1/10. Tolosa Hunt syndrome--intractable pain treatment with acupuncture?PURPOSE: The Tolosa Hunt syndrome (THS) is a painful granular inflammation of the cerebral vessels followed by pain and disorders of the extrabulbar muscles. The therapy consists of corticosteroids and analgetics. There was a 70 year old woman who suffered from painful paresis of the abducent and oculomotor nerves following an infection with borrelia burgdorferi--but without ocular symptoms. The treatment with corticosteroids reduced the palsy but she complained of excessively painful attacks in the region of the first branch of the trigeminal nerve. Opiold analgetic therapy did not bring about any relief. acupuncture is an irritative method with a physical effect on the nervous system: its pain-reducing effect is caused by the activation of transmitters like endorphins in thalamus and brain stem. Knowing this effect, the THS patient, after informed consent, was treated with acupuncture. To measure the extent of pain, a visual analog scale (0: no pain - 10: maximum pain) was used. acupuncture was performed according to the empirical rules of the Traditional Chinese medicine (TCM), during a period of 10 weeks and 12 weeks. There was a significant pain relief after acupuncture from VAS 10 to VAS 5. The effect vanished during the next four months. After a second series of 12 sessions pain reduction was reported from VAS 10 to 4. One year after the last Tolosa Hunt syndrome - intractable pain pain strength ranged between VAS 4 - 6. Therefore acupuncture seems to be a good additional method for reduction of intractable pain.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/10. Common factors contributing to intractable pain and medical problems with insufficient drug uptake in areas to be treated, and their pathogenesis and treatment: Part I. Combined use of medication with acupuncture, ( ) qi gong energy-stored material, soft laser or electrical stimulation.Most frequently encountered causes of intractable pain and intractable medical problems, including headache, post-herpetic neuralgia, tinnitus with hearing difficulty, brachial essential hypertension, cephalic hypertension and hypotension, arrhythmia, stroke, osteo-arthritis, Minamata disease, Alzheimer's disease and neuromuscular problems, such as amyotrophic lateral sclerosis, and cancer are often found to be due to co-existence of 1) viral or bacterial infection, 2) localized microcirculatory disturbances, 3) localized deposits of heavy metals, such as lead or mercury, in affected areas of the body, 4) with or without additional harmful environmental electro-magnetic or electric fields from household electrical devices in close vicinity, which create microcirculatory disturbances and reduced acetylcholine. The main reason why medications known to be effective prove ineffective with intractable medical problems, the authors found, is that even effective medications often cannot reach these affected areas in sufficient therapeutic doses, even though the medications can reach the normal parts of the body and result in side effects when doses are excessive. These conditions are often difficult to treat or may be considered incurable in both Western and Oriental medicine. As solutions to these problems, the authors found some of the following methods can improve circulation and selectively enhance drug uptake: 1) acupuncture, 2) Low pulse repetition rate electrical stimulation (1-2 pulses/second), 3) ( ) qi Gong energy, 4) Soft lasers using Ga-As diode laser or He-Ne gas laser, 5) Certain electro-magnetic fields or rapidly changing or moving electric or magnetic fields, 6) Heat or moxibustion, 7) Individually selected calcium channel blockers, 8) Individually selected Oriental herb medicines known to reduce or eliminate circulatory disturbances. Each method has advantages and limitations and therefore the individually optimal method has to be selected. Applications of ( ) qi Gong energy stored paper or cloth every 4 hours, along with effective medications, were often found to be effective, as Qigongnized materials can often be used repeatedly, as long as they are not exposed to rapidly changing electric, magnetic or electro-magnetic fields. Application of ( ) qi Gong energy-stored paper or cloth, soft laser or changing electric field for 30-60 seconds on the area above the medulla oblongata, vertebral arteries or endocrine representation area at the tail of pancreas reduced or eliminated microcirculatory disturbances and enhanced drug uptake.(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 0.55555555555556keywords = puncture (Clic here for more details about this article) |
3/10. A modified approach to transcrural celiac plexus block.OBJECTIVES: Transcrural celiac block using the needle "walking off" the L1 vertebra technique may cause complications. We used patient-specific computed tomography (CT) images as a roadmap to perform the block under fluoroscopy. We present 1 case to describe the technique. CASE REPORT: The patient is a 63-year-old woman with refractory pain from pancreatic cancer. Her CT showed the celiac trunk at the upper L1 vertebra and 2 cm left to the midline. Needle trajectories were drawn on that film. The line representing the classic "walking off" the bone technique on the left side crossed the aorta. Two lines targeting the base of the celiac trunk were modified, thereby avoiding both the L1 vertebra and the surrounding organs. The following were measured: the distance from the midline to the left needle entry (2.5 cm), the angle for the left needle insertion (90 degrees), the distance (6 cm) and the angle (65 degrees) for the right needle entry, and the distance from the anterior margin of the L1 to the celiac trunk (2.6 cm). During the procedure, 2 needles were placed according to these measurements in a plane superior to the transverse process of the L1. No bony contact or needle redirection was made. Both needles reached 3 cm anterior to the anterior margin of the L1. X-ray contrast crossed the midline and silhouetted the target vasculature. Five milliliters of 0.2% ropivacaine followed by 10 mL of 6% phenol were injected on each side. The patient's pain level improved to 0 to 1/10 on a visual analog scale. CONCLUSIONS: The modified technique avoided painful needle contact on the bone, reduced needle redirections, and decreased the possibility of vital organ puncture.- - - - - - - - - - ranking = 0.11111111111111keywords = puncture (Clic here for more details about this article) |
4/10. Management of cerebral spinal fluid leak complicating spinal cord stimulator implantation.Accidental puncture of the dura mater with resultant leakage of cerebral spinal fluid (CSF) and development of postdural puncture headache (PDPH) is a known potential complication of percutaneous placement of spinal cord stimulator (SCS) leads. However, the implications and management strategies for this complication have not been thoroughly reported. We report two cases of SCS lead placement complicated by CSF leak and PDPH.- - - - - - - - - - ranking = 0.22222222222222keywords = puncture (Clic here for more details about this article) |
5/10. Rejection of deeply implanted foreign body induced by acupuncture treatment in patient suffering intractable pains lasting ten years following traumatic injury to the left scapular region during a road accident.Upper back pains lasting ten years were promptly improved in a 63 year old woman following the rejection of a forgotten foreign glass body, through a scar located over the left scapula, and treated by acupuncture. The patient insisted on having this treatment after unsuccessful prolonged and multi-disciplinary formal medical interventions culminating in preparations for exploratory surgery. The acupuncture directed to the scar induced an inflammatory reaction characterized by a sterile granulomatous reaction which surrounded a large piece of glass, apparently implanted in the soft tissue of the suprascapular area during a severe road accident which occurred ten years previously. The surgical intervention was avoided.- - - - - - - - - - ranking = 0.66666666666667keywords = puncture (Clic here for more details about this article) |
6/10. On the possible specific role of acupuncture loci in therapeutics.The case history of a patient with thoracic vertebra fracture and following pain syndrome of the inferior limbs is reported. As a result of acupuncture treatment the pain was significantly reduced, but it could be reinduced by stimulation of the B1-31-33 loci during treatment. On needling the connecting locus of the related meridian of the bladder (Ki-6) the pain disappeared; otherwise stimulation of other loci showed a failure to stop the pain induced by the stimulation of B1-31-33 loci. It is remarkable that both the bladder's and the Ki-6 loci belong to the lumbal 4 spinal segment. The problem of the specific role of the acupuncture loci also is discussed.- - - - - - - - - - ranking = 0.66666666666667keywords = puncture (Clic here for more details about this article) |
7/10. Intraventricular administration of morphine in patients with neoplastic intractable pain.Since February 1981, eight patients with neoplastic intractable pain have been treated by intracerebroventricular administration of small doses of morphine. morphine was injected into the cerebrospinal fluid through a ventricular reservoir either by direct puncture or by self-administration. Clinical results were very good, and there were no deleterious effects.- - - - - - - - - - ranking = 0.11111111111111keywords = puncture (Clic here for more details about this article) |
8/10. reflex sympathetic dystrophy following arterial blood gas sampling in the intensive care setting.A 54-year-old woman developed signs and symptoms consistent with reflex sympathetic dystrophy in her left upper extremity following arterial puncture. diagnosis was confirmed by bone scan, and sympathetic blockade with intravenous regional bretylium completely relieved her severe, intractable pain.- - - - - - - - - - ranking = 0.11111111111111keywords = puncture (Clic here for more details about this article) |
9/10. Subarachnoid adrenal medullary transplants for terminal cancer pain. A report of preliminary studies.BACKGROUND: The prolonged use of opioids to treat intractable pain with currently available therapeutic modalities is often unsatisfactory, usually because of tolerance or complications. Extensive studies carried out in the authors' laboratories have indicated that the transplantation of adrenal medullary tissue into the spinal subarachnoid space can significantly reduce pain in animal pain models, most likely via release of opioid peptides and catecholamines. The current study was undertaken to assess the feasibility and efficacy of subarachnoid adrenal medullary transplantation in alleviating terminal cancer pain in humans. methods: Two milliliters of human adrenal medullary tissue were prepared in the laboratory and then transplanted via lumbar puncture into the subarachnoid space in five patients suffering from terminal cancer pain. Pain scores (VAS), functional activity, and opioid intake were assessed and recorded before and after the transplantation procedure. In addition, CSF samples were collected before and (when possible) at fixed intervals after transplantation for biochemical and cytologic analysis. RESULTS: Four of the five patients demonstrated progressive decreases in pain scores after the transplant procedure, with concomitant reductions in opioid intake. Three of these four patients remained pain free, two for over 10 months, while the other had a recurrence of her pain after surgery for spinal cord compression secondary to metastases 10 weeks after transplant. The fifth patient had no pain reduction by 1 month after the procedure, and refused further followup. After the transplants, spinal CSF samples revealed increased concentrations of met-enkephalin in three of the five patients, and increased concentrations of catecholamines in the four patients in whom they were determined. CONCLUSIONS: The results obtained in this study indicate that subarachnoid adrenal medullary transplantation may provide a unique and effective approach to the management of intractable chronic pain in humans.- - - - - - - - - - ranking = 0.11111111111111keywords = puncture (Clic here for more details about this article) |
10/10. Surgical interruption of a midline dorsal column visceral pain pathway. Case report and review of the literature.A punctate midline myelotomy performed in a patient effectively eliminated residual, intractable pelvic pain, which remained after resolution of uterine cervical cancer. The authors describe the case history of the patient, in whom pain assessments were made, and a surgical procedure performed. Despite large doses of opiate analgesic medications, the patient experienced constant pressure pain in the right lower pelvis, with excruciating pain on bowel movement. Severe weight loss necessitated better pain control. A minimally invasive surgical procedure, a 5-mm deep puncture using a 16-gauge needle on either side of the median septum in the dorsal column of the spinal cord (T-8), resulted in no new neurological deficits. Narcotic medication was tapered, no pain was reported, and the patient resumed daily household activity. Midline myelotomy has typically been performed with the intention of eliminating the crossing fibers of the spinothalamic tract in the anterior white matter commissure. The punctate midline myelotomy described here was performed with the specific intention of interrupting a newly described visceral pain pathway that ascends to higher brain centers through the midline of the dorsal column. The effectiveness of the pain relief seen in this patient suggests that visceral pain of the pelvis in humans may be transmitted in the midline of the dorsal column, as has been recently reported in studies using rats. The effectiveness of the punctate midline myelotomy performed in this one case of pelvic visceral pain suggests that the surgery may eventually be effective in greatly reducing or replacing opiate narcotic medication for visceral pain management.- - - - - - - - - - ranking = 0.11111111111111keywords = puncture (Clic here for more details about this article) |
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