1/64. The use of epidural ropivacaine in high doses for the management of pain from invasive carcinoma of the cervix.A case is presented of a young woman with advanced cervical cancer invading the rectum and sacral nerves giving rise to an intractable pain state. The management of her symptoms using a domicillary infusion of diamorphine with high doses of ropivacaine is described. It is believed that this is the first presentation of ropivacaine being used in daily doses approaching 2 g, and the associated problems are discussed.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/64. Indication for epidural morphine for the relief of intractable pain in advanced oral cancer: report of four cases.It can be difficult to manage the pain of advanced oral cancer. We present four patients in whom epidural morphine was used for intractable pain at primary or metastatic sites. For pain supplied by the trigeminal or cervical nerve a small dose of morphine was given through an epidural catheter inserted into the epidural space through C7-Th1. A favourable clinical response was achieved in three. In particular, in one patient who was given continuous morphine using a computerized ambulatory drug delivery system, we achieved excellent efficacy and stable control of pain. We think that the effect of the epidural morphine was decreased in the patient who did not respond because he had previously been treated with high oral doses. The present study confirmed that morphine given epidurally in small doses has a strong and prolonged analgesic action with less toxicity than when given orally.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
3/64. Tolosa Hunt syndrome--intractable pain treatment with acupuncture?PURPOSE: The Tolosa Hunt syndrome (THS) is a painful granular inflammation of the cerebral vessels followed by pain and disorders of the extrabulbar muscles. The therapy consists of corticosteroids and analgetics. There was a 70 year old woman who suffered from painful paresis of the abducent and oculomotor nerves following an infection with borrelia burgdorferi--but without ocular symptoms. The treatment with corticosteroids reduced the palsy but she complained of excessively painful attacks in the region of the first branch of the trigeminal nerve. Opiold analgetic therapy did not bring about any relief. acupuncture is an irritative method with a physical effect on the nervous system: its pain-reducing effect is caused by the activation of transmitters like endorphins in thalamus and brain stem. Knowing this effect, the THS patient, after informed consent, was treated with acupuncture. To measure the extent of pain, a visual analog scale (0: no pain - 10: maximum pain) was used. acupuncture was performed according to the empirical rules of the Traditional Chinese medicine (TCM), during a period of 10 weeks and 12 weeks. There was a significant pain relief after acupuncture from VAS 10 to VAS 5. The effect vanished during the next four months. After a second series of 12 sessions pain reduction was reported from VAS 10 to 4. One year after the last Tolosa Hunt syndrome - intractable pain pain strength ranged between VAS 4 - 6. Therefore acupuncture seems to be a good additional method for reduction of intractable pain.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
4/64. Neuropathic pain--from mice to men.The past decade has seen great progress in understanding the syndrome of neuropathic pain, its causes and in finding new drugs that promise great benefit. For example, an early outcome of the research has been the observation that the new drugs do not blunt normal pain sensation--a pattern beginning to find explanation through the realisation that neural pain circuits rewire themselves, both anatomically and biochemically, after nerve injury. In this article, we discuss a case of a known diabetic patient with intractable pain and the course of management provided by the use of novel tools and devices coming to the fore in this rapidly expanding specialty.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
5/64. A case report on the treatment of intractable anal pain from metastatic carcinoma of the cervix.INTRODUCTION: Cancer pain in the terminally ill often poses great therapeutic dilemma. Opioids, whilst being useful in most cases, often leaves a patient heavily sedated and constipated at high doses and sometimes, in persistent agony from cancer pain. CLINICAL PICTURE: An Indian lady who suffered from metastatic carcinoma of the cervix experienced tremendous pain and disability despite high doses of narcotics and membrane stabilizers. TREATMENT: A ganglion of impar block and superior hypogastric plexus block were performed with a neurolytic agent. OUTCOME: The patient's pain and opioids usage were markedly reduced. CONCLUSION: Neurolytic nerve block can offer a great therapeutic option in selected cancer patients.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
6/64. trochlear nerve neuroma manifested with intractable atypical facial pain: case report.OBJECTIVE AND IMPORTANCE: trochlear nerve neuromas are extremely rare. Seventeen surgical cases of this pathological condition have been reported in the English literature. The presented case is distinct from previous reports. CLINICAL PRESENTATION: A 26-year-old woman presented with atypical facial pain. The neurological examination results were normal. magnetic resonance imaging revealed a left parasellar mass. INTERVENTION: A left pterional craniotomy was performed, providing access to the left parasellar area. After incision of the tentorial edge, the tumor was observed to originate from the short segment of the trochlear nerve that runs between the tentorial leaves. The neuroma was totally removed. CONCLUSION: The facial pain resolved immediately after surgery. Although facial dysesthesias have been noted among patients with trochlear nerve neuromas, here the atypical facial pain was the only clinical manifestation. In all previously reported cases, neuromas originated from the cisternal segment of the trochlear nerve (always before the site of nerve entrance into the tentorial leaves) and expanded mainly into the prepontine and interpeduncular cisterns. Subtemporal and suboccipital approaches were used. In this case, the tumor arose from the short segment of the nerve running between the tentorial leaves. The tumor did not extend either into the ambient cistern or into the cavernous sinus but did involve the parasellar area. A pterional approach was appropriate for tumor removal. A trochlear nerve neuroma should be considered as a potential cause of atypical facial pain.- - - - - - - - - - ranking = 11keywords = nerve (Clic here for more details about this article) |
7/64. Long-term pain control in trigeminal neuralgia with local anesthetics using an indwelling catheter in the mandibular nerve.OBJECTIVE: The authors sought to determine the usefulness of long-term continuous trigeminal nerve block with local anesthetics using an indwelling catheter in a patient with trigeminal neuralgia. DESIGN: The study design included pain control in a patient with trigeminal neuralgia until the time of neurosurgical operation. SETTING: The study was conducted in the Dental Hospital of tokyo Medical and Dental University. PATIENT: The patient was a 78-year-old woman with trigeminal neuralgia in the right maxillary region. Her pain could not be controlled by carbamazepine and was unbearable. INTERVENTION: The authors estimated the patient's pain intensity, quality, and locality using a visual analog scale to determine the effectiveness of continuous nerve block. OUTCOME MEASURES: Visual analog scores were measured during treatment. The treatment term was divided into three periods according to the difference of the catheter location and injection protocol (premandibular nerve block, infuser injection, and patient-controlled analgesia [PCA] pump injection). The authors also examined the patient's general condition and blood concentration of drugs. RESULTS: The visual analog values were 44.8 /- 3.6, 26.7 /- 3.5, and 11.9 /- 3.1 mm in each period, respectively. The value in the PCA pump infusion period was significantly lower than that in the other periods. No side effects of the local anesthetics were observed on the patient's systemic condition. CONCLUSIONS: The authors controlled trigeminal neuralgia pain by blocking the mandibular nerve with local anesthetics administered through an indwelling catheter. Because the continuous nerve block with local anesthetics is reversible and only mildly toxic, this method is beneficial for pain control in patients with trigeminal neuralgia scheduled to undergo microvascular decompression.- - - - - - - - - - ranking = 9keywords = nerve (Clic here for more details about this article) |
8/64. Trigeminocardiac reflex: a unique case of recurrent asystole during bilateral trigeminal sensory root rhizotomy.BACKGROUND: The trigeminocardiac reflex is the sudden-onset of dysrhythmia and hypotension during manipulation of any of the branches of the trigeminal nerve. The trigeminal nerve and cardioinhibitory vagus nerve constitute the afferent and efferent pathways in the reflex arc. The trigeminocardiac reflex has been reported to occur during craniofacial surgery, balloon-compression rhizolysis of the trigeminal ganglion, and tumour resection in the cerebellopontine angle. PATIENT & METHOD: A 2-year-old male patient with haemangioma near the sella turcica underwent rhizotomies of both sides of the dorsal sensory roots, of the trigeminal nerves for palliation of intractable trigeminal pain. RESULTS: In this report, we experienced two unexpected episodes of asystole after transection of the sensory roots of the trigeminal nerves. CONCLUSION: Sectioning of the intracranial dorsal sensory root of the trigeminal nerve provides clear evidence of the central role of the trigeminal nerve as the afferent pathway of the trigeminocardiac reflex arc.- - - - - - - - - - ranking = 7keywords = nerve (Clic here for more details about this article) |
9/64. Neurohistopathologic findings after a neurolytic celiac plexus block with alcohol in patients with pancreatic cancer pain.Pancreatic cancer has a very poor prognosis resulting in the death of 98% of patients. Pain may be severe and difficult to treat. Management of pain includes chemotherapy, radiotherapy, pharmacologic treatment, and neurolytic celiac plexus block. Recent reviews of the efficacy of neurolytic celiac plexus block however, have reached conflicting conclusions. In this paper, we present two patients with severe pancreatic cancer pain resistant to pharmacologic treatment. Analgesic effect following repeated neurolytic celiac plexus blocks with alcohol was limited in time. Post-mortem neurohistopathologic examination of the celiac plexus revealed an abnormal celiac architecture with a combination of abnormal neurons with vacuolization and normal looking neuronal structures (ganglionic structures and nerve fibers) embedded in fibrotic hyalinized tissue. Our results show that a neurolytic celiac plexus block with alcohol is capable of partially destroying the celiac plexus. These findings may explain the significant but short-lasting analgesic effect following neurolytic celiac plexus block with alcohol.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
10/64. Medical modification of sensation.The authors describe the sensory examinations of 3 patients who had undergone cervical rhizotomy alone and in combination with trigeminal tractotomy and section of the nervus intermedius, the glossopharyngeal nerve, and the upper portion of the vagus nerve. Following administration of L-dopa there was an increase in their pain and a decrease in the area of clinically anesthetic or analgesic skin. When methyldopa was given, the subjective and objective changes were the opposite of those elicited by L-dopa. These observations support the existence of a wider dorsal root cutaneous distribution than is usually accepted as well as significant control of cutaneous sensation by suprasegmental areas of the central nervous system. Part of the suprasegmental bias supplied to the area in the spinal cord that processes sensory information apparently occurs by way of an aminergic descending reticulospinal tract. These findings are discussed in terms of attempts totally to denervate restricted cutaneous areas of the body for treatment of pain-producing states.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
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