1/10. pain management in palliative care. Reviewing the issues.BACKGROUND: Cancer pain remains significantly undertreated despite being one of the most prevalent and feared symptoms associated with cancer. Approximately 90% of patients can have their cancer pain controlled through relatively simple measures. OBJECTIVE: The aim of this review is to facilitate the current optimal approach to the assessment and management of cancer pain within the context of the multidimensional nature of the pain experience. DISCUSSION: Each component of the pain experience is addressed using a four point approach to pain and involves pharmacological and nonpharmacological measures. The general practitioner's role is pivotal in optimal cancer pain management. This is the first of two articles by Kiran Virik and Paul Clare on pain management in palliative care. The second, outlining treatment options, will appear in the December issue of Australian family Physician.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/10. Geniculate neuralgia: long-term results of surgical treatment.A rare cause of otalgia is geniculate neuralgia. In its most typical form, it is characterized by severe paroxysmal neuralgic pain centered directly in the ear. The pain can be of a gradual onset and of a dull, persistent nature, but occasionally it is sharp and stabbing. When the pain becomes intractable, an operation to surgically excise the nervus intermedius and geniculate ganglion via the middle cranial fossa approach is indicated. The purpose of this article is to review the long-term outcomes in 64 patients who were treated in this manner. Findings indicate that excision of the nervus intermedius and geniculate ganglion can be routinely performed without causing facial paralysis and that it is an effective definitive treatment for intractable geniculate neuralgia.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/10. Disappearance of central pain following iatrogenic stroke.An exceptional case of long-standing central pain temporarily relieved by a focal stroke in the primary somatosensory area is reported. This case highlights the focal nature of central pain mechanisms and the possible value of selective subparietal leukotomies in the management of central pain.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/10. Pathogenesis and treatment of pain caused by skin metastases in neuroendocrine tumours.BACKGROUND: prognosis of neuroendocrine tumours has improved during the last decade and one might expect that more patients with (sub)cutaneous metastases will be seen in the future. We investigated the cause of pain in skin metastases and tried to give recommendations about treatment options. methods: We compared histology of (sub)cutaneous metastases in four patients, two with severely painful skin lesions and two without pain. RESULTS: On the pathological slides there were no differences in neuroinvasion, angioinvasion or mitosis between painful and non-painful metastases. However, the painful metastases rapidly multiplied, while the others remained indolent in nature. Pain was very difficult to manage and did not respond to analgesics, irradiation or systemic treatment with interferon or chemotherapy. Local excision was the only successful treatment option. CONCLUSION: histology did not show differences between painful and non-painful skin metastases. Local excision is the treatment of choice.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/10. pudendal nerve entrapment as source of intractable perineal pain.Perineal pain caused by pudendal nerve entrapment is a rarely reported entity, with only a handful of cases in the modern literature. A 25-yr-old male medical student had refractory unilateral orchialgia for 32 mo and concomitant proctalgia for 14 mo. Pain was positional in nature, exacerbated by sitting and partially relieved when standing or recumbent. pudendal nerve entrapment was diagnosed clinically, with computed tomography-guided nerve blocks providing temporary relief. A prolonged left pudendal nerve distal motor latency on electrodiagnostic testing later confirmed the diagnosis. At surgery, the left pudendal nerve was found flattened in the pudendal canal of Alcock and in contact with the sharp inferior border of the sacrospinous ligament. After surgical decompression and rehabilitation, the patient experienced significant relief of pain and returned to medical school. This case suggests pudendal nerve entrapment should be considered in the differential diagnosis of chronic urogenital or anorectal pain, particularly if the pain is aggravated by sitting or if there is a history of bicycle riding.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/10. Palliative pain management: when both pain and suffering hurt.patients with advanced cancer frequently experience intractable pain without sufficient response to a conventional pharmacological approach. One reason for refractory pain at the end of life can be the bidirectional nature of pain and suffering. Three terminally ill patients were assessed using a multidimensional palliative pain concept, including sensory, affective, cognitive, and existential components. In these patients, resistant pain did not equal insufficient eradication of the nociceptive input, but also suffering. Unrelieved emotions, depressive or anxious symptoms, delirium, difficulties communicating, or chemical coping influenced the expression of pain, illuminating the phenomenon of somatization. Palliative pain treatment integrated analgesic treatments, psychological, rehabilitative, and existential interventions, in consideration of individual expectations and outcomes. With the disciplined assessment and alternative multidisciplinary palliative approach, the quality of life of three terminally ill cancer patients with intractable pain could be enhanced, and unnecessary interventions and escalation of medications avoided.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/10. Late bacterial granuloma at an intrathecal drug delivery catheter.In the case reported, neurological complaints were pain and dysaesthesiae in the lower back and thigh, as well as paresis of the ileopsoas muscle. MRI of the lumbar spine showed an intradural-extramedullary mass at the level of L1 homogeneously enhancing with gadolinium. This mass was situated at the tip of an intrathecal catheter implanted 11 years before for a morphine trial infusion as therapy for phantom pain after amputation of the right arm. Now, removal of the catheter was performed. Cultures of lumbar CSF and the catheter tip demonstrated coagulase negative staphylococcus. Antibiotic medication with cephalosporines was given for 6 weeks. After removal of the catheter, the patient was free of pain and he progressively regained full neurological function. Although most catheter-associated granulomas reported so far were sterile in nature, bacterial infection should still be considered even years after catheter placement.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/10. Drug delivery for intractable cancer pain. Use of a new disposable parenteral infusion device for continuous outpatient epidural narcotic infusion.Administration of narcotic analgesics through the epidural route has proven useful for treating pain of acute and chronic nature. This route of narcotic administration is frequently chosen for cancer patients with intractable pain that may be refractory to treatment by conventional oral or parenteral therapy. Implantable constant infusion devices have been commonly described as an alternative drug delivery system for this type of patient. This case report describes the use of the Travenol Infusor (Travenol laboratories Inc., Deerfield, illinois) an external, lightweight, disposable, drug delivery device for delivering continuous epidural morphine infusion to a patient with severe cancer pain. The patient has achieved stable pain relief for greater than 8 months without hospital admission for pain control, or management of complications due to the drug delivery system. The Travenol Infusor may prove to be an alternative drug delivery system for patients requiring continuous epidural narcotic infusion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/10. Transcutaneous nerve stimulation: its significance and applications in podiatry.In summation, the neuranatomy and neurophysiology of pain have been presented. Three of the classical theories of pain transmission were also discussed, these being the specificity, pattern, and gate control theories. The gate control theory postulates that stimulation of large diameter sensory nerve fibers blocks pain sensation at the level of the substantia gelatinosa in the dorsal horn of the spinal cord. This theory is used as the basic explanation for the function of the TNS, a device that can control pain by stimulation of the skin through surface electrodes. TNS stimulation appears to be most efficacious when the electrodes are placed either directly over or just proximal to the painful region. Podiatric application appears to lend itself quite naturally to TNS therapy. Several surgical and nonsurgical cases were presented where TNS therapy was employed and in this preliminary study approximately a 63% improvement in pain state was shown. We believe this modality is useful for patients who should limit their intake of analgesic medications, whether they are medically compromised, allergic to various pain medication, or simply are highly intolerant to pain. TNS is also useful in patients who do not respond well to the more traditional and conventional podiatric treatments. Our study illustrates TNS to be efficacious in pain states of a surgical, chronic or acute nature and even pain secondary to systemic disease. It should be noted that TNS is not curative, per se, but is a useful adjunct in the therapeutic regime. This form of therapy, although not without hazard, is relatively safe and easy to use, and although it is not the answer to all pain states, it is highly recommended when applicable.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/10. The abductor digiti minimi muscle flap: a salvage technique for palmar wrist pain.In a series of 12 patients incapacitated by persistent or recurrent pain in the palmar aspect of the hand and wrist, successful rehabilitation was aided by employing an abductor digit minimi muscle flap. It is emphasized that this muscle flap was utilized as an adjunct to microsurgical internal neurolysis and neuroma resection. Eleven of the 12 patients (92 percent) achieved good to excellent results in terms of relief of pain, plus either return to their previous job or vocational rehabilitation. The "salvage" nature, donor-site morbidity, and technical demands of the procedure are emphasized.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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