Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The postcholecystectomy syndrome in its chronic form is characterized by severe episodes of upper abdominal pain that may or may not be accompanied by hepatic or pancreatic dysfunction or ductal dilation. Endoscopic retrograde cholangiopancreatography is the most definitive way to identify anatomic defects. Transendoscopic papillary manometry is a promising new diagnostic technique. A surgical approach should be used only after persistence of symptoms without apparent cause and a prolonged trial of medical therapy. The operation should include exploration of the contents of the peritoneal cavity and transduodenal examination of the papilla of Vater. An extended papilloplasty should be performed to include a 1- to 2-cm anterior sphincteroplasty and an excision of the transampullary septum. Approximately 75 percent of patients with chronic pain after cholecystectomy will gain long-term relief of their symptoms.
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PMID:Postcholecystectomy syndromes. 354 8

Seven chronic pain patients (six with abdominal pain and one with headache pain) were detoxified from analgesic medications, taught relaxation techniques, and given an average of 3 supportive therapy sessions. The effects of these procedures at posttreatment and at 6 months follow-up were analyzed by means of self-report diaries of pain, mood, activity and medication usage. There was a significant reduction in pain from posthospital in 5 of 7 patients and a significant reduction in pain at 6-month follow-up for all patients. There was a significant reduction in medication use for all subjects. Mood ratings tended to improve when pain was reduced, and some patients reported increased activity levels. Detoxification combined with relaxation and supportive therapy appears to produce significant relief from pain for these 7 patients.
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PMID:The effects of detoxification, relaxation, and brief supportive therapy on chronic pain. 610 38

This article focuses on the basic premises underlying the behavioral assessment and treatment of chronic pain, particularly as they apply to the less distinct pain disorders of childhood, such as obscure headache and abdominal pain. Pain behavior management procedures, relaxation techniques, and biofeedback training are discussed in detail in reviewing recent research developments in this area.
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PMID:Behavioral approaches to the management of chronic pain in children. 638 2

Our objective was to identify and quantify sources of variation in the relief of chronic pain with morphine. Relief scores were extracted from records obtained during controlled trials of analgesics in cancer patients with chronic pain in which intramuscular morphine was the assay standard. Relief data from 715 patients after 565 8-mg and 538 16-mg doses were segregated according to age, race, sex, pre-drug pain intensity, character and site. Middle-aged patients obtained relief after 8 mg comparable to relief obtained by younger patients after 16 mg; oldest patients obtained relief after 8 mg comparable to relief obtained by middle-aged patients after 16 mg. Blacks receiving 8 mg obtained relief comparable to whites receiving 16 mg. Sex-related differences were not significant. Patients with moderate, as compared to severe, pre-drug pain obtained significantly greater relief only after 16 mg. Patients reporting dull pain obtained relief after 8 mg comparable to relief obtained with sharp pain after 16 mg. Patients with abdominal pain obtained relief after 8 mg comparable to relief of pain in the chest or arms after 16 mg. These results provide dose-related evidence of variation in relief with morphine in chronic cancer pain and establish particular patient and pain characteristics as variables for which controls should be provided in analgesic assays.
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PMID:Sources of variation in analgesic responses in cancer patients with chronic pain receiving morphine. 684 27

Pancreas divisum has been claimed to be a harmless congenital variant or to occasionally cause acute relapsing pancreatitis (ARP), chronic pancreatitis (CP), or a chronic abdominal pain (CAP) syndrome. Both surgical and endoscopic approaches to accessory papilla decompression have been promulgated and widely disparate results reported in the literature. We retrospectively reviewed a five-year experience with dorsal pancreatic duct decompression at our institution utilizing a variety of endotherapeutic techniques. Data collected included procedural complications; patient interpretation of pre- and posttherapy pain, frequency, and intensity graded on an analog pain scale; frequency of hospitalization; and patient perception of "global" improvement to endotherapy. At a mean follow-up of 20 months, there was a statistically significant decrease in pancreatitis incidence in 15 patients with ARP (P = 0.016) and 19 patients with CP (P = 0.025). The frequency and intensity of chronic pain was also significantly improved (P < 0.001) in the latter group. In contrast, only one of five patients with CAP and normal dorsal pancreatography and secretin tests experienced global improvement, and there was no improvement utilizing an analog pain scale (P = 0.262) in the group as a whole. There was a 20% incidence of mild procedure or subsequent stent-related pancreatitis and an 11.5% accessory papilla restenosis rate. It is concluded that a subset of carefully selected patients with pancreas divisum may respond to endotherapy but that long-term follow-up will be required to define its ultimate place in the management of symptomatic patients with this anomaly.
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PMID:Endoscopic approach to pancreas divisum. 755 52

A 47-year-old woman suffering from chronic abdominal pain developed erythema ab igne (reticular hyperpigmentation of the skin caused by exposure to heat). Histological examination revealed premalignant changes in two specimens of affected skin. The incidence of erythema ab igne is declining since fewer people use open fires for heating. Nowadays it is found mostly in patients suffering from chronic pain using hot water bottles, infrared lamps or heating pads. The disease is an important clinical indication for underlying chronic diseases. The affected skin runs a higher risk of development of actinic keratoses. Bowen's disease and squamous cell carcinomas. Dysplastic features of keratinocytes can be found histologically in lesions which are clinically not under suspicion.
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PMID:[Erythema ab igne]. 784

The role of alcohol in causing chronic pancreatitis is well-known, but the role of abstinence remains controversial and not well-understood. In this article, I examine the literature dealing with the effect of abstinence on chronic pain and the long-term outcome of chronic pancreatitis. A series of 50 patients with alcoholic chronic pancreatitis from my practice supplements the data. Alcohol consumption > 70 g/day for 7 or more years is characteristic. Moderate to severe abdominal pain is the dominant symptom. When patients stop drinking, abdominal pain disappears in the majority, pancreatic function deteriorates more slowly, the death rate diminishes, and a normal life is often possible. If abdominal pain continues after abstinence and the pancreatic duct remains dilated, a lateral pancreatojejunostomy helps most patients. In many patients not suitable for surgery, pain resolves with time.
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PMID:Abstinence in alcoholic chronic pancreatitis. Effect on pain and outcome. 788 76

Diagnostic laparoscopy is rapidly becoming a procedure used by general surgeons in increasing numbers. Its use will follow the therapeutic procedures now being used by many fellow surgeons. As the procedure is generally performed under local anesthesia, new techniques must be learned. The indications include abdominal pain (acute and chronic), focal liver disease, ascites, preoperative evaluation of malignant disease, and second-look evaluations after medical therapy for malignant disease. The overall diagnostic rate is 99% for acute abdominal pain, 70% for chronic pain syndromes, 95% for focal liver disease, 95% for abdominal masses, 97% for ascites, and greater than 80% for retroperitoneal disease. Diagnostic laparoscopy should be used with increasing frequency when a tissue diagnosis is needed.
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PMID:Diagnostic laparoscopy. 826 33

This report examined first onset rates of 5 common pain symptoms and assessed, on a prospective basis, whether depressive symptoms at baseline were associated with onset risks. Adult Health Maintenance Organization (HMO) enrollees (n = 1016) were interviewed in 1986 about their history of each of 5 pain conditions (back pain, severe headache, chest pain, abdominal pain and temporomandibular disorder (TMD) pain). Three years later, this sample was re-interviewed (n = 803) to measure site-specific first onset rates. The Symptom Checklist 90-Revised (SCL-90-R) Depression scale was administered at baseline and at 3 year follow-up. Over the three year follow-up interval, rates of first onset were: 17.7% for back pain; 4.2% for severe headache; 3.0% for chest pain; 3.1% for abdominal pain; and 6.5% for TMD pain. Onset rates of persistent pain and of chronic pain dysfunction were substantially lower, but over 1% experienced onset of chronic pain dysfunction for back pain and for headache. There were not significant differences in onset rates of back pain, abdominal pain or TMD pain by severity or chronicity of depressive symptoms. Relative to the non-depressed, persons with moderate-to-severe depressive symptoms were more likely to develop headache and chest pain (adjusted odds ratios of 1.7 to 5.0). For headache and chest pain, onset risks were highest among the chronically depressed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:First onset of common pain symptoms: a prospective study of depression as a risk factor. 830 12

Chronic intestinal pseudo-obstruction is a clinical diagnosis based on signs and symptoms of bowel obstruction in the absence of a physical obstruction demonstrable by X-ray or surgery. The phenotype may be caused by gastrointestinal motor, sensory, or psychological disturbances, or even by Munchausen's syndrome-by-proxy. Interactions between these pathophysiologic mechanisms may result in changes in the clinical presentation during development, including an increase in the number of affected children complaining of chronic abdominal pain. Chronic pain or the fear of pain may cause children to limit their voluntary oral intake, necessitating tube or parenteral supplements. A multidisciplinary team approach which includes input from the pediatric gastroenterologist, pain management specialist, and psychologist is most likely to effect positive change. In considering a diagnosis of chronic intestinal pseudo-obstruction, the clinician is obligated to evaluate gastrointestinal motility and sensory function, as well as the behavior of the child and family. This review aims to provide a biopsychosocial conceptual framework for understanding the heterogeneous group of gastrointestinal neuromuscular conditions that are diagnosed as chronic intestinal pseudo-obstruction. It will also provide a review and critique of the utility of new diagnostic methods, including antroduodenal and colonic manometry, and new therapeutic options, including the prokinetic agents such as cisapride which increase motility, and intestinal transplantation.
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PMID:Chronic intestinal pseudo-obstruction in childhood: progress in diagnosis and treatment. 857 42


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