pain-relief-3.matches: pain relief
Gamma knife surgery with a dose of 75 to 76.8 Gray for trigeminal neuralgia.

Brisman R.

Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York Presbyterian Hospital, New York, New York, USA. rb36 columbia.edu

OBJECT: The author presents a large series of patients with idiopathic trigeminal neuralgia (TN) who were treated with gamma knife surgery (GKS), at a maximum dose of 75 to 76.8 Gy, and followed up in a nearly uniform manner for up to 4.6 years. METHODS: Two hundred ninety-three patients were treated and followed up for at least 6 months (range 0.4-4.6 years, median 1.9 years). At the final follow-up review, there was complete (100%) pain relief without medicines in 64 patients (21.8%), 90% or greater relief with or without small doses of medicines in 86 (29.4%), between 75 and 89% relief in 31 (10.6%), between 50 and 74% relief in 19 (6.5%), and less than 50% relief in 23 patients (7.8%). Recurrent pain requiring a second procedure occurred in 70 patients (23.9%). Kaplan-Meier analysis showed that 100%, 90% or greater, and 50% or greater pain relief was obtained and maintained for 3.5 to 4.1 years in 5.6, 23.7, and 50.4% patients, respectively. Of 31 patients who described pain relief ranging from 75 to 89%, 80% of patients described it as good and 10% as excellent; of 17 patients who reported between 50 and 74% pain relief, 53% described it as good and none as excellent (p = 0.014). Dysesthesia scores greater than 5 (scale of 0-10, in which a score of 10 represents excruciating pain) occurred in four (3.2%) of 126 patients who had not undergone prior surgery; all these patients obtained either good or excellent relief from TN pain. There were 36 patients in whom the TN had atypical features; these patients were less likely to attain at least 50% or at least 90% pain relief compared with those without atypical TN features (p = 0.001). CONCLUSIONS: Gamma knife surgery is a safe and effective way to relieve TN. Patients who attain between 75 and 89% pain relief are much more likely to describe this outcome as good or excellent than those who attain between 50 and 74% pain relief.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15137604&dopt=Abstract pain, pain medicine, pain relief



pain-relief-3.matches: pain relief
Comparative evaluation of two hypofractionated radiotherapy regimens for painful bone metastases.

Amichetti M, Orru P, Madeddu A, Murtas R, Carau B, Farigu R, Carta S, Orru S, Nagliati M, Lay G, Dessi M.

Department of Radiation Oncology, Regional Oncological Hospital A Businco, Cagliari, Italy. amichettim yahoo.it

AIMS AND BACKGROUND: In 75% of the patients with bone metastases (BM) pain is the dominant symptom. Radiotherapy (XRT) plays a major role in the palliation of pain in patients with BM. Several schedules of short and long fractionation XRT are used in clinical practice, with hypofractionated treatments being even more attractive for practical reasons. A considerable body of evidence supports the clinical use of short schedules and single-dose XRT. We retrospectively evaluated the efficacy of two short fractionated schedules of 8 Gy as a single dose and 20 Gy in 5 fractions in relieving pain in patients with multiple uncomplicated BM. METHOD: From January to December 2001, 130 patients with 146 painful BM were treated with palliative localized XRT. There were 42 males and 88 females with a median age of 58 years (range 28-84). The commonest sites of treatment were the spine (59.6%) and pelvis (14.4%). The primary endpoint was clinically significant pain relief in the first six months of follow-up evaluated with the IAEA (International Atomic Energy Agency) pain measurement score measuring pain severity and pain frequency. Analgesic use was also recorded before and after treatment as drug frequency and drug severity. Patients with painful BM from any primary tumor site were irradiated. Treatment schedules consisted of a course of XRT with 4 Gy/fraction/day (total dose: 20 Gy/5 fractions) (group A, 59 lesions) or with a single dose of 8 Gy (group B, 87 lesions). RESULTS: There was no significant difference in complete response (CR) rates between treatment schedules: complete pain relief was achieved in 17/59 lesions (29%) in the fractionated group and in 29/87 lesions (33%) in the single-dose group. Also the overall response (complete + partial) was similar: 35/59 lesions (60%) in group A and 60/87 (69%) in group B. The minimum, maximum and median follow-up was 3, 23, and 9 months, respectively, for group A and 3, 20, and 11 months for group B. The actuarial median duration of pain relief was similar: 4.5 months in group A and 4 months in group B. No particular side effects were recorded in either group. CONCLUSIONS: There were no differences between the two fractionation schedules used in our study with regard to pain relief and use of analgesics. Palliation of pain was obtained in approximately two thirds of patients with both schedules, providing further evidence of the similar efficacy between single and multiple fractions. With regard to pain response these data justify a recommendation for the use of a more simple and convenient 8 Gy single fraction for the palliation of uncomplicated BM.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15143979&dopt=Abstract pain, pain medicine, pain relief



pain-relief-3.matches: pain relief
[Use of the World Health Organization guidelines on cancer pain relief before referral to a specialized pain service]

[Article in German]

Felleiter P, Gustorff B, Lierz P, Hornykewycz S, Kress HG.

Abteilung fur allgemeine Anasthesie und Intensivmedizin B, Universitatsklinik Wien.

In 1986 the World Health Organization (WHO) released guidelines for cancer pain relief. Since then, several controlled studies on effectiveness and practicability of these guidelines have been published. Various authors described inadequate use of these guidelines.We analysed, whether the pain medication of 160 cancer patients referred to the anesthesiological pain clinic at the university hospital of Vienna corresponded to the WHO guidelines or not. Adequacy of pain treatment was assessed using the pain management index (PMI). Multiple criteria were chosen to assess the conformity of the treatment with the guidelines. Furthermore we studied the effect of a strict use of the WHO guidelines in these patients.The average pain intensity of the referred patients was 75 mm (VAS). Negative PMI scores, indicating inadequate pain therapy, were fount in 39 % of cases. A violation of the rules was found in 38% of the therapy schedules. Pain medication was then modified by switching to fixed time intervals, escalation of the steps of the WHO ladder, increasing the dosage or treating neuropathic pain with adjuvant drugs. Two weeks later the average pain score of the patients was reduced to 27 mm (VAS). At that time 72% of the patients quoted an adequate reduction of pain.Inadequate knowledge or disregard of the WHO guidelines for cancer pain relief are common and result in unnecessary and prolonged suffering in these patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15164275&dopt=Abstract pain, pain medicine, pain relief



pain-relief-3.matches: pain relief
A survey of current perianesthesia nursing practice for pain and comfort management.

Krenzischek DA, Windle P, Mamaril M.

Johns Hopkins Hospital, Baltimore, MD, USA. dinaak comcast.net

Widespread dissemination of information and high-profile press coverage about pain and comfort management has resulted in heightened awareness among health care professionals and the public of the need for improvements in the way pain and comfort are managed. Despite significant advances in treatment options for pain relief and comfort, studies show that both phenomena continue to be poorly managed and undertreated. Providing pain relief and comfort to patients are important fundamental components of good nursing care; however, no studies have been performed to evaluate these responsibilities in perianesthesia nursing practice. Therefore, a descriptive survey was undertaken to assess the current practices for pain and comfort management among perianesthesia nurses. A convenience sample of 220 perianesthesia nurses working in preoperative and postoperative settings in rural and urban hospitals, outpatient centers, and freestanding facilities completed a questionnaire survey. The survey asked 10 questions that addressed various aspects of pain and comfort care, including assessment in different settings, discharge criteria, and obstacles in the management of pain and comfort. Findings showed that perianesthesia nurses assessed pain at a frequency of 58% and comfort at a frequency of 56% on admission. Preoperative assessment of patients' desired level of pain relief and comfort occurred at frequencies of 21% and 20%, respectively. Pain was assessed most often with self-report pain ratings and ordinal descriptions such as "no pain" to "severe pain." A moderate pain level was used most often as a discharge criterion. Inappropriate and inadequate physicians' orders were cited as two of the most common obstacles to managing pain and comfort. Findings of this study can be used to increase awareness of the need to evaluate and improve pain and comfort management education and practices in the perianesthesia settings. ASPAN will also use the results as baseline data as it establishes a strategic plan to address the educational needs of its members.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15195273&dopt=Abstract pain, pain medicine, pain relief



pain-relief-4.matches: pain relief
What decline in pain intensity is meaningful to patients with acute pain?

Cepeda MS, Africano JM, Polo R, Alcala R, Carr DB.

Department of Anesthesia, Javeriana University School of Medicine, San Ignacio Hospital, Bogota, Colombia.

Despite widespread use of the 0-10 numeric rating scale (NRS) of pain intensity, relatively little is known about the meaning of decreases in pain intensity assessed by means of this scale to patients. We aimed to establish the meaning to patients of declines in pain intensity and percent pain reduction. Upon arrival to the postanesthesia care unit, postsurgical patients rated their baseline pain intensity on both a 0-10 NRS and on a 4-point verbal scale. Patients whose NRS was higher than 4/10 received intravenous opioids until their pain intensity declined to 4/10 or lower. During opioid titration, patients were asked every 10 min to rate pain intensity on a NRS and to indicate the degree of pain improvement on a 5-point Likert scale from 'no improvement' to 'complete pain relief'. Seven hundred adult patients were enrolled. For patients with moderate pain, a decrease of 1.3 units (20% reduction) corresponded to 'minimal' improvement, a decrease of 2.4 (35% reduction) to 'much' improvement, a decrease of 3.5 units (45% reduction) corresponded to 'very much' improvement. For patients with severe pain, the decrease in NRS pain score and the percentage of pain relief had to be larger to obtain similar degrees of pain relief. The change in pain intensity that is meaningful to patients increases as the severity of their baseline pain increases. The present findings are applicable in the clinical setting and research arena to assess treatment efficacy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14499431&dopt=Abstract pain, pain medicine, pain relief



pain-relief-4.matches: pain relief
Linear accelerator radiosurgery using 90 gray for essential trigeminal neuralgia: results and dose volume histogram analysis.

Goss BW, Frighetto L, DeSalles AA, Smith Z, Solberg T, Selch M.

Department of Radiation Oncology, University of California Los Angeles Medical Center, Los Angeles, California 90095, USA. gossbryan yahoo.com

OBJECTIVE: To evaluate treatment of essential trigeminal neuralgia with 90 Gy delivered by a linear accelerator dedicated to radiosurgery. METHODS: This is a retrospective case series of 25 patients with essential trigeminal neuralgia treated from March 1999 to March 2001. All were treated with 90 Gy by means of a 5-mm collimator directed to the nerve root entry zone. Patient follow-up (range, 8-52 mo; median, 18 mo) was completed by an uninvolved party. Dose volume histograms of the brainstem were developed for the 20, 30, and 50% isodose lines by means of radiosurgery planning software. RESULTS: All patients obtained good to excellent pain relief with treatment. Nineteen (76%) of 25 patients achieved excellent pain relief (pain-free without medication). Six patients (24%) achieved good pain relief (50-90% reduction of pain with or without medication). Median time to pain relief was 2 months. Eight patients (32%) experienced relapse 4 to 13 months after treatment. Eight patients (32%) developed facial numbness, but none developed painful numbness. Mean brainstem volume within the 50% isodose line and occurrence of numbness was statistically significant (P = 0.03). There was no correlation between brainstem volume treated and outcome. CONCLUSION: Dedicated linear accelerator-based stereotactic radiosurgery that uses a 5-mm collimator to deliver 90 Gy to the nerve root entry zone is a safe and effective method for the treatment of essential trigeminal neuralgia. Care should be taken to limit brainstem volume included in the 50% isodose line in the treatment plan to avoid facial numbness.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14519214&dopt=Abstract pain, pain medicine, pain relief



pain-relief-4.matches: pain relief
Patients with lateral tracking patella have better pain relief following CT-guided tuberosity transfer than patients with unstable patella.

Diks MJ, Wymenga AB, Anderson PG.

Department of Orthopedics, St. Maartenskliniek, PO Box 9011, 6500 GM Nijmegen, The Netherlands. miranda.diks planet.nl

In patients with either lateral tracking patella or unstable patella the pathological lateral position of the tuberosity can be corrected by a medial transfer. This study compared the results of subtle CT-guided correction of the tuberosity for objective unstable patella (n=27) with the results for lateral tracking patella (potential instability) as described by Dejour (n=16). Follow-up was 37 months. CT revealed a pathological lateralization of the tibial tuberosity-trochlear groove greater than 15 mm in 41 knees. These patients underwent medialization of the tibial tuberosity up to 10-12 mm lateral from the trochlear groove, and 28 patients underwent a distalization to normalize the Caton index to 1.0-1.2. Results were evaluated using Cox' method. Patients with objective patellar instability were rated as 11% excellent, 52% good, 33% fair, and 4% poor. All patients became stable except one who had a 6 degrees valgus alignment. Although 96% had improved stability, 33% of the patients still had pain. The patients with lateral tracking patella (potential instability) were rated as 37.5% excellent, 44% good, and 19% fair. The lower proportion of pain relief in patients with unstable patella is likely the result of the cartilage damage experienced by these patients following multiple dislocations. Thus the patient with lateral tracking patella without patella dislocations must be differentiated from the one with unstable patella. Their prognosis in pain relief is better.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14523612&dopt=Abstract pain, pain medicine, pain relief