scholarly journals EXPERIENCE IN THE APPLICATION OF CONTINUOUS INTRATHECAL OPIOID THERAPY IN THE TREATMENT OF PHARMACORESISTANT NEUROPATHIC PAIN SYNDROME

2018 ◽  
Vol 1 (69) ◽  
pp. 93-96
Author(s):  
Денис Переверзев ◽  
Denis Pereverzev ◽  
В Погорелов ◽  
V Pogorelov ◽  
Наталья Симонова ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Spinal Injury ◽  
Pain Syndrome ◽  
Opioid Therapy ◽  
Neuropathic Pain Syndrome ◽  
Central Origin ◽  
Clinic Practice

The article gives information about the way how the problem of pharmacoresistant neuropathic pain is solved. It presents the definitions of pharmacoresistant neuropathic pain, which makes it possible to accurately identify such patients and to plan tactics for their treatment. Intrathecal opioid analgesia has been used in clinic practice since 1979 and has gained a great popularity till now due to its high analgesic potency. The case of treatment of pharmacoresistant neuropathic pain syndrome of central origin in a patient who had spinal injury and stabilizing spinal surgery is presented. Conservative therapy for 3 years was considered to be ineffective and the patient was implanted with an intrathecal port for long-term opioid therapy. The follow-up period was 6 months. The effect of the procedure allowed the patient to abandon the massive drug therapy, as well as significantly improve the quality of life.

Spinal Cord Stimulation Is Effective in Management of Complex Regional Pain Syndrome I: Fact or Fiction

Neurosurgery ◽  
2011 ◽  
Vol 69 (3) ◽  
pp. 566-580 ◽  
Author(s):  
Krishna Kumar ◽  
Syed Rizvi ◽  
Sharon Bishop Bnurs
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Functional Status ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Sf 36

Abstract BACKGROUND: Complex regional pain syndrome (CRPS) I is a debilitating neuropathic pain disorder characterized by burning pain and allodynia. Spinal cord stimulation (SCS) is effective in the treatment of CRPS I in the medium term but its long-term efficacy and ability to improve functional status remains controversial. OBJECTIVE: To evaluate the ability of SCS to improve pain, functional status, and quality of life in the long term. METHODS: We retrospectively analyzed 25 patients over a mean follow-up period of 88 months. The parameters for evaluation were visual analog scale (VAS), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), EuroQoL-5D (EQ-5D) and Short Form 36 (SF-36), and drug consumption. Evaluations were conducted at point of entry, 3 months, 12 months, and last follow-up at 88 months (mean). RESULTS: At baseline, the mean scores were VAS 8.4, ODI 70%, BDI 28, EQ-5D 0.30, and SF-36 24. In general, maximum improvement was recorded at follow-up at 3 months (VAS 4.8, ODI 45%, BDI 15, EQ-5D 0.57, and SF-36 45). At last follow-up, scores were 5.6, 50%, 19, 0.57, and 40, respectively. Despite some regression, at last follow-up benefits were maintained and found to be statistically significant (P < .001) compared with baseline. Medication usage declined. SCS did not prevent disease spread to other limbs. Best results were achieved in stage I CRPS I, patients under 40 years of age, and those receiving SCS within 1 year of disease onset. CONCLUSION: SCS improves pain, quality of life, and functional status over the long term and consequently merits early consideration in the treatment continuum.

Long-term Outcomes of Deep Brain Stimulation for Neuropathic Pain

Neurosurgery ◽  
2012 ◽  
Vol 72 (2) ◽  
pp. 221-231 ◽  
Author(s):  
Sandra G.J. Boccard ◽  
Erlick A.C. Pereira ◽  
Liz Moir ◽  
Tipu Z. Aziz ◽  
Alexander L. Green
Keyword(s):  
Quality Of Life ◽  
Neuropathic Pain ◽  
Short Form ◽  
Case Series ◽  
Mcgill Pain Questionnaire ◽  
Euroqol 5D ◽  
Deep Brain

Abstract BACKGROUND: Deep brain stimulation (DBS) to treat neuropathic pain refractory to pharmacotherapy has reported variable outcomes and has gained United Kingdom but not USA regulatory approval. OBJECTIVE: To prospectively assess long-term efficacy of DBS for chronic neuropathic pain in a single-center case series. METHODS: Patient reported outcome measures were collated before and after surgery, using a visual analog score, short-form 36-question quality-of-life survey, McGill pain questionnaire, and EuroQol-5D questionnaires (EQ-5D and health state). RESULTS: One hundred ninety-seven patients were referred over 12 years, of whom 85 received DBS for various etiologies: 9 amputees, 7 brachial plexus injuries, 31 after stroke, 13 with spinal pathology, 15 with head and face pain, and 10 miscellaneous. Mean age at surgery was 52 years, and mean follow-up was 19.6 months. Contralateral DBS targeted the periventricular gray area (n = 33), the ventral posterior nuclei of the thalamus (n = 15), or both targets (n = 37). Almost 70% (69.4%) of patients retained implants 6 months after surgery. Thirty-nine of 59 (66%) of those implanted gained benefit and efficacy varied by etiology, improving outcomes in 89% after amputation and 70% after stroke. In this cohort, >30% improvements sustained in visual analog score, McGill pain questionnaire, short-form 36-question quality-of-life survey, and EuroQol-5D questionnaire were observed in 15 patients with >42 months of follow-up, with several outcome measures improving from those assessed at 1 year. CONCLUSION: DBS for pain has long-term efficacy for select etiologies. Clinical trials retaining patients in long-term follow-up are desirable to confirm findings from prospectively assessed case series.

scholarly journals Perioperative Ketamine Administration for Thoracotomy Pain

2017 ◽  
Vol 3 (20;3) ◽  
pp. 173-184 ◽  
Author(s):  
Srinivas Pyati
Keyword(s):  
Neuropathic Pain ◽  
Randomized Controlled Trials ◽  
Pain Syndrome ◽  
Route Of Administration ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Postthoracotomy Pain

Background: Of all the postsurgical pain conditions, thoracotomy pain poses a particular therapeutic challenge in terms of its prevalence, severity, and ensuing postoperative morbidity. Multiple pain generators contribute to the severity of post-thoracotomy pain, and therefore a multimodal analgesic therapy is considered to be a necessary strategy. Along with opioids, thoracic epidural analgesia, and paravertebral blocks, N-Methyl-D-Aspartate (NMDA) receptor antagonists such as ketamine have been used as adjuvants to improve analgesia. Objective: We reviewed the evidence for the efficacy of intravenous and epidural administration of ketamine in acute post-thoracotomy pain management, and its effectiveness in reducing chronic postthoracotomy pain. Study Design: Systematic literature review and an analytic study of a data subset were performed. Methods: We searched PubMed, Embase, and Cochrane reviews using the key terms “ketamine,” “neuropathic pain,” “postoperative,” and “post-thoracotomy pain syndrome.” The search was limited to human trials and included all studies published before January 2015. Data from animal studies, abstracts, and letters were excluded. All studies not available in the English language were excluded. The manuscript bibliographies were reviewed for additional related articles. We included randomized controlled trials and retrospective studies, while excluding individual case reports. Results: This systematic literature search yielded 15 randomized control trials evaluating the efficacy of ketamine in the treatment of acute post-thoracotomy pain; fewer studies assessed its effect on attenuating chronic post-thoracotomy pain. The majority of reviewed studies demonstrated that ketamine has efficacy in reduction of acute pain, but the evidence is limited on the long-term benefits of ketamine to prevent post-thoracotomy pain syndrome, regardless of the route of administration. A nested analytical study found there is a statistically significant reduction in acute post-thoracotomy pain with IV or epidural ketamine. However currently, the evidence for a role of ketamine as a preventative agent for chronic postthoracotomy pain is insufficient due to the heterogeneity of the studies reviewed with regard to the route of administration, dosage, and outcome measures. Limitations: The evidence for a role of ketamine as a preventative agent for chronic post-thoracotomy pain is insufficient due to the heterogeneity of the studies reviewed. Conclusion: The majority of randomized controlled trials reviewed show no role for ketamine in attenuating or preventing post-thoracotomy pain syndrome at variable follow-up lengths. Therefore, additional research is warranted with consideration of risk factors and long-term follow-up for chronic post-thoracotomy pain though the evidence for benefit appears clear for acute post-thoracotomy pain. Key words: Ketamine, postoperative, thoracotomy pain, post thoracotomy pain syndrome, neuropathic pain

scholarly journals Dorsal Root Ganglion Stimulation for the Management of Chronic Neuropathic Pain: A Retrospective Case Series during Four Years follow-up in a Single Center

2020 ◽  
Vol 13 (1) ◽  
pp. 35-41
Author(s):  
Alfonso Papa ◽  
Elisabetta Saracco ◽  
Maria Teresa Di Dato ◽  
Pietro Buonavolontà ◽  
Anna Maria Salzano ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Data Collection ◽  
Dorsal Root ◽  
Case Series ◽  
Chronic Neuropathic Pain ◽  
Neuropathic Pain Syndrome

Objectives: The dorsal root ganglion (DRG) is involved in the transduction of pain signals to the central nervous system (CNS) and undergoes a number of physiopathological changes during chronic pain. The purpose of this data collection was to evaluate the long-term safety and efficacy of DRG stimulation for the treatment of chronic pain and its impact on functional aspects. Materials and Methods: Forty-four subjects with non-reactive chronic neuropathic pain syndrome were implanted with DRG stimulation. Patients were evaluated at baseline as well as at 15, and 30 days, and at 3, 6, 12, 24, 36 and 48 months after medical intervention/surgery using the Visual Analogic Scale (VAS), which measures pain intensity, and the Oswestry Scale, for the estimation of disability (ODI). Results: After four years of simulation, VAS and ODI showed a statistically significant reduction throughout the follow-up period. The average pain relief obtained after 48 months of treatment was 74.1% ± 3.4. Conclusion: The results of this data collection demonstrate the feasibility of DRG stimulation, the correspondence between the clinical indications at the DRG implant and what is commonly found in the literature on this technique.(18,20) Patients defined as clinical responders to DRG stimulation and so implanted with definitive IPG showed a sustained and long term efficacy. Eight patients had previously been implanted with a traditional SCS without any clinically relevant efficacy; they were then explained for unsatisfactory results. Six of them (75%) were later implanted with DRG, with long-term effectiveness. Another advantage of this therapy is the absence of positional effects and lead migration. The adverse events proved to be independent of the anatomical level of insertion; moreover, this series of cases show a lower incidence of lead migration than reported in the literature. In summary, DRGs have been ignored for too long, probably due to the technical difficulty of reaching their deep, almost extra-spinal anatomical position.

Long-term follow-up after cystectomy for bladder pain syndrome: Pain status, sexual function and quality of life

2019 ◽  
Vol 18 (1) ◽  
pp. e1977
Author(s):  
L. Mateu Arrom ◽  
C. Gutierrez Ruiz ◽  
O. Mayordomo ◽  
V. Martínez ◽  
J. Palou ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Sexual Function ◽  
Pain Syndrome ◽  
Bladder Pain Syndrome ◽  
Bladder Pain ◽  
Pain Status ◽  
Long Term Follow Up

scholarly journals Abdominal pain syndrome and quality of life in patients with cholelithiasis after cholecystectomy during a 10-year follow-up

2017 ◽  
Vol 89 (2) ◽  
pp. 70-75
Author(s):  
Yu V Makarovа ◽  
N V Litvinova ◽  
M F Osipenko ◽  
N B Voloshina
Keyword(s):  
Quality Of Life ◽  
Abdominal Pain ◽  
Time Course ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Assess Quality ◽  
Group 1

Aim. To estimate the incidence of abdominal pain syndrome (APS) and to assess quality of life (QOL) in patients within 10 years after cholecystectomy (CE). Subjects and methods. This investigation is part of a long-term prospective follow-up study of patients after CE for cholelithiasis (CL). It enrolled 145 people: 30 (21.5%) patients with baseline asymptomatic CL and 115 (80.7%) with its clinical manifestations. The time course of changes in APS and QOL were analyzed. Results. Over 10 years, all the patients showed a decrease in the incidence of APS from 84.1% (n=95) to 66.4% (n=75; p=0.004). In Group 1 (n=89), APS was at baseline detected in all the patients; 10 years later, its incidence declined to 67.4% (n=60; p < 0.001). Biliary pains were predominant; these had been identified significantly less frequently over the 10-year period in 47 (52.8%) patients; p

scholarly journals Transdermal electroneurostimulation in patients with diabetic neuropathy

2021 ◽  
Vol 20 (2) ◽  
pp. 119-124
Author(s):  
Mustafa Kh. Al-Zamil ◽  
Natalia G. Kulikova
Keyword(s):  
Neuropathic Pain ◽  
Drug Therapy ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Pain Syndrome ◽  
Diabetic Polyneuropathy ◽  
Control Group ◽  
Diabetic Neuropathic Pain ◽  
Neuropathic Pain Syndrome

BACKGROUND: The dynamics of pain syndrome determined using various algic tests in the treatment of patients with diabetic neuropathic pain syndrome using tansdermal electroneurostimulation has been little studied. AIMS: To study the dynamics of projection zones of neuropathic pain syndrome in patients with diabetic polyneuropathy while using TENS. MATERIAL AND METHODS: 75 patients with diabetic polyneuropathy were examined. The control group (n=25; 33.3%) received a course of standard pharmacotherapy. The main group consisted of 2 groups. The first group (n=25; 33.3%) underwent a course of high-frequency low-amplitude (HL TENS) transdermal electroneurostimulation, and the second group (n=25; 33.3%) underwent a course of low-frequency high-amplitude (LH TENS) therapy. Pain syndrome was determined using a visual analogue scale (VAS) and a body diagram before, after treatment and in the long-term period. RESULTS: Using a visual analogue scale (VAS), the dynamics of pain syndrome after the use of LF TENS was lower than after the use of HFTENS by an average of 35% (p 0.05). The data obtained indicate that the regression of pain syndrome after physiotherapeutic treatment of TENS in patients from the main comparison groups exceeds similar indicators in patients from the control group by an average of 63% (p 0.05) both immediately after the course of exposure and in the distant the observation period by 23%. Against the background of TENS, the area of pain syndrome according to the body pattern significantly decreased by 53% after treatment (p 0.05) and by 65.6% in the long-term period (p 0.05), compared with a decrease in the area of pain syndrome in the control group. CONCLUSION: There were revealed significant differences between the quantitative and projection forms of pain measurement. The use of TENS enhances the analgesic effect of drug therapy in the treatment of diabetic neuropathic pain syndrome by 1.37 times while maintaining this effect without negative dynamics for 2 months after the end of the course of non-drug therapy. The developed technique for assessing pain syndrome using a body diagram in combination with a visual analogue scale (VAS) in patients with diabetic polyneuropathy provides a more reliable assessment of pain syndrome.

Long-term follow-up after cystectomy for bladder pain syndrome: pain status, sexual function and quality of life

2018 ◽  
Vol 37 (8) ◽  
pp. 1597-1603 ◽  
Author(s):  
Laura Mateu Arrom ◽  
Cristina Gutiérrez Ruiz ◽  
Olga Mayordomo Ferrer ◽  
Virginia Martínez Barea ◽  
Joan Palou Redorta ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Sexual Function ◽  
Pain Syndrome ◽  
Bladder Pain Syndrome ◽  
Bladder Pain ◽  
Pain Status ◽  
Long Term Follow Up

scholarly journals Successful Long-term Nerve Root Stimulation for Chronic Neuropathic Pain: A Real World, Single Center Canadian Experience

2017 ◽  
Vol 2 (20;2) ◽  
pp. 95-106
Author(s):  
Keith W. MacDougall
Keyword(s):  
Neuropathic Pain ◽  
Nerve Root ◽  
Chronic Neuropathic Pain ◽  
Sf 36 ◽  
Permanent Implants ◽  
Dorsal Nerve ◽  
Root Stimulation

Background: Spinal cord stimulation (SCS) is a well-established treatment for chronic neuropathic pain in the lower limbs. However, some patients have pain in distributions that are difficult to target specifically and consistently with SCS. This often involves pain in the groin or upper limbs, or pain limited to a specific dermatome. We hypothesized that dorsal nerve root stimulation (DNRS) would provide similar pain relief for these patients, compared to our results using SCS. Objectives: In this study we report our experience treating patients with chronic neuropathic pain using SCS and DNRS. Study Design: Open label, prospective study that includes all patients treated with a new trial stimulator system at a single center between July 1, 2011, and October 31, 2013. Setting: Academic university neurosurgical pain center. Methods: One hundred thirty-two consecutive patients had trials of spinal stimulation. Seventy-six patients went on to permanent implants, of which 26 received only DNRS, 47 only SCS, and 3 both. The technique was selected based on clinical assessment and intraoperative test stimulation. Other than pain location and diagnosis, the DNRS and SCS groups had similar baseline characteristics. Follow-up is reported at 12 months. Patients were assessed using a visual analogue scale (VAS) for pain, the SF-36 for quality of life, and the morphine equivalent daily dose (MEDD). Results: At 12 months, the average VAS score for the DNRS group had decreased from 7.5 (SD 1.4) to 4.4 (SD 2.6) and 47% of patients with permanent implants achieved > 50% pain reduction. There were improvements in all subscores and component summary scores of the SF-36. The MEDD had been reduced in 55% of the patients with available data. There was no significant difference in complication or revision rates between the 2 groups. Limitations: Patients were not randomized to treatment groups, and instead were assigned to SCS or DNRS based on what was expected to provide superior pain coverage. There is incomplete follow-up data for some patients due to missed clinic visits. Conclusion: In our study, DNRS provided excellent pain reduction, quality of life improvement, and opioid medication use decreases. We conclude that it is an effective long-term treatment for chronic neuropathic pain. Key words: Spinal cord stimulation, dorsal nerve root stimulation, lumbar, thoracic, cervical, neuropathic pain, neuromodulation, clinical effectiveness, chronic pain, visual analogue scale

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