Search results for " Intractable"
showing 9 items of 19 documents
Ineffectiveness of dextromethorphan in cancer pain
1998
Experimental studies have indicated that N-methyl-D-aspartate (NMDA) receptor antagonists may be effective analgesics in a wide variety of chronic pain states. The mechanism is presumed to be related to decreased firing of dorsal horn neurons after constant repeated C-fiber stimulation. Dextromethorphan (DM), a potent NMDA antagonist with a good safety profile, may be a promising agent for the treatment of persistent pain. An open-label randomized trial was designed to examine the effects of combining DM with NSAIDs, dextropropoxyphene, or morphine in cancer patients with pain. Patients who required a change in the step of the World Health Organization's (WHO) analgesic ladder because of a …
Opioid plasma concentration during switching from morphine to methadone: Preliminary data
2003
Opioid switching is often used to improve the opioid response in cancer patients experiencing poor analgesia or adverse effects. However, no data are available on plasmatic changes of opioids and their metabolites during these phases, and whether there exists a relationship with the clinical events. In a prospective study of 10 consecutive cancer patients on oral morphine but with uncontrolled pain (greater >4 on a numerical scale of 0 to 10) and/or moderate to severe opioid adverse effects (on a level of 2 and 3 of a verbal scale) and not responsive to adjuvant medications, switching to oral methadone was performed using a fixed ratio of 5:1, leaving extra-doses of 1/5 of the daily dose of…
Low doses of transdermal buprenorphine in opioid-naive patients with cancer pain: A 4-week, nonrandomized, open-label, uncontrolled observational stu…
2009
OBJECTIVE: The aim of this study was to evaluate the effect and tolerability of low doses of transdermal (TD) buprenorphine patches in opioid-naive patients with cancer pain. METHODS: This was a nonrandomized, open-label, uncontrolled study in consecutive opioid-naive patients with advanced cancer and moderate pain. TD buprenorphine was initiated at a dose of 17.5 microg/h (0.4 mg/d), with patch changes every 3 days. Doses were then adjusted according to the clinical response. Pain intensity, opioid-related adverse effects, TD buprenorphine doses, and quality of life were monitored over 4 weeks. The time to dose stabilization and indexes of dose escalation were also calculated. RESULTS: Thi…
Neuromodulation of the superior hypogastric plexus: a new option to treat bladder atonia secondary to radical pelvic surgery?
2009
Abstract Background The aim of this study is to report on the impact of neuromodulation to the superior hypogastric plexus in patients with bladder atonia secondary to pelvic surgery. Methods In 4 consecutive patients with bladder atonia secondary to pelvic surgery, we performed a laparoscopic implantation of a neurostimulator—LION procedure—to the entire superior hypogastric plexus. Results Of the 4 reported patients, 3 are able to partially void or empty their bladder. Conclusions If the presented results could be obtained in further patients and maintained in long-term follow-up, the LION procedure to the superior hypogastric plexus could change the management of bladder function in pati…
Switching from Transdermal Drugs: An Observational "N of 1" Study of Fentanyl and Buprenorphine
2007
The aim of this study was to confirm that the concomitant presence of transdermal fentanyl (TTS FE) and buprenorphine (TTS BU) may be feasible without important consequences, using doses presumed to be equianalgesic. A prospective "N of 1" study was carried out in a sample of volunteers with cancer pain receiving stable doses of TTS FE or TTS BU, with adequate pain and symptom control. In the study design, each patient provided data before and after a switch from one opioid to the other and then back to the previous one. Sixteen patients receiving daily stable doses of 0.6 or 1.2 mg of TTS FE were switched to TTS BU using an FE-BU ratio of 0.6-0.8. After three days, the TTS BU patch was rem…
Approximate Bayesian Computation for Forecasting in Hydrological models
2018
Approximate Bayesian Computation (ABC) is a statistical tool for handling parameter inference in a range of challenging statistical problems, mostly characterized by an intractable likelihood function. In this paper, we focus on the application of ABC to hydrological models, not as a tool for parametric inference, but as a mechanism for generating probabilistic forecasts. This mechanism is referred as Approximate Bayesian Forecasting (ABF). The abcd water balance model is applied to a case study on Aipe river basin in Columbia to demonstrate the applicability of ABF. The predictivity of the ABF is compared with the predictivity of the MCMC algorithm. The results show that the ABF method as …
Neuromodulation of chronic headaches: position statement from the European Headache Federation
2013
The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases.Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain stimulation, occipital nerve stimulation, stimulation of sphenopalatine ganglion, cervical spinal cord sti…
Neuronavigation and epilepsy surgery
2010
Resective epilepsy surgery is an elective therapy indicated in focal epilepsy patients who are resistant to pharmacotherapy. Every effort should be undertaken to perform the procedures as safe and less traumatic as possible. Neuronavigation could represent a suitable tool to reduce surgical morbidity and increase surgical radicality. Here, we present a series of 41 patients who were operated on for medically intractable epilepsy using neuronavigation. Overall, complication rate was 17% with a favourable seizure outcome of 88% (Engel’s class I/II). Our data suggest that neuronavigation is a valuable surgical technique to accomplish a favourable outcome in epilepsy surgery.
Breakthrough pain in cancer patients
2015
The aim of this article was to examine the definition, the characteristics, and the management of breakthrough cancer pain (BTP) in cancer patients by a critical review of recent literature.BTP should be more correctly defined as an episode of severe intensity in patients receiving an adequate treatment with opioids able to provide at least mild analgesia. BTP is a heterogeneous condition as episodes vary between individuals. BTP can be classified into two big distinct pictures: spontaneous-type and incident-type pain. The principal pharmacological treatment of BTP is represented by the administration of opioids as needed. Recent reviews revealed that transmucosal preparation of fentanyl pr…