Articles: pain.
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At Howard University Hospital, nine terminally ill cancer patients with chronic pain have been treated with continuous intrathecal infusion of morphine delivered by the implantable Infusaid pump. The case of a patient treated at Howard University Hospital with this method of pain management is presented. Following Infusaid pump insertion, the patient lived for 22 months and obtained substantial relief of his cancer pain with no adverse side effects.
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The lack of an available exteriorized permanent epidural catheter led to the application of the Broviac catheter technology to the development of an epidural catheter. The resulting three-piece silicone-rubber catheter system allows specific spinal-level location of the catheter tip from a lumbar entry site, and exteriorization for ease of self-administration. ⋯ Hospitalizations for pain control was decreased by 90% after catheter placement. Therefore, the authors recommend early placement of this silicone-rubber epidural catheter to control pain unrelieved by oral analgesics.
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The method for cancer pain relief proposed by the World Health Organization (WHO) consists of guidelines for a three-step treatment, from non-opioids to weak and then strong opioids, according to need. Adjuvant drugs can be added to each step. This report presents the 2-year experience of the WHO Collaborating Centre at the National Cancer Institute of Milan in the use of this method. ⋯ Neurolytic procedures had to be used in 29%. The authors conclude that analgesics, as proposed by WHO, are the most suitable treatment arm in controlling pain in palliative treatment for advanced cancer patients. Lack of availability or underuse of opioids constitute the real obstacle to the application of this method.