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Archive for the ‘Pain Relief-Muscle Relaxers’ Category

MORPHINE: OTHER ROUTES OF ADMINISTRATION-DOSE AND INTRAVENTRICULAR MORPHINE

Friday, January 14th, 2011

The dose of morphine used for spinal therapy depends on the route of administration and the patient’s current opioid therapy. The dose is then adjusted according to effect and toxicity.
Spinal morphine is not without central side effects and respiratory depression, sedation, dysphoria, nausea and vomiting are all reported. However, the incidence is much less in cancer patients who have previously been receiving systemic morphine than in opioid naive patients. If severe, treatment is with small doses of naloxone. Occasionally, physical withdrawal symptoms occur if systemic opioid therapy is stopped after commencement of spinal therapy; in the absence of signs of respiratory depression, the previous systemic therapy should be weaned over several days.
Systemic side effects including urinary retention and constipation can occur but are less common and less severe in cancer patients who are not opioid naive.
High doses or high concentrations of spinal morphine may produce hyperaesthesia, dysaesthesia or myoclonus.
Tolerance will develop with continued spinal therapy, necessitating dose increments. There is no evidence that tolerance is particularly more or less likely to develop than with systemic therapy, and fear of tolerance is not a reason to withhold spinal therapy if it is indicated.
Intraventricular morphine-There are reports describing the administration of morphine into the cerebral ventricles of patients suffering uncontrolled pain related to advanced cancer. Whilst good pain relief is reported, the role of this therapy requires further evaluation and should be regarded as experimental at this time.
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SLEEP AND PAIN: EFFICACY OF MEDICATION

Tuesday, April 21st, 2009

Most people are surprised to find out that medications prescribed for sleep problems may not be very effective in the long term.

The old ‘classical’ sleeping pills, such as the barbiturates, have been proven to help only briefly. In regular use they actually impair sleep to the extent that after only 2 weeks of use sleep will be worse than it was before taking the medication.

Research done on the newer benzodiazepine group of sleeping pills such as Euhypnos, Normison, Mogadon, Dalmane and Ro-hypnol, and their close relatives Serepax, Valium and Xanax, indicates that they are useful for a longer period of time than the older drugs. However it is not known how much longer they will stay effective.

A major problem with all sleeping medication is that of ‘rebound’ insomnia. This means that when you stop taking the medication your sleep does not revert to the way it was. There is a rebound effect in which sleep may be very impaired due to the drug being stopped.

Most sedatives also suppress dreaming. Normally we dream about every 90 minutes of the night. This occurs whether you remember the dreams or not. When dreaming which occurs during so-called REM (rapid eye movement) sleep is suppressed by medications there is often a prolonged period of rebound dreaming in which the dreams often take the form of nightmares.

Because of these factors, drugs are not usually the best solution to the problem of insomnia. There are, however, a number of things which you can do to improve your sleep.

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SPECIFIC PAIN CONTROL TECHNIQUES: ‘GLOVE ANAESTHESIA’

Tuesday, April 21st, 2009

Pain may be controlled by suggesting an area of numbness produced by imagining a local anaesthetic has been administered. Another method previously mentioned is ‘glove anaesthesia’ which can be transferred to the pain area. For example, in dentistry, an anaesthetic gel can be used on a child’s finger. The child is then told that he or she has a ‘magic’ finger which can remove all the discomfort experienced during the procedure. The anaesthetic thus reinforces the therapist’s suggestions. This dissociation, or producing a feeling of separation from oneself, can be used to separate the pain from the person.

Dissociation can be achieved by imagining a pleasant scene. Perhaps a sunlit beach with warm, inviting sand or a cool green shady jungle scene where you can imagine shrinking small enough to fly away on the back of a butterfly! As you shrink, so does the pain.

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PAIN MANAGEMENT: NEUROSURGERY

Tuesday, April 21st, 2009

Neurosurgery has a definite but limited place in the treatment of non-malignant pain. The cutting of nerve pathways or the insertion of spinal cord stimulators are the province of this most specialised of surgical specialities.

The surgical interruption of nerve pathways in the body surgically should be the last treatment offered chronic pain patients.

The following are typical procedures performed by neurosurgeons attempting to obtain control of chronic or intractable pain.

• Sympathectomy involves the surgical excision of part of the sympathetic nervous system on either side of the vertebral column. A rhizotomy is the surgical division of a nerve root, usually the posterior (back) root of a spinal nerve.

• A percutaneous cordotomy is the severing of nerve tracts in the spinal cord through a small incision in the overlying skin of the spine.

• A thalamotomy is the surgical destruction of part of the thalamus, a collection of grey matter at the base of the cerebrum, the brain itself. (The thalamus is important in the pain story because sensory impulses from the entire body pass through it on the way to the cerebral cortex — the largest and uppermost part of the brain.) cerebral cortex-the largest and uppermost part of the brain.)

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MEDICATION IN USE OF PAIN TREATMENT: MAJOR TRANQUILLISERS

Tuesday, April 21st, 2009

‘Major’ tranquillisers are drugs more commonly used in the treatment of severe mental illness.

The best known are Largactil, Melleril and Stelazine. The major tranquillisers may be of value, particularly aiding the process of withdrawal from narcotic drugs and also for those where agitation is severe when associated with severe pain.

Such medications suffer from the fact that they occasionally cause a particularly unpleasant side-effect where the body develops uncontrollable muscular twitching — a condition known as tardive dyskinesia. This condition can be extremely troublesome and can prove very difficult to control. It sometimes develops after relatively short courses of the medication and in relatively small doses.

This therefore limits the use of such medications in the treatment of all but the severest forms of chronic pain.

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