Schulthess-Klinik, Zurich.
[Pain management from the viewpoint of the anesthetist]. [Review] [14 refs]
[German]
Schweizerische Rundschau fur Medizin Praxis. 87(7):232-7, 1998 Feb 11.
Abstract:
In a pain clinic team the anesthetist has the knowledge and experience concerning the peripheral and central neural blockades. The value of the diagnostic, prognostic and therapeutic blockades is today under discussion. Patients with a chronic regional pain syndrome (CRPS) can find some relief with a series of somatic and sympatholytic blockades, which allow an aggressive physiotherapy. Epidural steroid injections are helpful in radiculopathic pain. In other types of pain (neuropathic, postherpetic, failed back surgery syndrome, abdominal, cervico-cephalgic, phantom limb pain und tumor pain) the spinal cord stimulation (SCS) and the intrathecal morphine pump are approved methods for intactable pain.
[References: 14]
Service de Neuro-Chirurgie, Centre Hospitalier Regional et Universitaire A. Morvan, Brest.
[Treatment of chronic lumbago and radicular pain by spinal cord stimulation. Long-term results].
[Review] [18 refs] [French]
Revue du Rhumatisme. Edition Francaise. 61(4):271-7, 1994 Apr.
Abstract:
Seventy-seven patients with chronic, refractory, low back and radicular pain underwent implantation of a spinal cord stimulator between 1984 and 1992. Most patients had failed back surgery syndrome. In every case, an epidural quadripolar "Resume" electrode was implanted surgically. Results were evaluated after three months then after six to 98 months (mean follow-up 42 months). Long-term efficacy was good in 63.6% of cases, fair in 22%, and poor in 6.5%; treatment failure occurred in 7.9% of cases. Adverse events included one case of meningitis, two cases of local infection, and one case each of cerebrospinal fluidfistula and necrosis of the skin overlying the stimulator. The main causes of treatment failure were complications, inappropriate patient selection, and the escape phenomenon. The results of this study demonstrate that spinal cord stimulation is effective for the treatment of chronic low back and radicular pain in carefully selected patients; scrupulous application of restrictive selection criteria is essential to the success of the method.
[References: 18]
