Intrathecal and intraventricular morphine for pain in cancer patients: initial study

1982 ◽  
Vol 56 (2) ◽  
pp. 241-245 ◽  
Author(s):  
Milam E. Leavens ◽  
C. Stratton Hill ◽  
David A. Cech ◽  
Jane B. Weyland ◽  
Jaye S. Weston
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Cancer Patients ◽  
Intrathecal Morphine ◽  
Initial Study ◽  
Intractable Pain ◽  
Content Type ◽  
Fine Print

✓ Intractable pain in six cancer patients was treated with lumbar intrathecal morphine (two patients) and intraventricular morphine (four patients). Daily percutaneous injections of morphine through Ommaya reservoirs were made. Initially, 1 mg of lumbar intrathecal morphine resulted in pain relief for 10 to 14 hours, and 2.5 to 4.0 mg of intraventricular morphine gave relief for 12 to 24 hours. This treatment was continued for 3 to 7 months in three of the adults. Morphine requirements gradually increased. Side effects were minimal, and there were no complications.

Stereotaxic rostral mesencephalotomy in treatment of malignant faciothoracobrachial pain syndromes

1982 ◽  
Vol 56 (6) ◽  
pp. 807-811 ◽  
Author(s):  
Franco Frank ◽  
Francesco Tognetti ◽  
Giulio Gaist ◽  
Giorgio Frank ◽  
Ercole Galassi ◽  
...  
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Intractable Pain ◽  
Malignant Diseases ◽  
Pertinent Literature ◽  
Technical Aspects ◽  
Content Type ◽  
Pain Syndromes ◽  
Fine Print

✓ Stereotaxic rostral mesencephalotomy was performed 19 times in 14 patients suffering from intractable pain syndromes due to malignant diseases. The satisfying results in terms of pain relief during a necessarily short follow-up period (mean 4.9 months) are outlined. Undesired side effects were mainly confined to oculomotor disorders, which partly subsided over the months following the operation. Some technical aspects of the procedure and the pertinent literature are briefly discussed.

Punctate midline myelotomy for the relief of visceral cancer pain

2000 ◽  
Vol 92 (2) ◽  
pp. 125-130 ◽  
Author(s):  
Haring J. W. Nauta ◽  
Vicki M. Soukup ◽  
Roderic H. Fabian ◽  
James T. Lin ◽  
James J. Grady ◽  
...  
Keyword(s):  
Pain Relief ◽  
Cancer Patients ◽  
Visceral Pain ◽  
Posterior Column ◽  
Content Type ◽  
Significant Pain ◽  
Pain Ratings ◽  
Patient Pain ◽  
Neurological Effects ◽  
Fine Print

Object. This study offers clinical support for the concept that neurosurgical interruption of a midline posterior column pathway by performing a punctate midline myelotomy (PMM) provides significant pain relief without causing adverse neurological sequelae in cancer patients with visceral pain refractory to other therapies. Methods. A PMM of the posterior columns was performed in six cancer patients in whom visceral pain had been refractory to other therapies. The cause of the visceral pain was related to residual, progressive, or recurrent local cancer or postirradiation effects. Clinical efficacy of the procedure was examined by comparing patient pain ratings and narcotic usage pre- and post-PMM. Follow-up periods ranged from 3 to 31 months. Examination of the results indicates a significant reduction in pain ratings as well as a significant reduction in daily narcotic use. No adverse neurological effects were observed. One spinal cord has been recovered for postmortem examination. Conclusions. These findings provide corroborating clinical evidence for the existence of a newly recognized mid-line posterior column pathway that mediates the perception of visceral pelvic and abdominal pain. Preliminary data indicate that significant pain relief can be obtained following PMM with minimal neurological morbidity and suggest that the procedure may provide an alternative treatment modality for cancer-related pain in patients in whom adequate pain control with narcotics cannot be achieved or narcotic side effects cannot be tolerated.

Dorsal rhizotomy for the relief of intractable pain of malignant tumor origin

1973 ◽  
Vol 38 (6) ◽  
pp. 755-757 ◽  
Author(s):  
J. Martin Barrash ◽  
Milam E. Leavens
Keyword(s):  
Life Expectancy ◽  
Cancer Patients ◽  
Malignant Tumor ◽  
Physical Condition ◽  
Intractable Pain ◽  
Content Type ◽  
Dorsal Rhizotomy ◽  
Functional Value ◽  
Tumor Origin ◽  
Fine Print

✓ Experience with dorsal rhizotomy in 71 patients with intractable pain is presented. The authors believe this treatment is indicated for cancer patients who are in good enough physical condition to tolerate a laminectomy, have a moderate life expectancy, and whose pain involves structures innervated by one or several roots. An extremity should be denervated only if it is already without functional value. The advantage of sensory rhizotomy is that it produces a lasting anesthesia that is tolerable to the patient. The results Were good to excellent in 50 of the 71 patients. There were five operative deaths.

Treatment of postherpetic trigeminal neuralgia with the Leksell gamma knife

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 165-168 ◽  
Author(s):  
Dušan Urgošík ◽  
Josef Vymazal ◽  
Vilibald Vladyka ◽  
Roman Liščák
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Postherpetic Neuralgia ◽  
Pain Treatment ◽  
Gamma Knife Radiosurgery ◽  
Intractable Pain ◽  
Neurosurgical Procedures ◽  
Content Type ◽  
Fine Print

Object. Postherpetic neuralgia is a syndrome characterized by intractable pain. Treatment of this pain has not yet been successful. Patients with postherpetic neuralgia will therefore benefit from any progress in the treatment strategy. The authors performed gamma knife radiosurgery (GKS) as a noninvasive treatment for postherpetic trigeminal neuralgia (TN) and evaluated the success rate for pain relief. Methods. Between 1995 and February 1999, six men and 10 women were treated for postherpetic TN; conservative treatment failed in all of them. The median follow up was 33 months (range 8–34 months). The radiation was focused on the root of the trigeminal nerve in the vicinity of the brainstem (maximal dose 70–80 Gy in one fraction, 4-mm collimator). The patients were divided into five groups according to degree of pain relief after treatment. A successful result (excellent, very good, and good) was reached in seven (44%) patients and radiosurgery failed in nine (56%). Pain relief occurred after a median interval of 1 month (range 10 days–6 months). No radiation-related side effects have been observed in these patients. Conclusions. These results suggest that GKS for postherpetic TN is a relatively successful and safe method that can be used in patients even if they are in poor condition. In case this method fails, other treatment options including other neurosurgical procedures are not excluded.

Commissural myelotomy

1977 ◽  
Vol 47 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Albert W. Cook ◽  
Yasuto Kawakami
Keyword(s):  
Pain Relief ◽  
Operative Technique ◽  
Intractable Pain ◽  
Operating Microscope ◽  
Content Type ◽  
Total Failure ◽  
Bilateral Metastases ◽  
Fine Print

✓ The effect of commissural myelotomy in 24 cases with intractable pain is described. The operative technique employed with the operating microscope or magnifying glasses and a special myelotome is outlined. The results suggest an outstanding advantage in patients with bilateral metastases from malignancies except intrapelvic metastases. Patients with lumbar arachnoiditis showed a total failure of pain relief after 2 to 5 years, in spite of good relief temporarily.

Pain reduction by electrical brain stimulation in man

1977 ◽  
Vol 47 (2) ◽  
pp. 178-183 ◽  
Author(s):  
Donald E. Richardson ◽  
Huda Akil
Keyword(s):  
Side Effects ◽  
The Other ◽  
Spontaneous Pain ◽  
Intractable Pain ◽  
Electrical Brain Stimulation ◽  
Periaqueductal Gray Matter ◽  
Content Type ◽  
The Brain ◽  
Fine Print ◽  
Stimulation Of

✓ Acute studies performed in five patients indicate that electrical stimulation of the brain could be a powerful tool for the reduction or control of intractable pain. While chronic or spontaneous pain could be relieved by stimulation of the periaqueductal gray matter, the accompanying side effects render it impossible to stimulate this site regularly. On the other hand, stimulation of medial thalamic sites, particularly medial to the nucleus parafascicularis, yielded good relief of chronic pain at parameters which did not cause many undesirable side effects. The same parameters also produced inhibition of acute pain in two of the five patients.

Safety and efficacy of stereotactic radiosurgery for tumors of the spine

2004 ◽  
pp. 413-418 ◽  
Author(s):  
Deborah L. Benzil ◽  
Mehran Saboori ◽  
Alon Y. Mogilner ◽  
Ronald Rocchio ◽  
Chitti R. Moorthy
Keyword(s):  
Spinal Cord ◽  
Single Dose ◽  
Pain Relief ◽  
Total Dose ◽  
Stereotactic Radiosurgery ◽  
Medical Center ◽  
Primary Tumors ◽  
Content Type ◽  
Increased Risk ◽  
Fine Print

Object. The extension of stereotactic radiosurgery treatment of tumors of the spine has the potential to benefit many patients. As in the early days of cranial stereotactic radiosurgery, however, dose-related efficacy and toxicity are not well understood. The authors report their initial experience with stereotactic radiosurgery of the spine with attention to dose, efficacy, and toxicity. Methods. All patients who underwent stereotactic radiosurgery of the spine were treated using the Novalis unit at Westchester Medical Center between December 2001 and January 2004 are included in a database consisting of demographics on disease, dose, outcome, and complications. A total of 31 patients (12 men, 19 women; mean age 61 years, median age 63 years) received treatment for 35 tumors. Tumor types included 26 metastases (12 lung, nine breast, five other) and nine primary tumors (four intradural, five extradural). Thoracic tumors were most common (17 metastases and four primary) followed by lumbar tumors (four metastases and four primary). Lesions were treated to the 85 to 90% isodose line with spinal cord doses being less than 50%. The dose per fraction and total dose were selected on the basis of previous treatment (particularly radiation exposure), size of lesion, and proximity to critical structures. Conclusions. Rapid and significant pain relief was achieved after stereotactic radiosurgery in 32 of 34 treated tumors. In patients treated for metastases, pain was relieved within 72 hours and remained reduced 3 months later. Pain relief was achieved with a single dose as low as 500 cGy. Spinal cord isodoses were less than 50% in all patients except those with intradural tumors (mean single dose to spinal cord 268 cGy and mean total dose to spinal cord 689 cGy). Two patients experienced transient radiculitis (both with a biological equivalent dose (BED) > 60 Gy). One patient who suffered multiple recurrences of a conus ependymoma had permanent neurological deterioration after initial improvement. Pathological evaluation of this lesion at surgery revealed radiation necrosis with some residual/recurrent tumor. No patient experienced other organ toxicity. Stereotactic radiosurgery of the spine is safe at the doses used and provides effective pain relief. In this study, BEDs greater than 60 Gy were associated with an increased risk of radiculitis.

Preliminary percutaneous dorsal column stimulation prior to permanent implantation

1972 ◽  
Vol 37 (2) ◽  
pp. 242-245 ◽  
Author(s):  
Yoshio Hosobuchi ◽  
John E. Adams ◽  
Philip R. Weinstein
Keyword(s):  
Dorsal Column ◽  
Screening Procedure ◽  
Intractable Pain ◽  
Content Type ◽  
Dorsal Column Stimulation ◽  
Fine Print

✓ Percutaneous dorsal column stimulation was done as a screening procedure in 34 candidates before implantation of a permanent dorsal column stimulator for the treatment of intractable pain. This procedure was useful in forecasting the tolerance of the patient to the “vibratory sensation” produced by a dorsal column stimulator, and the efficacy of the device in relieving pain. Eight patients termed the “vibratory sensation” intolerable. Sixteen found it unpleasant but preferable to the pain, and two found it actually pleasant.

Minimally invasive implantation of epidural spinal cord neurostimulator electrodes by using a tubular retractor system

2004 ◽  
Vol 100 (6) ◽  
pp. 1119-1121 ◽  
Author(s):  
Matthew R. Johnson ◽  
Daniel J. Tomes ◽  
John S. Treves ◽  
Lyal G. Leibrock
Keyword(s):  
Spinal Cord ◽  
Postoperative Pain ◽  
Minimally Invasive ◽  
Intractable Pain ◽  
Tubular Retractor ◽  
Content Type ◽  
Novel Technique ◽  
Pain Syndromes ◽  
Hospital Stays ◽  
Fine Print

✓ The authors describe a novel technique for the implantation of multipolar epidural spinal cord neurostimulator electrodes with the aid of a tubular retractor system. Spinal cord neurostimulation is used as a neuroaugmentive tool for treating chronic intractable pain syndromes. Minimally invasive placement of the multipolar neurostimulator electrodes may allow for shorter hospital stays and less postoperative pain associated with the incision.

Sign in / Sign up

Export Citation Format

Share Document