Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0007859 (neck pain)
 3,931 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We investigated the response of chronic neck and shoulder pain to decompression of the carpal tunnel in 38 patients with whiplash injury. We also determined the plasma levels of substance P (SP) and calcitonin gene-related peptide (CGRP), which are inflammatory peptides that sensitise nociceptors. Compared with normal control subjects, the mean concentrations of SP (220 v 28 ng/l; p < 0.0001) and CGRP (400 v 85 ng/l; p < 0.0005) were high in patients with chronic shoulder and neck pain before surgery. After operation their levels fell to normal. There was resolution of neurological symptoms with improvement of pain in 90% of patients. Only two of the 30 with chronic neck and shoulder pain who had been treated conservatively showed improvement when followed up at two years. In spite of having neuropathic pain arising from the median nerve, all these patients had normal electromyographic and nerve-conduction studies. Chronic pain in whiplash injury may be caused by 'atypical' carpal tunnel syndrome and responds favourably to surgery which is indicated in patients with neck, shoulder and arm pain but not in those with mild symptoms in the hand. Previously, the presence of persistent neurological symptoms has been accepted as a sign of a poor outcome after a whiplash injury, but our study suggests that it may be possible to treat chronic pain by carpal tunnel decompression.
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PMID:Management of chronic pain in whiplash injury. 1293 21

Patients with cervical facet lesions and facet joint injury sometimes experience diffuse neck pain, headache, and arm and shoulder pain. However, the pathophysiology of the intensity and expansion of facet joint pain has not yet been investigated. Retrograde transport of fluoro-gold (F-G) and immunohistochemistry of calcitonin gene-related peptide (CGRP) was used in 20 rats (control group, n=10; injured group, n=10). For the injured group, the whole facet capsule was incised. Of the total F-G labelled dorsal root ganglion (DRG) neurons innervating the C5/6 facet joint, the number and the cross-sectional area of cell profiles of F-G labelled CGRP-ir neurons were evaluated in the bilateral DRGs of both groups. The numbers of CGRP-ir F-G labelled DRG neurons as a percentage of all F-G labelled DRG neurons at C3, C4, C5, C6, C7, C8, T1, T2, and T3 respectively were 30, 22, 43, 47, 21, 19, 25, 36 and 30% in the control group, and 13, 15, 23, 17, 15, 8, 16, 28 and 35% in the injured group, with the injured group showing a significantly lower percentage of CGRP-ir F-G labelled neurons than the control group at C5 and C6 (P<0.05). However, the mean cross-sectional area of F-G labelled CGRP-ir cells from C3 to C8 DRGs increased from 625+/-22 micro m(2) to 878+/-33 micro m(2) in the injured group (P<0.001). Associated with the injured facet joints, the phenotypic switch to large neurons may complicate the mechanism of injured facet pain.
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PMID:Calcitonin gene-related peptide immunoreactive DRG neurons innervating the cervical facet joints show phenotypic switch in cervical facet injury in rats. 1270 60

An 11-year-old girl presenting with neck pain was diagnosed as having an aneurysmal bone cyst involving the posterior arch of C1. Minimally invasive treatment was performed with percutaneous injections of calcitonin and methylprednisolone. Two injections separated in time by 2 months were performed with complete sclerosis and ossification of the cyst over a period of 6 months. Such percutaneous sclerosis offers an important primary therapeutic option or an adjunct to surgery of these otherwise vascular cystic masses and should be contemplated as the initial step in the treatment of these benign tumors, especially those in the spine where surgical treatment can involve complex resection and fixation procedures.
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PMID:Percutaneous treatment of pediatric aneurysmal bone cyst at C1: a minimally invasive alternative: a case report. 1566 94

Myofascial pain associated with myofascial trigger points (MTrPs) is a common cause of nonarticular musculoskeletal pain. Although the presence of MTrPs can be determined by soft tissue palpation, little is known about the mechanisms and biochemical milieu associated with persistent muscle pain. A microanalytical system was developed to measure the in vivo biochemical milieu of muscle in near real time at the subnanogram level of concentration. The system includes a microdialysis needle capable of continuously collecting extremely small samples (approximately 0.5 microl) of physiological saline after exposure to the internal tissue milieu across a 105-microm-thick semi-permeable membrane. This membrane is positioned 200 microm from the tip of the needle and permits solutes of <75 kDa to diffuse across it. Three subjects were selected from each of three groups (total 9 subjects): normal (no neck pain, no MTrP); latent (no neck pain, MTrP present); active (neck pain, MTrP present). The microdialysis needle was inserted in a standardized location in the upper trapezius muscle. Due to the extremely small sample size collected by the microdialysis system, an established microanalytical laboratory, employing immunoaffinity capillary electrophoresis and capillary electrochromatography, performed analysis of selected analytes. Concentrations of protons, bradykinin, calcitonin gene-related peptide, substance P, tumor necrosis factor-alpha, interleukin-1beta, serotonin, and norepinephrine were found to be significantly higher in the active group than either of the other two groups (P < 0.01). pH was significantly lower in the active group than the other two groups (P < 0.03). In conclusion, the described microanalytical technique enables continuous sampling of extremely small quantities of substances directly from soft tissue, with minimal system perturbation and without harmful effects on subjects. The measured levels of analytes can be used to distinguish clinically distinct groups.
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PMID:An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. 1603 3

Facet joints are implicated as a major source of neck and low-back pain. Both cervical and lumbar facet syndromes have been described in the medical literature. Biomechanical studies have shown that lumbar and cervical facet-joint capsules can undergo high strains during spine-loading. Neuroanatomic studies have demonstrated free and encapsulated nerve endings in facet joints as well as nerves containing substance P and calcitonin gene-related peptide. Neurophysiologic studies have shown that facet-joint capsules contain low-threshold mechanoreceptors, mechanically sensitive nociceptors, and silent nociceptors. Inflammation leads to decreased thresholds of nerve endings in facet capsules as well as elevated baseline discharge rates. Recent biomechanical studies suggest that rear-end motor-vehicle impacts give rise to excessive deformation of the capsules of lower cervical facet joints. Still unresolved is whether this stretch is sufficient to activate nociceptors in the joint capsule. To answer this question, recent studies indicate that low stretch levels activate proprioceptors in the facet-joint capsule. Excessive capsule stretch activates nociceptors, leads to prolonged neural afterdischarges, and can cause damage to the capsule and to axons in the capsule. In instances in which a whiplash event is severe enough to injure the joint capsule, facet capsule overstretch is a possible cause of persistent neck pain.
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PMID:Pain generation in lumbar and cervical facet joints. 1659 46

An aneurysmal bone cyst (ABC) is a rare skeletal tumor that accounts for approximately 1% of all bone tumors. A spinal location for an ABC is very rare. Methods for treatment of an ABC include resection, curettage, embolization, and intralesional injection of a variety of agents. The patient in this case was a 9-year-old girl presenting with neck pain who was diagnosed with an ABC involving the C-2 spinal level. Percutaneous intralesional injections of calcitonin and methylprednisolone were performed. Two years and 7 months after the initial injection, a CT scan showed massive bone formation and cortical thickening without a change in the size of the lesion. To the authors' knowledge, this is the third reported case of intralesional injection of calcitonin and methylprednisolone for treatment of an ABC. This method is safe and effective, and is an important alternative to surgery, especially when a surgical procedure is technically difficult or unsafe in high-risk patients.
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PMID:Percutaneous intralesional injection of calcitonin and methylprednisolone for treatment of an aneurysmal bone cyst at C-2. 1897 9

Mesenchymal origin of primary thyroid angiosarcomas (TAS) is extremely rare and comprises less than 1% of primary thyroid cancer worldwide. While TAS are most commonly occurring in the Alpine region, there are multiple reported cases of TAS in non-Alpine regions. Diagnosis of TAS is commonly made after thyroidectomy as cytologic diagnosis can be challenging due to paucity of cells, presence of necrosis and unawareness of the disease due to rarity. We report a case of primary TAS diagnosed by cytology in a 56-year-old man who presented with a sudden onset of left neck pain, swelling and haemoptysis. He was later noted to have suspicious nodules on both lobes of thyroid on ultrasound. Fine needle aspiration of thyroid nodules showed malignant epithelioid cells. The diagnosis of TAS was made based on positive endothelial markers such as thrombomodulin and CD31, with many pertinent negatives, including negative cytokeratins,thyroid transcription factor (TTF1), thyroglobulin, calcitonin and carcinoembryonic antigen (CEA).
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PMID:Primary angiosarcoma of thyroid. 3124 93

Unremitting head and neck pain (UHNP) is a commonly encountered phenomenon in Headache Medicine and may be seen in the setting of many well-defined headache types. The prevalence of UHNP is not clear, and establishing the presence of UHNP may require careful questioning at repeated patient visits. The cause of UHNP in some patients may be compression of the lesser and greater occipital nerves by the posterior cervical muscles and their fascial attachments at the occipital ridge with subsequent local perineural inflammation. The resulting pain is typically in the sub-occipital and occipital location, and, via anatomic connections between extracranial and intracranial nerves, may radiate frontally to trigeminal-innervated areas of the head. Migraine-like features of photophobia and nausea may occur with frontal radiation. Occipital allodynia is common, as is spasm of the cervical muscles. Patients with UHNP may comprise a subgroup of Chronic Migraine, as well as of Chronic Tension-Type Headache, New Daily Persistent Headache and Cervicogenic Headache. Centrally acting membrane-stabilizing agents, which are often ineffective for CM, are similarly generally ineffective for UHNP. Extracranially-directed treatments such as occipital nerve blocks, cervical trigger point injections, botulinum toxin and monoclonal antibodies directed at calcitonin gene related peptide, which act primarily in the periphery, may provide more substantial relief for UHNP; additionally, decompression of the occipital nerves from muscular and fascial compression is effective for some patients, and may result in enduring pain relief. Further study is needed to determine the prevalence of UHNP, and to understand the role of occipital nerve compression in UHNP and of occipital nerve decompression surgery in chronic head and neck pain.
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PMID:Emerging evidence of occipital nerve compression in unremitting head and neck pain. 3126 56

Mixed medullary and follicular cell-derived thyroid carcinoma (MMFTC) is a rare primary thyroid carcinoma with morphologic and immunophenotypic evidence of admixed parafollicular and follicular cell-derived tumor populations within the same tumor. We herein present the fine-needle aspiration biopsy (FNAB) cytology of a case of MMFTC that was diagnosed histologically and discuss potential clues to the diagnosis for cytologists. We also provide a literature review of this uncommon primary thyroid tumor. The patient was a 47-year-old man with a history of hypothyroidism who presented with ear and neck pain. Imaging demonstrated thyroid nodules with regional lymphadenopathy. FNAB samples of two thyroid nodules and an involved lymph node were diagnosed as papillary thyroid carcinoma (PTC). The subsequent total thyroidectomy specimen demonstrated classic-type PTC which transitioned to a morphologically and immunophenotypically distinct medullary thyroid carcinoma (MTC) component within the same lesion, indicative of MMFTC. The patient experienced recurrence of the medullary component 20 months later and received chemotherapy with subsequent external beam radiation. As in this case, the cytologic diagnosis of MMFTC is almost never made prospectively. Retrospective review of the preoperative FNAB samples showed subtle cytomorphologic features suggestive of MTC in two of three biopsies, an impression confirmed by calcitonin immunohistochemistry on cell block material. In the broader literature, most MMFTCs on FNAB have been diagnosed as MTC, which is usually the more aggressive component of the mixed neoplasm.
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PMID:Cytologic features of a case of mixed medullary and follicular cell-derived thyroid carcinoma with review of the literature. 3293 34