Effects of different analgesic methods of hydromorphone on analgesic efficacy and sleep quality in patients with refractory cancer pain / 中国基层医药

Objective:To investigate the effects of different analgesic methods of hydromorphone on analgesic efficacy and sleep quality in patients with refractory cancer pain.Methods:Sixty patients with refractory cancer pain who received three-step analgesic treatment in Quzhou People's Hospital from August 2018 to December 2019 and acquired poor analgesic effects were included in this study. They were randomly assigned to undergo either an intravenous patient-controlled analgesia with hydromorphone (HV group, n = 30) or an intrathecal patient-controlled analgesia with hydromorphone (HI group, n = 30) for 10 consecutive days. The analgesic efficacy in each group was evaluated using the numerical rating scale (NRS) before and 2, 4, 24, 48 hours, and 10 days after administration. The frequency of breakthrough pain (BTP) at each time point was recorded. The sedation effect of medication was evaluated using the Ramsay score. The sleep quality of patients was evaluated using the Pittsburgh sleep quality index (PSQI). The activities of CD 3+, CD 4+, and CD 4+/CD 8+ lymphocyte subsets were measured by flow cytometry at different time points. The adverse reactions within 10 days after treatment were observed and recorded. Results:Before and at each time point after treatment, there were no significant differences in NRS score, the frequency of BTP, Ramsay score, and PSQI score between the two groups (NRS score: t = 0.45, 0.91, 0.52, 1.19, 0.97, 1.92, all P > 0.05; frequency of BTP: t = 0.34, 1.88, 0.86, 1.71, 1.22, 0.76, all P > 0.05; Ramsay score: t = 0.56, 0.46, 0.63, 0.22, 0.99, 0.14, all P > 0.05; PSQI: t = 0.86, 1.25, 1.46, 1.05, 0.57, 1.93, all P > 0.05). At each time point after treatment, the activities of CD 3+, CD 4+, and CD 4+/CD 8+ cells increased in each group, and the activities of CD 3+, CD 4+, and CD 4+/CD 8+ cells in the HI group were significantly higher than those in the HV group (CD 3+: t = 3.72, 3.12, 2.85, 3.13, 2.44, all P < 0.05; CD 4+: t = 3.62, 2.45, 3.31, 3.19, 2.70; all P > 0.05; CD 4+/CD 8+: t = 3.10, 2.74, 2.83, 3.24, 3.41, all P < 0.05). The total incidence of adverse reactions was slightly, but not significantly, lower in the HI group than the HV group [14.00% (7/30) vs. 26.00% (13/30), χ2 = 2.70, P = 0.100]. Conclusion:Compared with intravenous administration of hydromorphone, intrathecal administration of hydromorphone can better effectively relieve pain, decrease the frequency of BTP, improve sleep quality, has a good sedative effect, improve immune function, and has fewer adverse reactions.

Treatment of radiation-induced brachial plexopathy with omentoplasty

Radiation-induced brachial plexus neuropathy (RIBPN) is a rare and delayed non-traumatic injury to the brachial plexus, which occurs following radiation therapy to the chest wall, neck, and/or axilla in previously treated patients with cancer. The incidence of RIBPN is more common in patients treated for carcinoma of the breast and Hodgkin lymphoma. With the improvement in radiation techniques, the incidence of injury to the brachial plexus following radiotherapy has dramatically reduced. The currently reported incidence is 1.2% in women irradiated for breast cancer. The progression of symptoms is gradual in about two-thirds of cases; the patients may initially present with paresthesia followed by pain, and later progress to motor weakness in the affected limb. We present the case of a 68-year-old female patient with breast cancer submitted to surgery, chemotherapy, and radiotherapy in the year 2000. Eighteen years later, she developed symptoms and signs compatible with RIBPN and was successfully submitted to omentoplasty for pain control. Omentoplasty is an alternative treatment for RIBPN refractory to conservative treatment, which seems to be effective in improving neuropathic pain. However, postoperative worsening of the motor strength is a real possibility, and all candidates for this type of surgery must be informed about the risk of this complication.

Clinical observation of Yangxue-Pinggan decoction in the treatment of intractable headache / 国际中医中药杂志

Objective To evaluate the clinical efficacy of Yangxue-Pinggan decoction on intractable headache. Methods A total of 66 patients with intractable headache who met the inclusion criteria were randomly divided into two groups by random number table method, 33 in each group. The control group was given flunarizine hydrochloride capsule orally, while the treatment group was given professor Guan Youbo's Yangxue-Pinggan decoction. Both groups were treated for 4 weeks. The improvement rates of headache were observed. The headache attacks, the degree of headache, the duration of headache and the accompanying symptoms were scored, and the clinical efficacy was evaluated. Results The total effective rate was 97.0％ (32/33) in the treatment group and 63.6％ (21/33) in the control group, which there was significant difference between the two groups (χ2=11.591, P=0.001). After treatment, the scores of the headache attacks, the degree of headache, the duration of headache and the accompanying symptoms in the treatment group were significantly lower than those in the control group (t=17.689, 12.523, 26.907, 25.569, P<0.001). Conclusions The Yangxue-Pinggan decoction can obviously improve the clinical symptoms of intractable headache, relieve the pain degree and reduce the number of attacks, and its clinical efficacy is better than oral flunarizine hydrochloride capsule.

Clinical research of psychological nursing intervention on the compliance of pain medication in ederly patients with malignant tumor / 中国基层医药

Objective To explore the effect of psychological nursing intervention on the compliance of pain medication in ederly patients with malignant tumor.Methods Retrospective analysis of 92 elderly patients with malignant tumors was conducted.All patients were treated with standardized drugs according to the three-step analgesic principle.The patients were randomly divided into two groups,the control group was given routine nursing intervention,and the observation group was given psychological nursing intervention on the basis of the control group.The improvement of pain response,depression and anxiety,the treatment compliance and nursing satisfaction of two groups before and after treatment were compared.Results The pain relief rate of the observation group was 89.36％,which was significantly higher than 64.44％ of the control group (Z =-3.534,P ＜ 0.05).The total remission rate of the observation group was significantly higher than that of the control group (x2 =4.058,P ＜ 0.05).The depression score of the observation group [(17.52 ± 4.06) points] was significantly lower than (23.35 ± 3.24) points of the control group (t =7.592,P ＜ 0.05).The anxiety score of the observation group [(17.52 ± 4.06) points] was significantly lower than (18.05 ± 4.02) points of the control group (t =7.622,P ＜ 0.05).The compliance of the observation group witb analgesic drugs was better than that of the control group (Z =-6.994,P ＜ 0.05).The nursing satisfaction of the observation group was 87.23％,which was significantly higher than 75.56％ of the control group (Z =-2.764,P ＜ 0.05).Conclusion Psychological nursing intervention can effectively improve the pain response,anxiety and depression of elderly patients with malignant tumor,thus to improve the compliance and safety of the treatment and the care of nursing staff.

Clinical assessment of hydrogen-rich water and oxycodone hydrochloride controlled-release tablets in the treatment of malignant neuropathic pain / 中国医师杂志

Objective To investigate the clinical efficacy of hydrogen-rich water (HRW) combined with oxycodone hydrochloride controlled-release tablets (OHCT) in the treatment of malignant neuropathic pain (MNP) patients.Methods Eighty MNP patients were randomly divided into two groups:OHCT group (group A,n =40) and HRW combined OHCT group (group B,n =40).The visual analog scale (VAS) score,frequency of pain outbreaks,pain relief rate,average dose of OHCT per day,and adverse reactions were observed.Results The VAS scores and frequency of pain outbreaks in groups A and B were significantly reduced after treatment (P ＜0.05).Compared to group A,the VAS scores,pain relief rate,outbreak pain and average dose of OHCT per day in group B were significantly improved after 14 and 28 days of treatment (P ＜ 0.05),and the adverse reactions,such as constipation,nausea and vomiting,in group B were significantly less than those in group A (P ＜ 0.05).Conclusions HRW combined with OHCT can effectively improve the MNP,and reduce average dose of OHCT per day and adverse reactions.

A clínica da dor crônica como ninho de pacientes difíceis: o papel da identificação projetiva / Chronic pain clinic as a haven for difficult patients: the role of projective identification

Pacientes difíceis - ou de personalidade difícil - são frequentemente encontrados na clínica da dor crônica não-oncológica, impondo à relação médico-paciente sobrecargas que vão além das complexidades da doença e do tratamento. Esta revisão/relato de experiência discute o papel que o processo psicológico e comunicacional da identificação projetiva exerce sobre as relações entre pacientes e médicos (e outros profissionais) nas equipes de dor crônica. São revisados os conceitos de identificação projetiva, na sua forma benigna e maligna. Duas vinhetas clínicas são dadas como exemplos de cada uma. São apresentadas situações no cenário da comunicação médico-paciente em que a identificação projetiva opera complicando a relação terapêutica. Ao final, recomendações são dadas sobre o manejo do paciente difícil que se comunica maciçamente por identificação projetiva, assim como às equipes multiprofissionais que lidam com estes pacientes. Os pacientes difíceis de nossa clínica de dor crônica têm em comum o fato de se comunicarem pela forma maligna de identificação projetiva e terem organizações imaturas de personalidade. Nas equipes de dor crônica, as relações entre pacientes e profissionais (assim como as relações entre os profissionais), podem ser otimizadas se a equipe for capaz de identificar precocemente o fenômeno da identificação projetiva e manejá-lo de forma terapêutica. Para o paciente, a psicoterapia de longo prazo é o tratamento de eleição

Difficult patients - or those with difficult personalities - are frequently encountered in the treatment of chronic non-oncologic pain, overburdening the doctor-patient relationship far beyond the complexities of their illness and treatment. The present review/experiential report discusses the role that projective identification, as a psychological process of communication, puts the doctor-patient relationship in within the multi-professional chronic pain team. The concepts of projective identification are reviewed both in their benign and their malignant forms. Two clinical vignettes exemplify each of them. Some situations in the setting of doctor-patient communication are presented in which projective identification appears and complicates the therapeutic relationship. Some recommendations are offered regarding the handling of patients that communicate mainly by means of projective identification, and some ideas are offered to the multi-professional team. In our chronic pain clinic, difficult patients as a whole seem to prefer to communicate by means of a malignant form of projective identification and present with immature types of personality organizations. Within the chronic pain teams, doctor-patient relationships (as well as relations among the professionals) can be enriched if projective identification is detected early and appropriately handled. Long-term psychotherapy is the treatment that should be chosen for such patients

Pulsed radiofrequency on dorsal root ganglia for chronic pain / Radiofrequência pulsada no gânglio da raiz dorsal para tratamento de dor crônica

Objective: Evaluate clinical outcome of dorsal root ganglia (DRG) pulsed radiofrequency (PRF) treatment in neuropathic pain of patients with radiculopathy regarding improvement of pain and degree of patients? satisfaction. Method: Forty-five procedures in cervical and lumbossacral spine. Data collected by phone call interviews (independent researcher). Evaluation done after one month and at minimum three months follow-up. Analyzed data included objective and subjective improvement, and degree of satisfaction. Results: Outcome much better in 31%, 36% better, 24% unchanged, 9% worse. At initial evaluation, relief was rated: 24% excellent, 16% good, 27% moderate, 33% poor. At late evaluation, 27% excellent, 18% good, 7% moderate, 49% poor. Degree of satisfaction was high (82% of patients reported they certainly or probably would repeat the procedure). Conclusion: PRF was effective and safe in selected patients. Most patients were satisfied and would repeat/recommend the procedure...

Objetivo: Avaliar a evolução clínica do tratamento com radiofrequência pulsada (RFP) de gânglio da raiz dorsal (GRD) na dor neuropática em pacientes com radiculopatia, considerando melhora da dor e grau de satisfação dos pacientes. Método: Quarenta e cinco procedimentos na coluna cervical e lombossacra. Os dados foram coletados por meio de entrevistas telefônicas (pesquisador independente). Avaliação inicial feita após um mês e final no mínimo de três meses de acompanhamento. Dados analisados incluíram melhora objetiva, subjetiva e o grau de satisfação. Resultados: Evolução ?muito melhor? em 31%, ?melhor? em 36%, ?inalterado? em 24%, ?pior? em 9%. Na avaliação inicial: 24% ?excelente?, 16% ?bom?, 27% ?moderada?, 33% ?pobre?. Na avaliação final, 27% ?excelente?, 18% ?bom?, 7% ?moderada?, 49% ?pobre?. O grau de satisfação foi elevado (82% dos pacientes relataram que certamente ou provavelmente repetiriam o procedimento). Conclusão: RFP foi eficaz e segura em pacientes selecionados. A maioria dos pacientes ficou satisfeita e repetiu/recomendou o procedimento...

Aplicação do método clínico centrado na pessoa (MCCP) com dor crônica / Application of patient-centered clinical method (PCCM) to a chronic pain patient

Propõe-se uma radical transformação do método clínico.O MCCP é dividido em seis componentes: exploraçãoda doença e da experiência de doença; entendimentodo ser na totalidade; elaboração de plano conjunto demanejo dos problemas; incorporação das dimensões depromoção e prevenção; intensificação da relação médico-paciente e ?sendo realista?. Este artigo busca desvelaro itinerário terapêutico de uma pessoa encaminhada aoAmbulatório de Diagnóstico Diferencial da UniversidadeRegional de Blumenau (FURB) para acompanhamento eavaliação, sob visão do MCCP. Trata-se de pesquisa qualitativadocumental realizada a partir do atendimento deuma pessoa do sexo feminino (M.), com dor osteomuscularcrônica e incapacitante. Foram analisados registrosmédicos e realizadas entrevistas gravadas e transcritascom a devida autorização. O foco esteve na vida conjugale laboral e a pauta nas intercorrências médicas. Foramdiscutidas expectativas, pactuados os problemas a seremenfrentados e revisada a sua experiência com medicações.Antes da aplicação do MCCP, M. não sabia dizerpor que havia feito tantos exames, cirurgias e tomadotantos remédios. Agora entende informações a respeitode sua doença, expressa suas opiniões e compartilha decisões.Ao usar o MCCP entende-se melhor o processo deadoecimento, proporcionando consulta mais satisfatóriapara as partes envolvidas na aliança terapêutica. Há umaevidente relação entre a inclusão das várias dimensõesreferentes à perspectiva da pessoa e o resultado da consultamédica. Essa vantagem justifica as propostas deatendimento médico apoiado no modelo centrado napessoa.

A radical transformation of the clinical method isproposed. The PCCM is divided into six components: assessmentof the illness and its experience; comprehensionof the individual as a whole; design of a commonproblem management; incorporating promotion andprevention dimensions; intensification of the doctor--patient relationship and ?being realistic?. This articleaims at unveiling the therapeutic itinerary of a personreferred to the Differential Diagnostics Ambulatoryof the Regional University of Blumenau (FURB) for assessmentand follow-up, under the PCCM perspective.This is a qualitative documental research conductedfrom the care of a female person (M.), with chronic anddisabling osteomuscular pain. Medical records wereanalyzed and with due consent interviews were recordedand transcribed. The focus was on the marital andthe working affairs, and the schedule on the medical intercurrences.The expectancies were discussed, the problemsto be dealt with were agreed, and her experiencewith the medication was revised. Before the applicationof the PCCM, M. wasn?t aware of the reason she had undergoneso many exams and taken so many medicines.Currently she comprehends information about her disease,expresses her opinion and shares decisions. Byusing the PCCM the process of sickening is better understood,providing a more satisfying consultation forthe involved parts in the therapeutic alliance. Thereis an evident relation between the inclusion of manydimensions concerning the person?s perspective andthe results of the medical consultation. This advantagejustifies the proposals of medical care/service based onthe person-centered model.

Intrathecal drug delivery system in the treatment of chronic intractable pain: a report of 18 cases / 中华麻醉学杂志

From November 2003 to May 2010, intrathecal drug delivery system (IDDS) was implanted in 18 patients with chronic intractable pain. Analgesia was provided with morphine. Thirteen patients suffered from late stage cancer and 5 from diseases other than cancer. VAS score was used to measure intensity of pain in all 18patients. QLQ-C30 score was used to evaluate quality of life in cancer patients. The patients were followed up for 3-62 months in 5 non-cancer patients. All 13 cancer patients died at 57 days-10 months after operation. VAS scores were significantly decreased and QLQ-C30 scores increased by intrathecal administration of morphine. Side effects developed in all patients to some extent including nausea, vomiting, constipation, urinary retention, pruritus and over-sedation and vanished in a week. Intrathecal catheter was cut while being pulled out of the needle in 1 patient. Two patients developed low intracranial pressure after operation. Cerebrospinal fluid leakage occurred in 1 patient. One patient developed neuropathic pain in the posterolateral side of right leg.

Dorsal root entry zone incision for pain induced by brachial plexus injury: an analysis of curative effect and complications / 中华创伤杂志

Objective To evaluate the efficacy and safety of dorsal root entry zone (DREZ) incision for pain induced by brachial plexus injury. Methods A cohort study was performed in 41 consecutive patients with pain induced by brachial plexus injury treated with DREZ incision from July 2005 to December 2007. Of all, 19 patients were amputated and had phantom limb sensation. Oral pain relief (0%-100%) and complications were followed up by one professional doctor. Oral pain relief rate ≥50% was considered satisfactory outcome. Results The proportion of patients with satisfactory pain relief was 90% (37/41), 81% (30/37), 77% (24/31) and 70% (16/23) at 2 weeks, 3 months, 6 months and last follow-up (over one year) after surgery. At last follow-up, 15 out of 16 patients with over 10 years of pain duration got satisfactory pain relief; while only 16 out of 25 patients with less than 10 years of pain duration got satisfactory pain relief (x2 =4.682, P =0.030). In 16 amputees who were followed up for more than three months, seven patients with alteration of phantom limb sensation got satisfactory pain relief, while only four out of nine patients without alteration of phantom limb sensation got satisfactory pain relief. Among 37 patients followed up for more than three months, severe neurological defects were found in three patients including one with mild motor disturbance in the ipsilateral lower limb and two with severe sensory disturbance in the ipsilateral lower limb. Conclusions DREZ incisions are effective and safe neurosurgical procedure for relieving pain induced by brachial plexus injury. The possible predictive factors of better outcome are the long preoperative pain duration and postoperative phantom limb sensation among amputees.

Observation of the curative effect of different dosage of flurbiprofen applied in refractory renal colic cases / 中国医师进修杂志

Objective To observe the curative effect and side effect ofdifferent dosage of flurbiprofen applied in refractory renal colic cases.Methods Two hundred refractory renal cohc cases were randomly divided into group A and group B,each group was 100 cases.Group A were apphed 100 mg flurbiprofen injection,group B were applied 50 mg flurbiprofen injection.Observed the time of the colic pain reheved,the curative effect and side effect Results The total effective rate of group A and group Bwere 99%(99/100)and 91%(911100)respectively,there was significant difference between two groups(P<0.05).In the time to relieve of group A and group B were(8.3±5.7)min and(13.2±9.1)min respectively,there Was significant difference between two groups(P<0.05).Analgesia continuous time of group A and group B were(19.3 ±3.2)h and(14.5 4±5.1)h respectively,there was no significant difference between two groups(P>0.05).And side effect was no significant difference between two groups.Conclusion The curative effect of 100mg flurbiprofen injection applied to the refractory renal colic cases is very outstanding,the time to relieve is very shod but side effect dose not increase.

Thoracoscopic Splanchnicectomy forRelief of Intractable Pain in Pancreatic Cancer: 2 case reports / 대한흉부외과학회지

Many patients with upper abdominal organ cancers, including pancreatic cancer, suffer from severe pain, and various methods and techniques have been used for relieving this pain. We present here two cases of patients with pancreatic cancer and they were both successfully relieved of their abdominal pain by performing video-assisted thoracoscopic sympathectomy and splanchnicectomy. This minimally invasive procedure offers promise in carefully selected patients with severe pain from pancreatic cancer and other conditions.

Algunos agentesnneurolíticos: consideraciones generaees / Some neurolytic agents: General considerations

Diferentes químicos han sido usados para la interrupción intencional de las vías nociceptivas. El agente ideal debería ser capaz de interrumpir selectivamente solo las fibras nerviosas A-delta y C, pero desafortunadamente todos los agentes comúnmente usados causan una indiscriminada destrucción del tejido nervioso. Los bloqueos neurolíticos destruyen las fibras nerviosas con la inyección de un agente neurolítico en el espacio subaracnoideo, peridural o directamente sobre la fibra nerviosa en cuestión. Es por ello que el modelo terapéutico a emplear debe discurrir entre la precaución extrema por no afectar fibras indispensables como las motoras y la necesidad de aliviar o eliminar las aferencias nociceptivas para mejorar la calidad de vida. A pesar de sus limitaciones, es un procedimiento más que permite dentro de un programa de evaluación y tratamiento, ofrecer según los criterios más avanzados sobre la "muerte digna," una terapéutica diferente para el alivio del dolor crónico, especialmente en pacientes con cáncer. Se realizó una revisión del mecanismo de acción de los neurolíticos más utilizados y las consecuencias de su uso y de esta forma brindar esta herramienta a todo el personal médico.

Different chemicals have been used for the intentional interruption of the nociceptive vias. The ideal agent should be capable of interrupting selectively only the nervous fibers A-delta and C, but unfortunately all the agents commonly used cause an undiscriminated destruction of the nervous tissue. The neurolytic blocks destroy the nervous fibers with the injection of a neurolytic agent in the subarachnoid space, peridural or directly over the nervous fiber as such. Therefore, the therapeutic model to employ should go deeply into the extreme precaution for not affecting indispensable fibers as the motor ones and the need to relieve or eliminate the nociceptive afferences to improve the quality of life. In spite of its limitations, it is another procedure that allows within a program of evaluation and treatment to offer according to the most advanced criteria on the "worthy death," a different therapeutic for the palliation of the chronic pain, especially in patients with cancer. A review of the neurolytic action mechanism most widely used was carried out and the consequences of its use, so as to provide this tool to all the medical staff.

El dolor: una psicología desde la perspectiva de la salud / Pain: the psychology from the perspective of health

Este artículo, en el contexto de la psicología de la salud, inicialmente presenta la definición del dolor, cómo se percibe y sus aspectos psicofisiológicos. Se revisan algunos estudios sobre la incidencia del dolor y los efectos de éste en costos sanitarios y a nivel laboral. Luego, se explican algunos aspectos relacionados concretamente con el dolor de espalda, por ser uno de los tipos de dolor más generalizados en la población. Posteriormente, se considera la problemática del dolor crónico desde una perspectiva cognoscitiva-comportamental. Finalmente se citan algunos instrumentos utilizados para la evaluación del dolor y se expone la necesidad de prevenir el dolor crónico lumbar a través de la identificación temprana de factores de riesgo psicosocial y los alcances que puede la investigación.

Pain Control by Permanant Spinal Cord Stimulation in the Post-herpetic Neuralgia / 대한마취과학회지

Post-herpetic neuralgia is the most frequent and feared complication of herpes zoster and is a common cause of chronic intractable pain in the elderly population. An 80 year old man who had suffered from intractable post-herpetic neuralgia received a percutaneous permanant spinal cord stimulator (ITREL3 Neurostimulator-Model 7425, Medtronic, USA) implantation. After implantation, he could sleep without interference of frequent acute sharp attacks of pain and showed improved daily life. We may suggest that this procedure could be applied for several kinds of intractable pain of neuropathic origin, including post-herpetic neuralgia, failed back surgery syndrome, complex regional pain syndrome, peripheral vascular disease and chronic intractable angina, after careful selection of the patient.

Clinical application of CT-guided curve-needle percutaneous ethanol injection for celiac plexus block analgesia / 第二军医大学学报

Objective:To validate the clinical value of CT-guided curve-needle percutaneous ethanol injection (CNPEI) for celiac plexus block analgesia. Methods: Thirty-two patients with end-stage cancer, including 13 complicated with extensive retroperitoneal lymph node enlargement and fusion, were enrolled in this study. All patients complained of refractory upper abdominal pain and had received narcotic analgesics and radiotherapy, but the analgesic effect was not good. CT-guided CNPEI was therefore prescribed. Results: The effective rates of CT-guided CNPEI were 100%, 100%, 96.9%, 90.6%, 87.5%, and 84.4% immediately,and at 2 weeks, 4 weeks, 8 weeks, 12 weeks, and 16 weeks after treatment, respectively. All enlarged lymph nodes had obvious necrosis and became shrunk. Conclusion: Combined application of bilateral anterior and posterior diaphragmatic crura block and trans-lymph node block can produce good analgesic effects, and curve-needle puncture make the above technique simpler.

Trial Stimulation of the Spinal Cord for Relief of Pain: A 6-year Experience / 대한마취과학회지

BACKGROUND: The results of 51 cases of trial spinal cord stimulation which had been carried out for relief of intractable pain were analyzed. METHODS: Most patients were referred due to failure of conventional pain treatment modalities. They consisted of 35 men and 16 women, ranging in age from 21 to 74 years. In 17 cases pain was associated with postherpetic neuralgia, 14 with failed back surgery syndrome, 3 with cauda equina syndrome, 3 with reflex sympathetic dystrophy, 3 with spinal cord injury, 2 with brachial plexus injury, 2 with torticollis, 2 with vertebral injury, 1 with phantom limb pain, 1 with myelitis, 1 with paraplegia, 1 with low back pain, and 1 with cancer metastasis to the vertebra. An electrode tip was positioned at varying sites from C1-2 to T11 dictated by the location of pain. T3, T6, and T8 were the most frequent sites. RESULTS: Pain due to postherpetic neuralgia, failed back surgery syndrome, cauda equina syndrome, reflex sympathetic dystrophy, and brachial plexus injury was well controlled. Noticeable complications included wound infection and electrode displacement. Following a trial period of stimulation, 10 patients had permanent stimulators implanted, while one patient died as a result of unrelated causes. CONCLUSIONS: We may suggest that spinal cord stimulation represents a useful technique in a well- selected group of patients with no other treatment options.

Feasibility of subarachnoid chromaffin cell allograft for terminal cancer pain / 中华麻醉学杂志

Objective To evaluate the analgesic effect and safety of subarachnoid chromaffin cell allograft for terminal cancer pain Methods Ten patients with intractable cancer pain despite traditional treatments were randomly divided into two groups In test group(n=4), 2ml of the suspension chromaffin cells cultured in vitro for 3 days was injected into the subarachnoid space through lumber puncture The same amount of cell free culture solution was injected intrathecally in control group(n=6) Opioids were administered continuously after transplantation The intensity of pain was assessed by VAS, the dose of opioids taken was recored,and the catecholamine and enkephalin concentrations in cerebrospinal fluid and immune function were measured before and after transplantation Results The VAS scores declined markedly in both groups after transplantation (P