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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pain due to bone metastasis in hormonodependent cancer (of the breast or the prostates more particularly) can be relieved by surgery directed at the endocrinic system. The most efficient techniques are hypophysectomies and hypophysiolysis (or neuroadenolysis). The intrasellar injection of alcohol through the transnasal-transsphenoidal route is a fairly simple procedure which can be carried out on such fragile patients without too much risk. The authors here report the first results obtained with this procedure in 12 pateints. Full sedation of pain is achieved in 30 to 40 p. cent of the cases. The duration of analgesia varies and pain frequently returns. One of the advantages of this procedure lies in the fact that such an injection may be repeated if necessary. The intrasellar injection of alcohol is but one of the many techniques available to practitioners working in the field of intractable pain.
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PMID:[Pain due to bone metastasis in hormonodependent cancer. Treatment by intrasellar injection of alcohol (author's transl)]. 52 38

Concentrations of meperidine and its active metabolite, normeperidine, were measured in plasma of patients receiving the drug for analgesia. Meperidine levels in cancer patients were 0.10 to 0.55 microng/ml 1 h after a dose and were 0.05 to 0.14 in patients in the oliguric period after renal transplantation. Normeperidine levels were 0.05 to 0.28 microng/ml in the cancer patients and 0.13 to 0.36 in the renal failure patients. The ratio of normeperidine to meperidine levels was always higher in the renal failure patients than in the cancer patients. Additionally, two patients receiving multiple doses of meperidine had high normeperidine levels and very high normeperidine/meperidine ratios when they showed signs of central nervous system excitation. These data indicate that normeperidine can contribute to the excitatory effects seen after multiple doses of meperidine and suggest that patients with renal failure are particularly susceptible to this problem.
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PMID:Accumulation of normeperidine, an active metabolite of meperidine, in patients with renal failure of cancer. 86 53

I describe the results of retrogasserian differential lidocaine block to aid in the selection of patients for a differential thermal lesion in the trigeminal ganglion and rootlets. This procedure temporarily duplicates the state of analgesia without anesthesia one seeks to make permanent with the radiofrequency heating. The results of this heating procedure are described in the treatment of 71 patients with facial pain of cancer, postherpetic, periodic migrainous neuralgia, acromegaly, trigeminal neuropathy, central pain, post-traumatic facial neuralgia, and atypical facial neuralgia.
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PMID:Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers: facial pain other than trigeminal neuralgia. 97 5

The physiological basis, historical evolution, and our own practice of stereotactic surgery for the relief of cancer pain are briefly described. Thirty-nine procedures have been performed on 33 patients, 27 for pain due to cancer. Lesions have been made both in the specific neospinothalamic pathway of midbrain and thalamus and in the non-specific reticulothalamic system with an overall five per cent mortality and five per cent morbidity. Initial pain relief was achieved in 90 per cent of patients with relief till death in 74 per cent. Lesions were more successful in releiving pain when the specific pain system was involved but only if the analgesia produced by the lesion "covered" the patient's pain. On the other hand, dysesthesia occurred only with lesions of the specific system, especially if they involved the thalamus.
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PMID:Neurological concepts of pain management in head and neck cancer. 110 70

Pain management, nutritional support, and psychosocial support are fundamental services that enhance patients' ability to cope with their cancer and its therapy. The common goal of symptom prevention mandates that each of these supportive services be provided to all patients throughout their cancer experience. Comprehensive cancer pain management begins with identifying the origin of all of the patient's pains and treating each one specifically. Pain prevention can be achieved through around-the-clock opioid administration with as-needed supplements for breakthrough pain and dose titration. Common narcotic side effects such as constipation and nausea also must be prevented. Successful opioid analgesia requires that patient and family concerns regarding addiction and tolerance be dispelled at the outset. Cancer pain prevention can be further optimized with the use of appropriate coanalgesics in response to the pathophysiology of the patient's pains. Cognitive and behavioral therapies may also be useful adjuncts to reduce both pain and suffering. Procedure-oriented pain control should be considered when systemic pharmacologic therapy does not provide adequate pain relief or is associated with intolerable side effects. The only absolute contraindications for pain-relieving procedures are untreatable coagulopathy and a decrease in mental status not related to medical pain management. Useful neurodestructive techniques include radiofrequency lesioning, cryoanalgesia, and chemical neurolysis with agents such as phenol, alcohol, and hypertonic saline. The most beneficial pain-relieving procedures and percutaneous cordotomy, spinal narcotics, celiac and hypogastric plexus ablation, spinal neurolysis, and epidural injection of steroids and hypertonic saline. Procedure selection depends on the cause of the pain and the patient's prognosis. Common indications for pain-relieving procedures include unilateral pain below the shoulder, upper abdominal visceral pains, pelvic visceral pain, perineal pain, vertebral body metastasis, discogenic pain, and spinal stenosis. As results of well-conducted scientific trials begin to appear in the literature, the indications for these procedures will be better understood, resulting in their more appropriate use. Principles of nutritional support in patients with cancer include an awareness of the problem of malnutrition and its impact on performance status, quality of life, prognosis, and treatment; identification of those patients at risk; prophylactic versus therapeutic intervention; and analysis and management of the specific impediment(s) to adequate nutrient intake and absorption. The primary goals for nutritional support in cancer patients are prevention of weight loss and maintenance of adequate protein status. Appreciation of practical issues of nutritional support will enable the practicing physician to achieve these goals using primarily oral nutrition options.(ABSTRACT TRUNCATED AT 400 WORDS)
Curr Probl Cancer
PMID:Supportive care in oncology. 128 50

Anaerobic necrotizing soft tissue infections are known for their devastating effects of tissue destruction and death. These infections may occur as a result of trauma, surgical intervention or occur spontaneously in predisposed individuals. They are caused by a wide range of anaerobic organisms and may be categorised according to the tissue involvement as Necrotizing Fasciitis and Myonecrosis. A five year review of patients admitted for hyperbaric oxygen (HBO) therapy and requiring intensive care revealed a patient group numbering 25, roughly equally divided between the two classifications of tissue involvement. Trauma was an aetiological factor in 5 of these cases. Cancer and diabetes mellitus were also prominent aetiological factors. Treatment consisted of the triad of early selective/aggressive surgery, high dose antibiotic therapy and HBO therapy. The mortality of the group was 25%. Delay in treatment was associated with increased mortality. Nursing care, for this particular patient group is demanding, requiring particular attention to wound care, analgesia, transport, psychosocial care of patient with mutilating wounds, nutrition and temperature homeostasis. It is a cause for concern that two cases occurred after elective orthopaedic procedures requiring the application of plaster of paris (POP) cast over a leg.
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PMID:A five year review of anaerobic, necrotizing soft tissue infections: a nursing perspective. 129 Aug 88

In a multicentric, interindividual, double-blind study, the analgesic action, duration of effect, tolerability and side effects of the new combination preparation, Combaren (diclofenac-Na 50 mg+codeine phosphate 50 mg), were compared with those of diclofenac-Na 50 mg (Voltaren 50) in 184 patients with severe tumor-related pain. The results show that Combaren is a highly effective preparation for the treatment of severe tumor pain. The combination of diclofenac-Na with codeine phosphate leads to a clear, statistically significant, augmentation of the effectiveness of additionally used analgesics on pain severity, and the general effectiveness of the combination is more positively assessed that that of monotherapy with diclofenac (also effective). In the staged approach to the treatment of malignancy-related pain in which the aim is to provide continuous, preventive analgesia rather than ad hoc treatment of newly developing or worsening pain, this combination preparation will presumably find a permanent place in stage I/II of the generally accepted staged pain-treatment scheme.
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PMID:[Drug therapy in severe tumor pain. Comparative study of a new combination preparation versus diclofenac-Na]. 138 30

Opiates remain the mainstay of cancer pain treatment, used in a logical and stepwise fashion with adjunctive therapies as needed. Certain neuropsychotropic drugs may enhance the analgesia produced by opiates and may occasionally be used in place of opiates. Some of these drugs may also provide additional psychoactive benefits. The types of neuropsychotropic drugs that may be useful in treating cancer pain include the tricyclic antidepressants, anticonvulsants, neuroleptics, antihistamines, psychostimulants, and benzodiazepines, as well as systemic local anesthetics. This article reviews the general principles of using adjunctive medications to achieve maximal analgesic benefit with the least number of side effects, and describes each class of neuropsychotropic drug, their proposed mechanism of analgesia, and appropriate use in cancer patients.
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PMID:Neuropsychotropic drugs as adjuncts in the treatment of cancer pain. 139 16

The safety and efficacy of patient-controlled analgesia for the long-term control of cancer pain was tested prospectively. Respiratory rates, mental status, and pain relief were recorded at baseline and compared with those during the study period. Patients had a lower analgesic demand (i.e., self-administered less morphine during the nighttime); specifically, dosing declined 48% from the daytime level. Respiratory rates did not change appreciably during the study and no cases of significant respiratory depression were encountered. Patients self-administered sufficient morphine to produce adequate but not complete pain relief in almost all trials. Pain relief was safely achieved by both intravenous and subcutaneous routes of administration in both the inpatient and outpatient settings. Mean 24-h morphine use stayed relatively constant even for patients receiving more than 2 weeks of treatment. In conclusion, patient-controlled analgesia is effective and safe therapy for the long-term control of severe cancer pain.
Cancer Invest 1992
PMID:Patient-controlled analgesia for cancer pain: a long-term study of inpatient and outpatient use. 139 84

Thirty cancer patients, clinical group IV, have been examined. It has been established that a persistent pain syndrome leads to lowering in beta-endorphin liquor level. Morphine analgesia is followed by beta-endorphin level elevation which directly depends on pain intensity and analgesia efficacy. Determination of changes in beta-endorphin liquor level may serve as a criterion of analgesia efficacy.
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PMID:[Changes in the concentration of beta-endorphin in the cerebrospinal fluid due to morphine analgesia in incurable oncologic patients]. 141 98


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