Articles: pain-management.
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Anesthesia and analgesia · Feb 1995
Meta AnalysisNeurolytic celiac plexus block for treatment of cancer pain: a meta-analysis.
We performed a meta-analysis of the efficacy and safety of neurolytic celiac plexus block (NCPB) for cancer pain. A literature search yielded 59 papers, but data on NCPB in two or more patients was available in only 24 papers. Twenty-one studies were retrospective, one was prospective, and two were randomized and controlled. ⋯ Patients with pancreatic cancer responded similarly to those with other intraabdominal malignancies. Common adverse effects were transient, including local pain (96%), diarrhea (44%), and hypotension (38%); complications occurred in 2%. This analysis suggests that: 1) NCPB has long-lasting benefit for 70%-90% of patients with pancreatic and other intraabdominal cancers, regardless of the technique used; 2) adverse effects are common but transient and mild; and 3) severe adverse effects are uncommon.
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Review Multicenter Study Clinical Trial
[Chronic spinal cord stimulation in the treatment of neurogenic pain. Cooperative and retrospective study on 20 years of follow-up].
The aim of this investigation is to evaluate the long-term spinal cord stimulation (SCS) efficacy and safety, with a 20-years study concerning 692 patients (series I: 279, series II: 413). The series concern 304 arachno-epidural fibrosis, 152 peripheral nerve lesions, 25 amputations pain, 17 plexus brachial lesions, 101 spinal cord lesions, 22 cancer pain, and 71 vascular pain. A multidisciplinary chronic pain evaluation must exclude contra-indications (nociceptive pain, serious drug habituations, psychological problems, unresolved issues or secondary pain). ⋯ Analysing the results etiologically confirms the therapeutic value of SCS for neurogenic pain secondary to partial deafferentation. For upper limb pain, ipsilateral radicular stimulation is preferable. When the nerve lesion extends to the pre-ganglionic portion (brachial plexus avulsion, herpes zoster) or in cases of pain of spinal or cerebral origin, thalamic stimulation must be considered, after failure of SCS.
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Spinal cord stimulation in ischemic pain conditions has proved to be an effective method of treatment for many patients. The indications are ischemic pain in the extremities from peripheral vascular disease and angina pectoris. The long-term results show that the response rate for ischemic pain is 70% to 90%, while the corresponding results for neuropathic pain average approximately 50% to 70%, which actually makes ischemic pain a very good indication for SCS. ⋯ For angina pectoris, SCS by now has become a routine supplementary method to conventional medical and surgical treatment. The technique is clinically effective, and several studies have shown decreased myocardial ischemia and decreased anginal pain during treatment. It is probable that the use of SCS in refractory angina will increase considerably in the 1990s.
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Randomized Controlled Trial Comparative Study Clinical Trial
Double-blind, placebo-controlled investigation of the effect of combined phototherapy/low intensity laser therapy upon experimental ischaemic pain in humans.
This study assessed the putative analgesic effect of combined monochromatic light/laser irradiation at low intensity (660-950 nm; 31.9 J/cm2; pulsed at 16 or 73 Hz). ⋯ These results do not provide convincing evidence for the hypoalgesic potential of combined monochromatic light/laser irradiation, at least at the parameters used here, and thus indicate the necessity of additional work to investigate this modality further in order to assess the potential benefit, if any, of such treatment in the clinical setting.
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The understanding and treatment of pain is one of the oldest challenges for physicians, scientists and philosophers. Much of our present rationale of pain control is based on the Cartesian idea that pain mostly originates from external or internal noxious stimuli, which are transmitted to and interpreted in the brain. Consequently, removal (blocking) of the stimuli and modification of cerebral awareness have been the prime targets of analgesic interventions. ⋯ The current preoccupation with quality assurance in healthcare is directed, ultimately, to the delivery of a better quality of care, which should also be more cost-effective, for large populations. An important intermediate step towards that ideal is the collection of data on pain and other symptoms, but also validated quality of life parameters on well-defined groups. Only by widening the scope of analgesic studies to include these dimensions can we hope to define appropriate strategies for more rational healthcare.