Articles: pain.
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From a survey of the recent literature on chronic intraspinal morphine administration for cancer pain concerning 412 cases, the present authors observe that: 1. data regarding follow-up on pain relief and complications are lacking; 2. continuous administration by closed systems shows more efficacy in long-term pain relief; 3. tolerance, although not reported by all authors, is present and becomes remarkable in prolonged administration; 4. serious side-effects are less frequent with the epidural administration technique. These data are confirmed by the present authors' clinical experience of 22 patients treated with epidural morphine administration and 53 patients treated with intrathecal morphine. The widespread use of these methods is limited not only by technical complications but also by the existence of certain types of pain which do not respond to morphine and which may develop, as part of the evolution of the neoplastic disease, even during treatment with intraspinal morphine.
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Acta Anaesthesiol Scand Suppl · Jan 1987
Review Historical ArticleIntraspinal analgesia: an historical overview.
The application of opioids in the proximity of the spinal cord is a recent addition to the forms of treatment available for pain relief. During the last 20 years we have learned more about the intimate mechanisms of the action of opiates then we had in the preceding 5 millennia. Opium, in fact, has been used for medical purposes from prehistoric times. On the basis of the newly acquired knowledge, we are now applying opioids in more effective ways and providing more patients with long overdue relief of their pain.
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Acta Anaesthesiol Belg · Jan 1987
Randomized Controlled Trial Comparative Study Clinical TrialCryoanalgesia for post-thoracotomy pain relief.
A randomized study comparing the postoperative requirements of narcotics of three groups of patients (Group I: no analgesia; Group II: internal intercostal nerve block; Group III: cryoanalgesia) was conducted. This study was performed in order to assess the efficiency of cryoanalgesia versus internal intercostal nerve block to obtain pain relief after thoracotomy. Regarding post-operative narcotic requirements (Piritramide-Dipidolor), there was no significant difference between Group I and Group II patients, but patients from Group III required a significantly lower amount of narcotics during the first 36 postoperative hours (p less than 0.01). We conclude that, although cryoanalgesia does not provide complete post-thoracotomy pain relief, it is however an easy and safe method and is more efficient than internal intercostal nerve block for pain relief after thoracotomy.
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The clinical evaluation of continuous administration of epidural morphine was undertaken using an infusion pump (Act-A-Pump 1000). Eleven patients who had undergone abdominal surgical procedures were treated with this therapeutic modality for postoperative pain control, and two cancer patients for chronic pain relief. The results were satisfactory and the advantages over repeated epidural injections are discussed.
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After a brief review of the supraspinal and spinal effects of morphine, the reference substance for studies on analgesia, the authors expose a synthesis of the recent literature regarding neurotransmitter involvement in pain perception and transmission. From these data, some future prospects for pain treatment research are identified.