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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The skeleton is the second most frequent site of metastasis. However, only a restricted number of solid cancers, especially those of the breast and prostate, are responsible for the majority of the bone metastases. Metastatic bone disease is a major cause of morbidity, characterised by severe pain and high incidence of skeletal and haematopoietic complications (fractures, spinal cord compression and bone marrow aplasia) requiring hospitalisation. Despite the frequency of skeletal metastases, the molecular mechanisms for their propensity to colonise bone are poorly understood and treatment options are often unsatisfactory. TGF-beta and the signalling pathway it controls appears to play major roles in the pathogenesis of many carcinomas, both in their early stages, when TGF-beta acts to arrest growth of many cell types, and later in cancer progression when it contributes, paradoxically, to the phenotype of tumour invasiveness. Here we discuss some novel insights of the TGF-beta superfamily-including BMPs and their antagonists-in the formation of bone metastasis. Increasing evidence suggests that the TGF-beta superfamily is involved in bone homing, tumour dormancy, and development of micrometastases into overt bone metastases. The established role of TGF-beta/BMPs and their antagonists in epithelial plasticity during embryonic development closely resembles neoplastic processes at the primary site as well as in (bone) metastasis. For instance, the tumour-stroma interactions occurring in the tissue of cancer origin, including epithelium-to-mesenchyme transition (EMT), bear similarities with the role of bone matrix-derived TGF-beta in skeletal metastasis formation.
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PMID:TGF-beta and BMP7 interactions in tumour progression and bone metastasis. 1800 74

Current clinical therapies for traumatic or chronic injuries involving osteochondral tissue result in temporary pain reduction and filling of the defect but with biomechanically inferior repair tissue. Tissue engineering of osteochondral repair tissue using autologous cells and bioactive biomaterials has the potential to overcome the current limitations and results in native-like repair tissue with good integration capabilities. For this reason, we applied two modem biomaterial design techniques, namely, electrospinning and fused deposition modeling (FDM), to produce bioactive poly(epsilon-caprolactone)/collagen (PCL/Col) type I and type II-PCL-tri-calcium phosphate (TCP)/Col composites for precursor cell-based osteochondral repair. The application of these two design techniques (electrospinning and FDM) allowed us to specifically produce the a suitable three-dimensional (3D) environment for the cells to grow into a particular tissue (cartilage and bone) in vitro prior to in vivo implantation. We hypothesize that our new designed biomaterials, seeded with autologous bone marrow-derived precursor cells, in combination with bioreactor-stimulated cell-culture techniques can be used to produce clinically relevant osteochondral repair tissue.
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PMID:Biomaterials/scaffolds. Design of bioactive, multiphasic PCL/collagen type I and type II-PCL-TCP/collagen composite scaffolds for functional tissue engineering of osteochondral repair tissue by using electrospinning and FDM techniques. 1808 5

A sharp intake of breath followed by a strong vocalisation is widely observed in response to acute pain although its function and mechanism is poorly understood. This study investigated the effect of percutaneous (overlying the tibial bone) electrical stimulation delivered early (20-30% of inspiratory time) during inspiration (INSP) or expiration (EXP) (20-30% of expiratory time) at sensory intensities at (100%), above (125%) and below (50% and 75%) the pre-determined pain threshold (PT), upon within-a-breath respiratory parameters (via pneumotachography). All INSP stimulation intensities provoked significant inspiratory time shortening thereby elevating mean inspiratory flow. Tidal volume, but not peak flow was increased in response to 100% PT and 125% PT stimulation (vs. PRE). Shortening and increased tidal volume combined to evoke significant mean inspiratory airflow increments. In contrast, EXP stimulation failed to evoke any effect. Thus, our study provides evidence of a within-a-breath inspiratory-specific, augmentory response to noxious stimulation.
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PMID:Electrical percutaneous tibial stimulation modulates within-a-breath respiratory drive in man. 1839 75

The fibrous dysplasia is a benign although progressive dysfunction, in which a gene mutation originates the production of fibrous disorganized bony matrix. The bony tissue is replaced by bony tissue in expansion (amorph conjuntival tissue) that produces bony deformities in some patients, pain, pathological fractures or deambulation disorders. The diagnosis is important since ocasionally the first symptom is the fracture. We show up the case of a 21 year-old patient with pain clinic in high cervical region. The complementary tests (radiology, bone scintigrraphy and MRI) and anatomo-pathology confirmed the diagnosis of polyostotic fibrous dysplasia with cranial (occipital, esfenoides and right frontal and temporal bone), iliac, femoral, tibial and cervical (apophysis of C2) affectation. Our attitude was of carrying out a narrow observation by means of periodical strict controls, advising to avoid hard activities or contact sports. To the five years the patient is free of symptomatology. Radiologically the injuries have been stabilized. The fibrous dysplasia can affect to a single bone (monostotic) or to several (polyostotic). In occasions it is associated to endocrine dysfunctions and skin pigmentations in McCune-Albright's syndrome. We confront a pathology that specifies an anatomo-pathologic diagnosis to be confirmed, an extension diagnosis to detect asymptomatic focuses and whose treatment is symptomatic in most of the cases only using surgery in frank deformities or when the fracture risk is considerable, although the recurrence is frequent. The malignization is exceptional but possible that's why continuous observation is needed. The radiation therapy is radically contraindicated.
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PMID:[Poliostotic fibrous dysplasia with affectation of cervical rachis]. 1877 Sep 37

Fortuitous combinations of anisotropic stiffness and permeability coefficients in a poroelastic structure (e.g. bone) result in counterintuitive flow when the structure is subjected to tension or compression. Nonlinearities in flow and transport result when loading is asymmetrical (tension and compression are not balanced over the course of a cycle), boundary conditions are asymmetrical (area available for inflow or outflow) or uptake of the transported agent is factored in (ratchet effect). These properties can be exploited for the development of flow directing materials, e.g. wound dressings that prevent development of stress concentrators while augmenting transport of pharmaceuticals to the wound site, as well as transport of drainage away from the wound site, via convective flow. The dressings are designed as carriers of pharmaceutical agents. Normally, the delivery of these agents is diffusion driven, e.g. as in nicotine, pain abatement, and hormone replacement therapy patches. However, by designing the structure of the pharmaceutical doped dressings to mimic the relationship between stiffness and permeability coefficients shown to produce counterintuitive flow in bone, it is possible to deliver the pharmaceuticals to the wound site and imbibe exudant from the wound in an accelerated fashion via convective transport. This unprecedented approach harnesses the mass and movement of the patient to provide the impetus for flow to and from the wound. It has a range of further applications in not only the medical sector but also the textile industry as well as in microfluidics.
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PMID:Bone as an inspiration for a novel class of mechanoactive materials. 1883 56

The aim of the research was to outline the normal sonoanatomy and improve achilles tendon pathology ultrasound diagnosis (Refinement of sonosemiotics) in order to optimize the diagnostic process and improve the treatment, to avoid the possible complications. 135 patients (age ranges from 15 to 70 years) underwent the radiological study of ankle joint posterior aspect. Pathology types: traumatic injuries--45%, inflammatory pathology--30% and degenerative-dystrophic diseases--25%. Unilateral pathology was diagnosed in 85%, bilateral--in 15% of cases. The diagnostic studies include: a) ultrasound, performed on digital ultrasound system using high frequency (7.5-12.0 MHz) linear probe with Doppler capability (all patients) b) X-Ray filming in antero-posterior and lateral projections (32 patients) and c) MRI - T1 and T2 weighted images in sagittal and transverse planes (5 patients). Ultrasound was successful in ankle joint posterior compartment pathology diagnosis in 132 cases (97.8%). It was ineffective in osseous pathology definition. Ultrasound failed defining pathology (posterior impingement-syndrome, due to the presence of triangular bone) in 3 cases (2.2%). In this cases MRI was helpful; it was also critical in differential diagnosis of massive partial tear and complete tear of the tendon. Ultrasound should be used as a Gold Standard when the patient presents with localized clinical symptoms (pain and swelling). Critical is the possibility of dynamic and Doppler studies in real-time. X-Ray should be used when the bony pathology is suspected and MRI should be considered if the pain is not localized exactly.
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PMID:[Normal sonoanatomy and ultrasound diagnosis of achilles tendon pathology]. 1964 7

Psoriatic arthritis (PsA) is a common form of inflammatory arthritis but is underdiagnosed. Psoriasis affects over 1.5% of the UK population. Around 15% of these patients will be diagnosed with PsA, but up to 40% may have evidence of arthritis if reviewed thoroughly. PsA can be difficult to diagnose as patients present with a variety of different patterns of arthritis. Most patients with PsA have relatively mild skin psoriasis, but some have more significant disease. Only 10-20% develop arthritis before their skin disease. Many patients have mild skin psoriasis that they are unaware of, or have not had diagnosed. Joint involvement is far more variable in PsA, compared with rheumatoid arthritis, and patients may present with: monoarthritis; oligoarthritis; involvement of the distal interphalangeal joints; a rheumatoid arthritis-like picture with multiple joints involved including the small joints in the hand or axial disease producing symptoms similar to ankylosing spondylitis. Features such as dactylitis (uniform sausage-like swelling of the whole digit either finger or toe) and enthesitis (inflammation at the sites of muscle or tendon attachment to bone) may also help diagnose PsA. Skin disease is present in the majority of patients although not all. Hidden areas for psoriasis include: behind the ears; at the top of the natal cleft and around the umbilicus. Larger joints, particularly the knees, can develop very big effusions causing obvious swelling. Areas to test for enthesitis should include the Achilles tendon, plantar fascia, costochondral joints and the elbow. Patients with suspected PsA should be referred promptly to a rheumatologist for further assessment and treatment. Diagnosis of PsA can be made on clinical grounds but blood tests and radiographs are performed routinely to aid diagnosis. Initial therapy for PsA should include NSAIDs to ease pain and stiffness. Local injections of corticosteroids are recommended for peripheral arthritis (given IA) and dactylitis (usually by injection into the flexor tendon or adjacent joints). DMARDs are routinely used to treat all aspects of psoriatic disease, except spinal disease, and prescribing should be initiated by a specialist.
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PMID:Improving recognition of psoriatic arthritis. 2012 Aug 27

Pressure algometry is widely used to assess deep tissue sensitivity. In this study the relation between pressure-induced pain in humans and stress/strain distribution within the deep tissue is evaluated. A three-dimensional finite-element computer model was used to describe the stress/strain distribution in tissues of the lower leg during pressure stimulation. The computer model was validated based on data recorded by computer-controlled pressure-induced muscle pain in eight subjects. An indentation of 7 mm was painful for all subjects and at this level data were extracted from each simulation. Simulations were performed with different stimulation sites (muscle, near-bone), probe diameters (5, 10, 15 mm), and probe designs (flat, rounded). The principal stress peaked in the skin and was reduced to about 10% in the underlying muscle tissue. The principal strain peaked in adipose tissue and was reduced in muscle tissue to 80% with the 15 mm probe and 66% with the 5mm probe. The large diameter probe evoked a strain peak in adipose tissue at 0.12 (flat probe) and 0.24 (rounded probe); in muscle tissue 0.10 and 0.20 respectively. The human pressure pain thresholds with the rounded probe were significantly lower compared with the flat probe (p<0.05). The results suggest that pressure-induced muscle pain is mainly related to muscle strain and most efficiently induced by large rounded probes, while smaller and flat ones mainly activate superficial structures. The relatively low stress in the deep tissue suggests that the mechanosensitivity of nociceptors in the deep tissue is lower compared with nociceptors in the superficial tissue.
Eur J Pain 2011 Jan
PMID:Pressure-induced muscle pain and tissue biomechanics: a computational and experimental study. 2059 7

Certain primary tumours including breast and prostate cancers have a particular propensity for metastasis to bone. Metastatic bone disease can have significant impact on morbidity and mortality of cancer patients. Skeletal-morbidity (spinal cord compression, hypercalcaemia, fracture, need for radiotherapy and surgery to bone) can be effectively reduced by bisphosphonates, a class of anti-resorptive drugs. They are also effective in relieving pain from bone metastases, and may improve survival in patients with accelerated bone resorption. Additionally, there is an exciting body of evidence that suggest these drugs may have anti-tumor effects that may be exploited to prevent or delay the development of bone metastases. Reported effects include inhibition of cancer cell migration, adhesion and invasion as well as anti-angiogenic and immunomodulating effects. The pre-clinical evidence is compelling, and some recently reported randomised clinical studies go part way to support their use in clinical practice at earlier stages of the disease to prevent bone metastases. However, further results are awaited before routine clinical use in the adjuvant setting can be recommended.
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PMID:Prevention and treatment of bone metastases. 2072 24

Between 1998 and 2007, a pronator quadratus pedicled bone graft was performed for 45 patients of ununited scaphoid fracture. One of them had bilateral ununited scaphoid fracture. There were 29 men and 16 women with a median age at operation of 24 (16-32) years. The affected side was the right side (dominant hand) in 32 patients whereas 13 patients had fracture of the nondominant left side. There had been 32 proximal pseudoarthrosis (through or proximal to the junction of the proximal and middle thirds of the bone) and 14 of the middle third of the scaphoid. The original fractures were caused by motor cycle accidents in 23 patients, falling on outstretched hand in 15 patients, and sport injuries in the remaining 7 patients. Surgery was indicated from 5 months to 6 years after injury (average 43 months) because of complaints of pain on heavy work. The fracture has been missed at the initial examination in 23 patients whereas cast immobilization was done for 6 weeks and 3 months in 15 and 7 cases, respectively, that had failed to result in union. There were no preoperative osteoarthritic changes, but in 25 cases, there were avascular necrosis of the proximal fragment of the scaphoid. Forty-three patients showed radiographic union after an average of 14 weeks (12-16 weeks). One patient had dislodgement of the graft and refused to do it again. The average range of movement of wrist improved after operation. Taken as a percentage of the normal range, dorsiflexion increased from 69% to 80%, palmar flexion from 66% to 76%, radial deviation from 45% to 70%, and ulnar deviation from 67% to 84%. Grip strength improved from 82% to 92% of normal. All the patients have been able to return to their former activities with no pain.
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PMID:Functional outcomes of nonunion scaphoid fracture treated by pronator quadratus pedicled bone graft. 2094 25


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