17 Agosto 2001
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Anesthesiology 2001 Jun;94(6):947-8
Publication Types:
PMID: 11465618, UI: 21358143
Anesthesiology 2001 Jun;94(6):1141-3
Department of Anesthesiology, Stanford University School of Medicine, California, USA. msleong@stanford.edu
PMID: 11465609, UI: 21358170
Anesthesiology 2001 Jul;95(1):259-61
Department of Anesthesiology and Resuscitology, Okayama University Medical School, Japan. masayoko@cc.okayama-u.ac.jp
PMID: 11465567, UI: 21358106
Clin Orthop 2001 Aug;(389):156-64
Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore, MD, USA.
[Medline record in process]
The current authors retrospectively reviewed 147 lower extremity peripheral nerve procedures in 114 patients (average age, 42 years) with chronic lower extremity neuropathic pain to determine whether surgical treatment based on an empirically derived algorithm could reduce pain and improve function. This algorithm assigns crush, stretch, and chronic transection injuries to treatment with transection and containment. Peripheral nerve stimulation was used in conjunction with transection and containment for patients with more chronic presentations for whom previous transections had been unsuccessful. Patients with adhesive neuralgia underwent revision neurolysis with vein wrapping. Patients with repetitive nerve trauma (overuse) underwent primary or revision neurolysis. Duration of symptoms averaged 37 months, and mechanisms of nerve injury included chronic transection, crush, adhesive neuralgia, stretch, repetitive trauma, and idiopathic etiology. Time to followup averaged 38 months. Pain and dysfunction were ranked from 0 points (no pain or dysfunction) to 10 points (pain prompting request for amputation or functional deficit warranting wheelchair use); preoperative and followup work status were documented. Average pain and dysfunction scores improved: 8.8 to 5.6 points and 7.6 to 5.0 points, respectively. Of the 114 patients, 52 (46%) patients improved their work status, including 35 of 87 (40%) involved in workers' compensation. There were no statistically significant differences in outcome based on mechanism of nerve injury or type of procedure. The consistent average improvement suggests this algorithm assigns the appropriate procedure to a given mechanism of injury.
PMID: 11501805, UI: 21392727
Eur J Pharmacol 2001 Jun 1;421(1):39-43
Department of Anesthesiology, Medical College of Wisconsin, Medical Education Building, Room M4308, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
The roles of endogenous opioid peptides in the brain in the modulation of nocifensive responses to formalin in ICR mice were studied. Mice were pretreated intracerebroventricularly (i.c.v.) with rabbit antiserum against beta-endorphin, [Leu5]enkephalin, [Met5]enkephalin or dynorphin A-(1-17) 1 h prior to intraplantar injection of formalin (0.5%, 25 microl) and the nocifensive licking responses were then observed. Pretreatment of mice with antiserum against beta-endorphin enhanced the second phase, but not the first phase of the nocifensive responses to formalin. Pretreatment with antiserum against [Leu5]enkephalin also caused a small but statistically significant enhancement of the second phase, but not the first phase of nocifensive responses to formalin. On the other hand, pretreatment with antiserum against [Met5]enkephalin or dynorphin A-(1-17) did not affect the nocifensive response to formalin. Our results indicate that beta-endorphinergic, and to a lesser extent, [Leu5]enkephalinergic systems are activated at the supraspinal sites to attenuate the nocifensive responses to formalin stimulation.
PMID: 11408047, UI: 21301431
J Pain Symptom Manage 2001 Aug;22(2):630-1
PMID: 11503631, UI: 21393523
J Pain Symptom Manage 2001 Aug;22(2):627-30
PMID: 11503630, UI: 21393521
J Pain Symptom Manage 2001 Aug;22(2):699-703
Pain and Palliative Care Service, Mount Sinai School of Medicine, New York, NY, USA
Clinical and animal data suggest that antihistamines may have efficacy in the management of pain. While many mechanisms of action have been proposed for the analgesic action of antihistamines, the exact mechanism is unknown. Controlled clinical trials in different pain models have demonstrated that antihistamines have direct and adjuvant analgesic activity. We report three patients with advanced cancer pain refractory to adjuvants and oral, intravenous, and epidural opioids, who achieved sustained pain relief after the repeated administration of diphenhydramine. Diphenhydramine may be useful in the treatment of neuropathic and nociceptive pain that has failed to respond to treatment with opioids and adjuvant analgesics. We suggest a starting dose of 25 mg of oral or parenteral diphenhydramine every 6 to 8 hours, with titration to effect.
PMID: 11495716, UI: 21387426
J Pain Symptom Manage 2001 Aug;22(2):688-98
Multidisciplinary Pain Center, Danish National Hospital, Copenhagen, USA
In this qualitative systematic review, we have evaluated studies of the economic effectiveness of multidisciplinary pain treatment in chronic non-malignant pain patients. Published reports were identified from a systematic search of bibliographic databases (MEDLINE and EMBASE) and reference lists of retrieved reports. Fourteen reports of nine studies of patients suffering from back pain, fibromyalgia, and mixed chronic pain conditions were considered to be appropriate as economic analyses. In the selected studies, we found serious methodological problems in study designs and application of outcome measures. The quality of the cost measurements was characterized by an apparent lack of tradition using economic methodology. This review does not give an answer to whether multidisciplinary pain management in chronic pain patients is cost-effective or not. Application of standard methods of costing and outcome measurement are essential before studies of cost-effectiveness in multidiciplinary pain treatment can be used in decision-making and planning.
PMID: 11495715, UI: 21387425
Lancet 2001 Jul 14;358(9276):139-43
Pain and Palliative Care Clinic, Medical College, 673008, Calicut, India. pain@vsnl.com
In less-developed countries, opioids such as morphine are often not available for pain relief because of excessive regulations imposed to prevent their misuse and diversion. We describe the effect that these draconian measures have had on the availability of drugs for medical use in Kerala, India, and present results of a study, which we did to ascertain whether or not the misuse and diversion of opioids is as prevalent as the government reaction would suggest. We followed 1723 patients in Calicut, India, who were being treated for pain with oral morphine on an outpatient home-care basis. Over 2 years, we did not identify any instances of misuse or diversion. These results suggest that, in the context of India as a less-developed country, oral morphine can be dispensed safely to patients for use at home. We recommend that palliative care programmes talk to concerned governmental authorities, to make them aware of the medical need for opioids, and communicate with local news media to increase awareness of palliative care and the use of these analgesics. Our project has overcome regulatory barriers that had interrupted availability of morphine and its use in pain relief in India.
PMID: 11463435, UI: 21356907
Neurology 2001 Aug 14;57(3):505-9
Pain Relief Unit (Drs. Eisenberg, Lurie, and Braker), the Haifa Pain Research Group (Drs. Eisenberg and Braker), and the Endocrine Institute (Dr. Daoud), Rambam Medical Center, The Technion-Israel Institute of Technology, Haifa.
OBJECTIVE: To study the efficacy of lamotrigine in relieving the pain associated with diabetic neuropathy. METHODS: The authors randomly assigned 59 patients to receive either lamotrigine (titrated from 25 to 400 mg/day) or placebo over a 6-week period. Primary outcome measure was self-recording of pain intensity twice daily with a 0 to 10 numerical pain scale (NPS). Secondary efficacy measures included daily consumption of rescue analgesics, the McGill Pain Questionnaire (MPQ), the Beck Depression Inventory (BDI), the Pain Disability Index (PDI), and global assessment of efficacy and tolerability. RESULTS: Twenty-four of 29 patients (83%) receiving lamotrigine and 22 of 30 (73%) patients receiving placebo completed the study. Daily NPS in the lamotrigine-treated group was reduced from 6.4 +/- 0.1 to 4.2 +/- 0.1 and in the control group from 6.5 +/- 0.1 to 5.3 +/- 0.1 (p < 0.001 for lamotrigine doses of 200, 300, and 400 mg). The results of the MPQ, PDI, and BDI remained unchanged in both groups. The global assessment of efficacy favored lamotrigine treatment over placebo, and the adverse events profile was similar in both groups. CONCLUSIONS: Lamotrigine is effective and safe in relieving the pain associated with diabetic neuropathy.
PMID: 11502921, UI: 21394336
Spine 2001 Jul 1;26(13):E300-2
Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD 20892, USA. jratliff@box-j.nih.gov
STUDY DESIGN: Case report and literature review. OBJECTIVES: Clinicians use methylmethacrylate vertebroplasty to treat vertebral hemangiomas, metastases, and osteoporotic fractures. Cement may leak out of the vertebral body and compress the adjacent spinal cord and nerve roots. We review a case of nerve-root and cord compression from methylmethacrylate extrusion during vertebroplasty. SUMMARY OF BACKGROUND DATA: A 50-year-old female presented with disabling thoracic back pain. A metastasis to T1 was discovered, with collapse of the vertebral body but without cord compression. Methylmethacrylate vertebroplasty was performed. After injection, portable computed tomography (CT) showed a leakage of methylmethacrylate into the C8 and T1 foramina and spinal canal. Radiculopathy and myelopathy developed. Surgical decompression using the anterior approach was necessary. METHODS: Case report. RESULTS: Early surgical intervention decompressed the neural elements and relieved the neurological deficits. CONCLUSIONS: Neurologic complications of methylmethacrylate vertebroplasty necessitate active involvement of spine surgeons in patient evaluation and management.
PMID: 11458170, UI: 21351470
Spine 2001 Jul 1;26(13):1505-6
PMID: 11458162, UI: 21351465
Spine 2001 Jul 1;26(13):1492-4
Department of Orthopaedic Surgery, South Tyneside District Hospital, Gateshead. cmcoapes@doctors.org.uk
STUDY DESIGN: A case of vertebral osteomyelitis secondary to epidural catheter use is reported. OBJECTIVE: To investigate the occurrence of vertebral osteomyelitis after the use of an epidural catheter. SUMMARY OF BACKGROUND DATA: Vertebral osteomyelitis is a rare but serious complication of epidural catheter use that apparently has not been reported previously in orthopedic literature. METHODS: A patient underwent abdominal surgery, and an epidural catheter was used for postoperative pain relief. He presented 3 months later with severe midlumbar pain. Magnetic resonance imaging and microbiologic examination of a specimen obtained at open biopsy were used in the investigation. RESULTS: Magnetic resonance imaging suggested vertebral osteomyelitis involving L1-L3. The patient underwent open debridement and posterior instrument stabilization. Biopsies taken from L3 pedicles yielded Pseudomonas aeruginosa, which had been recovered earlier from the epidural catheter tip. CONCLUSION: Vertebral osteomyelitis is a rare but serious complication of epidural catheter use.
PMID: 11458157, UI: 21351460
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