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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To verify the effectiveness and the incidence of complication in the transcutaneal celiac plexus block with CT-guided in the patient with intractable upper abdominal cancer, using alcoholic solutions to different concentrations (50% and 96%), previous insertion of the peridural catheter. From December 1997 to June 2002, studies were carried out on 24 patients with CT-guided percutaneous coeliac plexus neurolysis including 17 men and 7 women with inoperable abdominal malignancy and two with chronic pancreatitis. The patients were affected by very intense pain controllable only with high doses of analgesic narcotics. Before the procedure a catheter was installed in the peridurale space between L1-T12. To avoid general anesthesia, 40 mL of marcaine 0.5% was injected to relieve the back pain sometimes reported after the neurolysis, caused by the diffusion of alcohol in the coeliac plexus. This technique requires a posterior percutaneous procedural transaortic approach CT scan guided, to determine the correct position of the needle tips and the spread of neurolytic solution (40 mL of 96% + 3 mL of contrast medium) around the origin of the coeliac trunk's anatomical center of the plexus. The first 10 patients have received 40 mL of 50% ethyl alcohol + 3 mL of contrast medium. To evaluate the rate of the analgesia relief, a visual analogue pain score (VAS) was used before and 48 hours after the neurolysis. The percutaneous neurolysis of the celiac plexus is useful to relieve the pain in patients affected by cancer developing in upper abdomen. The CT-scan guide of the needle allows an omogeneous distribution of the contrast medium. The insertion of the peridural catheter made a complete analgesia and reduced the incidence of complications. Our method provided an excellent control of the pain in all patients. In our experience the pain relief was almost complete in patients treated with 96% ethyl alcohol solution (VAS from 8 before the treatment to 1, 48 hours after the treatment). The alcohol administered in elevated concentrations (96%), does not increase the incidence of complications.
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PMID:[Percutaneous neurolysis of the celiac plexus under CT guidance in the invasive treatment of visceral pain caused by cancer]. 1290 23

Neurolytic celiac plexus block is an established, well-developed procedure and the most accepted and applied in visceral pain; recognized by the WHO and the IASP, it is very good in palliative management of cancer pain in visceral of superior hemiabdomen. However, conventional techniques in celiac plexus have not been successful in patients with organomegaly and/or anatomic abnormalities, except when splanchnic nerve neurolytic blockade is used. On the other hand, conventional techniques in splanchnic nerves are highly associated with complications such as paraplegia, pneumothorax and liver or renal punction. For these reasons an alternative option has ben designed, termed transdiscal percutaneous approach of splanchnic nerves under tomographic control; this technique affords the option of improving accuracy and performance with minimum risks, particularly lung puncture and its consequences. Under this technique, 64 superior hemi-abdomen cancer patients initiated such a study (four without morphine treatment quit the study), 55% females and 45% males, visceral pain syndrome 65%, and mixed, 35%. Side effects were dyspnea 5%, hypotension 26.7%, nausea 31.7%, diarrhea 83.3% in which diarrhea means increased peristalsis showing adequate sympathetic inhibition via splanchnic nerves), vomiting 28.3%, punction-site pain 46.7%, aorta punction 6.7%, anal pleural punction 5%. All these incidents were dealt with by conservative treatment. Student t test showed that pain intensity in all measurements after procedure was different in comparison to basal pain intensity prior to procedure (p<0.05), emphasizing that at the 12th, 18th and 24th months, there was noticeable reduction in participants number with eight, five and four participants, respectively. Morphine intake at week 1, and 1, 2, 3, 6 and 12 months after procedure was different from basal intake prior to procedure (p<0.05) with same noticeable reduction in participant numbers at last stages. Butylhioscine intake at week 1, 1, 2, 3 and 6 months after procedure was different from basal intake prior to procedure (p<0.05). NSAIDs consumption was likely during 2 months after procedure (p<0.05). Linear regression showed that butylhioscine and morphine explained low percentage of pain intensity variance, controlling statistically that effect over pain. There were no differences in pain pathophysiology with regard to cancer type. Transdiscal percutaneous approach of splanchnic nerves guided by CAT is an alternative with minimal risks, as with lung punction, confirming that inhibiting splanchnic nerves has advantages in pain release, reducing and/or eliminating morphine consumption.
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PMID:[Transdiscal percutaneous approach of splanchnic nerves]. 1461 7

The purpose of the study was to determine what dimensions of pain predicted scores on numerical rating scales (NRSs) of Pain, Anxiety, Depression, and Health Expectation in cancer patients. Seventy-one patients with intra-abdominal cancer responded to the Multidimensional Affect and Pain Survey (MAPS) and rated their pain and emotion on the NRSs. Scores on the Pain NRS were predicted by 41% of clusters in the MAPS Somatosensory Pain Supercluster, but by 100% of clusters in the Emotional Pain Supercluster, and negatively by 51% of clusters in the Well-Being Supercluster. The Anxiety and Depression NRSs were each predicted by only the Intense Pain cluster in the Somatosensory Pain Supercluster, but by all of clusters in the Emotional Pain Supercluster. The findings indicate that cancer patients' emotional state is a strong co-determinant of their sensory pain ratings. Negative emotional aspects of pain contribute also to scores on the Anxiety, Depression and Health Expectation NRSs.
J Pain Symptom Manage 2004 Jul
PMID:What do ratings on unidimensional pain and emotion scales really mean? A Multidimensional Affect and Pain Survey (MAPS) analysis of cancer patient responses. 1522 81

Abdominal cancer is commonly associated with pain needing medical attention. Effective pain management is available to control pain. Oral opioids are the foundation of analgesic therapy. With adequate implementation of therapeutic guidelines into clinical practice including the use of co-analgesics, adjuvants and non-pharmacological treatment options the quality of life of abdominal cancer patients can be considerably improved. Only in a minority of patients with refractory pain more sophisticated options of pain management will be necessary, e. g., epidural, intrathecal or neurolytic techniques. In this situation the consultation of a pain therapist is recommended.
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PMID:[Pain management in gastrointestinal oncology]. 1614 15

To explore the association between hydration volume and laboratory findings, and between calculated fluid balance and changes in clinical signs of dehydration and fluid retention in terminally ill cancer patients, a secondary analysis of a large multicenter, prospective, observational study was performed. The study enrolled 125 abdominal cancer patients who received laboratory examinations in the last week before death. Patients were classified into two groups: the hydration group (n = 44), who received 1L or more of artificial hydration per day both 1 and 3 weeks before death, and the nonhydration group (n = 81). The mean albumin level 1 week before death was significantly lower in the hydration group than in the nonhydration group, and the interaction between hydration group and decrease in the albumin level was statistically significant after adjusting multiple covariates (from 2.8 +/- 0.68 mg/dL 3 weeks before death to 2.4 +/- 0.56 mg/dL 24 hours before death in the hydration group vs. a decrease of 2.8 +/- 0.53 to 2.6+ /- 0.45 mg/dL in the nonhydration group, P = 0.015). There was no significant difference between the groups in the mean blood urea nitrogen/creatinine, sodium, or potassium levels 1 week before death. Among 53 patients who had oral fluid intake of less than 500 mL/day throughout the last 3 weeks and completed a fluid balance study, the median of calculated fluid balance was -400 mL/day 3 weeks before death, -521 mL/day 1 week before death, and -421 mL/day 24 hours before death. Calculated fluid balances did not significantly differ between the patients with deterioration of dehydration signs, edema, ascites, and pleural effusion during the final 3 weeks and those without. These data suggest that active artificial hydration might result in hypoalbuminemia, with no clear beneficial effects on normalizing blood urea nitrogen/creatinine, sodium, or potassium levels. Fluid balance did not significantly correlate with changes in dehydration-and fluid retention-signs. Calculated fluid balance is not an appropriate alternative to direct monitoring of patient symptoms. More studies are needed to determine the clinical efficacy of artificial hydration for terminally ill cancer patients.
J Pain Symptom Manage 2006 Feb
PMID:Artificial hydration therapy, laboratory findings, and fluid balance in terminally ill patients with abdominal malignancies. 1648 46

Adrenal myelolipoma is a rare, benign and biochemically inactive tumor. It is usually diagnosed incidentally by radiological methods and is known to be associated with obesity, hypertension, endocrinological disorders and some malignancies. We report herein the association of a myelolipoma with a gastrointestinal stromal tumor. To our knowledge this is the first report of such an association to date. A 67-year-old male patient admitted to our clinic with abdomimal pain and fever; he had a history of hypertension and diabetes mellitus. In physical examination, a mass involving the right quadrants was palpated. Computerized tomography revealed a right retroperitoneal mass, probably originating from the kidney or cecum. In laparotomy, the tumor (12 cm radius and 1500 g) localized on the superior of right kidney was excised. Abdomen exploration revealed another mass with 10 cm radius 100 cm distal to the ligamentum of Treitz and segmental jejunal resection and anastomosis were applied. The pathological diagnosis was reported as myelolipoma for the retroperitoneal mass and leiomyosarcoma for the jejunal mass. Myelolipoma is a benign tumor, involving mature fat and hematopoietic stem cells. Pathogenesis is still not clear and the microscopical characteristics are hematopoietic, lipoid, and reticuloid cells and megakaryocytes. Myelolipomas are reported to be associated with some other malignancies (especially renal), but this is the first report showing the association with a leiomyosarcoma. Therefore, leiomyosarcoma should also be one of the possible associations kept in mind by the physician in the diagnosis and treatment of myelolipomas.
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PMID:Giant adrenal myelolipoma associated with small bowel leiomyosarcoma: a case report. 1683 Feb 97

This session focused on issues related to implementation of randomized clinical trials in palliative care studies. Topics discussed included what kinds of clinical sites and patient populations were suitable, what types of clinical investigators (clinical specialty) should be involved in or lead the studies, what multisite mechanisms could be used to conduct the trials, and what funding issues were related to these studies. A trial of operative versus nonoperative management for small bowel obstruction caused by recurrent intra-abdominal cancer was considered. The feasibility of such a trial was examined in terms of whether there was "equipoise" for a majority of likely investigators in the field around the trial question, what other issues might impact accrual to the trial, and how many patients would be required to answer which of these two treatment arms was better. This last question is related to selection of a primary endpoint for the trial and was a modestly contentious issue for the trial design group. Both sensible compromises in endpoint selection and the education of the community of investigators for a particular randomized trial in palliative care are crucial steps for successful implementation. A major conclusion of this session is that implementation considerations are intimately related to the architecture of a specific trial and should be addressed practically and early in the design phase of any randomized trial addressing a palliative care question. In this respect, randomized trials in palliative care are no different than in other fields.
J Pain Symptom Manage 2007 Jul
PMID:Implementing palliative care studies. 1754 45

This case report series describes eight patients (four patients with pancreatic carcinoma, one patient with hepatocellular carcinoma, one patient with gastric and rectal carcinoma, one with sigmoid colon cancer, and one with rectal cancer), whose abdominal cancer pain was treated with intravenous phentolamine infusion at 80 mg x day(-1) for 2 days. All but one of the patients had already been treated with opioids. All eight patients complained of severe abdominal pain; in five patients the pain radiated to the back, and there was associated anal pain in two patients. Analgesia was achieved in three patients; pain alleviation was obtained in four patients, but was not sustained in two of these four patients; and the treatment in one patient could not be judged for efficacy because epidural morphine was used together with the phentolamine. Adverse effects of phentolamine were tachycardia and/or hypotension.
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PMID:Intravenous phentolamine infusion alleviates the pain of abdominal visceral cancer, including pancreatic carcinoma. 1768 Jan 99

Interpleural blockade is effective in treating unilateral surgical and nonsurgical pain from the chest and upper abdomen in both the acute and chronic settings. It has been shown to provide safe, high-quality analgesia after cholecystectomy, thoracotomy, renal and breast surgery, and for certain invasive radiological procedures of the renal and hepatobiliary systems. It has also been used successfully in the treatment of pain from multiple rib fractures, herpes zoster, complex regional pain syndromes, thoracic and abdominal cancer, and pancreatitis. The technique is simple to learn and has both few contra-indications and a low incidence of complications. In the first of two reviews, the authors cover the history, taxonomy and anatomical considerations, the spread of local anaesthetic, and the mechanism of action, physiological, pharmacological and technical considerations in the performance of the block.
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PMID:Interpleural block - part 1. 1841 62

Interpleural blockade is effective in treating unilateral surgical and non-surgical pain from the chest and upper abdomen in both the acute and chronic settings. It has been shown to provide safe, high-quality analgesia after cholecystectomy, thoracotomy, renal and breast surgery, and for certain invasive radiological procedures of the renal and hepatobiliary systems. It has also been used successfully in the treatment of pain from multiple rib fractures, herpes zoster, complex regional pain syndromes, thoracic and abdominal cancer, and pancreatitis. The technique is simple to learn and has both few contra-indications and a low incidence of complications. In the second of two reviews, the authors cover the applications, complications, contra-indications and areas for future research.
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PMID:Interpleural block - part 2. 2432 Aug 65


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