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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Many studies in several species, including humans, have identified a subset of primary afferent nerve fibres that are activated by potential or actual tissue-damaging stimuli. Discharge patterns of these nociceptive afferents faithfully reproduce some aspects of the applied stimuli (e.g. shape of the stimulus-response function) but not others (e.g. time-course of a sustained stimulus). Since primary nociceptive afferents provide the input to the central nervous system, their encoding properties have to be considered when studying central processing. On the other hand, pain perception correlates with some aspects of nociceptor discharges (e.g. fatigue with repetition of brief heat pulses), but not with others (e.g. absolute thresholds). Therefore, the painfulness of a stimulus cannot be deduced from nociceptor discharges alone; central processing needs to be taken into account, particularly central summation. In addition to the immediate responses of nociceptive afferents to external stimulation, acute pain mechanisms also comprise the short-term plasticity of the nociceptive system as a consequence of prolonged noxious stimulation.
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PMID:Peripheral acute pain mechanisms. 763 16

Spectral parameters of the surface electromyographic (EMG) signal from lumbar back muscles assessed during a fatiguing isometric contraction can be used to classify different categories of low back pain (LBP) subjects and control subjects without LBP. In the test protocol currently used at the NeuroMuscular Research Center at Boston University, subjects contract their back muscles at 80% of their maximal voluntary contraction (MVC) force. This fatigue-based protocol has been successfully applied to persons with subacute or chronic LBP; those in acute pain, however, have not been included because of their inability to perform a maximal exertion. In this paper we will examine the force sensitivity of the currently used EMG parameters and also give an overview of some of our efforts to develop new test procedures. Our goal is to develop force-insensitive surface EMG parameters that can be used for classification purposes in populations of subjects who develop low trunk extension forces. In addition, the development of a model to predict MVC from anthropometrical measurements will be presented.
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PMID:Development of new protocols and analysis procedures for the assessment of LBP by surface EMG techniques. 932 45

Muscle strain is a very common injury. Muscles that are frequently involved cross two joints, act mainly in an eccentric fashion, and contain a high percentage of fast-twitch fibers. Muscle strain usually causes acute pain and occurs during strenuous activity. In most cases, the diagnosis can be made on the basis of the history and physical examination. Magnetic resonance imaging is recommended only when radiologic evaluation is necessary for diagnosis. Initial treatment consists of rest, ice, compression, and nonsteroidal anti-inflammatory drug therapy. As pain and swelling subside, physical therapy should be initiated to restore flexibility and strength. Avoiding excessive fatigue and performing adequate warm-up before intense exercise may help to prevent muscle strain injury. The long-term outcome after muscle strain injury is usually excellent, and complications are few.
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PMID:Muscle strain injury: diagnosis and treatment. 1043 80

Tension-type headaches, the most prevalent form of headache, are differentiated as being either episodic or chronic. The episodic form is a physiologic response to stress, anxiety, depression, emotional conflicts, fatigue, or repressed hostility. Treatment focuses on the use of over-the-counter or prescribed simple analgesics for pain relief. Successful treatment of the chronic form depends on recognition of depression or persistent anxiety states. Primary care physicians can effectively manage most of these patients with nonhabituating anxiolytic or antidepressant medications; however, referrals for psychotherapy may be required in some cases. When tension-type headaches occur in children and adolescents, the physician must explore the patient's family and social relationships as well as school performance. In addition to nonhabituating drug therapies, family counseling and biofeedback may be helpful. In coexisting migraine and tension-type headaches, nonhabituating analgesics may be used for the relief of acute pain; the use of ergotamine and triptans should be restricted to relief of the hard or sick headache. Tricyclic antidepressants or monoamine oxidase inhibitors are the gold standards for prophylaxis, although the selective serotonin reuptake inhibitors may be indicated in less severe cases. Several forms of biofeedback have also proved effective. Nonetheless, some patients with this form of headache may require psychiatric treatment for severe depression.
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PMID:Tension-type headache. 1068 86

Clinically significant pain has been found in as many as 65% of persons diagnosed with multiple sclerosis (MS). Acute pain conditions include trigeminal neuralgia, painful optic neuritis, and Lhermitte's syndrome. Chronic pain conditions such as dysesthesias in the limbs, joint pain, and other musculoskeletal or mechanical pain problems develop as a function of spasticity and deconditioning associated with MS. These painful conditions may respond to pharmacological, surgical, rehabilitation, and psychological interventions. However, unresolved pain, associated disability, and affective distress are common. In addition, efforts to manage MS and its associated symptoms, for example, may inadvertently cause osteoporosis and headache or other symptoms that may exacerbate pain and pain-related disability. Conversely, efforts to manage pain may have negative effects on the symptoms of MS (e.g., increased fatigue). A multidimensional approach to assessment and management that is guided by a comprehensive biopsychosocial model is recommended. Such an approach needs to consider the exacerbating nature of MS, MS-related pain, and interventions aimed at their management. Suggestions for future research on MS-related pain conclude the article.
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PMID:Pain in multiple sclerosis: a biopsychosocial perspective. 1205 66

Three basic classification schemes have been developed to categorize spondylolisthesis, the slippage or forward displacement of one vertebra over another. Two rely on radiographic appearance, and the third stresses the developmental aspect of the pathology. The pathology is relatively rare in individuals younger than 18 years, appears to be influenced by race, and is found more frequently in males than females and in patients with symptomatic low back pain. Lytic spondylolisthesis occurs more frequently at certain spinal levels, and certain sports activities have been implicated in its development. The etiology remains unclear, but hereditary factors are unlikely with no evidence of the lytic defect in newborns. Recent research indicates that the architecture of the pelvis may be an important parameter. Some have postulated that the underlying pathomechanical event is a fracture, either acute or secondary to fatigue. Once the pars defect has been created, anatomic and biomechanical forces conspire to prevent healing of the fracture and create a spondylolisthesis. Although mechanical considerations are likely most significant, genetic considerations have also been discussed. All the imaging modalities play useful roles in defining the pathoanatomy, including diskography. Patients typically report symptoms as back pain and/or neurologic symptoms; however, these symptoms can have other causes even though a spondylolisthesis is present. A thorough history and physical examination, along with the radiographic investigations, are essential to determining proper treatment. Nonsurgical options are activity modification, bracing, physical therapy, and intervention in the form of medications or injections. Use of muscle relaxers and narcotics may be appropriate for managing initial acute pain. Surgical options are direct repair of the pars defect, decompression, fusion, or a combination of these procedures. The various techniques of pars repair are recommended only for patients younger than 30 years. Although decompression alone may be suitable in some situations, decompression with fusion is more standard, certainly when instability and low back pain exist.
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PMID:Low-grade isthmic/lytic spondylolisthesis in adults. 1269 Aug 77

Disturbed sleep is a key complaint of people experiencing acute and chronic pain. These two vital functions, sleep and pain, interact in complex ways that ultimately impact the biological and behavioral capacity of the individual. Polysomnographic studies of patients experiencing acute pain during postoperative recovery show shortened and fragmented sleep with reduced amounts of slow wave and rapid eye movement (REM) sleep, and the recovery is accompanied by normalization of sleep. Objective assessments of sleep in patients with various chronic pain conditions have been less definitive with some studies showing fragmented and shortened sleep and others showing normal sleep. Although daytime fatigue is a frequent complaint associated with complaints of pain-related disturbed sleep, objective assessments of daytime sleepiness reveal minimally elevated levels of sleepiness and emphasize the importance of distinguishing sleepiness and fatigue. The pain-sleep nexus has been modeled in healthy pain-free subjects and the studies have demonstrated the bidirectionality of the sleep-pain relation. Given this bidirectionality, treatment must focus on alleviation of both the pain and sleep disturbance. Few of the treatment studies have done such, and as a result no clear consensus on treatment approaches, much less on differential etiology-based treatment strategies, has emerged.
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PMID:Sleep and pain: interaction of two vital functions. 1579 43

Strength training with low load under conditions of vascular occlusion has been proposed as an alternative to heavy-resistance exercise in the rehabilitation setting, when large forces acting upon the musculoskeletal system are unwanted. Little is known, however, about the relative intensity at which occlusion of blood flow significantly reduces dynamic muscular endurance and, hence, when it may increase the training effect. The purpose of this study was to investigate endurance during dynamic knee extension at different loads with and without cuff occlusion. Sixteen subjects (20-45 years of age) with strength-training experience were recruited. At 4 test sessions, the subjects performed unilateral knee extensions to failure with and without a pressure cuff around the thigh at 20, 30, 40, and 50% of their 1 repetition maximum (1RM). The pressure cuff was inflated to 200 mm Hg during exercise with occlusion. Significant differences in the number of repetitions performed were found between occluded and nonoccluded conditions for loads of 20, 30, and 40% of 1RM (p < 0.01) but not for the 50% load (p = 0.465). Thus, the application of a pressure cuff around the thigh appears to reduce dynamic knee extension endurance more at a low load than at a moderate load. These results may have implications regarding when it could be useful to apply a tourniquet in order to increase the rate of fatigue and perhaps also the resulting training effect. However, the short- and long-term safety of training under ischemic conditions needs to be addressed in both healthy and less healthy populations. Furthermore, the high acute pain ratings and the delayed-onset muscle soreness associated with this type of training may limit its potential use to highly motivated individuals.
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PMID:Effects of vascular occlusion on muscular endurance in dynamic knee extension exercise at different submaximal loads. 1668 66

The aim of this study was to characterize a group of patients (n=8) with sickle cell disease (SCD) and ischemic stroke concerning the clinical, neurological, imaging and progressive aspects. Data were collected from records and completed with an interview of patients and their parents. In this study there were 8 patients with ages ranging from 10 to 23 years old; SCD diagnosis was given between one and two years of age with clinical features of fatigue and anemia. The stroke was ischemic in all individuals and the first cerebrovascular event occurred before 6 years of age; 3 patients had recurrence of stroke despite prophylactic blood transfusion therapy and both cerebral hemispheres were affected in 4 patients. Clinical and neurological current features observed were: acute pain crises, sialorrhea, mouth breathing, motor, and neuropsychological impairments resulting from cortical-subcortical structure lesions.
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PMID:Stroke in patients with sickle cell disease: clinical and neurological aspects. 1839 10

There many open questions concerning the concept of primary prevention in FM. Diagnostic or classification criteria are not universally accepted, and this leads to difficulties in establishing the onset and duration of the disease. In the case of FM, primary prevention may consist of the immediate care of acute pain or treatment for affective disturbances as we do not have any specific laboratory or instrumental tests to determine risk factors of the disease. The goal of secondary prevention is early detection of the disease when patients are largely asymptomatic and intervention improves outcome. Screening allows for identification of an unrecognized disease or risk factor, which, for potential FM patients, includes analysis of tender points, Fibromyalgia Impact Questionnaire (FIQ), pain location and intensity, and fatigue and sleep complaints. Tertiary prevention inhibits further deterioration or reduces complications after the disease has developed. In FM the aim of treatment is to decrease pain and increase function via multimodal therapeutic strategies, which, in most cases, includes pharmacological and non-pharmacological interventions. Patients with FM are high consumers of health care services, and FM is associated with significant productivity-related costs. The degree of disability and the number of comorbidities are strongly associated with costs. An earlier diagnosis of FM can reduce referral costs and investigations, thus, leading to a net savings for the health care sector. However, every social assessment is closely related to the socio-economic level of the general population and to the legislation of the country in which the FM patient resides.
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PMID:Fibromyalgia syndrome: preventive, social and economic aspects. 1885 10


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