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Postsympathectomy neuralgia. Amelioration with diphenylhydantoin and carbamazepine
88 One chapter describes the vegetative nervous system and its role in pain. Chapters 5 and 6 deal with biochemical processes of the organism causing the sense of pain. Basing on his own persistent studies the author concludes that there are no special mediators of pain, but that pain can be caused by various biologically active substances (catecholamines, acetylcholine, histamine, serotonin) which are formed in normal and pathological states. The next chapters present current theories of complex pain sense, peculiarities of pain perception and methods of experimental study of pain. Medical aspects of pain are given in chapters 10 and 11. Great attention in chapter 12-13 is given to the stress conception and to the original theory of the phase development of the adaptation syndrome, formulated by the author. Psychological and emotional problems of pain are dealt with in chapter 14. The book is completed with a large section dealing with anesthesia. Along with pharmacologic methods of pain reduction and removal, the author devotes a special chapter to the needle therapy of pain senses.
SURGERY Bilateral thoracic sympathectomy-splanchnectomy tractable pain due to pancreatic carcinoma E.S. Sader and A.M. Cooperman,
in the treatment of in-
Cleveland Clin. Quart., 41 (1974) 185-188
Fifty-six patients with intractable abdominal or back pain or both due to pancreatic carcinoma underwent bilateral sympathectomy and splanchnectomy. Forty patients were males and 16 females. Almost all patients underwent exploratory laparotomy with associated biliary or gastric decompression or both when indicated, followed by bilateral splanchnectomy at the same time. In the follow-up study, 70% of these patients had good or complete relief of pain. Twenty-three per cent of those with good or complete relief experienced some recurrence or increase in pain, but this was usually in the long-term survivors (average 11 months) and was not usually severe. Overall operative mortality in this series was 7% (4 patients). But except for one death due to extrapleural empyema, the remaining three patients were debilitated and cathectic.
Postsympathectomy carbamazepine
neuralgia. Amelioration with diphenylhydantoin
and
N.H. Raskin, S.A. Levinson, P.M. Hoffman, J.B.E. Pickett and H.L. Fields, Amer. J. Surg., 128 (1974) 75-78 Postsympathectomy neuralgia was observed in 35% of the patients who underwent lumbar sympathectomies. It began abruptly on average 12 days
89
after operation and was often accentuated nocturnally. The pain was almost always described as a deep, dull ache in the localized portion of the thigh or hip and persisted 2-3 weeks before spontaneously remitting. In the few cases of such severe pain that parenteral narcotics afforded no relief, treatment with carbamazepine or diphenylhydantoin produced dramatic relief of pain within 24 h after the institution of therapy. Some possible mechanisms of the syndrome and of the action of these drugs are suggested.
Management R.D. Patman, 780-787
of post-traumatic J.E.
Thompson
pain syndromes:
report
and A.V. Persson,
of 113 cases
Ann. Surg., 177 (1973)
The purpose of this report, based upon the authors’ clinical experience with 113 patients, is to emphasize this very important entity in an effort to facilitate early diagnosis and outline a program of management. Therefore, a new classification with a new term, “mimo-causalgia”, has been introduced in an effort to standardize the nomenclature related to post-traumatic pain syndromes. It is an important entity and should be well known to most disciplines of medicine. Our concern is the early recognition of patients whose complaints have a real organic basis but whose physical signs are not of sufficient degree to make this fact apparent. These patients are often misunderstood and discredited. They are all too often mismanaged or neglected for sufficiently long periods as to permit the underlying pathologic physiology to secure supremacy over normal function.
NEUROSURGERY Threshold for pain from anterolateral quadrant stimulation success of percutaneous cordotomy for relief of pain D.J. Mayer, D.D. Price, (1975) 445-447
D.P. Becker
and H.F.
Young,
as a predictor
J. Neurosurg.,
of
43
Stimulation of the anterolateral quadrant of the cervical spinal cord at the C,-, level was done in 13 patients during percutaneous RF cordotomy. A 0.5 mm stainless steel wire insulated to within 2 mm of the tip was used as the cathode to deliver 1 set duration trains, 0.2 msec duration 50/set monophasic stimuli. A series of trains of stimuli starting at 50 PA intensity, with each of the trams increased by 50 PA until a report of pain was referred to the contralateral side of the body, was given and a 5 set RF 50 mA lesion was made. In 7 patients with pain threshold below 300 PA the RF lesion
SURGERY Bilateral thoracic sympathectomy-splanchnectomy tractable pain due to pancreatic carcinoma E.S. Sader and A.M. Cooperman,
in the treatment of in-
Cleveland Clin. Quart., 41 (1974) 185-188
Fifty-six patients with intractable abdominal or back pain or both due to pancreatic carcinoma underwent bilateral sympathectomy and splanchnectomy. Forty patients were males and 16 females. Almost all patients underwent exploratory laparotomy with associated biliary or gastric decompression or both when indicated, followed by bilateral splanchnectomy at the same time. In the follow-up study, 70% of these patients had good or complete relief of pain. Twenty-three per cent of those with good or complete relief experienced some recurrence or increase in pain, but this was usually in the long-term survivors (average 11 months) and was not usually severe. Overall operative mortality in this series was 7% (4 patients). But except for one death due to extrapleural empyema, the remaining three patients were debilitated and cathectic.
Postsympathectomy carbamazepine
neuralgia. Amelioration with diphenylhydantoin
and
N.H. Raskin, S.A. Levinson, P.M. Hoffman, J.B.E. Pickett and H.L. Fields, Amer. J. Surg., 128 (1974) 75-78 Postsympathectomy neuralgia was observed in 35% of the patients who underwent lumbar sympathectomies. It began abruptly on average 12 days
89
after operation and was often accentuated nocturnally. The pain was almost always described as a deep, dull ache in the localized portion of the thigh or hip and persisted 2-3 weeks before spontaneously remitting. In the few cases of such severe pain that parenteral narcotics afforded no relief, treatment with carbamazepine or diphenylhydantoin produced dramatic relief of pain within 24 h after the institution of therapy. Some possible mechanisms of the syndrome and of the action of these drugs are suggested.
Management R.D. Patman, 780-787
of post-traumatic J.E.
Thompson
pain syndromes:
report
and A.V. Persson,
of 113 cases
Ann. Surg., 177 (1973)
The purpose of this report, based upon the authors’ clinical experience with 113 patients, is to emphasize this very important entity in an effort to facilitate early diagnosis and outline a program of management. Therefore, a new classification with a new term, “mimo-causalgia”, has been introduced in an effort to standardize the nomenclature related to post-traumatic pain syndromes. It is an important entity and should be well known to most disciplines of medicine. Our concern is the early recognition of patients whose complaints have a real organic basis but whose physical signs are not of sufficient degree to make this fact apparent. These patients are often misunderstood and discredited. They are all too often mismanaged or neglected for sufficiently long periods as to permit the underlying pathologic physiology to secure supremacy over normal function.
NEUROSURGERY Threshold for pain from anterolateral quadrant stimulation success of percutaneous cordotomy for relief of pain D.J. Mayer, D.D. Price, (1975) 445-447
D.P. Becker
and H.F.
Young,
as a predictor
J. Neurosurg.,
of
43
Stimulation of the anterolateral quadrant of the cervical spinal cord at the C,-, level was done in 13 patients during percutaneous RF cordotomy. A 0.5 mm stainless steel wire insulated to within 2 mm of the tip was used as the cathode to deliver 1 set duration trains, 0.2 msec duration 50/set monophasic stimuli. A series of trains of stimuli starting at 50 PA intensity, with each of the trams increased by 50 PA until a report of pain was referred to the contralateral side of the body, was given and a 5 set RF 50 mA lesion was made. In 7 patients with pain threshold below 300 PA the RF lesion