A survey of patients with neuropathic pain at Siriraj Pain Clinic.

OBJECTIVE: To examine the profile and treatment pattern of patients with neuropathic pain attending Siriraj Pain Clinic. MATERIAL AND METHOD: A 2-year retrospective study of the prevalence of neuropathic pain, characteristics of the patients and the use of medical treatment. Records of all the patients that attended Siriraj Pain Clinic from September 1, 2002 until September 30, 2004 were reviewed. RESULTS: One thousand three hundred and thirty patients' records were reviewed. Five hundred and three patients were diagnosed as having neuropathic pain. The prevalence of neuropathic pain at Siriraj Pain Clinic during the survey period was 37.8%. The average age of neuropathic pain patients was 54 years. The most common type of neuropathic pain was peripheral type, nerve compression in particular. The most common concomitant illness was malignant tumor. The majority of patients (71.8%) had one pain location and the most common site was the lower extremity. The main descriptions of neuropathic pain were radiating, electric shock-like, burning, numbing and shooting. Oral medication was the most common method (79%) of pain-relief treatment. Almost all of the patients (93%) had received more than one type of oral medication. The most commonly used medicine was TCA (77.1%), followed by gabapentin (35%), carbamazepine (34%) and tramadol (24.3%). Most of the pain-relief medicines prescribed at this clinic were under the recommended doses for the treatment of neuropathic pain. CONCLUSION: Characteristics and treatment patterns of neuropathic pain at Siriraj Pain Clinic are similar to those seen in other pain clinics elsewhere in the world. The high prevalence of neuropathic pain in the clinic indicates that this type of pain syndrome is increasingly critical to our clinical practice. More educational programs on neuropathic pain and management are needed for Thai healthcare professionals.

A comparison study between oral morphine syrup and morphine intramuscular injection in premedication.

A randomized single blind clinical trial was carried out in order to compare the effectiveness of oral morphine syrup and injected morphine in premedication of postpartum tubal sterilization by local anaesthesia. A total of 200 postpartum patients were divided into two groups by systemic random sampling. The first group of 100 patients was premedicated with 30 mgs of syrup morphine orally 90 minutes before operation, and the second group of 100 patients was premedicated with 10 mgs of morphine hydrochloride via the intramuscular route 15 minutes before operation. All patients were given tubal sterilization by first- and second- year residents, using the modified Pomeroy technique. The pain experienced by each patient during the operation was evaluated by verbal and numerical rating scales. The pain scores and the operating time of both groups were analysed by the Mann Whitney U test and pair t test, respectively. The pain scores of the first and second group were 3.644 + 1.802 and 3.570 + 1.470, respectively, with no significant difference. The operating time was 10.300 + 1.904 and 11.200+ 2.543 minutes in the first and second group, respectively. The effectiveness of oral morphine syrup and intramuscular morphine in premedication for postpartum tubal sterilization was found to give the same results. The cost-effectiveness of oral morphine syrup is greater and it can therefore replace intramuscular morphine in premedication for postpartum tubal sterilization.

The out-patient pain surgery at Siriraj Hospital.

The epidemiological study of pain among patients attending the out-patient clinics at Siriraj Hospital was carried out from April to May 1987. The studied patients were randomly selected for interviewing as questionnaire prepared. The total of out 2889 patients was involved in this study. These were surgical, medical, orthopedical, ophthalmological and oto-rhinolaryngological and gynaecological patients which encountered in 809 (28.0%), 635 (22.5%), 514 (17.8%), 435 (15.1%) and 351 (12.1%) patients respectively. The mean age of these patients in year was 39.80+17.27, range 12-84. The ratio of female to male patients was 2.2:1. The locations of pain presented were abdominal, head and facial, neck and back, thigh and multiples encounted in 312 (19.6%), 304 (19.1%), 256 (16.1%), 238 (15.0%) and 113 (7.1%) respectively. Only 44 patients (2.8%) presented with pain of indefinite location. The acute pain was encountered in 813 patients (51.2%) while the chronic one was encountered in 776 patients (48.8%). Only 10.1% of these patients received no treatment prior to be seen while the rest had treatments elsewhere. Of the patients treated elsewhere 57.4% had previonsly treatment at other hospitals, 19.4% had self treatment and only 10.3% had treatment at the private clinics. Only 2.8% of the these patients were treated by either unskilled or unqualified personels.

New method for measuring blood volume.

Patients without nausea received a capsule of 200 mg of Sn Cl2 orally and waited for 1 hour or patients with nausea were injected intravenously with a dose of MDP-Sn (II) and waited for 10 minutes. After the waiting time, 10 ml of blood was withdrawn. Whole blood was incubated with 99mTc 200 ตCi for 30 minutes and 1 wash with normal saline was sufficient. This procedure of labeling RBC with 99mTc is much more convenient than the conventional one. We have used this method since 1979 until 1984 with 52 patients without any adverse reaction occurring. The results are satisfactory not only in accuracy and cost but also in reducing the radiation dosage to patients and operators. This report offers 3 main benefits for this procedure. First of all it can help doctors to make decisions about the priority of examination. Secondly, it can be useful for those who are looking for a good method of measuring blood volume. Finally it can be most helpful in a teaching programme.