pain-relief-22.matches: pain relief
[Radiotherapy for symptomatic osseous metastases: special reference to the analysis of patients achieved complete pain relief]

[Article in Japanese]

Okazaki A, Nakamura Y, Noda M, Ozawa Y, Rai T, Sekine M, Maehara T.

Department of Radiology, Kanto Teishin Hospital.

A total of 223 patients with 498 symptomatic osseous metastases treated by radiotherapy between July 1985 and June 1991 were retrospectively analyzed. Most sites, 409 (82%), were irradiated by conventional fractionation, while the remaining 89 sites were irradiated by dose-increment fractionation, low-dose short schedules or hyperfractionation. The total dose ranged from 5.4 to 74 Gy (mean, 41.4 Gy). Daily pain assessment was done by patients themselves on an 11-point scale, i.e., 10: pretreatment pain, 0: disappearance of pain following radiotherapy. In addition, improvement in performance status (PS) and the duration of complete pain relief were assessed. The following results were obtained. 1) Pain relief: Of 498 evaluated sites, complete pain relief and partial pain relief were achieved in 403 sites (81%) and 64 sites (13%), respectively. No significant difference was seen in the incidence of complete pain relief between weight-bearing bone and non-weight-bearing bone. Patients with PS 1, 2 or 3 were significantly superior to those with PS 4 in terms of complete pain relief (P < 0.05-0.001). The complete response rate increased in accordance with the dose delivered, i.e., 49% at 20 Gy, 70% at 30 Gy and 77% at 40 Gy, in all of the 498 sites irradiated; 60%, 86% and 95% of 403 sites, respectively, achieved complete pain relief. Regarding the fractionation regimens, dose-increment fractionation was superior to both conventional fractionation and low-dose short schedules in terms of complete pain relief rate. 2) Improvement of PS: Of 223 evaluated patients, PS was improved 1 to 3 steps in 162 (73%) at the completion of radiotherapy. The improvement rates of patients with PS 2 or 3 were significantly better than those with PS 4 (P < 0.025, 0.001). 3) Duration of complete pain relief: Of 288 appraisable sites, the recurrence of pain was recognized in 23 (9%) at intervals of 3 to 21 months (median, 5 months). On the other hand, the duration of pain relief was 16 to 79 months (median, 32 months) in 26 sites of survivors, and 1 to 28 months (median, 5 months) in 239 sites of decreased patients. The mean total dose was 48.5 Gy (TDF: 82) to 62 sites with a duration of pain relief of more than 13 months. 4) Re-irradiation to the same site: Of 14 sites retreated after initial complete response with a total dose of 30 to 50 Gy (mean, 48 Gy), 11 (79%) were in weight-bearing bone and 9 (64%) responded completely. 5) Patients with unsatisfactory pain relief (pain score > or = 6): Of 31 sites, 27 (94%) were in patients with PS 4, and 19 (61%) received a total dose below 30 Gy. 6) The 11-point scale for patient self-assessment of pain relief following radiotherapy was thought to be useful and easy to adopt in general clinics.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8108247&dopt=Abstract pain, pain medicine, pain relief



pain-relief-22.matches: pain relief
Long-term pain relief during spinal cord stimulation. The effect of patient selection.

Van de Kelft E, De La Porte C.

Department of Neurosurgery, Universitair Ziekenhuis Antwerpen, Edegem, Belgium.

We reviewed our experience with spinal cord stimulation (SCS) in treating 116 patients with pain in one or both legs. All these patients were selected for an initial week of trial stimulation by the criteria: pain due to a known benign organic cause, failure of conventional pain control methods and absence of major personality disorders. Selected patients included 78 with the Failed Back Surgery Syndrome (FBSS), in whom proven correlation existed between the clinical picture and the neuroradiological and electromyogram abnormalities. Eighty-four out of 116 selected patients underwent definitive SCS implantation after 1 week of trial stimulation with excellent results (more than 75% pain relief). They were followed clinically every 3 months for a mean follow-up period of 47 months. Forty-five patients (54%) continued to experience at least 50% of pain relief at the latest follow up. Seventy-seven patients (91%) were able to reduce their medication intake and 50 patients (60%) reported an improvement in lifestyle. FBSS patients responded more positively to the trial stimulation than the other patients. However, the later outcome was not affected by patient selection as long-term benefit was similar in all definitive SCS patients irrespective of aetiology.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8142944&dopt=Abstract pain, pain medicine, pain relief



pain-relief-22.matches: pain relief
[Analgesia in cancer: beliefs and an update]

[Article in Portuguese]

Pimenta CA, Koizumi MS.

Cancer pain relief is not yet adequate, but there are resources for this. Professional's misconception and the tabu about that pain in cancer is inevitable have been contributing to this problem. Important nurses' knowledge lacuna about pain relief in cancer was found by this study. The WHO program about pain relief in cancer is presented too.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8159857&dopt=Abstract pain, pain medicine, pain relief



pain-relief-22.matches: pain relief
[Evaluation of selective lumbar radiculography and radicular block]

[Article in Japanese]

Yamagami H, Hashizume K, Sha K, Furuya H, Okuda T.

Department of Anesthesiology, Nara Medical University, Kashihara.

We analyzed 56 patients who received selective lumbar radiculography and radicular block (88 procedures in total). The underlying conditions were spinal diseases in 43 cases, cancer pain in 6 cases, post-herpetic neuralgia (PHN) in 5 cases and reflex sympathetic dystrophy (RSD) in 2 cases. In the spinal disease group, 24 cases showed complete pain relief and 12 cases showed partial pain relief after the therapy, with a success rate of 83.7%. In the cancer pain group, 3 cases showed complete pain relief and one showed partial pain relief (success rate: 66.7%). In the PHN group, 1 case showed complete pain relief and 2 showed partial pain relief (success rate: 60%). In the RSD group, all cases showed pain relief. When examined 3 months after this treatment, the effect had persisted in 15 cases from the spinal disease group, in 1 case from the cancer pain group, in 2 cases from the PHN group and in 2 cases from the RSD group. Selective lumbar radiculography and radicular block are useful in identifying a nerve root responsible for abnormalities. In addition, this procedure is expected to exert a long-lasting therapeutic effect in cases indicated for the procedure.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8164333&dopt=Abstract pain, pain medicine, pain relief



pain-relief-22.matches: pain relief
[Postoperative pain relief by continuous epidural infusion: a comparison of three solutions]

[Article in Japanese]

Hayashi H, Kanoh T, Inoue T, Nishiuchi T, Tamura H, Takeda K.

Department of Anesthesia, Osaka National Hospital.

The effect of three solutions on postoperative pain relief by continuous epidural infusion was studied. Seventy-five patients after upper or lower abdominal surgeries were assigned to one of three groups and the postoperative pain relief was evaluated for 48 hours. Group I: bolus injection of buprenorphine (Bn) 0.1 mg + saline (S) 8 ml and continuous infusion (2 ml.h-1) of Bn 0.8 mg + S 92 ml; Group II: bolus injection of Bn 0.1 mg + 0.5% bupivacaine (Bc) 4 ml + S 4 ml and continuous infusion of Bn 0.8 mg + S 92 ml; Group III: bolus injection of Bn 0.1 mg + 0.5% Bc 4 ml + S 4 ml and continuous infusion of Bn 0.8 mg + 0.5% Bc 40 ml + S 60 ml. The combination of buprenorphine with low-dose bupivacaine (Group III) offered the most effective postoperative analgesia in three groups without increasing the frequency of adverse effects induced by epidural administration of local anesthetics. However, even in Group III, the percentage of patients complaining of pain at bed rest was still high during early postoperative period (56% at 6 hours postoperatively). The results suggest that further consideration is necessary on agents selection and dosage adjustment for the postoperative epidural analgesia.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8230700&dopt=Abstract pain, pain medicine, pain relief



pain-relief-22.matches: pain relief
[Cervical epidural morphine and buprenorphine for postoperative pain relief after thoracic surgery--a comparative study in the same patients]

[Article in Japanese]

Inoue Y, Nakazawa K, Hikawa Y, Saitoh Y, Yasuda K.

Department of Anesthesia, Tokyo Metropolitan Hospital of Fuchu.

The effects of cervical epidural morphine and buprenorphine on postoperative pain were studied in 12 patients who received thoracic surgery twice. The patients who had received morphine 3 mg on the first operation were given buprenorphine 0.15 mg on the second operation, and the others received them vice versa. Morphine or buprenorphine was administered with 6 ml of 0.25% bupivacaine before skin incision. The duration of pain relief with morphine was longer (21.5 +/- 4.0 h) than with buprenorphine (13.9 +/- 7.8 h). The result of the questionnaires to the patients after operation shows that 10 patients (84%) were satisfied with morphine whereas only 6 patients (50%) were satisfied with buprenorphine. Seven patients preferred morphine to buprenorphine for postoperative analgesia, and the rest of the patients stated that analgesic effects were similar between the two. It seems that epidural morphine 3 mg may give more excellent postoperative pain relief after the thoracic surgery than epidural buprenorphine 0.15 mg.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8230722&dopt=Abstract pain, pain medicine, pain relief



pain-relief-11.matches: pain relief
Continuous epidural analgesia for painless labor does not increase the incidence of cesarean delivery.

Fung BK.

Department of Anesthesia, Puli Christian Hospital, Nantou, Taiwan, R.O.C. bill mail.pch.org.tw

BACKGROUND: Continuous epidural analgesia is a popular technique provided for labor pain relief. However, the possible association between epidural analgesia and increased rate of cesarean delivery is always a concern. The purpose of this study was to explore if epidural analgesia would affect the rate of cesarean delivery in healthy term parturient women. METHODS: A retrospective review of obstetric records of 822 parturients was done to compute the proportions and odds ratio of cesarean delivery between parturients receiving epidural analgesia for labor pain relief and those not receiving. RESULTS: Results indicated that the overall proportion of cesarean delivery was 11.1% in the epidural group as against 16.2% in the control group and the odds ratio was 0.65 (95% confidence interval: 0.37 to 1.08). The difference between groups was not statistically significant. However, for nulliparous women alone, the proportions of cesarean delivery were 11.6% and 25.1% in exposure group and control group respectively. The odds ratio was 0.39 (95% CI: 0.20 to 0.71). This difference was statistically significant. CONCLUSIONS: The findings may support the conclusion that continuous epidural analgesia for pain relief during labor would not increase the rate of cesarean delivery. In contrast, it may reduce this risk in nulliparas.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11000670&dopt=Abstract pain, pain medicine, pain relief