The successful management of 5 consecutive patients with intractable phantom limb pain is describ... more The successful management of 5 consecutive patients with intractable phantom limb pain is described. The main therapy is a combination of a narcotic and antidepressant. Medication remained effective during the average observation time of 22 months. There were no signs of habituation or addiction. We conclude that narcotics can be safely and successfully utilized for long-term management of phantom limb pain.
Recent studies have shown that depression can be assessed in patients who have chronic pain. This... more Recent studies have shown that depression can be assessed in patients who have chronic pain. This study shows that various subtypes of depression can be differentiated in such patients using a standardized diagnostic schema for psychiatric disorders and a self-rating instrument for assessing the level of psychologic distress. In addition, when examining the onset of pain and subtypes of depression, there was no correlation between the onset of major depression and pain, whereas there was a strong positive correlation between the onset of chronic depression and pain. The recognition of the subtypes of depression has clinical implications in the management of the patient with chronic pain and depression.
CHRONIC LOW BACK PAIN. "1.". Urbanl, R.D. FranceL, F.JO Keefe2, Departments of Anesthes... more CHRONIC LOW BACK PAIN. "1.". Urbanl, R.D. FranceL, F.JO Keefe2, Departments of Anesthesiology and 2Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA Aim of Investigation: Comprehensive analysis of efficacy ofintensive multidisciplinary treatment condensed into a 2-3 week hospital stay. Methods: Fifteen patients with chronic low back/leg pain presenting to the Duke Pain Clinic were selected for the study. Inclusion criteria were: 1) disabling pain of longer than 6 months duration which was not responsive to standard medical treatment; 2) one or more operations for pain; 3) evidence of organic pathology related to pain; 4) absence of litigation; and 5) absence of personality disorders, Treatment for all patients was standardized and consisted of: 1) admission for 3 weeks to a pain unit, 2) Standardization of medications, 3) transcutaneous nerve stimulation, 4) a series of epidural steroid blocks (up to 3), 5) cognitive behavioral therapy, 6) EMG-assisted relaxation training, and 7) physical therapy. Comprehensive clinical, psychological and behavioral evaluations were performed before and after treatment. In selected patients, spinal fluid samples were also analyzed for neuropeptides and neurotransmitters. Results: Results indicate significant decrease in sensory and affective dimensions of pain (McGill Pain Questionaire, p < 0.03) and decrease in overall psychological distress (SCL-90-R, p < 0.05). Activity level was markedly increased with patients spending a significantly (p < 0.01) greater time walking and standing at discharge. Overt pain behaviors was reduced by more than 50% (p < 0.01) inspite of narcotic medications simultaneously being decreased to near zero level. Conclusions: A combined multidisciplinary pain treatment program is effectlve 1nXlie treatment of chronic low back pain patients. The clinical significance of CSF analysis for neuropeptides and neurotransmitters will be discussed. -
An association between chronic pain and depression has been recognized for a long time. However, ... more An association between chronic pain and depression has been recognized for a long time. However, the exact nature of this relationship remains unclear. The authors studied 71 patients for affective disorders and schizophrenia-lifetime version (SADS-L). Based on the interviews, we were able to identify 31 patients with major depression, 8 patients with minor depression and 18 with intermittent depressive disorder as defined by Research Diagnostic Criteria. Item analysis using the Hamilton Depression Rating Scale and the Montgomery-Asberg Depression Rating Scale showed that the items did not discriminate in patients with major depression the presence of organic findings. However, most of the items significantly discriminated between the various types of depression and patients without depression. The occurrence of clearly defined depression points to several avenues of research aimed at clarifying the incidence etiology and treatment of depression in these patients.
✓ Percutaneous epidural stimulation of the spinal cord was carried out in 20 patients with intrac... more ✓ Percutaneous epidural stimulation of the spinal cord was carried out in 20 patients with intractable pain. The procedure proved simple, and no major complications were encountered. The long-term results were comparable to the results obtained after a dorsal column stimulator implant by laminectomy. The percutaneous technique allowed extended trial stimulation without committing the patient to a major operation. Those patients in whom stimulation did not alleviate pain could be identified during a 2-week observation period, and the system could be removed easily. Seven patients were placed on chronic autostimulation and only one of those failed to experience continuing pain relief throughout the follow-up time of up to 2 years. It is concluded that percutaneous epidural stimulation constitutes a valid alternative to dorsal column stimulator implantation.
... Auteur(s) / Author(s). FRANCE RD (1) ; URBAN B. ; RANGA RAMA KRISHNAN K. ; BISSETT G. ; BANKI... more ... Auteur(s) / Author(s). FRANCE RD (1) ; URBAN B. ; RANGA RAMA KRISHNAN K. ; BISSETT G. ; BANKI CM ; NEMEROFF C. ; SPEILMAN FJ ; Affiliation(s) du ou des auteurs / Author(s) Affiliation(s). (1) Duke univ. medical cent., dep. psychiatry, Durham NC 27710, ETATS-UNIS ...
Promethazine (0.5 mg. per kg.) , propiomazine (0.2 mg. per kg.), and chlorpromazine (0.15 mg. per... more Promethazine (0.5 mg. per kg.) , propiomazine (0.2 mg. per kg.), and chlorpromazine (0.15 mg. per kg.) were administered intravenously separately and in cornbination with meperidine (0.5 mg. per kg.) . Meperidine was also given alone at the same dose level. Thus each volunteer received seven drugs or combinations thereof. RESULTS AND DISCUSSION None of the three phenothiazines tested caused respiratory depression when administered alone (tables 1, 2, and 3). Meperidine produced a consistent respiratory depression for up to 2 hours (p<0.025). Neither chlorpromazine nor promethazine in combination with meperidine resulted in statistically significant respiratory depression.
The successful management of 5 consecutive patients with intractable phantom limb pain is describ... more The successful management of 5 consecutive patients with intractable phantom limb pain is described. The main therapy is a combination of a narcotic and antidepressant. Medication remained effective during the average observation time of 22 months. There were no signs of habituation or addiction. We conclude that narcotics can be safely and successfully utilized for long-term management of phantom limb pain.
Recent studies have shown that depression can be assessed in patients who have chronic pain. This... more Recent studies have shown that depression can be assessed in patients who have chronic pain. This study shows that various subtypes of depression can be differentiated in such patients using a standardized diagnostic schema for psychiatric disorders and a self-rating instrument for assessing the level of psychologic distress. In addition, when examining the onset of pain and subtypes of depression, there was no correlation between the onset of major depression and pain, whereas there was a strong positive correlation between the onset of chronic depression and pain. The recognition of the subtypes of depression has clinical implications in the management of the patient with chronic pain and depression.
CHRONIC LOW BACK PAIN. "1.". Urbanl, R.D. FranceL, F.JO Keefe2, Departments of Anesthes... more CHRONIC LOW BACK PAIN. "1.". Urbanl, R.D. FranceL, F.JO Keefe2, Departments of Anesthesiology and 2Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA Aim of Investigation: Comprehensive analysis of efficacy ofintensive multidisciplinary treatment condensed into a 2-3 week hospital stay. Methods: Fifteen patients with chronic low back/leg pain presenting to the Duke Pain Clinic were selected for the study. Inclusion criteria were: 1) disabling pain of longer than 6 months duration which was not responsive to standard medical treatment; 2) one or more operations for pain; 3) evidence of organic pathology related to pain; 4) absence of litigation; and 5) absence of personality disorders, Treatment for all patients was standardized and consisted of: 1) admission for 3 weeks to a pain unit, 2) Standardization of medications, 3) transcutaneous nerve stimulation, 4) a series of epidural steroid blocks (up to 3), 5) cognitive behavioral therapy, 6) EMG-assisted relaxation training, and 7) physical therapy. Comprehensive clinical, psychological and behavioral evaluations were performed before and after treatment. In selected patients, spinal fluid samples were also analyzed for neuropeptides and neurotransmitters. Results: Results indicate significant decrease in sensory and affective dimensions of pain (McGill Pain Questionaire, p < 0.03) and decrease in overall psychological distress (SCL-90-R, p < 0.05). Activity level was markedly increased with patients spending a significantly (p < 0.01) greater time walking and standing at discharge. Overt pain behaviors was reduced by more than 50% (p < 0.01) inspite of narcotic medications simultaneously being decreased to near zero level. Conclusions: A combined multidisciplinary pain treatment program is effectlve 1nXlie treatment of chronic low back pain patients. The clinical significance of CSF analysis for neuropeptides and neurotransmitters will be discussed. -
An association between chronic pain and depression has been recognized for a long time. However, ... more An association between chronic pain and depression has been recognized for a long time. However, the exact nature of this relationship remains unclear. The authors studied 71 patients for affective disorders and schizophrenia-lifetime version (SADS-L). Based on the interviews, we were able to identify 31 patients with major depression, 8 patients with minor depression and 18 with intermittent depressive disorder as defined by Research Diagnostic Criteria. Item analysis using the Hamilton Depression Rating Scale and the Montgomery-Asberg Depression Rating Scale showed that the items did not discriminate in patients with major depression the presence of organic findings. However, most of the items significantly discriminated between the various types of depression and patients without depression. The occurrence of clearly defined depression points to several avenues of research aimed at clarifying the incidence etiology and treatment of depression in these patients.
✓ Percutaneous epidural stimulation of the spinal cord was carried out in 20 patients with intrac... more ✓ Percutaneous epidural stimulation of the spinal cord was carried out in 20 patients with intractable pain. The procedure proved simple, and no major complications were encountered. The long-term results were comparable to the results obtained after a dorsal column stimulator implant by laminectomy. The percutaneous technique allowed extended trial stimulation without committing the patient to a major operation. Those patients in whom stimulation did not alleviate pain could be identified during a 2-week observation period, and the system could be removed easily. Seven patients were placed on chronic autostimulation and only one of those failed to experience continuing pain relief throughout the follow-up time of up to 2 years. It is concluded that percutaneous epidural stimulation constitutes a valid alternative to dorsal column stimulator implantation.
... Auteur(s) / Author(s). FRANCE RD (1) ; URBAN B. ; RANGA RAMA KRISHNAN K. ; BISSETT G. ; BANKI... more ... Auteur(s) / Author(s). FRANCE RD (1) ; URBAN B. ; RANGA RAMA KRISHNAN K. ; BISSETT G. ; BANKI CM ; NEMEROFF C. ; SPEILMAN FJ ; Affiliation(s) du ou des auteurs / Author(s) Affiliation(s). (1) Duke univ. medical cent., dep. psychiatry, Durham NC 27710, ETATS-UNIS ...
Promethazine (0.5 mg. per kg.) , propiomazine (0.2 mg. per kg.), and chlorpromazine (0.15 mg. per... more Promethazine (0.5 mg. per kg.) , propiomazine (0.2 mg. per kg.), and chlorpromazine (0.15 mg. per kg.) were administered intravenously separately and in cornbination with meperidine (0.5 mg. per kg.) . Meperidine was also given alone at the same dose level. Thus each volunteer received seven drugs or combinations thereof. RESULTS AND DISCUSSION None of the three phenothiazines tested caused respiratory depression when administered alone (tables 1, 2, and 3). Meperidine produced a consistent respiratory depression for up to 2 hours (p<0.025). Neither chlorpromazine nor promethazine in combination with meperidine resulted in statistically significant respiratory depression.
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