pain-relief-12.matches: pain relief
Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute.

Rogers CL, Shetter AG, Fiedler JA, Smith KA, Han PP, Speiser BL.

St. Joseph's Hospital and Barrow Neurological Institute, Phoenix, AZ, USA. lelandroge aol.com

PURPOSE: To assess the efficacy and complications of Gamma Knife radiosurgery for trigeminal neuralgia. METHODS AND MATERIALS: The Barrow Neurological Institute (BNI) Gamma Knife facility has been operational since March 17, 1997. A total of 557 patients have been treated, 89 for trigeminal neuralgia (TN). This report includes the first 54 TN patients with follow-up exceeding 3 months. Patients were treated with Gamma Knife stereotactic radiosurgery (RS) in uniform fashion according to two sequential protocols. The first 41 patients received 35 Gy prescribed to the 50% isodose via a single 4-mm isocenter targeting the ipsilateral trigeminal nerve adjacent to the pons. The dose was increased to 40 Gy for the remaining 13 patients; however, the other parameters were unvaried. Outcome was evaluated by each patient using a standardized questionnaire. Pain before and after RS was scored as level I-IV per our newly-developed BNI pain intensity scoring criteria (I: no pain; II: occasional pain, not requiring medication; III: some pain, controlled with medication; IV: some pain, not controlled with medication; V: severe pain/no pain relief). Complications, limited to mild facial numbness, were similarly graded by a BNI scoring system. RESULTS: Among our 54 TN patients, 52 experienced pain relief, BNI score I in 19 (35%), II in 3 (6%), III in 26 (48%), and IV in 4 (7%). Two patients (4%) reported no relief (BNI score V). Median follow-up was 12 months (range 3-28). Median time to onset of pain relief was 15 days (range 0-192), and to maximal relief 63 days (range 0-253). Seventeen (31%) noted immediate improvement (</= 24 h). Prior to RS, all patients were on pharmacologic therapy felt to be optimal or maximal. Twenty-two (41%) were able to stop medications entirely (BNI score I or II). Another 16 (30%), with BNI Score III relief, decreased medication intake by at least 50%. Patients with classical TN pain symptoms were more likely to stop medications than those with atypical features, 49% (21 of 43) versus 9% (1 of 11). This difference was significant at p = 0.040. Statistically, the finding most predictive for pain relief was new facial numbness following RS. Each of the 5 patients with new numbness after RS developed BNI score I relief, contrasting with 35% for the 49 patients with no new numbness (p = 0.019). Complications have been limited to delayed, mild facial sensory loss. Before RS, 17 patients had numbness from prior invasive procedures, none of whom reported a worse numbness score after treatment. Thirty-seven patients had no facial numbness at the time of RS, of whom 5 developed facial hypesthesia. Each rated this as "mild, not bothersome." There have been no other sequellae. CONCLUSION: RS is an effective treatment, and is the least invasive nonpharmacologic therapy for TN. It carries a small risk of mild facial hypesthesia, a side effect which, somewhat ironically, may be desirable, because it appears to correlate favorably with an excellent pain response. We currently include radiosurgery among the appropriate options for TN patients who have failed optimal medical management, with or without prior invasive neurosurgical procedures. We present here BNI scoring systems for pain intensity and facial numbness. These have proved simple and reliable, have facilitated data collection, rendered analysis more objective, and improved our ability to discuss results with patients and colleagues.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10863073&dopt=Abstract pain, pain medicine, pain relief



pain-relief-34.matches: pain relief
A survey of pain relief clinics in the South Western Region.

Alexander JI.

All the district general hospitals in the South Western Health Region have a pain relief service in existence or planned for the immediate future. Almost all are recognized by the allocation of anaesthetic consultant sessions. In most cases, this allocation is less than the time required for pain relief. All the consultants concerned work in single disciplinary clinics and accept both in-patient and out-patient referrals. They provide an advisory and therapeutic service to patients in the care of other clinicians and give tuition, mainly to junior anaesthetists. Most also undertake domiciliary assessment and treatment. In most clinics the Pain Relief Service is hampered by inadequate facilities. The minimum facilities for a basic efficient service are here reviewed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10258567&dopt=Abstract pain, pain medicine, pain relief



pain-relief-34.matches: pain relief
Half-body irradiation in the treatment of metastatic prostatic carcinoma.

Rowland CG, Bullimore JA, Smith PJ, Roberts JB.

High dose radiation therapy given as a single fraction to the upper and lower halves of the body gives effective palliation for metastatic solid tumours. This treatment modality appears to be particularly effective in tumours which may have a slow doubling time such as carcinoma of the prostate. Fifty-two patients with metastatic carcinoma of the prostate involving the skeletal system have received half-body irradiation. All had prior treatment with additive hormones or orchiectomy and the majority had received localised irradiation and/or chemotherapy. Significant immediate pain relief was achieved in 42 out of 52 patients (80%). This pain relief was maintained until death in 29 out of 43 patients (67%). Pain relief in responders appears to occur within 24 to 48 h of treatment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6172173&dopt=Abstract pain, pain medicine, pain relief



pain-relief-12.matches: pain relief
Spinal cord stimulation in critical limb ischemia of the lower extremities: our experience.

Petrakis IE, Sciacca V.

1st Department of General Surgery, Policlinico Umberto I, University of Rome La Sapienza.

BACKGROUND: Spinal cord stimulation (SCS) improves microcirculatory blood flow, relieves ischemic pain and reduces amputation rate in patients with severe peripheral arterial occlusive disease. Aim: To evaluate the specific prognostic parameters in the prediction of successful SCS and to perform a retrospective data analysis obtained during our patient follow-up. METHODS: 150 patients (97 men, 53 women; mean age: 68 years; range: 46-81) were submitted to implantation of a spinal cord electrical generator for rest pain, and trophic lesions with dry gangrene in severe lower limb ischemia, after failed conservative or surgical treatment. The clinical status was classified as Fontaine's stage III and IV and the main pathology was essentially due to atherosclerosis and diabetic vascular disease. In clinical controls, pedal transcutaneous oxygen tension (TcPO2), ankle and toe pressure Doppler measurements were utilised to select and follow-up the patients. RESULTS: After a mean follow-up of 71 months (range 24-138), pain relief >75% and limb salvage was achieved in 85 patients. In 28 patients was obtained a partial success with pain relief >50% and limb salvage for at least 6 months, while in 37 patients the method failed or for technical problems the device was removed, and the patients were amputated. TcPO2 was assessed on the dorsum of the foot. Clinical improvement and SCS success was associated with the increasing of TcPO2, before and after implantation (temporary period). Limb salvage was achieved in the patients that presented significant TcPO2 changes within the first 2 weeks of the testing period, indifferent from the stage of the disease, and from the initial TcPO2 value. After long-term patient follow-up TcPO2 changes, from 22.6 to 43.1 mm Hg in these with rest pain (p<0.01), from 16.2 to 36.1 mmHg (p<0.02) in those with trophic lesions <3 cm2, and from 12.4 to 28.1 in the patients with trophic lesions >3 cm2. A TcPO2 increase of more than 50% in the first 2 months after implantation was predictive of success, and was related with the presence of adequate paresthesias in the painful area during the trial period. The systolic ankle/brachial blood pressure index did not change under stimulation. CONCLUSIONS: In patients with failed conservative and surgical treatment for severe critical lower limb ischemia, the SCS increases the skin blood flow, is associated with a significant pain relief and could be proven an excellent alternative therapy that improves the quality of life. TcPO2 changes, within a test period of 2 weeks, is a predictive index of therapy success and should be considered before the final decision in terms of cost effect, for the permanent implantation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10864391&dopt=Abstract pain, pain medicine, pain relief



pain-relief-34.matches: pain relief
Ventilatory response to intractable pain.

Glynn CJ, Lloyd JW, Folkhard S.

Fifty-two patients, admitted to a pain relief unit, had a cannula placed in the radial artery to measure the paO2, paCO2 and pH of arterial blood every 2 h, for periods ranging from 12 to 24 h. The patients were divided into 3 groups: 14 had low back pain, 21 patients had pain from cancer, and 17 had pain from other causes. Twenty were male and 32 were female with a mean age of 53 years (range 16-82 years). The mean paO2 of these groups was within normal limits. The mean paCO2 and pH for the 3 groups were, low back pain paCO2 4.1 kpa, pH 7.42, others, paCO2 4.2 kpa, pH 7.42. The finding of a normal pH associated with a low paCO2 suggests that patients were "reset" to a low paCO2. Treatment, which was most commonly nerve blocks, resulted in marked pain relief in 30 patients. Ten of these patients were available for follow-up at least 1 week later (4 from the low back pain group, 6 from the cancer group), and in every patient, after pain relief, there was a rise in paCO2 which was statistically significant (P less than 0.001) and was not accompanied by a fall in pH. This suggests that intractable pain is accompanied by chronic hyperventilation and that the relief of pain is accompanied by a decrease in ventilation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6459556&dopt=Abstract pain, pain medicine, pain relief



pain-relief-34.matches: pain relief
Behavioral treatment of chronic low back pain: clinical outcome and individual differences in pain relief.

Keefe FJ, Block AR, Williams RB Jr, Surwit RS.

The response of 111 chronic low back pain patients to a comprehensive behavioral treatment program emphasizing relaxation procedures is examined. Over the course of treatment, significant reductions were obtained on measures of subjective tension, EMG activity, and pain. Many patients also decreased their intake of analgesic/narcotic agents and reported an increase in activity level. In order to examine individual differences in pain relief, the 28 patients who had the greatest decreases in pain were compared to those who had the least decreases in pain. Patients who had the best outcome in terms of pain relief were significantly more likely to show improvements in other outcome measures. In addition, these patients rated their pain initially as more severe, had continuous pain for fewer years, and were less likely to be on disability or to have had multiple surgical procedures. These results are discussed in the light of recent data from other behavioral treatment studies with chronic low back pain patients and implications for behavioral assessment and treatment are discussed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6459557&dopt=Abstract pain, pain medicine, pain relief



pain-relief-34.matches: pain relief
[Centro-median thalamotomy for central pain following stroke --its effectiveness and limits]

[Article in Japanese]

Niizuma H, Kwak R, Ohyama H, Ikeda S, Suzuki J, Saso S.

Centro-median thalamotomy was performed on 18 patients with central pain caused by cerebrovascular disease. Fourteen were males and four were females. Clinical diagnoses were thalamic pain in 17 cases including cheiro-orale syndrome in one case and phantom limb pain in one case. CT scans were performed on six recent cases. Four cases had a small low density sera in the thalamus. The other two cases had no remarkable findings. The target was 7.5-11.0 nm posterior to the middle point of the intercommissural line, 1.0 mm below-2.0 mm above that line and 5.5-10.0 mm from the midline. Unilateral lesion was made on 15 cases. Postoperatively, five cases had almost completely relief of pain and four cases had partial improvement. The duration of pain relief was, however, less than two months in four cases, and between three and seven months in four cases. One case had a pain free period for seven months. But, then, severe dysesthesia appeared. Six cases had no pain relief by unilateral lesion. Two cases had no pain relief by bilateral lesions. In the remaining case, unilateral lesion was effective for six months. Then lesion of opposite side was made, but the result was unsatisfactory. The durations from the onset of apoplectic attack to the occurrence of pain were between four months and three years in ten effective cases, and within three months in six among eight failed cases. Many surgical and medical treatments have been attempted for central pain. However, ideal method is still not appeared. Centro-median thalamotomy was effective for 56% of the patients with central pain. But in most of the cases, the duration of pain relief is about a half year at the longest. And may be, this is the limit of effectiveness of centro-median thalamotomy for central pain.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6750432&dopt=Abstract pain, pain medicine, pain relief