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

Psychological, neurophysiological and therapeutic aspects of chronic pain are reviewed in the light of recent progress achieved in the respective fields (alpha-feedback training; gate-control theory; transcutaneous electrostimulation; percutaneous stereoactic radio-frequency cordotomy). The efficacy of selective large fibre stimulation has been evaluated in 39 spinal cord injury patients suffering from chronic intractable pain of 6 to 35 months's duration. Stimulation was applied daily for 6 consecutive hours. Pain reflief was assessed by verbal and visual analogue scales and McGill's pain questionaire. After 1 week, total or almost total relief of pain was reported by 49 per cent, moderate relief by 41 per cent and no improvement by 10 per cent of the cases; at a 3-months follow-up the figures were 28 per cent, 49 per cent and 23 per cent respectively.
Paraplegia 1978 Feb
PMID:Psychological, neurophysiological and therapeutic aspects of chronic pain: preliminary results with transcutaneous electrical stimulation [proceeedings]. 30 20

A drug combination was used against sub-lesional pain with some good results. Transcutaneous stimulation was used in three cases of pain in the roots without result.
Paraplegia 1978 Feb
PMID:Two therapeutic experiments on stubborn pain in spinal cord lesions: coupling melitracen-flupenthixol and the transcutaneous nerve stimulation [proceedings]. 30 21

Extinction and synesthesia were studied in 50 patients with spinal cord injury with various levels and extents. Extinction was found in 20 (40 per cent) and synesthesia in 6 (12 per cent) of the 40 males and 10 females. No correlations were found between either of the two phenomena and parameters of patient's age, lesion's age, lesion's level and extent, or accompanying head injury. The latter occurred in 22/50 patients (44 per cent), diagnosed by a history of amnesia. Extinction was tested by synchronous double stimulation unilaterally and bilaterally, symmetrically and asymmetrically. It was more frequent unilaterally than bilaterally. The modalities of superficial sensibility were prone to be extinct but those of deep sensibility (pallesthesia from bone conduction and kinesthesia) were not. Extinction of tactile responses did not imply that all other skin modalities (pain, temperature, pressure, skin pallesthesia) will also be extinct in an all or nothing fashion. Modalities could become extinct either singly or in combination. Extinction in spinal man was presumed to be caused by a reduction of perception in hypesthetic areas and was of diagnostic value insofar as its segmental distribution suggested the longitudinal extent of a cord lesion. This concept is in accord with the results of monkey experiments by Eidelberg and Schwartz (1971). Synesthia in spinal man is not identical with synchiria of the monkey. It is not in a reciprocal relationship with extinction and both phonemena co-existed in four of the six patients. Synesthesia is elicited by a stimulus delivered to the normesthetic skin above the level of the lesion with two responses: one well localised at the site of stimulation and the other unilaterally or bilaterally in anaesthetic parts of the body. Five of the six patients reported volitional phantom movements of somatic (toes) and/or visceral (micturition-defaecation) structures. Such sensations are elicited by remembering the engrams of pre-traumatic experiences in areas of the body image connected with motor function. Synesthesia could be understood as a sensory counterpart in areas of the body image when ascending impules of actual perception are mixed with impulses modulated at the artifical synapse of the rostral cord stump creating a phantom sensation.
Paraplegia 1979 May
PMID:Extinction and synesthesia in patients with spinal cord injuries. 49 48

A diagnosis of vertebral multiple myeloma, based on radiographic evidence of osteolytic lesions and the finding of monoclonal paraprotein and large numbers of plasma cells in bone marrow biopsies, was made in a mature Doberman Pinscher. The abnormal serum paraprotein was a cryoglobulin of the immunoglobulin A class. Neurologic signs associated with the tumor included pain, progressive pelvic limb paresis, and paraplegia that developed during a 6-week period.
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PMID:Neurologic complications of IgA multiple myeloma associated with cryoglobulinemia in a dog. 51 33

An experiment using a dummy with a cervical traction recorder was used in place of a patient. Nurses and orderlies from the Spinal Unit carried out manual lifting and turning techniques, used in the conservative treatment of spinal injury. Variation in manual traction continues throughout a turn. Traction force may be quadrupled or quartered. Inco-ordination between the individuals lifting, causes bending forces in the neck. This, together with sharp variation in traction, elicits pain. Manual traction, lifting, and turning, should be totally avoided, by employing kinetic nursing, provided by the use of the Roto Rest Spinal Bed.
Paraplegia 1978 Feb
PMID:Pain and cervical traction variation during manual turning [proceedings]. 62 35

The authors have reviewed 35 cases in the literature and reported on 12 cases seen personally of late onset syringomyelia in paraplegics. Initial pain was found to be present in only slightly more than half the cases and an insidious onset particularly with sensory disturbance led sometimes to delayed recognition. In the fully developed case, it can closely simulate idiopathic syringomyelia with arthropathy but impairment of touch and proprioception sometimes occurs in addition. Neurosurgical treatment to the fluid-filled cavity, does not seem to modify obviously the spontaneous evolution of the condition. In 5 cases, the paraplegia was not of traumatic origin. Possible mechanisms are discussed.
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PMID:[Late syringomyelic syndromes in paraplegics]. 89 41

A retrospective series of 12,478 patients with breast cancer included 2467 patients with spinal metastases. Local treatment was not necessary in 688 patients. Neurological dificit did not develop in 1735 patients who underwent radiotherapy. Forty-four patients developed myelopathy due to spinal cord compression as demonstrated by neurological examination and myelography. Twenty-six of these patients were initially treated by laminectomy and 18 were initially treated with radiotherapy. The two groups did not significantly differ in their outcome with respect to motor power, pain relief, or ability to walk. Six patients who underwent radiotherapy deteriorated during 2 months of treatment. Four of these patients were not operative candidates because of poor general condition (three patients) or long duration of paraplegia (one patient). Of two patients who underwent emergency laminectomy, one became paraplegic; however, the other patient was significantly improved. For this reason it is essential that patients undergoing radiotherapy for spinal cord compression be followed closely by a neurosurgeon. The authors believe that in appropriate cases radiotherapy alone can yield results as good as laminectomy combined with radiotherapy.
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PMID:Indications for nonoperative treatment of spinal cord compression due to breast cancer. 90 30

Sudden, often severe pain in the spinal region that is followed-sometimes within minutes-by paraplegia may signal spontaneous spinal epidural hematoma. This is a true surgical emergency calling for immediate laminectomy. Otherwise, the neurologic deficit becomes irreversible and the patient probably will die. The cause may be a fall or straining but in most cases there's no history of trauma. A myelogram reveals a block at the level of the hematoma, usually in the thoracic region or in the cervicothoracic or thoracolumbar area. Manometric tests shouldn't be done because they can increase the neurologic deficit. Urinary retention and sensitivity to pinprick at the level of the hematoma are additional diagnostic clues. The case reported here and 13 others from the literature point up the importance of prompt surgical treatment. Eight of the 12 patients who had laminectomy improved and five of them recovered completly, but both of the patients who were not treated surgically died.
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PMID:Recognizing spontaneous spinal epidural hematoma. 95 21

The case of a patient suffering from acute lumbosciatic pain, flaccid paraplegia, bladder retention and subarachnoid hemorrage, is reported. The patient underwent operation for a large ependymoma of the filum terminale. The author underlines the rare association of a spinal cord tumour and subarachnoid hemorrage and the opportunity of a routine mielo-radiculographic examination in case of lumbo-sciatic pain requiring surgical intervention: the patient, in fact, had been operated for "lumbar disc prolapse", in an orthopaedic department, four years before.
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PMID:[Subarachnoid haemorrhage from an ependymoma of the filum terminale. (author's transl)]. 102 41

The authors -- about a series of 124 cancerous patients treated during the 12 last years with open spino-thalamic cordotomy for intractable pain -- have tried to evaluate effectiveness of the operation with regard to its levels in relation to the site of pain. Patients suffering median or bilateral perineo-pelvic pain, isolated or associated with algias in one or both legs (group I: 50%) underwent a bilateral C8-C6 cordotomy in one stage. Patients with the same perineo-pelvic cancers but suffering only unilateral pain (group II : 31,8%) and patients with painful cancers in the leg (group III : 3,2%), were operated on with a C7 controlateral cordotomy. Patients suffering widespread unilateral pain in the chest, isolated or associated with algias in the arm, for instance from lung or breast cancers (group IV : 15%) underwent a controlateral C2 cordotomy. There was 3,2% mortality and one paraplegia. A useful early effect(i.e. complete or partial relief) was obtained : in 85% cases (60% and 25%) for the 1st group, in only 51% (36% and 15%) for the 2nd, and in 87% (56% and 31%) for the 4th. Relief was complete in each of the 4 cases of the 3rd group. In the 2nd group 39% of patients were completely relieved of their initial unilateral pain, but complained of an early post-operative pain on the other side. This secondary pain was supposed existing prior to the operation, but masked because of its lesser intensity. The useful results at the time of death, after a 6 month mean survival (from 1 month to 4 years), were 63,75% in the 1st group, 33% in the 2nd, 100% in the 3rd and 72% in the 4th. The high rate of poor results with unilateral cervical cordotomy in the perineo-pelvic cancers with apparently unilateral pain, led us since then to systematically perform for them a bilateral cordotomy. Thus, our general management for pain of malignant origin is now as follows: C8-C6 bilateral cordotomy for all the perineo-pelvic cancers whatever uni- or bilateral the site of pain may be; C7 controlateral cordotomy for the painful cancers of the leg; and C2 controlateral cordotomy for hemithoracic and/or arm pain, when related to very extended lung or breast cancers. We prefer complete posterior rhizotomy for limited cancers of the thoracic wall, and selective posterior rhizotomy through the scope, from -- the brachial plexus roots down to T4 -- for pain as from the PANCOAST-TOBIAS syndromes, or in case of painful involvements of the upper limb roots. For cervico-facial cancers we generally use combined sections of the sensory cranial nerves in the posterior fossa and of the cervical posterior roots.
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PMID:[Spino-thalamic cordotomy in cancerous pain. Results of a series of 124 patients operated on by the direct posterior approach]. 107 Nov 36


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