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

Trigeminal (V) tractotomy and cold block of synaptic transmission in V nucleus caudalis were used to show that caudalis modulates the responses to innocuous and noxious stimuli of single V main sensory-oralis neurones recorded in anaesthetized or decerebrate cats. Cold block caused a reversible depression of mechanosensitivity of 91 of 105 V-thalamic relay and non-relay cells tested; V tractotomy also decreased sensitivity. The possibliity that the effects observed with cold block of caudalis were caused by direct spread of cooling to the main sensory-oralis region, and not by depression of a tonic, net facilitatory influence of caudalis on main sensory-oralis cells, was ruled out by several controls. With cold block of caudalis there also occurred a reversible shrinkage in mechanoreceptive field size and reversible reduction in sensitivity of rapidly adapting and slowly adapting mechanoreceptive neurones. Occasionally no change or an increase in sensitivity occurred, the latter suggesting the liklihood of an inhibitory influence from caudalis as well as the facilitatory influence. The effects of interactions of innocuous and noxious V stimuli were likewise subject to ascending influences from caudalis. Cold block also reversibly depressed responses to tooth pulp and V cutaneous noxious stimuli, although pulp-evoked responses were depressed less than mechanical or infraorbital nerve-elicited responses. Our results indicate that caudalis, as well as acting as a relay site to thalamus, also exerts a predominantly facilitatory influence on the relay to the thalamus and local reflex centres of mechanoreceptive and nociceptive information through the V main sensory-oralis region. The findings also might in part explain the analgesia, partial loss of tactile sensibility, and relief from V neuralgia reported after V tractotomy.
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PMID:Inputs to trigeminal brain stem neurones from facial, oral, tooth pulp and pharyngolaryngeal tissues: II. Role of trigeminal nucleus caudalis in modulating responses to innocuous and noxious stimuli. 18 52

Dental examples are given (e.g. referred pain, V neuralgia) which exemplify the multifactorial and puzzling nature of pain. Pain results from a noxious stimulus activating some of the small-diameter myelinated and unmyelinated afferent nerve fibres that innervate skin, mucosa, teeth etc. It is complex experience including the sensation experienced as well as the emotional, cognitive and motivational reactions evoked by the stimulus. Pain is not a simple function of the magnitude of damage caused by the stimulus, but also depends on factors such as the person's emotions, past experience of pain, and other concomitant sensory experiences (e.g. with acupuncture). Early postulates of pain failed to take all these factors into account. In the V system (Fig. 1), the specificity theory would maintain that there exists a 'private pain path' from oral-facial tissues to the cerebral cortex, with nerve fibres and brain cells in this path responsive only to stimulu of a noxious character (Fig. 2). But anatomical, physiological and psychological observations have failed to give full support to this theory and other postulates of pain. Although some details of the more recently proposed gate control theory have not been sustantiated, this theory has provided a good general framework for viewing pain and has stimulated much recent research. It emphasizes sensory interaction between large and small-diameter afferent nerve fibres in the gate control system, and regulation over central pain transmission through the gate by descending central controls (Fig. 3). In the V system, brain cells involved in central pain transmission have now been found (Fig. 4), and sensory interactions and descending controls on these brain cells noted (Fig. 5). Neural mechanisms such as these have been implicated in pain, and in its control by procedures such as acupuncture, suggestion, distraction and narcotic analgesia.
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PMID:Oral--facial pain: old puzzles, new postulates. 20 11

The authors report their experience in the treatment of essential facial neuralgia by differential thermocoagulation of the gasserian ganglion. This method is based upon the fact that small pain fibres (A delta and C) are more sensitive to warmth than large touch fibres. Thus progressive and controlled thermocoagulation of the trigeminal ganglion makes it possible to obtain selective destruction of the small fibres (analgesia without anaesthesia). 76 patients were treated using the method, and in 75 cases the symptoms of neuralgia disappeared immediately. Mortality is nil and morbidity insignificant other than the effects on the trigeminal nerve. The most serious complication (Approximately 10% of cases) was that of marked hypoaesthesia, rather than pure analgesia, in the coagulated area.
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PMID:[Treatment of essential facial neuralgia by selective thermocoagulation of Gasser's ganglion]. 27 Jul 94

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

Percutaneous radiofrequency ablation of the Gasserian ganglion or posterior root, or both, was performed in 140 patients. Of the 135 patients with trigeminal neuralgia, satisfactory analgesia was achieved in 121. Postoperative complications included unintentional first-division analgesia (10), transient sixth-nerve palsy (1), neuroparalytic keratitis (2), and anesthesia dolorosa (2). The phenomenon of facial blush may be helpful in avoiding unwanted first-division analgesia. In four of five patients with other forms of neuralgia, the procedure did not relieve pain; the fifth patient experienced significant relief from pain due to carcinoma of the mandible.
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PMID:Radiofrequency percutaneous Gasserian ganglion lesions. Results in 140 patients with trigeminal pain. 111 46

The neuralgia of the trigeminal nerve is the most frequent neuralgia of the cranial nerves. It is mostly seen in the elderly. In younger patients it must always be suspected as a symptomatic neuralgia. The course is recurrent and progressive. Spontaneous temporary remissions are usual. Later the pain becomes more frequent, unbearable and disabling. At first the therapy is a conservative one, the drug of choice is Carbamazepin, alternatively Phenytoin and Baclofen. If the conservative therapy fails, the only possible treatment is a neurosurgical one. Nowadays all methods aim at the Gasserian ganglion. In use are several percutaneous transoval procedures or the microvascular decompression through a craniotomy. Our surgical procedure of choice is the percutaneous thermorhizotomy in the Gasserian ganglion and the nerve root, where the pain-conducting fibers are destroyed, preserving tactile sensibility. This procedure is practically without vital hazards for the patient. It is applied in local anesthesia and a short intravenous analgesia. The recurrence rate of 32% is considerable, but the procedure can be repeated. The success cannot be deduced from the recurrence rate alone but must take into account the side effects of the procedure. These are mainly a loss of sensibility to touch by too aggressive rhizotomy and anesthesia of the cornea. By the criteria explained in the text we achieved a good result in 44%, a fair one in 25%, an indifferent one in 10% and a poor result in 7%. In 14% the result is unknown.
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PMID:[The current treatment of trigeminal neuralgia. Experience in 162 thermorhizotomies]. 147 59

Thirty-eight consecutive patients with neuralgia after peripheral nerve injury were treated with one or two series of peripheral local anesthetic blocks. All patients experienced an initial total relief of ongoing pain for 4-12 h. Evoked pain (hyperalgesia or allodynia), which occurred in 17 patients, was blocked simultaneously with the spontaneous pain. In 18 patients the analgesia outlasted the conduction block and there was a period of complete pain relief of 12-48 h in 13 patients and of 2-6 days in the other 5. In 8 patients there was a second phase of analgesia of 4 h to 6 days duration occurring within 12 h of pain recurrence. Thus, mono- or biphasic prolonged complete analgesia occurred in 25 out of 38 patients. A prolonged analgesia may be the result of a central action of the local anesthetic at the spinal level after intra-axonal incorporation and centripetal axoplasmic transport. To test this hypothesis, an experimental study with [3H]lidocaine was performed in 6 rats. The radioactive local anesthetic was injected into one hind limb foot with the other side serving as a control. Tissue samples from the peripheral nerve, nerve root and the lumbosacral spinal cord segment were analyzed for radioactivity using a scintillation counter technique at various time intervals after the [3H]lidocaine injection. There was a low grade of activity in all samples and no difference between the test side and the control side. Thus these experiments provided no evidence in support of this hypothesis. Various alternative peripheral and central mechanisms are discussed. Further studies specifically directed to these alternatives and with longitudinal controls are prompted.
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PMID:Prolonged relief of neuralgia after regional anesthetic blocks. A call for further experimental and systematic clinical studies. 170 93

This study was performed to determine whether the addition of norepinephrine to local anaesthetics prolongs epidural analgesia in man. In addition, cerebrospinal fluid norepinephrine (NE) concentrations were measured. In the first part of the study, epidural catheters were inserted in 14 patients before herniotomy. Mepivacaine, 1.5 per cent (0.35 ml.kg-1), was administered and norepinephrine (5 micrograms.ml-1) was added in seven patients. The duration of anaesthesia was prolonged from 54 +/- 11 min to 83 +/- 12 min (P less than 0.05) and CSF NE concentrations increased from 68 +/- 12 pg.ml-1 to 336 +/- 85 pg.ml-1 in the NE group (P less than 0.01). In the second part, eight patients with herpetic neuralgia received epidural analgesia at the fourth to eighth thoracic interspace, using bupivacaine 0.25 per cent, with and without NE. The CSF NE concentrations in this group were greater than in the surgical patients before operation and increased from 254 +/- 58 to 406 +/- 58 pg.ml-1 30 min after administration of bupivacaine with NE. The duration of pain relief was prolonged with NE. These results suggest that adding NE to local anaesthetics prolongs epidural analgesia. Moreover, NE concentrations in surgical patients increased to levels similar to those found in patients suffering from herpetic analgesia. This suggests that the increase of CSF NE in chronic pain states has an antinociceptive effect.
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PMID:Cerebrospinal norepinephrine concentrations and the duration of epidural analgesia. 225 89

Spinal cord stimulation is considered to be ineffective in relieving deafferentation pain. We have retrospectively analyzed the results obtained in a series of 41 patients. Sixteen suffered from pain associated with an incomplete traumatic spinal lesion, 15 from a posttherapeutic neuralgia, and 10 from pain due to root and/or nerve damage. At the end of the test period, 43.7% of the patients with paraplegic pain, (40% of those with peripheral deafferentation pain and 66.6% of the ones with postherapeutic neuralgia), reported satisfactory pain relief and were connected to a chronic stimulation system. At mean follow-up (15 months), only 20% of the patients of the first two groups reported sufficient pain relief. In the postherapeutic group the figure of responders was unchanged. The mean analgesia achieved was 70%. From this analysis we conclude that the results achieved in the postherapeutic pain patients, although positive in only 66% of them, are remarkably stable with time. Therefore, we recommend a percutaneous test trial of SCS in every case of postherapeutic pain resistant to medical treatment.
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PMID:Spinal cord stimulation (SCS) in deafferentation pain. 247 55

Since the first paravertebral blockade was carried out by Sellheim in 1905, this method has proved effective for the isolated blockade of spinal nerves. The efficacy of preoperative intercostal blockade (ICB) in combination with neuroleptanalgesia (NLA) or Pentothal-pentazocine-N2O anesthesia (Pe-Pz) was studied (unilateral analgesia for cholecystectomy). Group 1: NLA; group 2: NLA with ICB; group 3: Pe-Pz; group 4: Pe-Pz with ICB. The analgesic requirement differed significantly between groups 1 (0.33 mg fentanyl) and 2 (0.15 mg fentanyl) and groups 3 (63.5 mg pentazocine) and 4 (31.5 mg pentazocine). There were also significant differences in circulatory responses. The maximum deviation from the initial value at the beginning of the operation in group 1 compared to group 2 was pulse rate + 28.7% vs + 2.4%, mean arterial pressure (Part) + 24.6% vs + 3.1%, and systolic pressure (Psyst) + 33% vs +/- 0%; group 3 compared to group 4: pulse rate + 16.4% vs + 3.2%, Part + 24.5% vs 0.0%, and Psyst + 26.5% vs + 196. The times of action of ICB extended from 7.54 h to 11.33 h for partial analgeisa, time to the first dose of analgesic from 12.3 h to 16.9 h (etidocaine 0.5% and 1% respectively without and with epinephrine). The mean blood levels after 100 mg bupivacaine-CO2 rose to 1.16 micrograms/ml after 5 min and reached a maximum after 15 min (1.29 micrograms/ml) as compared to 0.98 micrograms/ml after addition of ornithine-vasopressin. These values are very much higher than those after the use of bupivacaine-HCl solution. Etidocaine and bupivacaine-HCl have comparable durations of analgesia. Toxicologically, both substances can be applied safely with consideration of all pharmacological data for ICB. Of a total of 3,485 intercostal blockades, 2,775 were applied perioperatively (pre- and postoperatively); 265 were carried out for trauma patients (rib fractures) and 445 for therapeutic indications (herpes zoster neuralgia, tumor pain, costovertebral pain). In 8 blocks 10% ammonium sulfate, in 4 blocks absolute alcohol, and in 19 blocks 5% phenol were used for neurolysis. In 2 cases a marginal pneumothorax was seen, which was resorbed spontaneously (0.06%). Altogether 16,270 single intercostal nerves were blocked. Single-session intercostal blockade can be combined as unilateral analgesia with general anesthesia. This combination is characterized by stable circulatory conditions with avoidance of hypertensive reactions. The long-lasting analgesia allows early mobilization and physiotherapy both postoperatively and posttraumatically in patients with unilateral thoracic and abdominal pain.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[The single intercostal block--surgical and therapeutic indications]. 264 21


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