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

Fibromyalgia syndromes are common noninflammatory, painful musculoskeletal disorders that vary in the extent and intensity of involvement. The biologic gradient of musculoskeletal pain varies from no or few symptoms and tender points in the majority of persons to generalized fibromyalgia with multiple tender points. Standardized criteria are needed in order to categorize different strata of the biologic gradient of fibromyalgia syndromes and differentiate them from other conditions. Both the sensitivity and specificity of criteria should be high. The course and prognosis of fibromyalgia syndromes are not yet known. Limited clinical data suggest three basic patterns: remitting-intermittent; fluctuating-continuing; and progressive. However, course patterns need to be derived scientifically. Multiple host and environmental factors seem to contribute to the onset and course of fibromyalgia syndromes, and these require definition. Generalized fibromyalgia syndromes share many constitutional manifestations with other common functional disorders, e.g., irritable bowel syndrome and tension headache syndrome, which suggest common underlying psychoneurophysiologic mechanisms in a subset of patients. Progress made in fibromyalgia research will find application in many dysfunctional syndromes without obvious organ pathology.
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PMID:Concepts of illness in populations as applied to fibromyalgia syndromes. 353 80

A 41-year-old white man with a 2-year history of irritable bowel syndrome (IBS) was referred for psychological treatment. At the time of assessment he was being treated with Metamucil and Darvocet N-100s with little success. A detailed psychosocial assessment indicated several areas for cognitive-behavioral intervention. Nine months after the patient began treatment, the frequency of IBS episodes had greatly reduced, he was off narcotic pain medication, and his general health was improved as measured by clinic and emergency room visits. We suggest that psychological interventions of the type described here can be an efficacious and cost-effective treatment for IBS.
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PMID:Cognitive-behavioral intervention for irritable bowel syndrome. 355 10

Four patients with the irritable bowel syndrome completed 28 day continuous stool collections and concurrent symptom diaries. The diaries revealed that three patients had multiple pains. When the diaries were compared with objective measurements, no relationship could be detected between the occurrence of pain or any other symptom on the one hand and stool weight, stool form or consistency, mean whole gut transit time, or interdefecatory transit on the other. Patients' descriptions of urgency, looseness and frequency of defecation give little guide to intestinal events, at least using currently available techniques.
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PMID:Is there a relationship between symptoms of the irritable bowel syndrome and objective measurements of large bowel function? A longitudinal study. 355 87

We examined retrospectively premorbid factors that might relate to the development of irritable bowel syndrome (IBS). We administered a semistructural interview to adult IBS patients, adults with symptoms of IBS who had not visited a doctor (nonpatients), and asymptomatic normals. Patients with IBS differed from nonpatients by reporting more severe bowel problems, more frequent doctor visits in childhood, and more pain associated with current bowel symptoms. These factors may contribute to the tendency of people with bowel symptoms to seek medical care. More patients, and in most cases nonpatients with IBS, reported poorer general health and headaches, stomachaches, and bowel complaints during childhood. They also showed evidence for greater parental attention to illness with more frequent school absences and doctor visits than normal subjects. Loss and separation during childhood, and in the current family, and conflicted or dependent maternal relationships were also more frequently reported among patients and nonpatients. These factors may contribute to the development of IBS.
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PMID:Recollection of childhood events in adults with irritable bowel syndrome. 361 87

A low tolerance for pain has been postulated as a factor in the expression of symptoms in patients with irritable bowel syndrome. This has been based on previous work demonstrating reduced intestinal thresholds for rectal pain induced by balloon distention in patients with irritable bowel syndrome. As the disease may alter the rectal response to distention, inferences regarding pain perception and reporting behavior cannot be drawn from these data. In this study, using electrocutaneous stimulation, we found that patients with irritable bowel syndrome had pain reporting behavior comparable to patients with Crohn's disease. Both patient groups were less likely than normals to report a noxious stimulus as painful. This suggests that pain perception and reporting is attenuated in patients with chronic abdominal pain and, accordingly, a generalized reduction in the threshold for reporting pain is not a factor in the expression of symptoms in the irritable bowel syndrome.
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PMID:Patients with irritable bowel syndrome have greater pain tolerance than normal subjects. 362 19

So-called acalculous gallbladder disease is an ill-defined entity, mainly seen in young women, which could be due to a motility disorder of the biliary tract. Seven young women with relapsing pain in the right upper quadrant of the abdomen or in the epigastrium, with cholesterol crystals in the bile and with normal sonographic and radiologic findings as well as normal gastroscopy, were investigated by hepato-biliary scintigraphy with 99mTc-HIDA. This first group was compared with a second group of 6 young women suffering from irritable colon, and with a third group of 6 asymptomatic control subjects. The half emptying-time of the gallbladder after cholecystokinin injection was 104.36 +/- 43.93 minutes in the first group, 17.92 +/- 23.57 minutes in the second and 20.42 +/- 23.67 minutes in the third group (p less than 0.005). After 6 weeks of ursodeoxycholic acid treatment, regression of pain and a significant reduction in the half emptying-time from 104.36 +/- 43.93 to 74.35 +/- 52.79 minutes (p less than 0.01) was observed in the first group. These results, which need to be confirmed by further studies, show that in acalculous gallbladder disease there is a delay in gallbladder emptying which could explain the formation of cholesterol crystals by bile stasis as described by various authors.
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PMID:[Study of gallbladder emptying using 99m Tc-HIDA in acalculous cholecystopathy]. 367 67

Every physician managing patients with inflammatory bowel disease should be alert to the possibility of the development of hepatobiliary disorders, especially in patients with extensive colonic involvement. There is the question concerning type of follow-up study to be instituted in patients with IBD. Elevation of the level of serum alkaline phosphatase appears to be the most useful and consistent biochemical indicator of hepatic dysfunction (101). This should be estimated at six monthly intervals. A persistent elevation of the level of serum alkaline phosphatase or more overt clinical manifestations, such as pain in the right upper quadrant, hepatomegaly, obstructive jaundice or weight loss, would all indicate the need for further investigations. This would normally take the form of roentgenologic investigation of the biliary tree and biopsy of the liver. Once a patient with IBD has been diagnosed as having one or more hepatobiliary disorders, what is the appropriate management? Each instance should be treated individually according to the nature of the disorder. In general, most of these conditions are histologic abnormalities and are of little clinical importance. There is the question of whether or not there is a role for prophylactic colectomy. There has been conflicting evidence to both support and refute the rationale that colectomy will prevent the development of, or arrest, existing disease of the liver. In the view of the authors, based upon a large experience with the management of these patients, the indication for colectomy should be based upon the severity and extent of colonic disease and almost never upon the existence of associated hepatobiliary disorders.
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PMID:Hepatobiliary disorders in inflammatory bowel disease. 388 36

About five per cent of the adult population each year will see their doctor with complaints that are finally characterised as irritable bowel syndrome (IBS). The complaints are constipation (perhaps alternating with diarrhoea), abdominal pain (dull or colicky), abdominal distension, abdominal rumbling and flatulence. The diagnosis of IBS implies that a relevant examination has precluded any organic disease. The etiology is unknown and the syndrome probably does not represent a disease entity. It is therefore difficult, if not impossible, to produce a definite rationale of treatment. However, several aspects of the pathogenesis of the individual symptoms of IBS are well known: 1) chronic constipation is most likely due to fibre-depleted diet, psychological factors, local organic disorders (e.g., anal fissures, hemorrhoids, diverticulosis) and disturbance of the body fluid balance (e.g., high consumption of diuretic compounds such as coffee and tea); 2) pain is related to spasms and motility disturbances causing increased intraluminal pressure; 3) meteorism is not due to an increased amount of intestinal gas, but "air traps" and segmental accumulation of gas seem to occur. Furthermore, psychopathological factors and perhaps also food intolerance may play an etiological role. At present the rationale of treatment in IBS is: 1) management of constipation, 2) ease of spasms, 3) reduction of surface tension of intestinal contents, 4) ease of mental stress.
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PMID:Irritable bowel syndrome: current concepts and future trends. 389 85

The frequency of an abnormal duodenal loop (AD) was investigated in 36 patients with irritable bowel syndrome (IBS) and in a sex- and age-matched control group of patients with Crohn's disease. The frequency was significantly higher in the patients with IBS than in the control group (41% versus 18%; p less than 0.02). Among IBS patients with AD, the frequency of food-provoked pain was higher than in IBS patients with a normal duodenum (65% versus 21%; p less than 0.01). We conclude that AD may be one of the reasons for complaints in IBS.
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PMID:Abnormal duodenal loop in patients with irritable bowel syndrome. 395 53

We have studied 22 consecutive patients referred for investigation of severe chronic right upper quadrant pain. The majority were women whose symptoms had been present for many years. All had undergone repeated investigations of the pancreatico-biliary, gastro-intestinal, urinary, and even gynaecological systems without a satisfactory diagnosis. Most had undergone at least one abdominal operation in an unsuccessful attempt to cure their pain. In 21 of 22 patients the customary pain was completely and reproducibly mimicked by balloon distension of the small or large intestine in at least one site. The trigger sites were jejunum (15), ileum (12), right colon (nine), and duodenum (six). In 12 more than one trigger site was found. Close questioning revealed features of the irritable bowel syndrome in the majority and depression in many though the symptoms were not spontaneously volunteered. Reproduction of pain has provided a convincing demonstration to this difficult group of patients that they have a sensitive gut and allows appropriate management.
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PMID:Origin of chronic right upper quadrant pain. 401 43


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