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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To establish strict clinical criteria for reflex sympathetic dystrophy (RSD) of the foot and to characterize any associated scintigraphic pattern, the authors performed three-phase radionuclide bone scanning in 51 patients prospectively referred because RSD was a diagnostic consideration. To establish sensitivity and specificity data, the cases of an additional 100 consecutive patients referred for a variety of foot problems were retrospectively reviewed. The authors defined RSD of the foot as a pain syndrome characterized by diffuse nonanatomic, often unrelenting pain; autonomic-vasomotor signs including warm or cool skin temperatures and moist-sweaty or dry-scaly skin; and a positive response to a lumbar sympathetic block. Patients with RSD have a characteristic delayed bone-scan pattern consisting of diffuse increased tracer throughout the foot, with juxta-articular accentuation of tracer uptake. Overall, sensitivity in this study was 100%; specificity, 80%; positive predictive value, 54%; and negative predictive value, 100%. False-positive images were obtained in patients with infection, diabetes, and chronic pain. Specificity was 66% in the subgroup of patients who underwent sympathetic block, with a positive-predictive value of 88%. There were no differences in scan pattern related to duration of symptoms prior to imaging.
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PMID:Reflex sympathetic dystrophy in the foot: clinical and scintigraphic criteria. 162 Aug 60

Neuralgic pain during or following herpes zoster infection is a common problem in pain therapy. The current management of neuralgias due to zoster is discussed with reference to patients in a chronic pain clinic within an anesthesiology department. The courses of 80 patients followed up for at least 3 months from the pain clinic at the University Hospital in Kiel were analyzed. The mean age was 69 years. The predominant locations for zoster lesions were the thoracic segments (65%) and the first branch of the trigeminal nerve (19%). Diabetes mellitus was present in 20% of the patients and malignant disease in 18%. In 2 patients recurrent postherpetic neuralgia was the first symptom of HIV infection. Despite pretreatment, the mean initial pain score was 8 on an analog scale (range 0-10). Acute herpes zoster pain during the infection was treated with virustatic agents, corticosteroids and sympathetic blocks. Postherpetic neuralgias required a more sophisticated approach, depending on the stage of the disease and the type of pain involved: sympathetic blockade with local anesthetic agents or injections of very low dose opioids to sympathetic ganglia, transcutaneous electrical nerve stimulation, and antidepressants or anticonvulsants. The success of the therapy is correlated with the duration of pain. If the history of zoster pain was less than 1 month, the majority of patients showed good or excellent results. On the other hand, only one-third of patients with a history longer than 6 months had adequate pain relief. Therefore, early and appropriate treatment is desirable for patients suffering from zoster neuralgias.
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PMID:[The treatment of zoster neuralgia]. 168 93

Multiple aspects of family functioning were assessed when mothers experienced either chronic pain, a chronic illness (diabetes), or no illness. Mothers' and fathers' self-report measures of depression, anxiety, and family environment were collected. Children's self-report measures of depression and anxiety, as well as information about their overall adjustment, were collected. Family communication patterns were also assessed. Families with a mother who had chronic pain had poorer perceived family environments and higher levels of depression and anxiety compared to the other two groups of families. Children from chronic pain families also appeared to be adversely affected. The data suggest that level of disability appeared more salient than the type of chronic illness. Implications of the findings are discussed in light of the fact that mothers with chronic pain in the present sample reported relatively mild disability and were not actively seeking treatment for their condition.
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PMID:A comparison of family functioning when mothers have chronic pain. 320 Jun 1

The mechanism of painful diabetic neuropathy remains unknown. Spontaneous activity in nociceptive primary afferents has been implicated in the genesis of chronic pain due to peripheral nerve injury, and diabetic axonopathy shares some histologic features with traumatic neuropathy. We hypothesized that spontaneous hyperactivity of nociceptive neurons might represent the neurophysiologic mechanism of diabetic neuropathic pain. To test this, we examined the spontaneous activity of primary afferent axons from diabetic BB/Wistar and normal Wistar rat saphenous nerves isolated from central and peripheral connections. Microfilament recordings from diabetic nerves showed a significantly higher incidence of spontaneous discharges in comparison to normal nerves. Furthermore, this spontaneous hyperactivity occurred almost exclusively in potentially nociceptive C-fibers. We conclude that in the diabetic BB/Wistar rat, spontaneous impulses are generated in potential nociceptive primary afferent neurons, and that this may represent the mechanism of chronic diabetic neuropathic pain.
Diabetes 1985 Nov
PMID:Spontaneous activity of primary afferent neurons in diabetic BB/Wistar rats. A possible mechanism of chronic diabetic neuropathic pain. 404 59

This study examines the relationship between MMPI scales and functional limitation for the chronic illness populations of chronic low back pain, migraine headache, hypertension and diabetes. Average MMPI profiles for these groups approximate those of previous studies with the chronic low back group having the most disturbed profile and showing elevations especially on the Hs, Hy and D scales. Several kinds of analyses, however, demonstrate that, in general, the MMPI group differences can be accounted for by individual self-rated functional limitation. The data do not support attempts at defining a low back pain or chronic pain personality profile apart from the emotional disturbance associated with chronic limitation and disruption of activity.
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PMID:Does the MMPI differentiate chronic illness from chronic pain? 621 8

Psychologic assessment is an integral aspect of the comprehensive functional assessment of geriatric patients. Medical areas in which psychologic testing and evaluation can be of significant service in the diagnosis and formulation of treatment plans include psychiatric and neurologic disturbances, psychosomatic disorders, circulatory diseases (especially hypertension), diabetes, chronic pain, sexual dysfunctions, and gastrointestinal problems. In the effort to gain an understanding of the total patient, it is important to clarify the effect of physical condition on a person's psychologic reactions as well as the impact of psychologic states on his/her biologic status. This orientation is particularly important in dealing with elderly patients because the interaction between the physical and the psychologic in this age group is exceedingly strong and significant. Despite the fact that research in the psychology of the aged is of long standing, the attention given by clinical psychologists to the provision of services to geriatric patients has been quite limited until recently. Many psychologic tests have been developed during the past 70 years, but relatively few of them have been standardized for use with the aged. Of late, however, this has been changing. Several tests have been adapted, and some new ones have been organized with the needs and characteristics of the aged in mind. Closer attention has been paid to psychometric principles in the development of the tests, leading to the organization of useful norms and the demonstration of proper levels of reliability and validity. Accordingly, the state of the art of psychologic assessment of the aged is currently rather limited, but the outlook for the near future appears encouraging. In evaluating the condition of a geriatric patient, the clinical psychologist normally generates data through observations, testing, and interviewing. The resulting report covers the following areas: 1) adaptation to the examination and behavioral characteristics during the procedure, 2) cognitive functioning, 3) visual motor coordination and perception of spatial relationships, and 4) personality characteristics and mental health status. Data for the first area are normally derived by the examiner from observations and subjective impressions of the patient's behavior. For each of the other areas the information is obtained through standardized tests. In this discussion, some of the principal assessments that are currently available are reviewed and evaluated for their usefulness with the aged.
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PMID:Psychologic assessment technology for geriatric practice. 636 Nov 3

Biohybrid implants represent a new class of medical device in which living cells, supported in a hydrogel matrix, and surrounded by a semipermiable membrane, produce and deliver therapeutic reagents to specific sites within a host. First proposed in the mid-1970s for diabetes, this treatment modality has progressed rapidly in the past four years and is now being investigated not just for endocrine disorders but also for alleviation of chronic pain, treatment of neurodegenerative disorders, and delivery of neurotrophic factors to sites within the blood brain barrier, and as a practical alternative to conventional ex vivo.
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PMID:Recent progress in immunoisolated cell therapy. 782 81

Form C of the Multidimensional Health Locus of Control (MHLC) scales is an 18 item, general purpose, condition-specific locus of control scale that could easily be adapted for use with any medical or health-related condition. Data from 588 patients with one of four conditions--rheumatoid arthritis, chronic pain, diabetes, or cancer--were utilized to establish the factor structure of Form C and to establish the reliability and validity of the resultant four subscales: Internality; Chance; Doctors; and Other (powerful) People. The alpha reliabilities of the subscales are adequate for research purposes. Data from the arthritis and chronic pain subjects established that the Form C subscales were moderately stable over time and possessed considerable concurrent and construct validity. Some discriminant validity of Form C with Form B of the MHLC was also demonstrated.
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PMID:Form C of the MHLC scales: a condition-specific measure of locus of control. 784 39

The streptozocin-induced diabetic rat has been put forward as a model of chronic pain with signs of hyperalgesia and allodynia that may reflect signs observed in diabetic humans. The aim of this work was to assess, in streptozocin-induced diabetic rats, the pharmacological activity to several analgesic drugs known to be effective (clomipramine, amitriptyline, desipramine, clonidine, lidocaine), ineffective (aspirin), or with a doubtful effectiveness (morphine) in human painful diabetic neuropathy. The animals were submitted to a mechanical pain test (paw pressure) and the ability of the drugs to reverse diabetes-induced hyperalgesia was tested. The tested antidepressants (0.125-8 mg/kg, i.v.) were slightly effective in diabetic rats; amitriptyline and clomipramine induced a weak effect, whereas desipramine was more active, suggesting noradrenergic specificity. This was confirmed by the effectiveness of clonidine (50, 100, 150 micrograms/kg, s.c.). Lidocaine (1-9 mg/kg, i.v.) had prolonged efficacy on mechanical hyperalgesia. Aspirin (100 mg/kg, i.v.) was without effect and morphine (0.5-4 mg/kg, i.v.) induced a dose-dependent antinociceptive effect but at doses twice as high as those used in normal rats. These results demonstrate the high pharmacological predictivity of this model of painful diabetes and suggest that in this pathological condition, among the drugs acting on monoaminergic transmission, noradrenergic drugs seem the most active.
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PMID:Study of the sensitivity of the diabetes-induced pain model in rats to a range of analgesics. 809 May 11

Chronic pancreatitis is mainly due to longstanding alcoholism. In general treatment is based on drug therapy. The clinical appearance is determined by chronic pain, steatorrhoea and eventually by the onset of diabetes mellitus. Beyond other measures total avoidance of alcohol ingestion provides a condition of a more benign course of the disease. Treatment of pain consists of symptomatic therapy and prescription of pancreatic enzymes in order to lessen pancreatic stimulation by inhibition of feedback mechanisms. The same principle applies to the prescription of octreotide which is used only in selected cases since it has failed to prove general effectiveness. Symptoms of exocrine insufficiency are alleviated by substitution of pancreatic enzymes. Attention must be directed on dose and preparation of pancreatic enzymes being used. Treatment of pancreatogenic diabetes resembles therapy of type I diabetes mellitus. In principle treatment of chronic pancreatitis should be adjusted to the highly variable clinical appearance of the disease and requires a systematic approach. It has to be kept in mind that some complications of chronic pancreatitis [e.g. pseudocysts] may require surgical intervention.
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PMID:[Chronic pancreatitis: conservative therapy]. 868 54


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