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

Thalamic EEG recordings were made in 10 patients; the therapeutic goal of the implantation was the electrical stimulation treatment for pain. The patients' ages ranged from 37 to 72 years; seven patients had thalamic pain (Dejerine-Roussy syndrome), two had chronic spinal arachnoiditis and one had facial anaesthesia dolorosa. Platinum-iridium electrodes were stereotaxically inserted; the ventrobasal complex of the thalamus including the ventral posterior zone was the target of the implant. Excessive thalamic slowing was found in four of seven patients with Dejerine-Roussy syndrome and also in two of three cases with other causes of pain. One patient had marked rhythmical intermittent delta activity in the thalamus which was often triggered by arousing stimuli. Thalamic spindle activity was sometimes noted without concomitant spindle activity on the scalp and would occasionally occur in states of early drowsiness.
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PMID:Thalamic EEG recordings in patients with chronic pain. 8 Dec 84

Intramedullary or subarachnoid injections of alumina cream were made in the lumbar region of 38 adult cats. The animals were observed for 3 to 12 months and then subjected to acute neurophysiologic and histologic analysis. Neuronal hyperactivity in the dorsal horns was reliably produced by either subarachnoid or intramedullary alumina; behavioral abnormalities were not produced unless some of the alumina was present adjacent to dorsal root fibers in the subarachnoid space. Neuronal hyperactivity does not predict cutaneous hyperesthesia or motor abnormality; alumina produces scarring in the subarachnoid space and probably causes pain by making the dorsal root fibers mechanosensitive. Subarachnoid alumina may be a good model for human arachnoiditis.
Pain 1978 Oct
PMID:Intraspinal alumina injection: the relationship between epileptiform focus, root scarring and chronic pain. 10 60

Transcutaneous electrical stimulation appears to be a valid technique for the treatment of many pain states. Its use in chronic pain is limited and it appears to be much more likely to be effective in the relief of acute painful states. Nevertheless, since it provides a simple way to treat a significant number of patients whose pain would otherwise by intractable, it has been a valuable addition to the armamentarium of the physician dealing with chronic pain. Peripheral nerve stimulation is an excellent way to relieve pain of peripheral nerve injury origin and certain painful, poorly understood, vasopastic or reflex sympathetic states. Spinal cord stimulation has been revived by the advent of percutaneous stimulators. The technique is currently the best available for the treatment of the patient suffering from the chronic low back syndrome with severe arachnoiditis, for whom no definitive therapy is available. Brain stimulation has been relegated to therapy for pain of central nervous system origin. It is a most promising technique though its application appears to be limited at this point to a few specific problems. The seriousness of potential complications has kept it from being widely applicable to date. There is little information concerning the mechanism whereby these various techniques are effective. Transcutaneous and peripheral nerve stimulation might have their effect through peripheral mechanisms or through a gating mechanism in the posterior horn (Melzack and Wall 1965; Campbell and Taub 1973). Spinal cord stimulation could act through a retrograde effect upon a dorsal horn gate or have more central actions. Brain stimulation in the opiate receptor system may be effective through activation of this system. The mechanisms of action of stimulation in the sensory system centrally are certainly not well understood (Bloedel 1974).
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PMID:Electrical stimulation of the nervous system for pain control. 31 90

Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Hashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post-traumatic and postamputation neuroma. Long term follow-up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.
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PMID:Spinal epidural neurostimulation for treatment of acute and chronic intractable pain: initial and long term results. 31 23

From a series of 681 patients with lumbar disc disease treated between 1966 and 1978, 17 patients required surgical lysis of lumbar adhesive arachnoiditis, 8 having initially been operated upon by another surgeon. All patients had severe pain as a predominant feature, with pain being bilateral in 9 patients. Pain was the only major symptom in 3; the other 14 exhibited varying combinations of progressive neurological dysfunction. Three patients developed late symptoms after trauma, 8 to 21 years after back surgery. At operation, multisegmental arachnoiditis was found in 5 patients and anular or subtotal adhesions were found in 12. Complete lysis could not be obtained in 4 patients. Fourteen patients were treated with steroids at the time of operation. Follow-up after lysis was less than 1 year for 5 patients but averaged 4.8 years for the remaining 12. During the 1st year after operation, 76% experienced improvement in pain (35%, good to excellent), 71% experienced improvement in neurological status. Follow-up after at least 1 year revealed 50% still enjoying pain relief (25%, good to excellent) and 45% experiencing neurological improvement. Pain relief persisted in 4 of 5 patients followed 5 years or more. The etiological role of myelograpy and lumbar disc surgery in arachnoiditis has probably been over-rated. Arachnoiditis may be symptomatic or asymptomatic and may mask other, treatable lumbar lesions. More frequent intradural exploration for discrepancies between operative and myelographic findings might reveal, and benefit, more cases of spontaneous arachnoiditis mimicking lumbar disc disease.
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PMID:Results of surgical lysis of lumbar adhesive arachnoiditis. 46 May 67

A series of 93 consecutive patients whose myelograms were reported as showing arachnoiditis were studied, and correlations between the radiographic appearance and the clinical and surgical findings were tabulated. All but 1 patient had had either lumbar disc surgery and/or Pantopaque myelography. The study led to a classification of such roentgenogram changes which revealed that the majority of patients studied did not have the usual adhesive arachnoiditis, but the picture they projected was more commonly due to spinal stenosis, extraarachnoid dye injection, extradural scar, etc. Only 1 patient of the 93 presented the classic severely disabling paraparesis, intractable pain, and loss of bowel and bladder functions commonly ascribed to adhesive arachnoiditis. The presence of such myelographic changes need not deter necessary surgery for coexisting disc pathology, nerve root entrapment, or spinal stenosis. In only a small percentage of these patients could the symptoms be attributed to the arachnoiditis changes seen in the myelogram.
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PMID:Cauda equina arachnoiditis. A correlative clinical and roentgenologic study. 64 93

Chronic lumbar radiculopathy following spinal surgery is reported, in which 7 of 25 patients reviewed developed a postoperative syndrome immediately after their original surgery. Later, sometimes years later, all 7 patients developed severe chronic spinal arachnoiditis. This syndrome was characterized by transient violent spasms in the legs, muscle cramps, increased radicular pain, and often fever and chills. The recognition of this syndrome and a proposed method of treatment is discussed.
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PMID:Chronic spinal arachnoiditis. A postoperative syndrome that may signal its onset. 64 96

In Thailand there are 3 parasites that commonly cause neurological diseases in man. 1) In gnathostomiasis man becomes an accidental host by eating infected under-cooked fresh water fish. The tissue nematode involved, Gnathostoma spinigerum, because of its high motility, may cause widespread damage in the spinal cord and brain stem. The common presenting neurological symptoms are severe nerve root pain, paralysis of limbs and urinary retention. Less frequently seen are cranial nerve palsies and symptoms of subarachnoid haemorrhage. The disease has significant morbidity and mortality. 2) Eosinophilic meningitis caused by Angiostrongylus cantonensis, the lungworm of rats, has a more benign, self limiting course. It occurs in Thai people of lower socio-economic groups who acquire the parasite by eating infected raw Pila snails. 3) Cysticercus cellulosae, caused by Taenia solium, commonly results in epilepsy, and sometimes increased intracranial pressure from intraventricular obstruction or from basal arachnoiditis. Spinal cord and cauda equina involvement occurs much less frequently. Cysticercus complement fixation tests on the CSF and computerised axial tomography have been found to be of great diagnostic value.
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PMID:Parasitic diseases of the nervous system in Thailand. 75 25

For fifty-five patients with acute low-back pain or radicular pain, ascending lumbar venography was as accurate as myelography (86 per cent) in localized herniation of a lumbar disc in surgically proved cases. Myelography and lumbar venography are complementary diagnostic studies which should be used together in doubtful cases. Lumbar venography is easily performed is well-tolerated, and is relatively painless. It is not associated with arachnoiditis and has a negligible complication rate.
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PMID:Ascending lumbar venography in lumbar-disc disease. 84 98

The effect of commissural myelotomy in 24 cases with intractable pain is described. The operative technique employed with the operating microscope or magnifying glasses and a special myelotome is outlined. The results suggest an outstanding advantage in patients with bilateral metastases from malignancies except intrapelvic metastases. Patients with lumbar arachnoiditis showed a total failure of pain relief after 2 to 5 years, in spite of good relief temporarily.
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PMID:Commissural myelotomy. 86 94


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