The aim of this prospective study was to evaluate the efficacy of endoscopic epidurolysis in the treatment of degenerative chronic low back pain.Two hundred and thirty four patients affected by chronic low back pain, with VAS ≥ 5 and Oswestry Low Back Pain Disability Index (ODI) from 0 to 60% (0-20%, group A; 20-40%, group B; 40-60%, group C) were enrolled and treated prospectively with endoscopic epidurolysis by means of a flexible fiberoptic endoscope introduced into the caudal epidural space and by the intermittent instillation of saline solution added with 150 UI hyaluronidase. Targeted application of ozone (8 ml; 38 γ/ml) and 50 mg ciprofloxacin close to the abnormal areas was also performed.
View Article and Find Full Text PDFIt is known that, in spite of meeting appropriate clinical criteria for spinal cord stimulation (SCS) and having undergone flawless procedures, a significant number of patients who fail the therapy continues to exist. It is the purpose of this article to focus on the development of psychosocial indicators of success for SCS, if any. Referring to specialist literature authors present a review of what is known, what is not known, and what remains controversial on this topic.
View Article and Find Full Text PDFStudy Objective: To evaluate the perioperative antinociceptive effect of intrathecal morphine (a pure mu agonist), intravenous (IV) buprenorphine (a partial mu agonist) or their combination.
Design: Randomized, double-blind, placebo-controlled study.
Settings: Anesthesiology department of a university-affiliated public hospital.
Concurrent administration of opioids with different affinity produces synergistic antinociceptive effect in rats. We tested the perioperative antinociceptive effects of the simultaneous double blind administration of morphine, a pure agonist and buprenorphine, a partial agonist, in 30 patients undergoing hysterectomy under general anesthesia. Pre- and post-operatively regimens consisted of random patient assignment to intrathecal 0.
View Article and Find Full Text PDFIt is well-known that morphine is the king of analgesics. It is widely used, and administered in various ways for the control of acute and chronic pain states. There are, however, certain types of pain and certain clinical conditions in which morphine cannot be used due to the risk of possible complications.
View Article and Find Full Text PDFAn overview of the spinal administration of ketamine is presented. Ketamine acts as a noncompetitive antagonist of the NMDA receptor Ca(++ channel pore. This effect provides interesting possibilities in pain therapy.
View Article and Find Full Text PDFThe results obtained from 355 patients of both sexes subjected to general and orthopaedic surgery with super-selective subarachnoid anesthesia (SSA) by means of small (26-27 gauge) needles with a modified Whitacre needle with ogival point are described. The use of thin spinal needles with "pencil-point" type ends together with microdoses of local anesthetics has meant a reduction in the complications typical of this technique such as hypotension, post-dural puncture, headache (PDPH) and urinary retention. Super-selective subarachnoid anesthesia realised through an infusion of 0.
View Article and Find Full Text PDFThe authors examine the pharmacological characteristics, distribution and clinical effects of natural (somatostatin) and synthetic (octreotide) growth hormone release inhibitors (GHRIH). They mainly discuss the analgesic effect of these substances using intraspinal, epidural and subarachnoid administration. The intraspinal use of somatostatin and its synthetic analog, octreotide, are not without risks: among these, it is worth recalling the neurotoxic and vasomotor effects.
View Article and Find Full Text PDFAim: To analyse therapeutic morphine consumption in Italy and explain the current trend.
Environment: Morphine consumption was examined at Santa Croce Hospital, Cuneo, a general provincial hospital.
Method: The overall annual consumption of morphine was used as a starting point from which to evaluate the "average daily consumption of set doses", both in general and using a number of methods of administration.
The problem of pain and suffering in the terminal phase of illness such as cancer or Aids has not received adequate attention and has not been given valid solutions. The author tries to offer a new interpretation key for the problem starting from the Good Samaritan Novel that is considered a clear example of the capability of bringing help and assistance in concrete terms. The request for euthanasia will never be considered a superfluous problem unless a patient can receive concrete answers to his physical and emotional suffering and to the problem of his personal "quality of life".
View Article and Find Full Text PDFIn patients affected by unbearable pain secondary to peripheral vascular disorders beyond surgical repair such as thromboangitis obliterans, diabetic microangiopathy, arteriosclerosis obliterans, there is a need to establish the degree of micro-circulation functionality before proceeding with invasive pain therapy, such as Spinal Cord Stimulation (SCS). From our series some cases of refractory ischaemic pain subjected to nuclear medicine techniques assessment before and after SCS implant will be presented; these data suggest that the use of radionuclides for quantifying regional perfusion, in view of the information it offers us both in the dynamic angiographic phase and in the later static phase, constitutes a very valid aid in the diagnosis and treatment of chronic pain conditions of ischaemic origin. Cutaneous, musculoskeletal and bone flow scintiscan is a non-invasive procedure which allowed us to make an objective selection of patients who are candidates for prolonged conservative treatment thus limiting the incidence of ineffective permanent SCS implants.
View Article and Find Full Text PDFObjective: The current study sought to determine whether there were any significant cross-cultural differences in medical-physical findings, or in psychosocial, behavioral, vocational, and avocational functioning, for chronic low back pain patients.
Design: Partially double-blind controlled comparison of six different culture groups.
Setting: Subjects were selected from primarily ambulatory care facilities specializing in treating chronic pain patients.
The aim of this paper is to focus on a medical issue which is not held in due consideration in Italy. In chronic pain control and management, specialists may advise at various times drugs, physical therapies, behavioral modification techniques, and not demolitive antinociceptive procedures. Quite often patients do not follow medical prescriptions as one should expect, especially if they are not inpatients.
View Article and Find Full Text PDFThe MMPI scores, the PPI and the MPQ of seven multi-operated patients for chronic pain complaints of non malignant origin were studied. The results of the analysis performed in this group of surgically treated patients point out that there is a strong evidence of relationship between personality traits and the persistence of pain.
View Article and Find Full Text PDFChronic pain in patients suffering from advanced cancer as well as unbearable chronic pain states depending on non-malignant pathology have always represented a test bench to verify results of advanced therapeutical programs as to more traditional approaches. The Authors present their experience resulting from longterm spinal infusion with peridural catheters connected to portable micropumps for the continuous administration of analgesic solutions. The availability of portable micropumps, a better understanding of spinal opioid receptors and advances in pharmacokinetics of opiate analgesics led in these years to a tremendous improvement of pain control possibilities and of the quality of life of patients.
View Article and Find Full Text PDFA study has been carried out on the effectiveness of a total parenteral nutrition (TPN) program on 12 patients in intensive care units (ICU). Conclusions have been drawn from biohumoral parameters during the first fornight's stay in the ICU. Results, relating to the re-equilibrium of the glycid and protydic sectors, varied in respect of their temporal distribution.
View Article and Find Full Text PDFThe treatment of trigeminal neuralgia (TN), which is resistant to medical therapy, has benefited from many surgical techniques. It is not possible, in light of the present level of knowledge, to establish exactly which method is the most suitable. It does, however, seem significant that certain side effects appear, in varying percentages, in all kinds of operations.
View Article and Find Full Text PDFAlthesin was used on account of its pharmacokinetic and pharmacodynamic properties and its high therapeutic index in a search for a narcotic drug displaying minimal interference with metabolic and functional parameters in the aged. Continuous perfusion of the anaesthetic proved an extremely flexible method bearing in mind the varying length of the operations concerned. Stress is laid on the need for clinical control, especially at the moment of induction to ensure that timely action can be taken in the event of complications.
View Article and Find Full Text PDFThe biochemical data relating to the physiological distribution of potassium and its regulating factors in the normal human body are explained. Reference is then made to the clinical symptoms and aetiopathogenesis of hypokalaemia. A serious case coupled with flaccid quadriplegia in a 34-yr-old male is presented.
View Article and Find Full Text PDFMinerva Med
October 1980
On the basis of personal experience of many patients affected by neoplastic lesions, the conviction that the assistance provided to a terminal cancer patient in the hospital ward is deficient and takes no account of the medical, emotional, social and spiritual needs of the patient and his family, is expressed. It would be advisable for assistance to terminale patients to be supplied in adequate centres operating on multidepartmental bases, with the participation of experts in antalgic treatment and psychological problems.
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