidities. Further studies are warranted. [source]

A Case Series of Pulsed Radiofrequency Treatment of Myofascial Trigger Points and Scar Neuromas

PAIN MEDICINE, Issue 6 2009
FIPP, Mazin Al Tamimi MD
ABSTRACT Introduction., Pulsed radiofrequency (PRF) current applied to nerve tissue to treat intractable pain has recently been proposed as a less neurodestructive alternative to continuous radiofrequency lesioning. Clinical reports using PRF have shown promise in the treatment of a variety of focal, neuropathic conditions. To date, scant data exist on the use of PRF to treat myofascial and neuromatous pain. Methods., All cases in which PRF was used to treat myofascial (trigger point) and neuromatous pain within our practice were evaluated retrospectively for technique, efficacy, and complications. Trigger points were defined as localized, extremely tender areas in skeletal muscle that contained palpable, taut bands of muscle. Results., Nine patients were treated over an 18-month period. All patients had longstanding myofascial or neuromatous pain that was refractory to previous medical management, physical therapy, and trigger point injections. Eight out of nine patients experienced 75,100% reduction in their pain following PRF treatment at initial evaluation 4 weeks following treatment. Six out of nine (67%) patients experienced 6 months to greater than 1 year of pain relief. One patient experienced no better relief in terms of degree of pain reduction or duration of benefit when compared with previous trigger point injections. No complications were noted. Discussion., Our review suggests that PRF could be a minimally invasive, less neurodestructive treatment modality for these painful conditions and that further systematic evaluation of this treatment approach is warranted. [source]

Modulatory Effects of Transcranial Direct Current Stimulation on Laser-Evoked Potentials

PAIN MEDICINE, Issue 1 2009
Gabor Csifcsak MD
ABSTRACT Objective., Invasive stimulation of the motor cortex has been used for years to alleviate chronic intractable pain in humans. In our study, we have investigated the effect of transcranial direct current stimulation (tDCS), a noninvasive stimulation method, for manipulating the excitability of cortical motor areas on laser evoked potentials (LEP) and acute pain perception. Designs and Settings., The amplitude of the N1, N2, and P2 LEP components of 10 healthy volunteers were evaluated prior to and following anodal, cathodal, and sham stimulation of the primary motor cortex. In a separate experiment subjective, pain rating scores of 16 healthy subjects in two perceptual categories (warm sensation, mild pain) were also analyzed. Results., Cathodal tDCS significantly reduced the amplitude of N2 and P2 components compared with anodal or sham stimulation. However, neither of the tDCS types modified significantly the laser energy values necessary to induce moderate pain. In a separate experiment, cathodal stimulation significantly diminished mild pain sensation only when laser-stimulating the hand contralateral to the side of tDCS, while anodal stimulation modified warm sensation. Conclusions., The possible underlying mechanisms of our findings in view of recent neuroimaging studies are discussed. To our knowledge this study is the first to demonstrate the mild antinociceptive effect of tDCS over the primary motor cortex in healthy volunteers. [source]

PHYSIOLOGIC ABNORMALITIES AS BIOLOGIC MARKERS IN SEVERE, INTRACTABLE PAIN

Broad-band ultraviolet B phototherapy in zoster patients may reduce the incidence and severity of postherpetic neuralgia

PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE, Issue 5 2006
Mir Hadi Aziz Jalali
Background: Postherpetic neuralgia (PHN) is one of the common complications of herpes zoster infection, particularly in the elderly. Current therapeutic measures are only partially effective in the affected patients. As inflammatory mediators released by different cells play an important role in the pathogenesis of this neuropathic pain and with regard to the immunomodulatory effects of ultraviolet B (UVB) spectrum, we presumed that UVB phototherapy might be effective in the prevention of PHN. Method: This study was performed in two phases. Phase I was a prospective open controlled trial. Twenty-five patients with severe pain in the first 7 days of zoster rash were divided into two groups: the prevention group (n=12) received oral acyclovir (800 mg five times a day for 10 days) plus broad-band UVB to the affected dermatomes, starting with 20 mJ/cm2 and gradually increasing the dose by 10 mJ/cm2 each session to a maximum dose of 100 mJ/cm2. Treatment sessions were repeated three times a week until pain relief or to a maximum of 15 sessions. The control group (n=13), who had disease characteristics similar to the prevention group, received only oral acyclovir with the same dose. All patients reported their severity of pain on a verbal rating scale (VRS, score 0,4) before treatment and at 1 and 3 months' follow-up. In phase II of the study, five patients with established PHN (more than 3 months after rash onset) received UVB with the above-mentioned protocol. Results: A total of 17 patients older than 40 (10 females, seven males; mean age, 65.5 years; range: 47,82 years) who had intractable pain due to zoster infection received UVB in two phases of the study. In patients who received phototherapy in the first 7 days of rash, 58.33% and 83.33% were completely pain free at 1-and 3-month follow-up, respectively. The corresponding figure in the control group was significantly lower (38.46% at 1 month and 53.85% at 3 months). The severity of pain was also lower in the phototherapy group than the control group (mean VRS 2.50 vs. 3.28 at 3 months). None of the patients who were treated more than 3 months after rash onset (established PHN) experienced significant (more than 50%) pain relief. Conclusion: UVB phototherapy in the acute stage of zoster rash might reduce the incidence and severity of PHN. Treatment after 3 months does not seem to have a significant beneficial effect. [source]

Improvement of Chronic Pain by Treatment of Erectile Dysfunction

THE JOURNAL OF SEXUAL MEDICINE, Issue 12 2008
Jalil Arabkheradmand MD
ABSTRACT Introduction., Pain specialists, who do not routinely examine patients regarding their sexual medicine problems, need to be aware that sexual problems can and do aggravate the patient's pain. Patients may refuse to admit suffering from erectile dysfunction (ED) but complain about continuous or progressive severe pain. These patients may be best managed by the combined team effort of a sexual medicine specialist and pain specialist. Aim., This report documents the management of three cases with long-term intractable pain after severe trauma. Treatment of occult ED led to significant improvement of their pain. Main Outcome Measures., The association of the treatment of uncovered ED and improvement of chronic severe pain. Methods., Three case reports of patients with severe pain who attended a pain clinic in an academic medical center. Results., Three men suffering from chronic pain due to severe trauma were observed for several years by different physicians as well as pain specialists. In spite of different treatments, including administration of several analgesics, psychotherapy, and physical therapy, pain was not alleviated. After finding ED problems, patients were referred to the family health clinic. Using different therapies such as psychosexual therapy, correction of sexual misconceptions, relaxation training, treatment of interpersonal difficulties, and pharmacological intervention ED was cured. Treatment of ED was accompanied by a significant reduction of chronic pain in all three patients. Conclusion., The present report indicates that uncovered ED in patients suffering from chronic pain may trigger their somatic pain or reduce its threshold. Significant improvement in sexual functioning may improve the pain and reduce its complications. Arabkheradmand J, Foroutan SK, Ranjbar S, Abbasi T, Hessami S, and Gorji A. Improvement of chronic pain by treatment of erectile dysfunction. J Sex Med **;**:**,**. [source]