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

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

Self-aggression is a behavioural disorder in which an individual damages its own body parts by intense biting or scratching. Self aggression has been reported in human patients in Lesch-Nyhan syndrome and in cases of schizophrenia, depression, and congenital analgesia. In human patients as well as in experimental animals some kind of dysesthesia of the part of the body that is mutilated has been suggested. This study was conducted to find out the underlying pain mechanisms in self-aggressive behaviour arising out of stereotypy. The study was performed in 40 adult male rats. In all these animals, self-aggression was produced as part of amphetamine induced stereotyped behaviour. A predetermined scale was used for quantifying this behaviour. Reserpine and phenoxybenzamine pretreatment led to an increase in the incidence of self-aggression. Naloxone administration in reserpine pretreated animals led to a further significant increase in the incidence of self biting as compared to controls. From these studies it appears that self-aggressive behaviour may be associated with increased pain sensation.
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PMID:Role of opioid receptors in self-aggression in rats. 166 47

The acute effects of electrical injuries are well known. However, the occurrence and the mechanisms of the delayed sequelae are still unclear. The effects on peripheral nerves and the sympathetic system in particular are poorly documented. A 47-year old man was injured on the left arm by contact with a 380 V tension switch in January 1990. A few hours after the accident he complained of burning pain, dysesthesia, weakness and motor impairment of the arm. Allodynia and anhidrosis without cutaneous trophic lesions were observed. During the subsequent months the symptoms did not change except for the appearance of signs of autonomous nervous system hyperactivity (hyperhidrosis, edema, atrophy of the skin and nails, excessive sweating). One year later thermographic evidence and the effect of anesthetic blockade of the sympathetic chain on the burning pain, stiffness of joints and weakness of the arm confirmed the clinical diagnosis of reflex sympathetic dystrophy. Analgesia and motility improvement were achieved by means of sympathetic blockades although the patient's hand grip force and thumb-little finger grip were still weakened. Any known etiology besides electric shock could be associated with these clinical signs. The cause of the reflex sympathetic dystrophy may be multifactorial. In this patient the electric shock might have damaged peripheral sympathetic fibres or cervical ganglia. Lesions of the peripheral nerves and sympathetic hyperactivity can contribute to the development of such syndrome.
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PMID:[Reflex sympathetic dystrophy following electric shock: description of a clinical case]. 180 13

Percutaneous microcompression of the trigeminal ganglion for the relief of trigeminal neuralgia is a technically simple, nonpainful procedure, carried out under brief general anesthesia. One hundred patients treated by this method have been followed for 1 to 10 years; treatment has been technically successful in 97% of cases. Relief persisted at five years in 80%, and it is estimated that at 10 years the figure will be 70%. There were no deaths, no cerebral damage, no keratitis, and no analgesia dolorosa; 4% of the patients reported dysesthesia.
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PMID:A 10-year follow-up review of percutaneous microcompression of the trigeminal ganglion. 229 84

Spinal intradural arachnoid cysts (S-IAC) are rarely found and only 80 cases have been reported since 1915. We report two of them. A 68-year-old male had slowly progressive dull pain in both thighs for about 6 years prior to admission. Neurological examination and plain x-ray on admission showed no abnormality. Myodil myelography showed a S-IAC at T4 vertebral level. Surgical treatment of cyst wall excision resulted in success. The other case, a 39-year-old male suddenly noticed monoparesis and sensory disturbance of left leg in the morning. On admission were observed spastic monoparesis of the left leg, analgesia at right T2-3 cord segment and sensory disturbance (hypesthesia, dysesthesia, paresthesia) below T3-4 cord segment on the left side. Plain X-ray showed no abnormality. Myodil myelography revealed a S-IAC at T3-4 vertebral level. This patient was treated not surgically but conservatively because all neurological deficits but numbness in the left leg almost subsided after bed rest. The patient has experienced no neurological deterioration for five years since then. We also discuss the clinical feature, treatment and etiology of the S-IAC, by analyzing these 82 cases. There is a slight male preponderance. The age ranges between 3 and 66 years (mean 38 years). The duration from onset to admission is 2 days to 30 years. Sixty percent (48/80) of the cases were ill far longer than a year (mean 6.7 years). Of 82 cases, 83% suffered from motor disturbance, 70% had sensery disturbance, 62% local pain and 24% urinary with/without fecal disturbance.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical study of spinal intradural arachnoid cyst]. 408 43

This paper reviews the author's nine years of experience in analgesic brain stimulation. During this time, of 22 patients with pain of peripheral origin who were treated with periaqueductal gray (PAG), stimulation 16 achieved successful control of pain. Of 40 patients who presented with deafferentation pain, 16 were able to control their dysesthesia by brain stimulation of the subcortical somatosensory region alone; follow-up was over a long period. The mechanism of deafferentation pain is poorly understood and the effectiveness of subcortical somatosensory electrical stimulation to relieve such pain is based on empirical observation. The analgesia produced by PAG stimulation appears to be mediated by the release of beta-endorphin from the anterior hypothalamus. The released beta-endorphin binds to the opiate receptors in the PAG and activates the descending pain-inhibitory pathway. However, the repetitive stimulation of this serotonergic system produces tolerance to its analgesic effect, due to a decreased rate of serotonin turnover. Loading of the serotonin precursor by dietary supplementation of the essential amino acid L-tryptophan reverses this tolerance.
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PMID:The current status of analgesic brain stimulation. 616 68

There is a lack of prospective studies for the long-term results of percutaneous stereotactic radiofrequency rhizotomy (PSR) in the treatment of patients with trigeminal neuralgia. The authors present results in 154 consecutive patients with trigeminal neuralgia treated by PSR and prospectively followed for 15 years. Ninety-nine percent of the patients obtained initial pain relief after one PSR. Dysesthesia occurred in 31 patients (23%): in 7% with mild initial hypalgesia; in 15% with dense hypalgesia; and in 36% with analgesia. Dysesthesia was mild and did not require treatment in most patients. The corneal reflex was absent or depressed in 29 patients, and keratitis developed in three patients. In 19 of 22 patients with trigeminal motor weakness, the paresis resolved within 1 year. Of 33 patients who had pain recurrence, 10 patients had pain that was mild or controlled with medications, and 23 patients required additional surgical treatment. The authors estimated using Kaplan-Meier analysis that the 14-year recurrence rate was 25% in the total group: 60% in patients with mild hypalgesia, 25% in those with dense hypalgesia, and 20% in those with analgesia. Timing of pain recurrence varied according to the degree of sensory loss. All pain recurrences in patients with mild hypalgesia occurred within 4 years after surgery; 10% more of the patients with dense hypalgesia had pain recurrences within the first 10 years compared with patients with analgesia. The median pain-free survival rate was 32 months for patients with mild hypalgesia and more than 15 years for patients with either analgesia or dense hypalgesia. Of the 100 patients followed for 15 years after one or two PSR procedures, 95 patients (95%) rated the procedure excellent (77 patients) or good (18 patients). The authors conclude that PSR is an effective, safe treatment for trigeminal neuralgia. Dense hypalgesia in the painful trigger zone, rather than analgesia, should be the target lesion.
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PMID:A prospective 15-year follow up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy. 749 Jun 43

The efficacy of preemptive analgesia on postoperative pain is discussed. From experimental neurophysiological data, the present policy of preventive analgesia aims at precluding modifications of the nervous system secondary to a nervous lesion and the appearance of chronic pain, particularly of the neurogenic kind. The post-mastectomy pain syndrome (PMPS) falls within the realm of neurogenic pain and is still poorly understood and underestimated. This study evaluated the preemptive effect of a perioperative administration of an oral non steroid anti-inflammatory, the ibuprofen-arginine, on PMPS. Thirty patients scheduled for partial or total mastectomy with axillary dissection were prospectively and randomly assigned to 2 groups. The ibuprofen-arginine group (group I) (n = 15), received an oral administration of 400 mg of ibuprofen-arginine, 90 min before surgery, 2 h after surgery and then every 8 h in the first 32 postoperative hours. The control group (group C) received in doubled blind a placebo at the same time. At 6 months, we looked after pain or dysesthesia. We confirmed the diagnosis of PMPS in presence of association of diagnosis criterias. Fourteen patients in each group have been included. Eighty-six percent of the patients (13 patients in group I and 11 patients in group C) presented at 6 months dysesthesia of the upper member ipsilateral to the mastectomy and/or the operated breast, appearing either immediately or after a laps of time. Nine patients (group I) and 6 patients (group C) had PMPS. Postoperative radiotherapy and lymphoedema were statistically associated with PMPS (p = 0.019 and p = 0.011). The perioperative preventive administration of a non-steroid anti-inflammatory drug reduces neither the incidence of pain in the first post-operative months, nor the appearance of PMPS at 6 months. These results suggest that others factors than the nervous lesion may play a role in the occurrence of PMPS, as radiotherapy, lymphoedema, but also psychosocials factors.
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PMID:[Preventive analgesic effect of intraoperative administration of ibuprofen-arginine on postmastectomy pain syndrome]. 920 71

We investigated the analgesic effect of regional application of bupivacaine and a morphine-bupivacaine combination on iliac crest donor-site pain in a randomized, double-blind controlled study of 45 patients. Patients were divided into three groups: group I (control group), group II (bupivacaine) and group III (morphine-bupivacaine combination). Pain in the acute stage was evaluated by visual analogue scale scoring and analgesic consumption. Chronic pain and dysesthesia were evaluated at 12 weeks after operation at a follow-up visit. It was found that local bupivacaine administration with or without morphine provided satisfactory analgesia in the acute stage following iliac crest bone harvesting. The amount of analgesic consumption was found to be significantly less with the addition of morphine to bupivacaine, when compared to bupivacaine alone. Effective pain control in the acute stage had a favorable effect on long-term pain and dysesthesia, which are the main complaints after iliac crest bone harvesting. This effect was augmented significantly by addition of morphine to the local anesthetic solution.
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PMID:Short- and long-term effects of regional application of morphine and bupivacaine on the iliac crest donor site. 1110 84

The investigation was undertaken to elucidate the impact of epidural analgesia (EA) during labor on the incidence of transient neurological symptoms (TNS). By the agreement of a local ethics committee, an informed consent was obtained from 90 healthy puerperas enrolled in the investigation. The patients were randomized into 3 groups, with 30 patients in each. At the beginning of labor, an epidural catheter was inserted in all the puerperas. For EA, 1% lidocaine solution and 0.2% ropivacaine solution were used in Groups 1 and 2, respectively; Group 3 was control in which EA was not performed. Two days after labor, an independent observer asked the females about possible neurological symptoms, by using the standard questionnaire. TNS included symmetric pain and/or dysesthesia in the buttocks, lower lumbar region, and/or legs. The patients who presented problems were proposed to indicate the degree of discomfort by a 10-score verbal scale. The findings were statistically processed using the U-test and X-test (p < 0. 05). A total of TNS occurred in 22 (25%) patients, including 7 (27%), 8 (27%), and 7 (23%) in Groups 1, 2, and 3, respectively. This difference was not statistically significant. The duration of TNS was generally short; in all the patients, the symptoms were completely resolved after 24-72 hours. Labor EA is not a cause of TNS. The type of a local anesthetic (lidocaine, ropivacaine) does not affect the incidence of TNS in puerperas after labor EA.
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PMID:[Transient neurological symptoms in puerperas after epidural analgesia during labor]. 1832 51


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