Articles: pain-management-methods.
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Background. Expert panels of physicians and nonphysicians in the field of intrathecal therapies convened in 2000 and 2003 to make recommendations for the rational use of intrathecal analgesics based on the preclinical and clinical literature known up to those times. An expert panel of physicians convened in 2007 to update previous recommendations and to form guidelines for the rational use of intrathecal opioid and nonopioid agents. ⋯ Results. The panelists, after review of the literature from 2000 to 2006 and discussion, created an updated algorithm for the rational use of intrathecal opioid and nonopioid agents in patients with nonmalignant and end-of-life pain. Of note is that the panelists felt that ziconotide, based on new and relevant literature and experience, should be updated to a line one intrathecal drug.
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Introduction. Intractable pain in the affected arm is a common sequel to severe traction lesions of the brachial plexus. Its management presents a challenge. Existing interventional therapies are not effective for the intractable pain from brachial plexus traction lesions, in the long term. ⋯ Methods. We report here a single case report of the successful management of intractable pain of uncertain pathology following traction injury of the shoulder and brachial plexus with the percutaneous implantation of a permanent stimulating electrode via a stimulating needle to the brachial plexus using the posterior route at the interscalene level. Results. Stimulation of the brachial plexus in this one patient has resulted in excellent pain control and unexpected beneficial sensory and motor changes in the arm of the patient. Conclusions. We cautiously conclude that percutaneous implantation of a stimulating electrode to the brachial plexus via a stimulating needle is a relatively simple procedure when compared to surgical implantation and, as shown in our case, very effective.
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Objectives. Vertebral fractures are the most common consequences of severe osteoporosis. The chronic pain from collapse of osteoporotic vertebrae affects quality of life (QoL) and autonomy of patients. The management of pain with oral or transdermal opiates can cause severe side-effects. ⋯ The mean morphine dose during the spinal trial was 11.28 mg/day, 7.92 mg/day at pump implantation, and 16.32 mg/day at one-year follow-up. Conclusions. Our results show that intrathecal administration of morphine efficiently relieves the symptoms of pain and improves QoL. Continuous intrathecal administration of morphine appears to be an alternative therapy to conventional analgesic drug delivery and has advantages in those patients who have severe side-effects with systemic administration of analgesics.
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Objective. When using spinal cord stimulation (SCS) for chronic pain management, precise longitudinal positioning of the cathode is crucial to generate an electrical field capable of targeting the neural elements involved in pain relief. Presently used methods have a poor spatial resolution and lack postoperative flexibility needed for fine tuning and reprogramming the stimulation field after lead displacement or changes in pain pattern. We describe in this article a new method, "electrical field steering," to control paresthesia in SCS. ⋯ Conclusions. By means of cathodal steering on a longitudinal contact array, the group of excited DC and DR fibers, and thus paresthesia coverage, can be controlled when using SCS. With widely spaced contacts, superposition of the electrical field from each steering contact is limited. To precisely control segmental paresthesia (DR stimulation), a small contact spacing is necessary.
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Objective. To present different aspects and advantages of the laparoscopic implantation of a peripheral nerve stimulator adjacent to the pelvic nerves, aimed at treating intractable pelvic neuralgia by means of neuromodulation-the laparoscopic implantation of neuroprothesis (LION) procedure. Materials and Methods. We report here a series of three patients with different types and etiologies of chronic pelvic neuralgia who underwent laparoscopy for implantation of a peripheral nerve stimulator for neuromodulation, the first for neuromodulation of the ilioinguinal and pudendal nerves, the second for neuromodulation of the sciatic nerve, and the third for neuromodulation of the sacral nerve roots. ⋯ Conclusions. Laparoscopy allows optimal implantation of electrodes on all pelvic nerves through a minimally invasive approach. In addition, it permits new applications of neuromodulation for pelvic polyneuropathies or mononeuropathy, not covered by classical spinal cord or transcutaneous techniques.