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

Twenty patients with chronic low back pain received 12 lumbar sympathetic injections, in a series of 6 with bupivacaine and a series of 6 with saline. Changes in subjective pain intensity, EMG from paravertebral muscles, joint ranges of mobility, and daily activity levels were measured at multiple intervals throughout treatment and at 3 monthly follow-up intervals. The MMPI was administered before treatment, after treatment and at 3-month follow-up. Results revealed significant reductions in subjective pain intensity lasting 1 month after treatment which were not significantly different during bupivacaine and saline injection periods. Patients' MMPI profiles were indicative of reduced depression and an increase in ability to manage their lives. No significant changes were recorded with respect to EMG, joint range of mobility, or daily activity levels. Results were discussed in terms of a massive placebo effect and analgesia obtained through hyperstimulation of various tissue structures. They are consistent with the hypothesis that central postsynaptic mechanisms were predominant in these patients' chronic back pain states. Because subjective pain relief did not independently produce increasing function, it was recommended that deep analgesic injections or other pain relieving techniques be matched with behavior modification leading to functional rehabilitation.
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PMID:Chronic back pain: electromyographic, motion and behavioral assessments following sympathetic nerve blocks and placebos. 644 50

We have reviewed our experience with spinal cord stimulation (SCS) in patients with low back and leg pain. 33 patients complaining of leg and low back pain underwent percutaneous tests of SCS. 28 patients had failed back surgery syndromes, 1 patient had pain related to an L1 vertebral body fracture, another from Tarlow cysts and the remaining 3 patients had lumbosacral spondyloarthrosis and osteoporosis without radiological signs of root compression. 28 patients showed mono- or pluriradicular deficits. At the end of the test period (5-65 days), 21 patients (63.6%) reported more than 50% of pain relief (mean analgesia 75%) and were submitted to chronic stimulation. The mean follow-up was 45.5 months. At maximum available follow-up, 40% of the patients (13 out of the 33 initial patients) were successfully using the stimulator (mean analgesia 66.6%).
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PMID:Spinal cord stimulation in low back and leg pain. 763 Oct 79

The rate of low back pain and headache following parturition seems to be higher in patients delivered under epidural analgesia. The aim of this study, performed in the immediate postpartum (up to 3rd day) and including 200 patients delivered vaginally, was to assess the incidence and the risk factors of low back pain and headache. A total of 31.5% of them complained of low back pain (LBP+) after parturition. They were significantly younger than those without low back pain (LBP-) (p < 0.03) and have had significantly more often epidural analgesia (p < 0.05). However, there were no statistically significant differences concerning weight, weight gain, parity, duration of labour and duration of epidural analgesia. The LBP+ patients complained significantly more often of cervical (p < 0.04) and low back pain (p < 0.02) during pregnancy, than the LBP-. In the immediate postpartum period, cervical and dorsal pain as well as headache occurred significantly more often in LBP+ than in LBP+ (p < 0.001). The intensity of low back pain during pregnancy (p < 0.006). Risk factors for postpartum LBP were epidural analgesia (OR = odds ratio = 6.59), LBP (OR = 6.50) and cervical pain (OR = 2.75) during pregnancy. The influence of epidural analgesia is questionable, as there was no difference between duration of labour and duration of epidural analgesia, if used, between the two groups. Patients for whom epidural analgesia was required are probably more susceptible to pain during pregnancy. Patients who suffered from postpartum headache (PPHDA+) were comparable to those who did not (PPDHA-).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Low back pain and headache during immediate postpartum. Role of obstetrical epidural analgesia]. 767 73

We reviewed the out-patient consultation notes of 136 pregnant women seen at the Ottawa Civic Hospital from 1985 to 1991 to evaluate the efficacy of an Obstetric Anaesthesia Assessment Clinic (OAC). In addition, their anaesthetic records from labour and delivery were reviewed. For each patient the reason for referral was recorded according to the involved organ system. The anaesthetic management at delivery was compared with the proposed anaesthetic plan by the OAC consultant (obstetric anaesthetist). The majority of women 84 (62%) had complaints related to the musculo-skeletal system. In addition, 18 patients were referred because of previous anaesthetic problems, ten with a history of cardiac disease, and eight with neurological disease. Lumbar epidural analgesia (LEA) was a safe and effective choice for parturients with low back pain, history of lumbar fractures or single level discectomies without lumbar fusion. Parturients with posterior instrumentation experienced an increased incidence of inadequate pain relief from LEA. Individualized anaesthetic management plans were executed for parturients with spina bifida occulta, neurological, cardiac, and haematological disease as well as for women, with a history of adverse drug reactions and previous problems with regional or general anaesthesia. It is concluded that the OAC has provided a valuable service to obstetricians and anaesthetists for the anaesthetic management of pregnant women with co-existing disease. The OAC gave an opportunity for patient education regarding anaesthetic options for labour and delivery. The attending anaesthetist was provided with a risk assessment and anaesthetic management plan which was adhered to with only two exceptions. Finally, the obstetrician was given consistent advice regarding anaesthesia management that may affect obstetrical decisions.
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PMID:The obstetrical anaesthesia assessment clinic: a review of six years experience. 848 95

Forty-six permanent epidural catheters and life-port units were implanted in 43 patients with severe, recurrent low back pain who had been considered not to be candidates for surgical intervention and in whom other therapeutic modalities had failed. Eight cases developed epidural fibrosis (EF). For analgesia, patients received either infusions with preservative-free solutions of fentanyl and bupivacaine or daily boluses of morphine and bupivacaine. Catheters remained from 75 days to 433 days. Signs of EF appeared from 21 days to 320 days after implantation. Pain at injection or resistance to injection were initial manifestations of EF, followed by poor, and eventually, nil analgesic effect. The epidural catheters were made of either polyamide, silicone, or polyurethane. Epidurograms revealed encapsulation, narrowing, and loculation of epidural space with gradually reduced spread of the contrast material. The occurrence of EF limits the permanency of implanted epidural catheters. The infusate does not cause this complication, which appears to be a foreign body reaction due to the presence of the catheter in the epidural space.
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PMID:Epidural fibrosis after permanent catheter insertion and infusion. 859 23

The article by Brown et al does not provide data to justify long-term opioid use but does suggest a treatment option for the many patients who have chronic back pain and who want the help that our medical delivery system often does not provide. Having worked in a tertiary referral pain clinic that serves many low back pain patients who have demonstrated the ineffectiveness of chronic opiate therapy, I am strongly ambivalent about recommending prescribing ongoing opioiod therapy for chronic pain patients. The caveats about prescribing opioids for such patients are most appropriate (i.e., do not prescribe opioids for those who have a history of problems with opioid therapy or for whom increased intake is associated with decreased function); however, for patients who do not display these problems (and there could be many out there), I am sympathetic with the sentiments expressed by Brown et al. A trial of these drugs might be warranted if all else fails and continued therapy with opioids seems justified, but only with zealous attention to monitoring function and therapeutic compliance, as outlined by the authors. With regard to the doses needed for control, the method of opioid administration might be important, that is, whether it is in tablets or in a masking vehicle. In this day of open dialogue, it is not fashionable to blind the patient to the drug or dose, but I believe blinding has a place in the care of a particular group of patients whose symptom (pain) can vary considerably with time. I have found that most chronic pain patients rarely, if ever, reduce their analgesic intake in better times, but an attentive physician can if masking vehicles are used. Thus the physician can limit the amount of drug consumed long term. In my personal experiences with comparable chronic nonmalignant pain patients (albeit in different hemispheres), the average opioid maintenance (methadone) dosage was halved by prescribing the drug in a masking vehicle rather than as a tablet. If pain complaints are reduced and if function is improved according to the record (eg, patient is working) and the relatives' report, and if you, the prescribing physician, are happy, then a long-term regimen of opioid therapy is probably fine. Further controlled trials are needed to see whether this therapy works, and if so, what are the optimal agent(s) and dosages, what is optimal monitoring, and most important of all, who is the optimal patient who might derive not only analgesia but also functional benefit rather than compromise from this therapy. If we cannot make patients better, we must not make them worse.
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PMID:Chronic opioids for chronic low back pain--solution or problem? 888 84

Fifteen adults with chronic low back pain (M = 4 years), age 18 to 43 years (M = 29 years), participated. All but one were moderately to highly hypnotizable (M = 7.87; modified 11-point Stanford Hypnotic Susceptibility Scale, Form C [Weitzenhoffer & Hilgard, 1962]), and significantly reduced pain perception following hypnotic analgesia instructions during cold-pressor pain training. In Part 1, somatosensory event-related potential correlates of noxious electrical stimulation were evaluated during attend and hypnotic analgesia (HA) conditions at anterior frontal (Fp1, Fp2), midfrontal (F3, F4), central (C3, C4), and parietal (P3, P4) regions. During HA, hypothesized inhibitory processing was evidenced by enhanced N140 in the anterior frontal region and by a prestimulus positive-ongoing contingent cortical potential at Fp1 only. During HA, decreased spatiotemporal perception was evidenced by reduced amplitudes of P200 (bilateral midfrontal and central, and left parietal) and P300 (right midfrontal and central). HA led to highly significant mean reductions in perceived sensory pain and distress. HA is an active process that requires inhibitory effort, dissociated from conscious awareness, where the anterior frontal cortex participates in a topographically specific inhibitory feedback circuit that cooperates in the allocation of thalamocortical activities. In Part 2, the authors document the development of self-efficacy through the successful transfer by participants of newly learned skills of experimental pain reduction to reduction of their own chronic pain. Over three experimental sessions, participants reported chronic pain reduction, increased psychological well-being, and increased sleep quality. The development of "neurosignatures of pain" can influence subsequent pain experiences (Coderre, Katz, Vaccarino, & Melzack, 1993; Melzack, 1993) and may be expanded in size and easily reactivated (Flor & Birbaumer, 1994; Melzack, 1991, 1993). Therefore, hypnosis and other psychological interventions need to be introduced early as adjuncts in medical treatments for onset pain before the development of chronic pain.
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PMID:Hypnotic analgesia: 1. Somatosensory event-related potential changes to noxious stimuli and 2. Transfer learning to reduce chronic low back pain. 943 5

A non-protein extract isolated from the inflamed skin of rabbits inoculated with vaccinia virus (Neurotropin, NTP), has been clinically used in Japan for the treatment of chronic painful conditions such as low back pain, osteoarthritis, postherpetic neuralgia, subacute myelo-opticoneuropathy, and so on. Recent studies have shown its efficacy on patients with complex regional pain syndrome (CRPS). The chronic constriction injury (CCI) model described by Bennett and Xie has been thought to show similar painful conditions to those seen in CRPS patients. Thus, the antinociceptive effects of NTP were tested in CCI model. In rats with mechanical hyperalgesia 2 weeks after nerve injury, i.p. injection of NTP (100 Neurotropin Unit, NU/kg) produced an analgesic effect that lasted for at least 50 min. An analgesic effect lasting up to 30 min. was observed in rats with heat hyperalgesia 2 weeks after nerve injury. Seven daily i.p. injections (50 NU/kg) of NTP commencing 1 week after surgery produced an early recovery from heat hyperalgesia. Prior studies suggest that NTP produces analgesia by activation of a descending pain inhibitory system. Thus, our findings suggest the possibility that the dysfunction of the descending pain inhibitory system could be related to the hyperalgesia in the nerve injury model, and perhaps also in people who suffer from painful peripheral neuropathies.
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PMID:Antinociceptive effects of neurotropin in a rat model of painful peripheral mononeuropathy. 949 14

Since April 1995 this endoscope assisted laser technique has been used for widening the lumbar exit route foramina. Patient selection included individuals with primarily unilateral sciatica as well as low back pain and referred buttock pain following various operative interventions. Endoscopic laser foraminoplasty (ELF) utilises an endoscope, a uniportal posterolateral approach and a side firing holmium laser probe. Under direct vision and within the protection of saline solution, epidural scarring, extruded and sequestrated disc protrusions and/or osteophytes are removed by holmium laser ablation. The patient is responsive and aware under neurolept analgesia and this ensures the protection and the integrity of the nerve root. A total of 219 such interventions has been performed up to January 1, 1997. The first 48 cases with a follow-up exceeding 12 months have been included in this preliminary review. Initial experience is encouraging. The ELF seems to provide another means of addressing sequelae of primary degenerative disorders as well as the common consequences of conventional spine surgery. ELF provides an alternative to minimal intervention fenestrectomy and open surgical undercutting for predominantly unisegmental and unilateral lateral recess stenosis and in selected cases it may prevent or delay the indication of spinal fusion.
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PMID:Endoscopic laser foraminoplasty on the lumbar spine--early experience. 956 57

Acute low back pain is a common problem in the emergency department (ED). Effective management of acute pain enhances early rehabilitation and recovery. Given the importance of inflammatory mediators in pain generation and the adverse effects associated with opioids, it is logical to expect that a non-opioid agent with antiinflammatory and analgesic properties would provide excellent analgesia with fewer adverse effects. This double-blind, randomized, multicenter clinical trial, performed in six university and community hospital EDs, compares the analgesic efficacy and adverse effects of ketorolac to those of acetaminophen-codeine in ED patients with acute musculoskeletal low back pain. Our hypothesis was that ketorolac would provide superior analgesia with fewer adverse effects. One hundred twenty-three patients with acute low back pain were randomized to receive ketorolac (KET, N = 63) or acetaminophen-codeine (ACOD, N = 60). Most (79%) were males, and the mean age was 34.5 years. After baseline clinical assessment, patients were treated with ketorolac (10 mg every 4 to 6 h as needed, up to four daily doses) or acetaminophen-codeine (600 mg-60 mg, respectively, every 4 to 6 h as needed, up to six daily doses) and followed for one week. Pain intensity was assessed on visual analogue and categorical scales. Functional capacity, overall pain relief, and overall medication rating were assessed on categorical scales. Adverse events were documented. Primary outcomes included: 1) Pain intensity differences, based on visual analogue scores, for the 0 to 6 h treatment phase. 2) Incidence of adverse events. Secondary outcomes included analgesic efficacy, functional capacity, and overall subjective drug evaluation at one week. Both drugs provided substantial pain relief, with maximal effect 2.2 h after oral dosing. There were no significant differences in analgesic efficacy, functional capacity, or overall pain relief between the two groups. Sixteen patients (10 KET vs. 6 ACOD, NS) withdrew prematurely because of drug inefficacy. Patients in the ACOD group reported significantly more adverse drug events and serious adverse drug events. Seven patients--all in the ACOD group--withdrew from the study because of adverse drug events. Based on comparable efficacy and a superior adverse event profile, ketorolac was preferable to acetaminophen with codeine for the treatment of acute low back pain in the ED.
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PMID:Ketorolac versus acetaminophen-codeine in the emergency department treatment of acute low back pain. 969 69


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