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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chronic pain plagues older adults more than any other age group; thus, practitioners must be able to approach this problem with confidence and skill. This article reviews the assessment and treatment of the most common chronic nonmalignant pain conditions that affect older adults--myofascial pain, generalized osteoarthritis, chronic low back pain (CLBP), fibromyalgia syndrome, and peripheral neuropathy. Specific topics include essential components of the physical examination; how and when to use basic and advanced imaging in older adults with CLBP; a stepped care approach to treating older adults with generalized osteoarthritis and CLBP, including noninvasive and invasive management techniques; how to diagnose and treat myofascial pain; strategies to identify the older adult with fibromyalgia syndrome and avoid unnecessary "diagnostic" testing; pharmacological treatment for the older adult with peripheral neuropathy; identification and treatment of other factors such as dementia and depression that may significantly influence response to pain treatment; and when to refer the patient to a pain specialist. While common, chronic pain is not a normal part of aging, and it should be treated with an emphasis on improved physical function and quality of life.
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PMID:Office management of chronic pain in the elderly. 1739 21

The occurrence of diabetic peripheral neuropathy (DPN) is linked to poor glycemic control over time. While most people never develop diabetic peripheral neuropathic pain (DPNP) as a consequence of DPN, enough of them do that we must have effective options for the management of this disabling condition. Two years ago there were no formally approved medications for the treatment of DPNP, and now there are two medications with Food and Drug Administration approval for DPNP. One of these medications, duloxetine has been established to significantly improve pain and to address depression by its reuptake inhibition of norepinephrine and serotonin. This article examines the epidemiology of DPNP, its underlying pathogenesis, necessary evaluation methods, and treatment options available with a focus on the role of duloxetine.
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PMID:Diabetic peripheral neuropathic pain: recognition and management. 1771 13

Humoral immune mechanisms may have a role in the neurological complications of celiac disease (CD). We assessed 71 CD patients for neurologic manifestations and presence of serum antibodies to neural antigens. Sixteen patients (22.5%) were found to have neurological deficits including headache, depression, entrapment syndromes, peripheral neuropathy, and epilepsy. Antibody reactivity to neural antigens was detected in 30/71 (42.2%) patients. There was no clear correlation between anti-neural reactivity and neurologic dysfunction. Follow-up of 62 patients did not reveal change in electrophysiology or antibodies, regardless of diet. However, in 2 patients with neuropathy, symptoms improved or worsened depending on the diet.
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PMID:Neurological complications of celiac disease and autoimmune mechanisms: a prospective study. 1834 8

MtDNA instability is associated with a wide spectrum of clinical presentations, from dominant or recessive progressive external ophthalmoplegia (PEO) to juvenile-onset spino-cerebellar ataxia and epilepsy (SCAE) or infantile Alpers-Huttenlocher syndrome. We present here the clinical and molecular features of a patient with a clinical presentation characterized initially by PEO with mtDNA multiple deletions lately evolving into a severe neurological syndrome, which included sensory and cerebellar ataxia, peripheral neuropathy, parkinsonism, and depression. This complex phenotype is the result of mutations in two distinct proteins, ANT1 and PolgammaA, which cause additive, deleterious effects on mtDNA maintenance and integrity.
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PMID:Additive effects of POLG1 and ANT1 mutations in a complex encephalomyopathy. 1850 26

Fragile X-associated tremor/ataxia syndrome (FXTAS) is a progressive neurological disorder that affects older adult carriers, predominantly males, of premutation alleles (55 to 200 CGG repeats) of the fragile X (FMR1) gene. Principal features of FXTAS are intention tremor, ataxia, parkinsonism, cognitive decline, and peripheral neuropathy; ancillary features include, autonomic dysfunction, and psychiatric symptoms of anxiety, depression, and disinhibition. Although controlled trials have not been carried out in individuals with FXTAS, there is a significant amount of anecdotal information regarding various treatment modalities. Moreover, there exists a great deal of evidence regarding the efficacy of various medications for treatment of other disorders (eg, Alzheimer disease) that have substantial phenotypic overlap with FXTAS. The current review summarizes what is currently known regarding the symptomatic treatment, or potential for treatment, of FXTAS.
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PMID:Treatment of fragile X-associated tremor ataxia syndrome (FXTAS) and related neurological problems. 1868 48

The burden of painful diabetic peripheral neuropathy (DPN) is a common complication of diabetes. This study expanded on the human burden of painful DPN by quantifying functional and health status impairments among international patients from a randomized, double-blind, placebo-controlled trial of painful DPN. Evaluated outcomes measures included: Brief Pain Inventory-Short Form (mBPI-sf), EuroQOL 5D, Hospital Anxiety and Depression Scale, and Medical Outcomes Study Sleep Scale. Outcomes were stratified by pain severity using cut-points: 0 to 10 numeric rating scale (NRS) for average pain (0 to 3: none/mild, 4 to 6: moderate, 7 to 10: severe). Study sample is: 401 patients (163 in Asia, 110 in Latin America and 128 in the Middle East), mostly female (61%) (+/- standard deviation, SD), age of 57 +/- 10 years. Participants reported at least moderate levels of pain severity (mean [+/- SD] scores on a 0 to 10 NRS for average pain of 5.9 +/- 1.8 for Asia, 6.7 +/- 1.6 for Latin America, and 6.6 +/- 1.7 for the Middle East). Mean (+/- SD) values on the mBPI-sf Pain Interference Index were 4.7 +/- 2.3 for Asia, 5.6 +/- 2.1 for Latin America, and 5.5 +/- 2.3 for the Middle East. Patients in all 3 regions reported difficulties with functioning, sleep, and overall health status, which increased with higher pain severity levels. Patients in Asia had substantial impairments; however, they reported less serious problems than the other regions. These data are consistent with painful DPN being a burdensome condition worldwide: people with poorly managed neuropathic pain report a substantial burden of disease.
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PMID:Cross-national burden of painful diabetic peripheral neuropathy in Asia, Latin America, and the Middle East. 1901 46

Most patients with hepatic porphyria exhibit neuropsychiatric symptoms, including abdominal pain, peripheral neuropathy, confusion, insomnia and mental disturbances such as anxiety and depression. Although heme deficiency and accumulation of heme precursors are thought to be responsible for neuropsychiatric manifestations in patients with acute porphyria, the pathogenetic mechanisms remain poorly understood. In the present study, we observed psychiatric behaviors in mice with hepatic porphyria induced by the ingestion of a griseofulvin (GF)-containing diet over a period of 12 weeks. GF ingestion by the mice caused an accumulation of porphyrins in the feces and a decrease in heme in the liver; these effects were observed throughout the entire duration of the experiment, with maximum levels observed after circa 1 week of ingestion of this diet. In addition, the mice developed enlargement of the liver, hepatocyte injury, and cholestasis. Mice with hepatic porphyria manifested an anxiety-like behavior by the long-term treatment (over 5 weeks) in a GF-dose and duration dependent manner. The hepatic porphyria mice also manifested depression-like behaviors by the short-term treatment (3 weeks) of GF2.0, which was reversed by administration of anti-depressant, imipramine. In conclusion, this study for the first time demonstrated psychiatric manifestations in GF-induced hepatic porphyria mice. The present results suggest that model animals could be useful for elucidating the mechanisms underlying psychiatric manifestations in syndromes such as hepatic porphyria and hepatic encephalopathy that are associated with the impairment of hepatic function.
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PMID:Manifestation of psychiatric behaviors in a mouse model of griseofulvin-induced hepatic porphyria. 1904 81

Paclitaxel (PTX) is frequently used for a chemotherapy of breast cancer and gynecologic cancer. Besides a bone-marrow depression and hypersensitive reaction, the peripheral neuropathy is one of the serious adverse events of PTX. The mechanism of peripheral neuropathy has not been clarified, and few agents have been reported to be effective for the treatment and the prevention of that. Recently, it has been reported that Gosya-jinki-gan is useful for the PTX induced peripheral neuropathy, so we carried a retrospective study(n=82)to evaluate the effectiveness of Gosya-jinkigan with the medical records. It is suggested that peripheral neuropathy developed more rapidly in sequential administration of PTX every week than in administration in 4 weeks cycles consisting of 3 weeks on and 1 week off(5.4w vs. 9.4w). We have also found that Gosya-jinki-gan was possibly effective for the treatment and the prevention of peripheral neuropathy. Additionally Gosya-jinki-gan might be more effective for peripheral neuropathy when it is administered from the beginning of chemotherapy including PTX.
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PMID:[Clinical features of paclitaxel-induced peripheral neuropathy and role of Gosya-jinki-gan]. 1915 69

Chronic ulcers such as pressure, ischemic, and venous ulcers are common in long-term care (LTC) and frequently do not heal. A retrospective medical records review of all LTC residents referred to a wound consultative service between April 1999 and January 2007 was conducted to assess predictors of 6-month healing outcome. Variables abstracted and analyzed included wound, resident demographic, and laboratory values at diagnosis and comorbid medical illnesses. The average age of study participants (n = 397) was 78.1 years (+/- 11), 47% were men, 48% had more than one wound, and the most common wound diagnosis was pressure ulcer (n = 163). After 6 months, 66% of ulcers were not healed. The odds ratio for nonhealing was significantly higher in residents who had more wounds, a larger wound area, diabetes mellitus, or peripheral vascular disease and lower in residents with increased age and hemoglobin values and/or a history of stroke, depression, dementia, degenerative arthritis, peripheral neuropathy, and falls. After adjustment in the multivariate model, only the number of wounds and hemoglobin level remained significant predictors of healing status. A higher number of chronic ulcers and lower hemoglobin counts increased the risk of nonhealing after 6 months of care. Including these variables in LTC resident assessments may help clinicians ascertain expected outcomes of care.
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PMID:A retrospective cohort study of factors that affect healing in long-term care residents with chronic wounds. 1960 67

Diabetes has been associated with depression since Thomas Willis' work in 1684 (Rubin and Peyrot in Diabetes Metab Rev 18:173-175, 2002). The aim of this study is to identify social and clinical factors independently associated with depression in individuals with type 1 diabetes. We carried out a descriptive transversal study with 110 type 1 diabetes patients, administered a questionnaire and obtained demographical and diabetes-related data (number of years from diagnosis, initial admission at diagnosis, glycated hemoglobin, number of complications, insulin dose, number of insulin injections per day, admission for ketoacidosis or hypoglycemia at diagnosis, and specific diabetes complications such as nephropathy, retinopathy, peripheral neuropathy, coronariopathy, and amputation). Depressive symptoms were quantified using the Hamilton Score. We used T tests to investigate potential relations between the covariates and depression (Hamilton score). We concluded the following: as few as 10% of our patients had glycated hemoglobin under 7%; women had more symptoms of depression, and there are four independent factors associated with depression in individuals with type 1 diabetes mellitus: age, Graffar score, admission for ketoacidosis, and insulin dose.
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PMID:Independent factors associated with depression in type 1 diabetes mellitus. 1930 Aug 97


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