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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study was carried out to evaluate the impact of birth preparation courses on the health of the mother and the newborn. A randomized clinical trial study was carried out on 200 primigravid women younger than age 35 years with gestational age of 20 weeks. Subjects were randomly divided into two groups: control and trial. Birth preparation classes were introduced to the trial group in eight sessions during pregnancy, whereas the control group received only routine care. Measurable clinical, obstetrical, and neonatal advantages were monitored and compared in two groups. Patients in the trial group suffered from back and pelvic pain and headache significantly less often than patients in control group (two-tailed p(2) < 0.05). Preparation is significantly related to reduction in dystocic deliveries and cesarean section ( p(2) = 0.044). Antenatal preparation could play a major role in the health of mother and newborn during labor and postpartum. In addition, antenatal preparation should be introduced to all women during pregnancy as a national health policy in Iran.
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PMID:Evaluation of the impact of birth preparation courses on the health of the mother and the newborn. 1566 38

Neuromodulation in one form or another has been studied for decades for various disease states. Although its mechanism of action remains un-explained, numerous clinical success stories suggest it is a therapy with efficacy and durability. Controlled studies have led to the approval of sacral neuromodulation for urinary urgency and frequency, urinary retention, and urinary urge incontinence. The future holds hopeful possibilities for the application of neuromodulation, namely in the areas of interstitial cystitis, in-tractable pain syndromes, fecal incontinence and constipation, spinal cord injury, and erectile dysfunction. Neuromodulators have also been used in nonurologic conditions, including chronic headaches and intractable chest pain. In adults and children, in the neurologically intact and neurologically impaired, neuromodulation has been shown to improve the quality of life of those suffering chronic disease states. Neuromodulation is changing the future of urology. Treatment of voiding dysfunction and likely other disorders, such as pelvic pain, sexual dysfunction, and bowel disorders, will no longer rely only on medications that are "OK" or destructive-reconstructive procedures that suffer from significant complications. Rather, by modulating the nerves, the urologists will treat these disorders in a minimally invasive fashion and neuromodulation will become the first-line therapy before any major surgery is undertaken.
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PMID:Expanding indications for neuromodulation. 1569 77

A young woman presented with multiple central hypersensitivity disorders, including fibromyalgia, headache, pelvic pain and several smooth muscle spasm disorders, including irritable bowel syndrome, irritable bladder and Raynaud's phenomenon. She also had significant fatigue and sleep problems. Her case illustrates the importance and surprising frequency of atypical bipolar mood disorders in people with multiple central hypersensitivity pain disorders, especially with depression and anxiety resistant to antidepressant treatment. Considering neurological mechanisms common to her overlapping disorders was very helpful in guiding treatment choices. This experience illustrates the value of serotonin receptor type 2 (5HT2) inhibition with atypical neuroleptics, of neural cation channel and glutamate inhibition with anticonvulsants, and the potential usefulness of antidepressants after establishing 5HT2 control to enhance downward inhibitory tracts. Medications with combined usefulness for both bipolar mood and pain disorders were highly effective for her multiple hypersensitivity problems.
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PMID:Serotonin mechanisms in pain and functional syndromes: management implications in comorbid fibromyalgia, headache, and irritable bowl syndrome - case study and discussion. 1576 Aug 6

Drug challenge test (DCT) is performed to evaluate chronic pain pharmacologically and determine its medical treatment. One test drug is administered in one day for DCT and characterization of the test drug. Four patients developed side effects of the test drugs for DCT in whom other drug tests were postponed or canceled. A 58-year-old man with multiple arthritis of rheumatic arthritis and fibromyalgia had headache, nausea, and vomiting all day after ketamine test. A 76-year-old man with chronic general pain and failed back surgery syndrome had vomiting and abdominal discomfort two hours after morphine test and had redness and itching on his bilateral forearms the following day. A 78-year-old man with chronic lumbar and right lower limb pain due to L 4-5 lumbar disc herniation and postherpetic neuralgia felt dizzy, fell down and bruised on his lower back and left knee twelve hours after morphine test. A 32-year-old woman with chronic pelvic pain had skin eruption on her thigh the day after phentolamine test. Although the amount of the test drug in DCT is small and its half-life is short, long-term side effects might occur. We should decrease the amounts or frequencies of ketamine and morphine, and administer them taking long intervals before other tests.
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PMID:[Postponed or canceled drug challenge tests and side effects of the test drug--a report of four cases]. 1649 93

Somatic symptoms are common in primary care and clinicians often prescribe antidepressants as adjunctive therapy. There are many possible reasons why this may work, including treating comorbid depression or anxiety, inhibition of ascending pain pathways, inhibition of prefrontal cortical areas that are responsible for "attention" to noxious stimuli, and the direct effects of the medications on the syndrome. There are good theoretical reasons why antidepressants with balanced norepinephrine and serotonin effects may be more effective than those that act predominantly on one pathway, though head-to-head comparisons are lacking. For the 11 painful syndromes review in this article, cognitive-behavioral therapy is most consistently demonstrated to be effective, with various antidepressants having more or less randomized controlled data supporting or refuting effectiveness. This article reviews the randomized controlled trial data for the use of antidepressant and cognitive-behavior therapy for 11 somatic syndromes: irritable bowel syndrome, chronic back pain, headache, fibromyalgia, chronic fatigue syndrome, tinnitus, menopausal symptoms, chronic facial pain, noncardiac chest pain, interstitial cystitis, and chronic pelvic pain. For some syndromes, the data for or against treatment effectiveness is relatively robust, for many, however, the data, one way or the other is scanty.
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PMID:Antidepressants and cognitive-behavioral therapy for symptom syndromes. 1657 78

The aim of this study was to conduct a systematic review of the efficacy of specific stabilisation exercise for spinal and pelvic pain. Randomised clinical trials evaluating specific stabilisation exercise were identified and retrieved. Outcomes were disability, pain, return to work, number of episodes, global perceived effect, or health-related quality of life. A single trial reported that specific stabilisation exercise was more effective than no treatment but not more effective than spinal manipulative therapy for the management of cervicogenic headache and associated neck pain. Single trials reported that specific stabilisation exercise was effective for pelvic pain and for prevention of recurrence after an acute episode of low back pain but not to reduce pain or disability associated with acute low back pain. Pooled analyses revealed that, for chronic low back pain, specific stabilisation exercise was superior to usual medical care and education but not to manipulative therapy, and no additional effect was found when specific stabilisation exercise was added to a conventional physiotherapy program. A single trial reported that specific stabilisation exercise and a surgical procedure to reduce pain and disability in chronic low back pain were equally effective. The available evidence suggests that specific stabilisation exercise is effective in reducing pain and disability in chronic but not acute low back pain. Single trials indicate that specific stabilisation exercise can be helpful in the treatment of cervicogenic headache and associated neck pain, pelvic pain, and in reducing recurrence after acute low back pain.
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PMID:Specific stabilisation exercise for spinal and pelvic pain: a systematic review. 1676 45

Caudal block with a local anesthetic through the hiatus sacralis has been performed in patients with chronic low back pain, lower limb pain, anal pain, and pelvic pain due to spinal canal stenosis, lumbar disc herniation, lumbar spondylolisthesis, postherpetic neuralgia, peripheral vascular disease, complex regional pain syndrome and so on. We prepar- ed an information and consent sheet on caudal block in The University of Tokyo Hospital. In the information sheet, we included disease, purpose, methods, outcome, accidental complications of caudal block, other treatments, progress on unperformed case, questions and answers, influence of rejection, and doctor's name. We experienced some cases of boring pain, deterioration of low back pain and lower limb pain, headache, nausea, hypertension, hypotension, and tachycardia as accidental complications of caudal block. In describing some accidental complications, we included boring pain, high intracranial pressure, dural puncture, nerve injury, infection, hemorrhage, embolism, allergy, and heart, lung, brain, liver, and kidney failures. Further, we could refer to the accidental complications of epidural block. However, the rate of each accidental complication has not been known in detail. We should survey the outcome and accidental complication of caudal block prospectively in multiple facilities and provide the patients with useful information.
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PMID:[Information and consent sheet of caudal block in the University of Tokyo Hospital]. 1678 90

There is an evidence that increased capillary permeability in the standing position is related to a deficit in the sympathetic nervous system. The leakage of this fluid leads to various clinical conditions which frequently puzzle the consulting physician because despite the frequency of this condition intelligent physicians and patients are unaware of the cause of their condition. One of the most common manifestations is the inability to lose weight despite proper dieting. A randomized study comparing the efficacy of a diuretic, a converting enzyme inhibitor, spironolactone and a sympathomimetic amine on weight loss in diet refractory women found that only the latter in the form of dextroamphetamine sulfate demonstrated significant weight reduction over a six month time span. In fact, the dextroamphetamine sulfate proved effective when given in the next 6 months to the three groups failing to respond for the first 6 months. The diagnosis of a deficit in sympathomimetic amines is established by demonstrating an abnormal clearance of a water load in the erect position and exclusion of other conditions that are associated with an abnormal free water clearance, e.g., hypothyroidism, renal or liver disease or congestive heart failure. The original definition of an abnormal water load test was excretion of <55% of a 1500 ml water load in 6h but we found that <75% defines a greater population who suffer from this problem. There are several conditions that have proven refractory to conventional theory that respond quickly and effectively to sympathomimetic amines. There have been many anecdotal reports of relieving interactable pain syndromes quickly and efficiently with sympathomimetic amine theory, despite failure with a multitude of other therapies. These include interstitial cystitis and pelvic pain that was attributed to endometriosis, gastrointestinal pain including esophagitis and gastroparesis, headaches, joint pain, fibromyalgia, and carpal tunnel syndrome. It is not clear if the improvement in pain is related to a decrease in fluid retention or a direct effect of the sympathomimetic amines on the sympathetic nervous system. Sympathomimetic amine theory has helped other conditions besides pain, e.g., chronic fatigue, vasomotor symptoms in young women not associated with decreased ovarian egg reserve, and chronic urticaria resistant to all other therapies. Thus, these studies strongly suggest that physicians be aware of this condition involving a deficit in the sympathetic nervous system when faced with various enigmatic complaints especially if standard therapy has not proven effective.
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PMID:A disorder of sympathomimetic amines leading to increased vascular permeability may be the etiologic factor in various treatment refractory health problems in women. 1776 3

Myofascial pain as a cause of chronic pelvic pain with or without pelvic organ pathology is well-documented in the literature. Causes of this pain are multifactorial, including specific pelvic organ pathologies, neuromuscular disorders, and psychologic causes. Management of this myofascial component of chronic pelvic pain involves a multidisciplinary approach including physicians, physical therapists, neurologists, and psychiatrists. Treatment strategies, including behavioral management, medications, physical therapy, trigger point injections, neuromodulation, botulinum toxin injection, and other lesser known treatment modalities, are discussed in detail in this article.
Curr Pain Headache Rep 2007 Oct
PMID:Myofascial dysfunction associated with chronic pelvic floor pain: management strategies. 1789 26

The proper management of pain is a critical issue in the practice of medicine. Despite the availability of a large number of analgesic medications, management of pain that is refractory to conventional treatments remains a challenge for both clinicians and surgeons. Botulinum neurotoxin (BoNT) has recently emerged as a potential novel approach to control pain. Animal studies have revealed a number of mechanisms by which BoNTs can influence and alleviate chronic pain, including inhibition of pain peptide release from nerve terminals and sensory ganglia, anti-inflammatory and antiglutaminergic effects, reduction of sympathetic neural discharge, and inhibition of muscle spindle discharge. In humans, prospective, placebo-controlled, double-blind studies have also provided evidence for effectiveness of BoNT therapy in a number of painful disorders. These include cervical dystonia, pelvic pain, low back pain, plantar fasciitis, postsurgical painful spasms, myofascial pain syndromes, migraine, and chronic daily headaches. Long-term studies on cervical dystonia and low back pain have demonstrated safety and sustained efficacy after repeated injections. This Review focuses on the analgesic effects of BoNT and the mechanisms of its pain control as revealed by animal models, and provides evidence-based data on the efficacy of BoNT therapy in various pain syndromes in humans.
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PMID:Botulinum neurotoxins in the treatment of refractory pain. 1904 24


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