1/5. amputation and the prevention of phantom pain.Although it has been proposed that preoperative analgesia with epidural administration of analgesics may prevent long-term phantom pain, published results to date have been contradictory and controversial. In this case report, we describe a 41-year-old man with local recurrence of squamous cell carcinoma of the anus who underwent a hemipelvectomy. Preoperatively he had a significant neuropathic pain syndrome requiring oxycodone 60 mg every 4 hours. An epidural infusion of morphine and bupivacaine was started 24 hours preoperatively and discontinued on the third postoperative day. Over the next 10 days the oxycodone was gradually decreased and eventually discontinued prior to discharge. A review of the literature reveals conflicting reports on the benefit of preoperative epidural pain management in the prevention of postoperative pain syndromes. Conflicting research and conclusions of commentators leaves unanswered questions for clinicians. Nevertheless, we do know that we need to provide the best pain relief for patients both before and after amputation. This may require a combination of the oral, subcutaneous or intravenous, and epidural routes.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
2/5. methadone for phantom limb pain.OBJECTIVE: The objective of this case series was to determine if severe phantom limb pain could be reduced with oral methadone. DESIGN: Four cases of phantom limb pain refractory to multiple treatment modalities were treated with oral methadone. SETTING: Pain clinic at a major university medical center. patients: Four patients with severe, intractable phantom limb pain. INTERVENTION: Oral methadone was administered, starting with a low dose of 2 to 5 mg twice a day or three times a day and slowly titrated upward to achieve pain relief. OUTCOME MEASURES: Repeated administration of a visual analog scale for pain. RESULTS AND CONCLUSIONS: Administration of oral methadone may be of value in the treatment of phantom limb pain; controlled clinical trials would be appropriate to verify this observation.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
3/5. flumazenil and dialysis for gabapentin-induced coma.OBJECTIVE: To describe a case of gabapentin-induced coma that was reversed with flumazenil and hemodialysis. CASE SUMMARY: We describe an 83-year-old dialysis-dependent white man who became comatose after a single dose of gabapentin for phantom limb pain. The patient was successfully revived from the coma with administration of flumazenil, which was then followed by hemodialysis. serum concentration data before and 4 hours after dialysis document the effectiveness of hemodialysis for gabapentin toxicity. DISCUSSION: An objective causality assessment revealed that this adverse event was probably related to the gabapentin that the patient received. To our knowledge, this is the first documented case of not only gabapentin-induced coma, but also the effectiveness of flumazenil for treatment of this type of coma. Although therapeutic hemodialysis has been previously described, our case report is strengthened by the serum concentration monitoring accompanying it. CONCLUSIONS: This report underscores the importance of initiating gabapentin therapy at low doses in dialysis-dependent patients and introduces a novel treatment for those who experience toxicity.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
4/5. Post-amputation phantom pain and autonomous stump movements responsive to doxepin.A 40-year old man with post-amputation phantom pain and involuntary autonomous movements experienced dramatic relief of both pain and autonomous movements with administration of the antidepressant doxepin. The pathophysiology of pain and post-amputation autonomous movements, as well as the therapeutic response to doxepin are discussed in terms of the effects of limb amputation on spinal excitability and alterations in both spinal and supraspinal transmitter functions.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
5/5. Effect of barbiturate on central pain: difference between intravenous administration and oral administration.OBJECTIVE: To examine whether the oral administration of barbiturates is of clinical use in a patient with central pain. SETTING: Pain Clinic, Osaka University Medical Hospital, Osaka, japan. PATIENT: A patient with central pain after loss of his left upper extremity. INTERVENTIONS: A 50-mg dose of intravenous amobarbital, which produced a plasma concentration of 2.5-4.0 microg/ml, was effective in reducing the central pain. Subsequently, doses of 300-400 mg/day were administered orally; these succeeded in achieving similar plasma concentration levels. RESULTS AND CONCLUSIONS: Oral administration of barbiturate did not alleviate central pain, even when the plasma concentration was the same as the effective level in intravenous use. Pharmacokinetic and pharmacodynamic factors more complex than simple plasma concentrations may be involved in producing the difference in the effects.- - - - - - - - - - ranking = 10keywords = administration (Clic here for more details about this article) |