Combined fluphenazine and lidocaine for pain relief in head and neck cancers.

A successful method of treating intractable neoplastic pain in 12 cases is discussed. A completely new method was tried combining long-acting phenothiazine and lidocaine to achieve long-lasting pain relief. This combination gave pain relief which lasted for weeks. A possible explanation of the mechanism is offered.

Transcatheter arterial embolization for bone metastases from hepatocellular carcinoma.

The objective of this study was to determine which of the following three methods is the most effective for the treatment of bone metastases from hepatocellular carcinoma (HCC): transcatheter arterial embolization (TAE); combination of TAE and external radiotherapy; or external radiotherapy alone. Thirty-nine metastatic bone lesions from HCC in 33 patients were retrospectively reviewed. Each lesion underwent either TAE alone (group A, n = 11), TAE followed by radiotherapy (group B, n = 17), or radiotherapy alone (group C, n = 11). They were evaluated on the following subjects: pain relief; improvement of daily activities; and complications. Each treatment was effective for pain relief (89-94%) and improvement of daily activities (73-82%). The mean time interval from the beginning of each treatment to the onset of initial pain relief was 4.7 days in group A, 4.8 days in group B, and 15 days in group C. Recurrence of the pain after the initial pain relief was noted in 75% in group A, 20% in group B, and 88% in group C. Pyrexia and local pain commonly occurred after TAE. In conclusion, TAE is effective in relieving pain immediately and in improving the patients' daily activities. The combination of TAE and radiotherapy is recommended for permanent pain relief.

Long-term results of cervical epidural steroid injections.

Fifty-eight patients undergoing cervical epidural injection of corticosteroids were followed for a 6-month period. Patients with 90% pain relief lasting 6 months were considered to have excellent results, those with greater than 50% pain relief lasting at least 6 weeks were considered to have good results, and all others were considered to have poor results. Six months after the injection, 41.4% of patients had excellent pain relief by our criteria. Twenty-nine percent of patients reported good results and 29.3% had poor results. Those patients with the diagnosis of cervical spondylosis and those with subacute cervical strain had statistically significantly (p less than 0.001, difference of proportions test) better results than patients with other diagnoses. The procedure of cervical epidural steroid injection may be most effective in patients with cervical degenerative joint disease as the etiology of their cervical pain.

The effect of wound perfusion on the relief of postoperative pain

The efficacy of wound perfusion (WP) with lidocaine for postoperative pain relief was studied in patients with median incision for cholecystectomy. Twenty four patients were divided into 3 groups according to the method of postoperative pain relief; group C, n = 8: intramuscular injections of penta-zocine 30 mg administered on demand, group WP, n = 8: WP with continuous lidocaine perfusion for 24 hours (plus pentazocine on demand); group EPI, n = 8: buprenorphine administered epidurally for 24 hours (plus pentazocine on demand). Pain scores at 0, 6, 12, 24, 48, hours after operation were examined. Arterial blood gas analysis, FVC and FEV1 were measured preoperatively and on the first postoperative day. Pain scores at 0 and 24 hours in group WP and EPI were significantly lower than those in group C. There were no significant differences in the scores between group WP and EPI at all the points. Analgesic requirement was significantly reduced in group WP and EPI compared with group C. FVC, FEV1 and PaO2 were significantly reduced postoperatively in every group but there were no differences among three groups. PaCO2 significantly increased postoperatively in group C and EPI. We conclude that the technique of wound perfusion with lidocaine is effective and safe for postoperative pain relief.

Pain problems in oncology

1. Not every cancer patient suffers from pain, but approximately 30-40% of regular inpatients and 60-70% in terminal stages do. 2. Not every pain syndrome in a cancer patient is tumor-derived: its role and potential cause need to be thoroughly investigated and treated. 3. Successful antineoplastic treatment is the best and most durable pain prophylaxis in advanced cancer patients. 4. Locally applicable pain treatments such as anesthesiologic, radiotherapeutic and surgical measures should be discussed on an interdisciplinary basis. 5. With chronic tumor pain and no further effect of antineoplastic and locally active treatments, pharmacologic analgesia is the most adequate method of effective pain relief. 6. Prophylactic prescription of effective analgesics in adequate doses and at regular intervals, according to accepted "pain-ladders", is the most successful method of effective and lasting pain relief. 7. Public and medical bias against adequate use of oral opiates in chronic cancer pain must be overcome. 8. Effective pain relief leads to improvement of life quality as well as social reintegration of late stage cancer patients. 9. The influence of psychosocial variables on pain perception and the outcome of analgesia should not be underestimated.

Antidiuretic hormone levels and the effect of indomethacin on ureteral colic.

We treated 25 patients with ureteral colic and urographically verified stones with 50 mg. indomethacin intravenously. Pain was relieved completely in 17 patients, while in 8 incomplete or no pain relief was achieved after the infusion of indomethacin. Patients completely relieved of pain had significantly higher levels of antidiuretic hormone in plasma before the infusion of indomethacin (18.2 plus or minus 3.4 pg./ml.) than patients with incomplete or no pain relief (7.2 plus or minus 1.3 pg./ml.) (p less than 0.01). These findings indicate that the volume status and/or the level of antidiuretic hormone may be of critical importance for pain relief after infusion of indomethacin in patients with ureteral colic.

Methylmethacrylate as an adjunct in internal fixation of pathological fractures. Experience with three hundred and seventy-five cases.

In 323 patients with 375 pathological fractures or impending fractures, local tumor resection and internal fixation supplemented by intramedullary methylmethacrylate proved highly successful. One hundred and thirty-nine patients had metastases from breast carcinoma; 142, metastases from other tumors; and forty-two, myeloma or lymphoma. The mean survival for the 210 patients who had undergone operation two years or more before final evaluation was 15.4 months. Ninety-four per cent of the patients who were ambulatory before fracture regained the ability to walk. Eighty-five per cent had excellent or good pain relief and in only five was pain relief rated poor. There were four failures of fixation and six functionally poor results. Twenty patients died within four weeks of operation, but the remaining patients benefited from the procedure in terms of pain relief, improved mobility, and ease of nursing care.

Vinblastin iontophoresis in treating intractable pain.

A group of 36 patients were tested for the effects of percutaneous iontophoretic application of Vinblastin inj., a microtubular transport inhibitor (Gideon Richter, Hungary) in the treatment of chronic intractable pain. The group is divided into two subgroups: (1) 16 patients with persistent root pain following one or more operations for lumbar intervertebral disk herniation. (2) 20 patients with persistent pain in the area of the radicular skin zones or in the skin innervation areas of peripheral nerves. Vinblastin was injected in the place of maximal pain, 0.01% concentration in the total amount of 5 mg of active substance. The active electrode was the anode. There were at least 15 procedures per patient. The therapeutic effect was evaluated from the patients' subjective reports on pain relief in per cent, from the intensity of actual pain and from the interference of pain intensity with daily activities. Considering all the criteria, an improvement was achieved in 29 cases, i.e. 81%. The beneficial effect of the therapy was observed from the 8th to 10th application. In the first group of patients, 69% showed a clinically significant relief of the algetic symptoms. In the other group, the therapeutic effect was 90% of cases. A significant difference between both these groups was found to be in the degree of pain relief after the end of therapy. In the first group the average pain relief was 22.2%, in the other one 47.7%. This difference is statistically highly significant. Except for one case, the beneficial effect was always recorded in the place of administration (under the anode). Apart from local skin irritation in 2 patients and spot burns under the electrode in 2, no other side adverse effects were seen in the course of therapy, after its termination or at the checks made after some time interval (maximum 3 years).

Long-term outcome of spinal cord stimulation and hardware complications.

Spinal cord stimulation (SCS) is a treatment modality for medically intractable chronic pain. This study reports an 11-year experience with SCS assessing long-term pain relief and specifically evaluating complications and revisions. It took the form of a retrospective review of medical/surgical records with a postal questionnaire. The subjects were 102 patients with medically intractable chronic pain who underwent SCS implantation between 1989 and 2000. There were 64 revision operations carried out on 35 patients. These comprised electrode replacement/repositioning (29), generator replacement (23), cable failure (3) and implant removal (5). Five (4.9%) implants became infected and 2 required removal. Clinician-reported pain relief was substantial in 69 (68%) patients. This study adds to the weight of evidence that patients undergoing SCS derive significant benefits in terms of pain relief. However, revision rates remain high due to technical and biological factors. Copyright 2003 S. Karger AG, Basel

Surgical treatment of metastatic long bone disease.

A retrospective study of the results of operative treatment of 60 long bones secondaries in 46 patients was carried out. The mean period of follow-up was 10 months. The most common primary in this study was carcinoma of the breast (28.2%), followed by carcinoma of the lung (21.7%) and unknown primary (10.9%). Three groups of patients were studied--pathological fracture group, prophylactic fixation group and a mixed group. In the pathological fracture group, 70% of patients achieved good to excellent pain relief and 60.9% was able to walk with or without walking aids. In the prophylactic group, all the patients achieved good to excellent pain relief and 60% were able to ambulate with or without walking aids. In the mixed group, all the patients achieved good to excellent pain relief and 66.6% of the patients were able to walk with aids. The operative mortality in both the pathological fracture group and prophylactic fixation group was 10% and 33.3% in the mixed group. Multiple internal fixation performed at one operative session was associated with high operative mortality (50%).