1/17. Supraclavicular glomus tumor, 20 year history of undiagnosed shoulder pain: a case report.A long-standing case of severe dysesthesia due to a supraclavicular glomus tumor is presented. chronic pain caused by a subcutaneous glomus (non-chemodectoma) tumor is rare and usually misdiagnosed. The supraclavicular location, presentation, and coincidence of trauma history are unique in this case. A 62-year-old male complained of 20 years of intractable right shoulder and supraclavicular region pain, which started 6 months after a fall. The pain was unrelieved by repeated and extensive physical therapy, chiropractic manipulation, local steroid injections, and two shoulder operations. The cause of the condition remained undiagnosed and obscure. Local surgical exploration revealed a subcutaneous grayish mass with pathologically proven glomus tumor. Immediate alleviation of the pain and tenderness followed complete resection of the mass. The patient remained free of pain at a 2-year follow-up. Subcutaneous glomus (non-chemodectoma) tumors can occur in unusual sites, and should be considered in chronic regional pain syndromes. Immediate cure is generally achieved by local resection. Pertinent literature is reviewed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/17. 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 = 1keywords = physical (Clic here for more details about this article) |
3/17. Opioids in non-cancer pain: a life-time sentence?There is continuing reluctance to prescribe strong opioids for the management of chronic non-cancer pain due to concerns about side-effects, physical tolerance, withdrawal and addiction. Randomized controlled trials have now provided evidence for the efficacy of opioids against both nociceptive and neuropathic pain. However, there is considerable variability in response rates, possibly depending on the type of pain, the type of opioid and its route of administration, the time to follow-up, compliance and the development of tolerance. Five patients were selected with nociceptive or neuropathic pain in whom other pharmacological or physical therapies had failed to provide satisfactory pain relief. They received transdermal fentanyl (starting dose 25 microg/h) for at least 6 weeks. Transdermal fentanyl dosage was titrated upwards as required. Transdermal fentanyl provided adequate pain relief in patients with nociceptive pain (diabetic ulcer, osteoporotic vertebral fracture, ankylosing spondylitis) or neuropathic pain with a nociceptive component (radicular pain due to disc protrusion, herpetic neuralgia). The duration of treatment ranged from 6 weeks to 6 months for four cases. In the case of ankylosing spondylitis, treatment was carried out for 2 years, stopped and then restarted successfully. There were no withdrawal effects or addictive behaviour on treatment cessation, regardless of duration of the treatment. In conclusion, strong opioids may provide prolonged effective pain relief in selected patients with nociceptive and neuropathic non-cancer pain. Transdermal fentanyl treatment can often be temporary and can easily be stopped following adequate pain relief without withdrawal effects or any evidence of addictive behaviour.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/17. Long-term opioid treatment in Behcet's syndrome with intractable abdominal pain--a case report.Opioids are the most potent and effective analgesics available for treating acute and chronic cancer pain, but its usefulness in treating non-cancer chronic pain is still controversial. We report a 23-year-old male suffering from Behcet's disease with persistent excruciating abdominal pain. Oral non-steroid anti-inflammation analgesics and milder opioids (codeine and tramadol) failed to relieve the pain. His excruciating abdominal pain resulting from ulcerative viscera aggravated with repeated gastrointestinal tract surgeries. Intravenous morphine given through patient-controlled analgesia (PCA) could effectively reduce his pain with minimal side effects. No sign of physical or psychological dependence was observed during the period of opiate administration, and no withdrawal phenomenon was found as the dosage was tapered. During the total treatment course of 213 days, the daily dose of morphine once surged up to 259.2 mg. The long-term opioid treatment and its possible effects are, herein, discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/17. The importance of the complete history in the discovery of a potential suicide: a case report.suicidal ideation and completed suicides are an increasing problem among the elderly. In 1992, the elderly accounted for 13% of the population but represented 20% of all completed suicides. There are recognized risk factors for suicides in elderly patients, which include depression, deteriorating physical health, and loss of independent functioning. A complete history enables the examiner to establish a relationship with the patient and to formulate a diagnosis. Unfortunately, histories are often incomplete. Many factors can account for this, including financial pressures, patient volume, and overspecialization. The physiatric history is the integration of many parts. It incorporates not only the physiatrist's evaluation but those of other disciplines as well, for example, physical and occupational therapy. The physiatric history is a sensitive tool for assessing the state of being of the whole patient. We describe a case in which a careful and complete physiatric history and physical examination revealed an elderly patient with suicidal ideation and a plan.- - - - - - - - - - ranking = 3keywords = physical (Clic here for more details about this article) |
6/17. Medication-focused approach to total pain: poor symptom control, polypharmacy, and adverse reactions.Neuropathic pain, known to have poor opioid response, can be difficult to control. Although several classes of adjuvant medications are believed to be of benefit in managing neuropathic pain, they have potential side effects that occasionally outweigh their benefits. The psychospiritual suffering of patients with advanced cancer may heighten the distress associated with physical symptoms. If undiagnosed, this may lead to increases in dose and the number of medications administered in the hope of better symptom control. This case report describes the successful interdisciplinary management of an advanced cancer patient whose multiple drug therapy had added to rather than alleviated his distress by causing more side effects than symptom relief.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/17. Chronic fentanyl application induces adrenocortical insufficiency.We report a case of a 64-year-old man with secondary adrenocortical insufficiency who has been on a chronic transdermal fentanyl treatment because of sciatic pain syndrome. Shortly before admission to our hospital, the patient had discontinued his hydrocortisone medication. Adrenal crisis was assumed and during therapy with hydrocortisone infusion, the patient recovered. We suspected an opiate-induced suppression of the hypothalamus-pituitary-adrenal (HPA) axis. Therefore, we gradually reduced the opiate dosage. After 1 week, HPA axis function was markedly improved. We conclude that opiate medication may inhibit - in a life-threatening way - the organism's ability to respond to physical, emotional or metabolic stressors.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/17. Use of oxcarbazepine to treat a pediatric patient with resistant complex regional pain syndrome.We describe a 12-year-old patient with severe, protracted complex regional pain syndrome type I. His pain did not respond to gabapentin, amitriptyline, physical therapy, opioids, or nonsteroidal drugs. Sympathetic or regional block was not attempted because of persistent bacteremia and severe local sepsis. His pain responded dramatically to the addition of oxcarbazepine, with rapid improvement in his symptoms and functional status. We suggest that oxcarbazepine might be a useful adjunct in the treatment of gabapentin-resistant complex regional pain syndrome type I in children and should be considered. PERSPECTIVE: Oxcarbazepine's antinociceptive effect is mediated via sodium channel inhibition in neuropathic models and by inhibition of substance p and prostaglandins in anti-inflammatory models. The efficacy of oxcarbazepine in this patient might be attributable to these mechanisms or possibly to synergism with either gabapentin or the anti-inflammatory effects produced by amitriptyline.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/17. The use of spinal cord stimulation in refractory abdominal visceral pain: case reports and literature review.patients will commonly seek medical attention for refractory abdominal pain. The many causes of abdominal pain include pathologies of the gastrointestinal, genitourinary, musculoskeletal, and nervous systems. Unfortunately, a large number of patients will develop chronic abdominal pain that is recalcitrant to definitive therapies and nonspecific treatments such as cognitive-behavioral, physical, and pharmacologic therapies. Although spinal cord stimulation is classically used for neuropathic and ischemic conditions, a growing number of reports describe its efficacy in visceral disease. We describe our experience with spinal cord stimulation in two patients with refractory abdominal pain. Although the exact etiology in these complex patients is not defined, it is theorized that visceral hypersensitivity is at least one component. Finally, we will summarize the applicable literature in order to explain a possible mechanism of analgesia in visceral disease.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/17. Misperceptions and inadequate pain management in cancer patients.This article examines misperceptions and barriers to adequate pain relief in cancer patients. Healthcare professionals have gaps in their knowledge of opioid drugs as well as misconceptions concerning tolerance, physical dependence, and addiction that often lead to the underprescribing of these agents. The pervasiveness of the "say no to drugs" message in our society and the fear of addiction on the part of patients and their families creates yet another barrier to the legitimate use of opioids to treat cancer pain. Legal and regulatory documents filled with arbitrary and ill-defined labels meant to promote the legitimate use of these drugs and curtail their misuse may instead intimidate healthcare professionals and negatively influence prescribing habits. Increased educational efforts for pharmacists and other healthcare professionals as well as the development of clinical role models and state cancer pain initiatives are cited as means to break down these barriers in order to achieve adequate pain relief for all cancer patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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