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Background: In daily practice, the intravenous lidocaine drip has been introduced as a predictive test for subsequent oral treatment with adjuvant drugs (anti-depressants, channel blockers and anti-convulsants). Our aim is the assessment of the correlation between the test response and the effectiveness of the consequent oral drug therapy., Methods: 183 inpatients (central and peripheral neuropathic pain), treated between 1996-1997, were retrospectively checked. The trial was conducted as follows: a VAS reading > 5 was taken; a subsequent continuous i.v. lidocaine drip was given, at a dose of 4 mg/kg, in saline solution; a VAS reading was taken before (VAS 0), every 5 minutes, and at the end of the drip (VAS 1); the results of the drip were to be considered positive where pain relief was > or = 50%; irrespective of test results, all patients were given a different follow-up drug therapy; a VAS reading was taken one month after the drug therapy (VAS 2)., Results: Eighty-five patients (90%), responders to lidocaine, had a pain relief and 71 patients (85%), no responders to lidocaine, did not have improvement by taking oral drugs., Conclusions: In agreement with a other authors, we also noted that there was a statistically significant correlation between the results obtained and the therapy prescribed; the usefulness of a lidocaine drip as routine procedure to predict the therapeutic response of neuropathic pain to adjuvant analgesics is underlined.

The authors review the cases of 81 patients complaining of pain due to lung cancer referred to a Pain Clinic. The cause and characteristics of pain together with treatments and results were assessed. The time elapsed from beginning of pain complaints to diagnosis, referral to the Pain Clinic and death was calculated. The data collected are discussed keeping in mind the aim of providing these patients a better quality of life.

Coeliac plexus neurolesion techniques for pain due to upper abdominal cancer (pancreas cancer above all), have changed during the years. In this paper we report the results of coeliac plexus alcohol neurolysis for cancer of pancreas and of other abdominal organs achieved with the different techniques. It appears that precrural techniques provide very favorable results but they require the use of CT scan. Retrocrural techniques, while giving good results, can be performed under fluoroscopic control.

The aim of this work was to evaluate--reviewing CT images--the spread of contrast medium injected following the different techniques of coeliac plexus block. We point out that the spread of c.m. is often difficult and not homogeneous at the level of coeliac plexus, due to tumoral masses invading this area.

Two cases of accidental subdural catheterisation, occurred in cancer patients during pain treatment, are presented and radiographically confirmed. The possible mechanisms that can cause such malposition, the X-ray picture and the effect of subdurally injected morphine are discussed.