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Neurosurgical treatment of chronic migrainous neuralgia
S294
TIME-EFFECT RELATIONSHIP AFTER A SINGLE DOSE OF 1000 MG OF EFFERVERSCENT ASPIRIN OR PLACEBO IN POSTOPERATIVE ORO-FACIAL PAIN. 1Ekblom.A.,1~2Hansson,P.,3Thomsson,M.,4Gustavsson,G. ‘Departments of Physiology II, Karolinska Institute, *Neurology, Karolinska Hospital, 30ral Surgery, Sijder Hospital, Stockholm, and 4Pharmacia LEO Therapeutics AB, Helsingborg, Sweden.
r---
Poster 19 GREY Th-Fri Hali Exhibit Abs No
559
_ll_l_~-_
AIM OF INVESTIGATION: The time-effect relationship concerning the analgesic effect of a single dose of efferverscent ASA and placebo was studied in detail using a newly developed computerized datalogger. The effect was correlated to the patients personality characteristics. METHODS: 40 patients, mean age 26 years, scheduled for operative removal of impacted mandibular third molar teeth were included. Following surgery when a stable pain intensity level was reached 20 patients received 1000 mg ASA (ASAG) while 20 patients received placebo (PC). Pain intensity was rated every minute for 120 min following drug intake using a seven graded scale (O-6). Assessment of state anxiety, neuroticism, extroversion, depression, and general health was made preoperatively. RESULTS: ASA vs placebo: The ASAG showed a noticeable pain reduction after I5 min which reached significance at 20 min in comparison to the PG in which no significant pain reduction was found. 14 patients in the ASAG but only 1 in the PG reported total pain re4ief. a significant difference. ResDonders vs non-responders: 19/20 in the ASAG and 5/20 in the PG were characterized as responders (>I step decrease on O-6 scale). The total pain reduction (area under the curve) was not significantly different in ASAG vs PG responders! Nonresponders anticipated the operation to be significantly more painful and reached a constant pain intensity level significantly faster than responders. None of the assessed personality characteristics differed betweeen the groups. CONCLUSION: 1000 mg ASA in efferverscent tablets has a fast onset and good effect with total pain relief in 70% of the patients. Only a small placebo effect could be recorded. The differences between responders and non-responders could not be explained with the used personality characteristics.
NEUROSURGICAL TREATMENT OF CHRONIC MIGRAINOUS NEURALGIA. W.H.Sweet,lJ.R.Graham,Land C.E. Poletti,llNeurosurgical Service, Massachusetts General Hospital, Boston, MA 02115 and 2Headache Research Foundation, Faulkner Hospital, Jamaica Plain, MA 02130
Poster 20 GREY Th-Fri Exhibit Hall
Abs No 560 This is a report of 48 patients treated since 1968 most of whom had proven intractability to the sustained medical treatment of J.R.Graham. Since many of these patients have neural impulses for their pains conducted over lower intracranial sensory nerves - i.e. n. intermedius and possible IX and upper X, whereas in most, only trigeminal pathways are implicated, it is important to determine objectively which nerves are involved since the clinical picture in the 2 groups is essentially the same. Moreover, it is also important to determine if the numbness accompanying the state of analgesia without anesthesia produced by focal radiofrequency heating will be acceptable. These patients are more likely to find such numbness intolerable than those with trigeminal neuralgia. Instillation of one or a few drops of 1% lidocaine into the trigeminal cistern is likely to bring on analgesia only, so this enables one to see if the analgesia will stop a provoked attack of pain and be replaced by acceptable numbness. This tactic carried out in the last 40 of the 48 patients yielded acceptability in 21, unacceptability in 13; 2 patients were uncertain and in 4 the provoked attack of pain was not stopped precluding assessment of the less disagreeable numbness. In the 23 in whom an attack could be provoked, lidocaine analgesia gave relief in 18, but failed in 5; in 14 no attack was provoked. Relief was uncertain in 3. Following radiofrequency lesions , pain continued unabated in the analgesic area in 6, was poorly relieved in 2 and finally good to excellent in 15 - of whom 4 required 1 or 2 repeated procedures. The results of the 13 petrosal neurectomies, 3 sections of n. intermedius and 4 sections of the bulbar descending cephalic tract will also be analyzed.
TIME-EFFECT RELATIONSHIP AFTER A SINGLE DOSE OF 1000 MG OF EFFERVERSCENT ASPIRIN OR PLACEBO IN POSTOPERATIVE ORO-FACIAL PAIN. 1Ekblom.A.,1~2Hansson,P.,3Thomsson,M.,4Gustavsson,G. ‘Departments of Physiology II, Karolinska Institute, *Neurology, Karolinska Hospital, 30ral Surgery, Sijder Hospital, Stockholm, and 4Pharmacia LEO Therapeutics AB, Helsingborg, Sweden.
r---
Poster 19 GREY Th-Fri Hali Exhibit Abs No
559
_ll_l_~-_
AIM OF INVESTIGATION: The time-effect relationship concerning the analgesic effect of a single dose of efferverscent ASA and placebo was studied in detail using a newly developed computerized datalogger. The effect was correlated to the patients personality characteristics. METHODS: 40 patients, mean age 26 years, scheduled for operative removal of impacted mandibular third molar teeth were included. Following surgery when a stable pain intensity level was reached 20 patients received 1000 mg ASA (ASAG) while 20 patients received placebo (PC). Pain intensity was rated every minute for 120 min following drug intake using a seven graded scale (O-6). Assessment of state anxiety, neuroticism, extroversion, depression, and general health was made preoperatively. RESULTS: ASA vs placebo: The ASAG showed a noticeable pain reduction after I5 min which reached significance at 20 min in comparison to the PG in which no significant pain reduction was found. 14 patients in the ASAG but only 1 in the PG reported total pain re4ief. a significant difference. ResDonders vs non-responders: 19/20 in the ASAG and 5/20 in the PG were characterized as responders (>I step decrease on O-6 scale). The total pain reduction (area under the curve) was not significantly different in ASAG vs PG responders! Nonresponders anticipated the operation to be significantly more painful and reached a constant pain intensity level significantly faster than responders. None of the assessed personality characteristics differed betweeen the groups. CONCLUSION: 1000 mg ASA in efferverscent tablets has a fast onset and good effect with total pain relief in 70% of the patients. Only a small placebo effect could be recorded. The differences between responders and non-responders could not be explained with the used personality characteristics.
NEUROSURGICAL TREATMENT OF CHRONIC MIGRAINOUS NEURALGIA. W.H.Sweet,lJ.R.Graham,Land C.E. Poletti,llNeurosurgical Service, Massachusetts General Hospital, Boston, MA 02115 and 2Headache Research Foundation, Faulkner Hospital, Jamaica Plain, MA 02130
Poster 20 GREY Th-Fri Exhibit Hall
Abs No 560 This is a report of 48 patients treated since 1968 most of whom had proven intractability to the sustained medical treatment of J.R.Graham. Since many of these patients have neural impulses for their pains conducted over lower intracranial sensory nerves - i.e. n. intermedius and possible IX and upper X, whereas in most, only trigeminal pathways are implicated, it is important to determine objectively which nerves are involved since the clinical picture in the 2 groups is essentially the same. Moreover, it is also important to determine if the numbness accompanying the state of analgesia without anesthesia produced by focal radiofrequency heating will be acceptable. These patients are more likely to find such numbness intolerable than those with trigeminal neuralgia. Instillation of one or a few drops of 1% lidocaine into the trigeminal cistern is likely to bring on analgesia only, so this enables one to see if the analgesia will stop a provoked attack of pain and be replaced by acceptable numbness. This tactic carried out in the last 40 of the 48 patients yielded acceptability in 21, unacceptability in 13; 2 patients were uncertain and in 4 the provoked attack of pain was not stopped precluding assessment of the less disagreeable numbness. In the 23 in whom an attack could be provoked, lidocaine analgesia gave relief in 18, but failed in 5; in 14 no attack was provoked. Relief was uncertain in 3. Following radiofrequency lesions , pain continued unabated in the analgesic area in 6, was poorly relieved in 2 and finally good to excellent in 15 - of whom 4 required 1 or 2 repeated procedures. The results of the 13 petrosal neurectomies, 3 sections of n. intermedius and 4 sections of the bulbar descending cephalic tract will also be analyzed.