[Percutaneous electrical nerve stimulation of peripheral nerve for the intractable occipital neuralgia]. / Neurostimolazione elettrica subcutanea del nervo periferico utilizzata nel controllo della nevralgia occipitale refrattaria.

UNLABELLED: Occipital neuralgia is characterized by pain paroxysm occurring within distribution of the greater or lesser occipital nerves. The pain may radiates from the rear head toward the ipso-lateral frontal or retro-orbital regions of head. Though known causes include head injuries, direct occipital nerve trauma, neuroma formation or upper cervical root compression, most people have no demonstrable lesion. METHOD AND MATERIALS: A sample of 8 patients (5 females, 3 males) aging 63,5 years on the average with occipital neuralgia has been recruited. The occipital neuralgic pain had presented since 4, 6 years and they had been treated by pharmacological therapy without benefit. Some result has been obtained by blocking of the grand occipital nerve so that the patients seemed to be suitable for subcutaneous peripheral neurostimulation. The pain was evaluated by VAS and SVR scales before treatment (TO) and after three and twelve months (T1, T2). RESULTS: During the follow up period 7 patients have been monitored for a whole year while one patient was followed only for 3 months in that some complications have presented. In the other 7 patients pain paroxysms have interrupted and trigger point disappeared with a VAS and SVR reduction of about 71% and 60%, respectively. CONCLUSIONS: Our experience demonstrates a sound efficacy of such a technique for patients having occipital neuralgia resistant to pharmacological therapies even if action mechanisms have not yet clearly explained. Some hypothesis exist and we think it might negatively affect the neurogenic inflammation that surely acts in pain maintaining.

[Management of pain from osteoporotic vertebral fractures with continuous intrathecal administration of morphine]. / Trattamento del dolore cronico benigno da crollo vertebrale osteoporotico con infusione continua intratecale di morfina.

UNLABELLED: Vertebral fractures are the most common consequences of severe osteoporosis. The chronic pain from collapse of osteoporotic vertebrae affects quality of life and autonomy of patients. The management of pain with oral or transdermal opiates can cause severe side-effects. Continuous intrathecal administration of morphine with an implantable pump represents a good alternative therapy and has advantages in pain relief and quality of life. MATERIALS AND METHODS: We report our experience in the treatment of refractory chronic pain due to vertebral fractures using pumps for intrathecal infusion of morphine in 24 patients. We administered the Visual Analogue Scale (VAS) and the Quality of Life Questionnaire of the European Foundation of Osteoporosis (QUALEFFO). RESULTS: A significant pain relief was obtained in all implanted patients. Using the QUALEFFO we observed significant improvements of all variables such as QDL (quality of life), DW (domestic work), ambulation and PHS (perception of health status), before and after 1 year from pump implantation. With intrathecal morphine infusion none of the patients required additional systemic analgesics. CONCLUSIONS: Our results show that intrathecal administration of morphine efficiently relieves the symptoms of pain and improve the quality of life. Continuous intrathecal administration of morphine represents a good alternative therapy and has advantages in those patients who suffer from severe side-effects with systemic administration.