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1

Viswanathan, Ashwin, and Kim J. Burchiel. "Introduction: Intractable pain." Neurosurgical Focus 35, no. 3 (September 2013): Introduction. http://dx.doi.org/10.3171/2013.7.focus13277.

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2

Supler, Mitchell L., and William A. Friedman. "Intractable Cancer Pain." Contemporary Neurosurgery 15, no. 25 (1993): 1–6. http://dx.doi.org/10.1097/00029679-199302000-00001.

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3

Supler, Mitchell L., and William A. Friedman. "Intractable Cancer Pain." Contemporary Neurosurgery 15, no. 25 (1993): 1–6. http://dx.doi.org/10.1097/00029679-199315250-00001.

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4

Abbott, Paul, Bruce Rounsefell, Robert Fraser, and Alastair Goss. "Intractable Neck Pain." Clinical Journal of Pain 6, no. 1 (March 1990): 26–31. http://dx.doi.org/10.1097/00002508-199003000-00005.

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5

Green, Alexander L., and Tipu Z. Aziz. "Neuromodulation for Intractable Pain." Brain Sciences 10, no. 5 (April 30, 2020): 267. http://dx.doi.org/10.3390/brainsci10050267.

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6

Bourne, I. H. J. "Intractable Functional Abdominal Pain." Journal of the Royal Society of Medicine 80, no. 12 (December 1987): 785. http://dx.doi.org/10.1177/014107688708001231.

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7

Thomson, W. H. F., and S. ST Carter. "Intractable Functional Abdominal Pain." Journal of the Royal Society of Medicine 81, no. 2 (February 1988): 124. http://dx.doi.org/10.1177/014107688808100234.

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8

Frost, Elizabeth A. M. "Relief of Intractable Pain." Journal of Neurosurgical Anesthesiology 3, no. 1 (March 1991): 82. http://dx.doi.org/10.1097/00008506-199103000-00018.

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9

Mercadante, Sebastiano. "Intractable pain and cordotomy." BMJ Supportive & Palliative Care 10, no. 3 (May 20, 2020): 339. http://dx.doi.org/10.1136/bmjspcare-2020-002360.

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10

&NA;. "Options for Intractable Pain." Back Letter 19, no. 3 (March 2004): 25. http://dx.doi.org/10.1097/00130561-200403000-00002.

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11

Kato, Jitsu. "Pharmacotherapy for Intractable Pain." Journal of Nihon University Medical Association 69, no. 3 (2010): 170–75. http://dx.doi.org/10.4264/numa.69.170.

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12

Sloan, Paul A. "Neuraxial pain relief for intractable cancer pain." Current Pain and Headache Reports 11, no. 4 (August 2007): 283–89. http://dx.doi.org/10.1007/s11916-007-0205-5.

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13

Deer, Timothy, Sameer Jain, Corey Hunter, and Krishnan Chakravarthy. "Neurostimulation for Intractable Chronic Pain." Brain Sciences 9, no. 2 (January 24, 2019): 23. http://dx.doi.org/10.3390/brainsci9020023.

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The field of neuromodulation has seen unprecedented growth over the course of the last decade with novel waveforms, hardware advancements, and novel chronic pain indications. We present here an updated review on spinal cord stimulation, dorsal root ganglion stimulation, and peripheral nerve stimulation. We focus on mechanisms of action, clinical indications, and future areas of research. We also present current drawbacks with current stimulation technology and suggest areas of future advancements. Given the current shortage of viable treatment options using a pharmacological based approach and conservative interventional therapies, neuromodulation presents an interesting area of growth and development for the interventional pain field and provides current and future practitioners a fresh outlook with regards to its place in the chronic pain treatment paradigm.
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14

Raffa, Robert B., and Joseph V. Pergolizzi Jr. "Intracerebroventricular opioids for intractable pain." British Journal of Clinical Pharmacology 74, no. 1 (June 11, 2012): 34–41. http://dx.doi.org/10.1111/j.1365-2125.2012.04201.x.

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15

Jeon, Jae Kyu, Jung Kil Chung, and Sang Bum Chung. "A Treatment for Intractable Pain." Korean Journal of Anesthesiology 18, no. 3 (1985): 269. http://dx.doi.org/10.4097/kjae.1985.18.3.269.

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16

&NA;. "Managing Intractable Pain with Methadone." Nursing 15, no. 5 (May 1985): 32–43. http://dx.doi.org/10.1097/00152193-198505000-00006.

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17

Osta, Badi El, Ahmed Elsayem, Sriram Yennurajalingam, and Eduardo Bruera. "Intractable Pain: Intoxication or Undermedication?" Journal of Palliative Medicine 10, no. 3 (June 2007): 811–14. http://dx.doi.org/10.1089/jpm.2007.9947.

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18

WATSON, P. N., and R. J. EVANS. "Intractable Pain with Lung Cancer." Survey of Anesthesiology 31, no. 6 (December 1987): 349. http://dx.doi.org/10.1097/00132586-198712000-00027.

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19

Nicolaidis, Stylianos. "Neurosurgical treatments of intractable pain." Metabolism 59 (October 2010): S27—S31. http://dx.doi.org/10.1016/j.metabol.2010.07.018.

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20

Collins, John J. "Intractable Cancer Pain in Children." Child and Adolescent Psychiatric Clinics of North America 6, no. 4 (October 1997): 879–88. http://dx.doi.org/10.1016/s1056-4993(18)30283-9.

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21

Clarke, I. M. C. "Pain measurement—An intractable problem." Journal of Pain and Symptom Management 1, no. 3 (1986): 171–72. http://dx.doi.org/10.1016/s0885-3924(86)80071-9.

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22

Gilliland, Robert, Steve J. Heymen, Donato F. Altomare, Dawn Vickers, and Steven D. Wexner. "Biofeedback for intractable rectal pain." Diseases of the Colon & Rectum 40, no. 2 (February 1997): 190–96. http://dx.doi.org/10.1007/bf02054987.

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23

Lota, Amrit S., and Simon W. Dubrey. "Intractable pain from trigeminal neuralgia." British Journal of Hospital Medicine 73, no. 4 (April 2012): 230–31. http://dx.doi.org/10.12968/hmed.2012.73.4.230.

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24

Agarwal, Nitin, Phillip A. Choi, Samuel S. Shin, David R. Hansberry, and Antonios Mammis. "Anterior cingulotomy for intractable pain." Interdisciplinary Neurosurgery 6 (December 2016): 80–83. http://dx.doi.org/10.1016/j.inat.2016.10.005.

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25

Watson, Peter N., and Ramon J. Evans. "Intractable pain with lung cancer." Pain 29, no. 2 (May 1987): 163–73. http://dx.doi.org/10.1016/0304-3959(87)91033-5.

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26

Gunn, Chan C., and A. E. Sola. "Chronic intractable benign pain (CIBP)." Pain 39, no. 3 (December 1989): 364–65. http://dx.doi.org/10.1016/0304-3959(89)90052-3.

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27

Fitzgerald, Conall, Orla Mc Cormack, and John V. Reynolds. "Severe Intractable Postprandial Chest Pain." JAMA 310, no. 4 (July 24, 2013): 424. http://dx.doi.org/10.1001/jama.2013.8567.

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28

Tsuda, Makoto, Simon Beggs, Michael W. Salter, and Kazuhide Inoue. "Microglia and intractable chronic pain." Glia 61, no. 1 (June 27, 2012): 55–61. http://dx.doi.org/10.1002/glia.22379.

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29

Watts, P. G. "Intractable Trigeminal Neuralgia." Journal of the Royal Society of Medicine 80, no. 9 (September 1987): 561–62. http://dx.doi.org/10.1177/014107688708000909.

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In 49 cases of trigeminal neuralgia seen at the Abingdon Pain Relief Unit, Oxfordshire, the average time between initial onset of pain and first referral to the unit was 9.8 years. The pattern of presentation and distribution was no different from previously published studies, indicating that the more intractable cases cannot be predicted at first presentation.
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30

Malhotra, Vivek Tim, James Root, Joseph Kesselbrenner, Innocent Njoku, Kenneth Cubert, Amitabh Gulati, Vinay Puttanniah, Mark Bilsky, and Michael Kaplitt. "Intrathecal Pain Pump Infusions for Intractable Cancer Pain." Anesthesia & Analgesia 116, no. 6 (June 2013): 1364–70. http://dx.doi.org/10.1213/ane.0b013e31828d670e.

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31

Seamans, David P., Gilbert Y. Wong, and Jack L. Wilson. "Interventional Pain Therapy for Intractable Abdominal Cancer Pain." Journal of Clinical Oncology 18, no. 7 (April 7, 2000): 1598–600. http://dx.doi.org/10.1200/jco.2000.18.7.1598.

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32

Seamans, D. P. "Interventional Pain Therapy for Intractable Abdominal Cancer Pain." Journal of Clinical Oncology 21, no. 90090 (May 1, 2003): 92s—94. http://dx.doi.org/10.1200/jco.2003.01.184.

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33

Kato, Jitsu, Setsuro Ogawa, Mariko Tamura, Miho Kashiwazaki, Takashi Nakamura, and Shigeru Saeki. "Pharmacological Tests in 100 Patients with Intractable Pain." PAIN RESEARCH 14, no. 2 (1999): 89–95. http://dx.doi.org/10.11154/pain.14.89.

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34

Penn, Richard D., and Judith A. Paice. "Chronic intrathecal morphine for intractable pain." Journal of Neurosurgery 67, no. 2 (August 1987): 182–86. http://dx.doi.org/10.3171/jns.1987.67.2.0182.

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✓ Forty-three patients with intractable pain received intrathecal morphine delivered by implanted continuous-infusion (Infusaid) or programmable (Medtronic) devices. In 35 patients the pain was due to cancer, and eight patients had chronic nonmalignant pain. The origin of the nonmalignant pain included lumbar arachnoiditis, multiple sclerosis, severe osteoporosis resulting in a thoracic compression fracture, and intractable pain as a consequence of cancer therapy in individuals cured of their disease. Twenty-eight (80%) of the patients with cancer-related pain experienced excellent or good relief. Side effects were rare. Tolerance occurred infrequently and could be managed effectively. The results of this study support earlier studies on the application of chronic intrathecal morphine for intractable cancer pain. These findings also indicate that, in carefully selected patients, nonmalignant pain may be managed satisfactorily with this technique.
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35

Thomas, D. G. T. "Surgical management of benign intractable pain." International Disability Studies 9, no. 1 (January 1987): 27–30. http://dx.doi.org/10.3109/02599148709166227.

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36

IGARASHI, Takashi, Kunihiko MURAI, Koichi MOGI, Nobuhiro SHIMADA, Kenji TAMAI, and Mamoru TAKEUCHI. "Epiduroscopy for Intractable Low Back Pain." JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA 32, no. 2 (2012): 271–76. http://dx.doi.org/10.2199/jjsca.32.271.

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37

Eastman, Peggy. "Controlling Intractable Pain Resistant to Opiates." Oncology Times 34, no. 13 (July 2012): 31. http://dx.doi.org/10.1097/01.cot.0000416577.87137.82.

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38

&NA;. "Why Intractable Pain Outlives the Injury." Lippincott's Bone and Joint Newsletter 9, no. 5 (May 2003): 58. http://dx.doi.org/10.1097/01300517-200305000-00008.

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39

Loyd, Ryan D., Perry A. Ball, and Gilbert J. Fanciullo. "Surgical procedures for intractable cancer pain." Techniques in Regional Anesthesia and Pain Management 9, no. 3 (July 2005): 167–76. http://dx.doi.org/10.1053/j.trap.2005.06.010.

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40

May, A., MA Gamulescu, U. Bogdahn, and CP Lohmann. "Intractable Eye Pain: Indication for Triptans." Cephalalgia 22, no. 3 (April 2002): 195–96. http://dx.doi.org/10.1046/j.1468-2982.2002.00342.x.

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Management of pain is difficult in many eye diseases. Particularly in patients undergoing surgical procedures, postoperative intractable pain is a major concern and severely influences the patient's comfort. We present 13 patients (eight male, five female, mean age 36 years) in whom sumatriptan, a highly selective 5-HT1B/1D agonist that is normally used as a specific anti-migraine drug, was used for the treatment of pain following photorefractive keratectomy (PRK). In two patients both eyes were operated on different days, resulting in a total of 15 operated eyes. A positive clinical response was achieved in all patients. In particular, in four patients, who received a second dose prophylactically 4 h following the first dose and before the recurrence of pain, we achieved excellent efficacy and stable control of pain. Further controlled studies are needed to investigate the usefulness of 5-HT1B/1D agonists in painful eye conditions.
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41

Vrba, I. "S708 INTRACTABLE NEUROPATHIC PAIN AND PNS." European Journal of Pain Supplements 5, S1 (September 2011): 288. http://dx.doi.org/10.1016/s1754-3207(11)70992-0.

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42

Osenbach, Richard K., Randall Brewer, and Emily Davis. "Motor Cortex Stimulation for Intractable Pain." Techniques in Neurosurgery 8, no. 3 (September 2003): 144–56. http://dx.doi.org/10.1097/00127927-200308030-00003.

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43

Macnicol, MF. "Patellar osteotomy for intractable patellar pain." Knee 1, no. 1 (March 1994): 41–45. http://dx.doi.org/10.1016/0968-0160(94)90007-8.

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44

Hirata, Yoshifumi, Shinichi Gotoh, Masaji Murakami, and Naoko Kunitoku. "Spinal Cord Stimulation for Intractable Pain." Japanese Journal of Rehabilitation Medicine 53, no. 8 (2016): 620–25. http://dx.doi.org/10.2490/jjrmc.53.620.

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45

Elisevich, Kost. "Spinal Cord Stimulation for Intractable Pain." Contemporary Neurosurgery 14, no. 16 (1992): 1. http://dx.doi.org/10.1097/00029679-199214160-00001.

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46

Agari, Takashi, and Isao Date. "Spinal Cord Stimulation for Intractable Pain." Japanese Journal of Neurosurgery 28, no. 6 (2019): 334–41. http://dx.doi.org/10.7887/jcns.28.334.

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47

Goss, A. N. "Cryoneurotomy for intractable temporomandibular joint pain." British Journal of Oral and Maxillofacial Surgery 26, no. 1 (February 1988): 26–31. http://dx.doi.org/10.1016/0266-4356(88)90146-5.

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48

Staquet, Hélène. "Intracerebroventricular Pain Treatment with Analgesic Mixtures including Ziconotide for Intractable Pain." July 2016 6;19, no. 6;7 (July 14, 2016): E905—E915. http://dx.doi.org/10.36076/ppj/2016.19.e905.

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Intracerebroventricular (ICV) administration of opioids for control of intractable cancer pain has been used since 1982. We present here our experience of intracerebroventricular administration of pain treatments including ziconotide associated with morphine and ropivacaine for patients resistant to a conventional approach, with nociceptive, neuropathic, or mixed pain. These clinical cases were conducted with patients suffering from refractory pain, more than 6/10 on a numerical pain rating scale (NPRS) while on high-dose medical treatment and/ or intolerance with significant side effects from oral medication. The baseline study visit included a physical examination and an assessment of pain intensity on a NPRS. Under general anesthesia, a neuronavigation device was used to place the catheter on the floor of the third ventricle, supported by an endoscope. Then, drugs were injected in the cerebroventricular system, through a pump (external or subcutaneous). The primary objective was to measure pain evaluation with ICV treatment after a complete withdrawal of other medications. Four patients were enrolled: 3 with intractable cancer pain and one with central neuropathic pain. The median NPRS at baseline was 9.5 [8.5; 19]. The mean NPRS after one month was 3.5 [3; 4.5]. Ziconotide was initiated at 0.48 µg/dy and up to a median of 1.2 µg/dy [1.0; 1.56]. The median dose of morphine and ropivacaine used initially was respectively 0.36 mg/dy [0.24; 0.66] up to 0.6 mg/dy [0.45; 4.63] and 1.2 mg/dy [0; 2.4] up to 2.23 mg/dy [1.2; 3.35]. Minor side effects were initially observed but transiently. One psychiatric agitation required discontinuation of ziconotide infusion. For intractable pain, using ziconotide by intracerebroventricular infusion seems safe and efficient, specifically for chronic neoplastic pain of cervicocephalic, thoracic, or diffuse origin and also for pain arising from a central neuropathic mechanism. Key words: Intracerebroventricular infusion, ziconotide, intractable pain, nociceptive and neuropathic pain
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49

Shati, Mariam Faruqui, Nasreen Begum, and Nasim Jahan. "A case of intractable Dysmenorrhoea." Northern International Medical College Journal 5, no. 2 (April 29, 2015): 351–52. http://dx.doi.org/10.3329/nimcj.v5i2.23136.

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Dysmenorrhea (dysmenorrhoea or painful periods) is a medical condition of pain during menstruation that interferes with daily activities, defined by ACOG (American Congress of Obstetricians and Gynecologists). Still, dysmenorrhea is often defined simply as menstrual pain or at least menstrual pain that is excessive. A 19yr old girl presented frequent dysmenorrhoea which was increasing in intensity and finally a lump was palpable on the left lower abdomen. She was treated surgically. A big mass size of a cricket ball was removed by laparotomy and patient was relieved from intractable dysmenorrhoea.Northern International Medical College Journal Vol.5(2) 2014: 351-352
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50

Strasser, Florian, Paul Walker, and Eduardo Bruera. "Palliative Pain Management: When Both Pain and Suffering Hurt." Journal of Palliative Care 21, no. 2 (June 2005): 69–79. http://dx.doi.org/10.1177/082585970502100202.

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Patients with advanced cancer frequently experience intractable pain without sufficient response to a conventional pharmacological approach. One reason for refractory pain at the end of life can be the bidirectional nature of pain and suffering. Three terminally ill patients were assessed using a multidimensional palliative pain concept, including sensory, affective, cognitive, and existential components. In these patients, resistant pain did not equal insufficient eradication of the nociceptive input, but also suffering. Unrelieved emotions, depressive or anxious symptoms, delirium, difficulties communicating, or chemical coping influenced the expression of pain, illuminating the phenomenon of somatization. Palliative pain treatment integrated analgesic treatments, psychological, rehabilitative, and existential interventions, in consideration of individual expectations and outcomes. With the disciplined assessment and alternative multidisciplinary palliative approach, the quality of life of three terminally ill cancer patients with intractable pain could be enhanced, and unnecessary interventions and escalation of medications avoided.
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