OBJECTIVES: Managing patients with refractory head and neck cancer pain is one of the more challenging issues in clinical practice, and traditional intrathecal drug delivery also fails to provide adequate analgesia. There are currently no comprehensive and effective treatment methods. This study aims to observe the efficacy and safety of treating intractable head and neck cancer pain with morphine pump via lumbar approach to the prepontine cistern. METHODS: A total of 18 patients with intractable head and neck cancer pain treated with prepontine cistern morphine pumps were selected from the Department of Pain Management, Second Xiangya Hospital, Central South University between September 2019 and July 2023. Statistical analysis was performed on patients' preoperative and postoperative (1 week, 1 month, and 2 months after surgery), Numerical Rating Scale (NRS) scores, Self-Rating Depression Scale (SDS) scores, daily oral morphine consumption, the number of daily breakthrough pain episodes, and postoperative daily intrathecal morphine dosage. RESULTS: The NRS scores, SDS scores, daily oral morphine consumption, and the number of daily breakthrough pain episodes of patients at each time point after surgery were significantly lower than before surgery (all P<0.05). With the gradual increase in the dosage of intrathecal morphine, the daily oral morphine consumption of patients at each postoperative time point was significantly reduced compared to preoperative levels (all P<0.05). The complications related to the operation were mild, including nausea in 5 cases (31.3%), headache in 2 cases (12.5%); hypotension, urine retention, hypersomnia and constipation in 1 case (6.3% each), and no serious adverse events occurred. All improved and were discharged after symptomatic treatment. CONCLUSIONS The implantation of prepontine cistern morphine pump effectively controls intractable head and neck cancer pain, demonstrating characteristics of minimal invasiveness, mild side effects, and low medication dosage under the premise of standardized procedures.
Humans ; Morphine/administration & dosage* ; Male ; Female ; Middle Aged ; Head and Neck Neoplasms/surgery* ; Analgesics, Opioid/administration & dosage* ; Cancer Pain/drug therapy* ; Pain, Intractable/etiology* ; Aged ; Adult ; Infusion Pumps, Implantable ; Pain Management/methods*

OBJECTIVETo investigate the clinical outcomes of semicircular decompression in treating old thoracolumbar fractures and intractable neuropathic pain.

METHODSFrom September 2009 to September 2013, 21 patients with old thoracolumbar fracture and intractable neuropathic pain were treated with semicircular decompression. Among initial surgery, posterior pedicle screw fixation was used in these patients, with or without laminectomy. All patients were male, range in age from 20 to 28 years old with an average of (25.00±2.38) years. Vertebral body residual bone block resulted in intra-spinal placeholder more than 50%. All patients were complete spinal cord injury (ASIA grade) or cauda equina injury. VAS scores was from 6 to 10 points with the mean of 7.14±0.91. In these patients, MRI, CT, X-rays were performed; denomination and dosage of analgesics were recorded; nerve function and pain status were respectively evaluated by ASIA grade and VAS score before and after operation.

RESULTSAll patients were followed up from 8 to 32 months with an average of (17.29±6.02) months. All bone fragments of spinal canal were removed and spinal cord decompressions were achieved. At final follow-up, VAS scores were from 0 to 8 points with an average of (2.43±2.46) points, and were obviously reduced than peroperative data (P<0.05). Eleven cases of them stopped analgesic intake and 7 cases reduced using. Three patients' symptoms and VAS scores were not improved.

CONCLUSIONOld thoracolumbar fractures and intractable neuropathic pain need receive imaging examination as soon as possible and consider semicircular decompression therapy if bone fragments were in vertebral canal and spinal canal stenosis existed. This therapy can effectively relieve pain and profit nerve functional recovery.

Adult ; Decompression, Surgical ; methods ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Neuralgia ; etiology ; surgery ; Pain, Intractable ; etiology ; surgery ; Spinal Fractures ; physiopathology ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Visual Analog Scale ; Young Adult

BACKGROUND: Surgical treatment for metastatic spine disease has been becoming more prominent with the help of technological advances and a few favorable reports on the surgery. In cases of this peculiar condition, it is necessary to establish the role of surgery and analyze the factors affecting survival. METHODS: From January 2011 to April 2015, 119 patients were surgically treated for metastatic spine lesions. To reduce the bias along the heterogeneous cancers, the primary cancer was confined to either the lung (n = 25) or the liver (n = 18). Forty-three patients (male, 32; female, 11; mean age, 57.5 years) who had undergone palliative surgery were enrolled in this study. Posterior decompression and fusion was performed in 30 patients (P group), and anteroposterior (AP) reconstruction was performed in 13 patients (AP group) for palliative surgery. Pre- and postoperative (3 months) pain (visual analogue scale, VAS), performance status (Karnofsky performance score), neurologic status (American Spinal Injury Association [ASIA] grade), and spinal instability neoplastic score (SINS) were compared. The survival period and related hazard factors were also assessed by Kaplan-Meier and Cox regression analysis. RESULTS: Most patients experienced improvements in pain and performance status (12.3% +/- 17.2%) at 3 months postoperatively. In terms of neurologic recovery, 9 patients (20.9%) graded ASIA D experienced neurological improvement to ASIA E while the remainder was status quo. In an analysis according to operation type, there was no significant difference in patient demographics. At 12 months postoperatively, cumulative survival rates were 31.5% and 38.7% for the P group and the AP group, respectively (p > 0.05). Survival was not affected by the pre- and postoperative pain scale, Tokuhashi score, neurologic status, SINS, or operation type. Preoperative Karnofsky performance score (hazard ratio, 0.93; 95% confidence interval [CI], 0.89 to 0.96) and improvement of performance status after surgery (hazard ratio, 0.95; 95% CI, 0.92 to 0.97) significantly affected survival after operation. CONCLUSIONS: There was no significant difference in surgical outcomes and survival rates between posterior and AP surgery for metastatic lesions resulting from lung and hepatocellular cancer. Preoperative Karnofsky score and improvement of performance status had a significant impact on the survival rate following surgical treatment for these metastatic spine lesions.
Aged ; Back Pain ; *Decompression, Surgical/adverse effects/methods/mortality ; Female ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/*pathology ; Lung Neoplasms/*pathology ; Male ; Middle Aged ; Pain, Intractable ; Palliative Care/*methods ; Prognosis ; Retrospective Studies ; *Spinal Fusion/adverse effects/methods/mortality ; *Spinal Neoplasms/mortality/surgery ; Spine/*surgery

Intrathecal drug administration system (ITDAS) can reduce the side effects while increasing the effectiveness of opioids compared to systemic opioid administration. Therefore, the use of ITDAS has increased in the management of cancer pain and chronic intractable pain. Catheter obstruction is a serious complication of ITDAS. Here, we present a case of catheter obstruction by a mass formed at the side hole and in the lumen. A 37-year-old man suffering from failed back surgery syndrome received an ITDAS implantation, and the ITDAS was refilled with morphine every 3 months. When the patient visited the hospital 18 months after ITDAS implantation for a refill, the amount of delivered morphine sulfate was much less than expected. Movement of the pump rotor was examined with fluoroscopy; however, it was normal. CSF aspiration through the catheter access port was impossible. When the intrathecal catheter was removed, we observed that the side hole and lumen of the catheter was plugged.
Adult ; Analgesics, Opioid ; Catheter Obstruction ; Catheters ; Catheters, Indwelling ; Failed Back Surgery Syndrome ; Humans ; Infusion Pumps, Implantable ; Injections, Spinal ; Morphine ; Pain, Intractable ; Stress, Psychological

Cancer pain is complex and multifactorial. Most cancer pain can be effectively controlled using analgesics in accordance to the WHO analgesic ladder. However, in a small but significant percentage of cancer patients, systemic analgesics fail to provide adequate control of cancer pain. These cancer patients can also suffer from intolerable adverse effects of drug therapy or intractable cancer pain in advance disease. Though the prognosis of these cancer patients is often very limited, the pain relief, reduced medical costs and improvement in function and quality of life from a wide variety of available interventional procedures is extremely invaluable. These interventions can be used as sole agents or as useful adjuncts to supplement analgesics. This review will discuss interventional procedures such as epidural and intrathecal drug infusions, intrathecal neurolysis, sympathetic nervous system blockade, nerve blocks, vertebroplasty and the more invasive neurosurgical procedures. Intrathecal medications including opioids, local anaesthetics, clonidine, and ziconotide will also be discussed.
Analgesics ; therapeutic use ; Humans ; Neoplasms ; physiopathology ; Pain Measurement ; Pain, Intractable ; drug therapy ; surgery

OBJECTIVETo study the clinical effect of combination of mesencephalotomy with bilateral anterior cingulotomy, and destroy spinal cord dorsal root entry zone (DREZ) treatment for phantom limb pain (PLP).

METHODSFifteen patients suffering from PLP secondary to amputation were treated with neurosurgical procedures, including 7 cases of left upper limb pain, 4 cases of right upper limb pain, 1 case of left lower limb pain and 3 cases of right lower limb pain. Group A, the mesencephalotomy and bilateral anterior cingulotomy, were co-performed in 4 patients. Group B, the other 11 patients were treated with DREZ lesion on the same side in the C5-T1 or L2-S1 spinal cord segments. The visual analog scale (VAS) and the McGill pain questionnaire (MPQ) were used for preoperative and postoperative evaluation of the pain status of each patient. Statistical analyses were conducted using paired-samples t test.

RESULTSAll cases had pain relief immediately after operation and did not take medicine. In group A, the short-term (3 months) follow-up results indicated a significant reduction in patients' pain scales (P < 0.01), but pain recurred in 4-18 months after operation. In group B, one patient died of serious lung infection at 2 months after operation. The other 10 patients had pain relief satisfactorily in long-term follow-up period (12-24 months postoperative, P < 0.05). There were no serious complication and surgery-related mortality.

CONCLUSIONThe cooperation of mesencephalotomy and bilateral anterior cingulotomy, DREZ lesion are effective methods for relieving PLP. DREZ lesion has a good long-term effect.

Adult ; Female ; Follow-Up Studies ; Gyrus Cinguli ; surgery ; Humans ; Male ; Mesencephalon ; surgery ; Middle Aged ; Neurosurgical Procedures ; methods ; Pain, Intractable ; surgery ; Phantom Limb ; Spinal Nerve Roots ; surgery ; Treatment Outcome

Spinal cord stimulation (SCS) has been used since 1967 for refractory chronic pain. SCS has recently undergone a variety of technical modifications and advances, and it has been applied in a variety of pain conditions. SCS has been most commonly applied for those patients with chronic back and leg pain and failed back surgery syndrome (FBSS). The clinical hallmark of FBSS is chronic postoperative pain. The pain pattern varies and the pain may show an axial or radicular distribution. Chronic intractable pain after FBSS is difficult to treat. This report describes our experience with treating chronic pain in two patients who suffered from FBSS with a spinal cord stimulator. A permanent spinal cord stimulator was implanted after a successful trial of stimulation with temporarily implanted electrodes. After 5 months of follow-up, the two patients had satisfactory improvement of their pain.
Chronic Pain ; Electrodes, Implanted ; Failed Back Surgery Syndrome* ; Follow-Up Studies ; Humans ; Leg ; Low Back Pain ; Pain, Intractable ; Pain, Postoperative ; Spinal Cord Stimulation ; Spinal Cord*

Spinal cord stimulation (SCS) has been used since 1967 for refractory chronic pain. SCS has recently undergone a variety of technical modifications and advances, and it has been applied in a variety of pain conditions. SCS has been most commonly applied for those patients with chronic back and leg pain and failed back surgery syndrome (FBSS). The clinical hallmark of FBSS is chronic postoperative pain. The pain pattern varies and the pain may show an axial or radicular distribution. Chronic intractable pain after FBSS is difficult to treat. This report describes our experience with treating chronic pain in two patients who suffered from FBSS with a spinal cord stimulator. A permanent spinal cord stimulator was implanted after a successful trial of stimulation with temporarily implanted electrodes. After 5 months of follow-up, the two patients had satisfactory improvement of their pain.
Chronic Pain ; Electrodes, Implanted ; Failed Back Surgery Syndrome* ; Follow-Up Studies ; Humans ; Leg ; Low Back Pain ; Pain, Intractable ; Pain, Postoperative ; Spinal Cord Stimulation ; Spinal Cord*

BACKGROUND: We investigated the effect of spinal cord stimulation on intractable chronic pain retrospectively and report our 5-year experience. METHODS: 49 patients with the medical history of trial spinal cord stimulation have been retrospectively analyzed. They consist of 34 men and 15 women, ranging in age from 22 to 89 years. Causes of intractable chronic pain included postherpetic neuralgia, failed back surgery syndrome, complex regional pain syndrome, chronic back and leg pain, cauda equina syndrome, perineal pain, diabetic polyneuropathy, and spinal cord injury. RESULTS: The pain due to failed back surgery syndrome, complex regional pain syndrome, chronic low back and leg pain, and spinal cord injury was well controlled by using spinal cord stimulation system. After a trial period of stimulation, 20 patients had permanent stimulators implanted. Most of them reported satisfactory pain relief for maximum 60 months and minimum 9 months. Noticeable complications included electrode displacement and hemorrhage. CONCLUSIONS: We may suggest that spinal cord stimulation is an effective and safe therapy for chronic intractable pain.
Chronic Pain* ; Diabetic Neuropathies ; Electrodes ; Failed Back Surgery Syndrome ; Female ; Hemorrhage ; Humans ; Leg ; Male ; Neuralgia, Postherpetic ; Pain, Intractable ; Polyradiculopathy ; Retrospective Studies ; Spinal Cord Injuries ; Spinal Cord Stimulation* ; Spinal Cord*

Spinal cord stimulation (SCS) was first attempted by Shearly et al for the relief of intractable pain. A spinal cord stimulator has traditionally been used for failed back surgery syndrome (FBSS) angina pectoris, complex regional pain syndrome (CRPS) and ischemic pain in the extremity. However, the complications associated with the use of a spinal cord stimulator, such as wound infection, hematoma, lead migration and device malfunction; make its long term application difficult. Here, our experience of an interesting case, in which intractable right leg pain was controlled using a spinal cord stimulator placed in the left epidural space, is reported, with a review of the literature.
Angina Pectoris ; Epidural Space* ; Extremities ; Failed Back Surgery Syndrome ; Hematoma ; Leg* ; Pain, Intractable ; Spinal Cord Stimulation ; Spinal Cord* ; Wound Infection