The Clinical journal of pain
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To present different aspects and advantages of the laparoscopic approach to the pelvic nerves aimed at treating intractable pelvic neuralgia. ⋯ Laparoscopic approach to the pelvic nerves opens new possibilities for the diagnosis and treatment of pelvic neuralgia, and offers new curative surgical techniques.
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Clinical Trial
Intrathecal treatment in cancer patients unresponsive to multiple trials of systemic opioids.
The aim of this study was to evaluate the clinical response to a combination of intrathecal morphine and levobupivacaine in advanced cancer patients who were highly opioid-tolerant, being previously treated with multiple opioid trials unsuccessfully. Initial intrathecal morphine dose was calculated from the previous opioid consumption using a morphine oral-intrathecal ratio of 100:1. Then, doses of both drugs were modified during the treatment according to the clinical needs and balanced with adverse effects. ⋯ Early complications included mild bleeding in 2 patients, without consequences, headache in 4 patients, bladder catheterization in 6 patients, reoperation for bleeding or changes of catheter position in 4 patients, unrelated death in 1 patient, and stroke in another 1. Late complications included local infection in 2 patients, and discontinuation of intrathecal therapy due to spinal compression. In patients who had received multiple trial of opioids and routes of administration, the intrathecal treatment started with an oral-intrathecal morphine conversion ratio of 100:1, and local anesthetics at the most convenient clinical doses provided a long-term improvement of analgesia, with a decrease in adverse effects and opioid consumption until death.
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It is claimed that transcutaneous electrical nerve stimulation (TENS) operates via a segmental mechanism by reducing ongoing transmission and sensitization of nociceptive dorsal horn neurons. Hence, TENS electrodes are usually placed at the site of pain. ⋯ Taken at face value, the findings suggest that TENS effects were nonspecific and that electrode location does not affect outcome. However, this study should be seen as a call for further research rather than a definitive conclusion.
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To evaluate interrater reliability using 5 newly trained observers in the assessment of pressure pain threshold (PPT) using a fixed-angle algometer. ⋯ This study provides new evidence that trained observers can apply an algometer at a consistent rate and provide highly reliable measures of PPT in healthy humans, when PPT is calculated as the mean of 3 trials.
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The purpose of this study was to compare sleep of adolescents with chronic pain and healthy adolescents using both subjective and objective sleep assessments, and to identify correlates of poor sleep. ⋯ Adolescents with chronic pain evidenced poorer sleep quality, increased insomnia symptoms, and less efficient sleep with more wake bouts in comparison with healthy adolescents, findings that require replication in a larger sample. Assessment and management of sleep disturbances is an important aspect of care for children and adolescents with chronic pain.