The use of surgical sympathectomy in the treatment of chronic renal pain.

OBJECTIVE: To assess the efficacy of renal sympathetic denervation in the treatment of chronic renal pain. PATIENTS AND METHODS: In a 10-year period, 21 patients suffering from chronic renal pain underwent 27 renal denervation operations, six of which were bilateral. The cause of pain was the loin pain haematuria syndrome in 18 patients. RESULTS: Four operations resulted in complete pain relief to date (median follow-up 53.5 months). pain relief after the other 23 operations in 18 patients lasted a median of 6 months. Assuming that recurrent pain was due to neuronal regeneration, nine of the 18 patients with recurrent pain underwent a total of 10 re-explorations of the renal pedicle, stripping it of all nerve fibres and areolar tissue. Three of these re-explorations produced complete pain relief to date (median follow-up 40 months). The median pain-free interval of the other seven re-explorations in six patients was 19 months. CONCLUSION: Renal denervation cures severe intractable pain in about 25% of patients. Recurrence of pain could be prevented in more patients if there was a way of preventing re-innervation.

No indications for percutaneous lumbar discectomy?

A questionnaire was used to assess the outcome of automated percutaneous lumbar discectomy (APLD), to correlate patients' data and to identify criteria for pain relief and patient satisfaction. Two hundred and thirty eight patients were operated on by APLD between 1988 and 1990. The questionnaire returned by 182 patients (76.4%) was suitable for evaluation. The mean follow-up was 2.5 years. Overall, 60% reported pain relief and 52% were satisfied with APLD. Conventional operations were carried out subsequently on 45 patients (25%). Bivariate and multivariate analyses were done for preoperative (age, gender, neurological deficit, Lasegue's sign, sports activity), perioperative (weight of disc material removed, level of APLD) and post-operative (conventional nucleotomy, change in condition, pain relief, satisfaction, sports activity, return to work, compensation claims) parameters. The only significant parameters for improvement in condition and pain relief was age, where patients younger than 41 do better. Risk factors for reoperation were a positive Lasegue's sign and over 41 years of age. Patient satisfaction was significantly higher for patients without sensory deficit preoperatively.

Patient expectations for pain relief in the ED.

The objective of the study was to assess patient expectations for pain relief in the ED. A convenience sample of 522 patients with pain and 144 patients without pain were enrolled in a prospective observational study at a university ED. Patients reported a mean expectation for pain relief of 72 % (95% CI 70-74). Eighteen percent expected complete (100%) pain relief in the ED. Patient expectations for pain relief were poorly correlated (r = 0.150) with initial pain intensity. Patients without pain reported a mean expectation for pain relief of 74% (95% CI 71-77) if they had presented with pain. There were no differences in patient expectations for pain relief based on age or gender. Patients expect a large percentage of their pain to be relieved in the ED, and many expect complete analgesia. Patient expectations for pain relief do not vary based on age, gender or pain intensity.

Patient attitudes to postoperative pain relief.

A study of the attitudes of general surgical patients to the management of their postoperative pain showed that although 86% initially expressed satisfaction with their postoperative pain relief, a quarter of these did in fact have moderate, severe or unbearable, unalleviated pain. These, together with those who expressed dissatisfaction with their pain relief, constituted one third of the total number, indicating that a problem of postoperative analgesic management existed in the hospital. As a result, techniques of continuous intravenous infusion of narcotics and more frequent use of regional analgesia have been introduced.