OR 29 Pain reduction in symptomatic, necrotic teeth using an intraosseous injection of Depo-Medrol

Object. Although reports in the literature indicate that thalamic pain syndrome can be controlled with chemical hypophysectomy, this procedure is associated with transient diabetes insipidus. It was considered reasonable to attempt gamma knife surgery (GKS) to the pituitary gland to control thalamic pain. Methods. Inclusion criteria in this study were poststroke thalamic pain, failure of all other treatments, intolerance to general anesthetic, and the main complaint of pain and not numbness. Seventeen patients met these criteria and were treated with GKS to the pituitary. The target was the pituitary gland together with the border between the pituitary stalk and the gland. The maximum dose was 140 to 180 Gy. All patients were followed for more than 3 months. Conclusions. An initial significant pain reduction was observed in 13 (76.5%) of 17 patients. Some patients experienced pain reduction within 48 hours of treatment. Persistent pain relief for more than 1 year was observed in five (38.5%) of 13 patients. Rapid recurrence of pain in fewer than 3 months was observed in four (30.8%) of 13 patients. The only complication was transient diabetes insipidus in one patient. It would seem that GKS of the pituitary might have a role to play in thalamic pain arising after a stroke.

Download Full-text

(213) Pain Reduction in Cognitively Impaired Cancer Patients Treated with Olanzapine

Pain Medicine ◽

10.1046/j.1526-4637.2001.01039-13.x ◽

2001 ◽

Vol 2 (3) ◽

pp. 243-244

Author(s):

Natalia Khojainova ◽

Juan Santiago-Palma ◽

Gilbert R. Gonzales

Keyword(s):

Cancer Patients ◽

Pain Reduction ◽

Cognitively Impaired

Download Full-text

The Safety and Effect of Local Botulinumtoxin A Injections for Long-Term Management of Chronic Pain in Post-Herpetic Neuralgia: Literature Review and Cases Report Treated with Incobotulinumtoxin A

Journal of Personalized Medicine ◽

10.3390/jpm11080758 ◽

2021 ◽

Vol 11 (8) ◽

pp. 758

Author(s):

Songjin Ri ◽

Anatol Kivi ◽

Jörg Wissel

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

Adverse Events ◽

Case Reports ◽

Pain Reduction ◽

Post Herpetic Neuralgia ◽

Botulinumtoxin A ◽

Incobotulinumtoxin A ◽

Term Management

There are few reports on the safety and effectiveness of long-term botulinumtoxin A (BoNT A) therapy in severe chronic pain of post-herpetic neuralgia (PHN). The literature was searched with the term “neuropathic pain” and “botulinum” on PubMed (up to 29 February 2020). Pain was assessed with the Visual Analogue Scale (VAS) before and after BoNT A therapy. A total of 10 clinical trials and six case reports including 251 patients with PHN were presented. They showed that BoNT A therapy had significant pain reduction (up to 30–50%) and improvement in quality of life. The effect duration seems to be correlated with BoNT A doses injected per injection site. Intervals between BoNT A injections were 10–14 weeks. No adverse events were reported in cases and clinical studies, even in the two pregnant women, whose babies were healthy. The repeated (≥6 times) intra/subcutaneous injections of incobotulinumtoxin A (Xeomin®, Merz Pharmaceuticals, Germany) over the two years of our three cases showed marked pain reduction and no adverse events. Adjunctive local BoNT A injection is a promising option for severe PHN, as a safe and effective therapy in long-term management for chronic neuropathic pain. Its effect size and -duration seem to be depended on the dose of BoNT A injected per each point.

Download Full-text