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

Traumatic spinal cord injured (SCI) patients may develop pain, new weakness and/or sensory loss due to an enlarging fluid-filled cyst in the spinal cord. The clinical history and physical exam are nonspecific and insensitive, particularly for diagnosing and monitoring recurrent or progressive post-traumatic syringomyelia (PTS). We compare the sensitivity and specificity of three electrodiagnostic tests, median and ulnar F waves, electromagnetic motor evoked potentials (MEP), and needle electromyography, with respect to syrinx by imaging (MRI or CT scan) and neurologic progression on serial clinical exams. Central motor conduction time (CMCT) calculated from scalp and spine MEP was the most sensitive diagnostic test. F waves were less sensitive and less specific than the CMCT, and did not provide evidence of syrinxes in the mid or upper cervical cord. Positive sharp wave and fibrillation potentials were the least sensitive and least specific. The CMCT is a useful adjunct to imaging studies for diagnosing and monitoring PTS.
J Am Paraplegia Soc 1992 Apr
PMID:Electrophysiologic findings in post-traumatic syringomyelia: implications for clinical management. 158 2

We have had the opportunity to treat and follow up two young males with cauda equina syndromes after recurrent resection of intraspinal lipomas. This condition is relatively rare. The patients underwent myelographies, operations, long periods of hospitalisation, and rehabilitation. The syndromes included low back pain, arachnoiditis, and recurrence of the lipoma after several years and multiple operations. These are the problems that we were faced with: (1) Although the tumor is benign it is impossible to resect it completely. (2) There are complications which interfere with rehabilitation, including pain, arachnoiditis, and neurological deterioration. (3) Long term prognosis might be grave and the patient and family should know this. (4) Physiotherapy and sports: should these patients perform strenuous exercise or not?
Paraplegia 1992 May
PMID:Long term follow up of patients with cauda equina syndrome due to intraspinal lipoma. 159 79

Upper abdominal and thoracic surgeries require efficient pain management. The complications of postoperative analgesia include respiratory depression and--when choosing the epidural route--possible damage to the spinal cord by infection, trauma, or bleeding. Therefore, thoracic epidural analgesia may appear to be too risky and is frequently cancelled although many studies have shown its excellent efficacy. Controlled studies comparing thoracic epidural analgesia to lumbar epidural analgesia or intravenous analgetic regimens with special regard to the patient's outcome are contradictory. To make the preoperative decision on the method of pain control more rational, we studied catheter-related complications from 2056 thoracic epidural catheters used for intra- and postoperative analgesia retrospectively (n = 1002) and prospectively (n = 1054) over a 5 1/2-year period. In all patients the thoracic epidural catheter was inserted preoperatively using local anaesthesia, in most cases by the paramedian approach between level T 5/6 and T 8/9. During the clinical course of all patients there were no clinical signs of any epidural bleeding or infection. Neurological complications caused by the epidural catheter did not occur. Seven patients (0.035%) experienced radicular pain that disappeared after removal of the catheter or interruption of the puncture, respectively. A primary perforation of the dura mater was noticed in 0.5% of cases retrospectively and 1.23% prospectively. Respiratory depression following epidural application of 0.3 mg buprenorphine was seen in 1 patient (0.05%). Continuous analgesia with local anaesthetics and/or opioids applied epidurally by a thoracic catheter was performed on the peripheral ward (n = 829, 40%) if close monitoring of the neurological status as well as rapid diagnosis of any painful paraesthesia or paraplegia was possible.
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PMID:[The integration of thoracic epidural anesthesia into anesthesia for intra-abdominal surgery]. 161 16

Longitudinal data and clinical experience indicate that a greater proportion of spinal cord injuries result in incomplete or resolving neurological lesions. Although it has been reported that persons with incomplete injuries enjoy better functional outcomes, routine contacts with these individuals indicate that many experience problems and complications strikingly similar to those with complete spinal cord injuries. Thus, to document the issues and needs of these individuals, data from Colorado's population-based spinal cord injury surveillance program were analyzed. Of 330 persons registered since January 1, 1986, 121 (37%) were found to be minimally disabled (Frankel class D or E). Review of medical records and follow up documentation for these individuals indicated that although over 75% were ambulatory and virtually all were physically independent, more than 80% did report problems in one or more areas: 21% had orthopedic issues and 17% faced additional spinal surgery; 16% reported neurological deterioration or increased spasticity; 25% had pain problems; and 16% had bladder difficulties. Other issues included bowel problems, blood pressure abnormalities, skin breakdown, sexual difficulties, depression, and unemployability. Implications for rehabilitation are discussed in the light of these and other findings.
Paraplegia 1992 Apr
PMID:Health and psychosocial issues of individuals with incomplete and resolving spinal cord injuries. 162 99

During a brief period from March 1988 to January 1990 we were faced with 13 patients with malignant vertebral neoplasms (metastasis) of the thoracic spine. Nine of these had progressive extradural spinal cord compression with motor, sensory and sphincter involvement of varying degrees and duration. After proper evaluation these 9 cases were aggressively managed by preoperative embolisation of the tumour, transpedicular decompression and a same stage posterior metallic fixation. The immediate results were encouraging, with 2 patients showing total recovery and 3 showing partial recovery. All of the 9 operated cases were pain free postoperatively and could sit up unaided and be easily transferred to the Cancer Institute for back up chemotherapy and radiotherapy. They also improved psychologically, and cooperated well in their subsequent rehabilitation programme.
Paraplegia 1992 Apr
PMID:Preoperative embolisation, transpedicular decompression and posterior stabilisation for metastatic disease of the thoracic spine causing paraplegia. 162 1

A case of acute aortic dissection (AAD) presenting as sudden, transient paraplegia and severe back pain is reported. The patient was a 66-year-old male with a 10-year-history of hypertension. The pain characteristically migrated from the back to the neck and then returned to the back. He showed complete transverse myelopathy at the level of the 9th thoracic cord. Computed tomography disclosed internal displacement of aortic intimal calcifications, without abnormalities in the spinal canal, and myelography showed no spinal canal block or stenosis. Electrocardiography and chest x-ray indicated nonspecific changes of high amplitudes and mild cardiomegaly, respectively. Together, these findings suggested acute aortic dissection with spinal cord ischemia. The initial systolic blood pressure of 220 mmHg was lowered with medication, and the pain was controlled with morphine. He recovered fully and was discharged 80 days after the onset of symptoms, with no neurological deficits. AAD carries a very poor prognosis unless treated immediately. Therefore, it is very important to promptly differentiate this disorder from spinal vascular conditions that also produce back pain and paraparesis.
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PMID:Transient paraplegia caused by acute aortic dissection--case report. 169 75

In a double blind study, 21 patients with chronic spinal cord injury (SCI) pain underwent placement of a lumbar subarachnoid catheter and injection of placebo and lidocaine. The effects on pain intensity, distribution, altered sensations and sensory level of anaesthesia were monitored. Four patients responded briefly to placebo, while 13 demonstrated a mean reduction of pain intensity of 37.8 +/- 37% for a mean duration of 123.1 +/- 95.3 minutes in response to lidocaine. The pain response to subarachnoid lidocaine differed significantly (p less than 0.01) from placebo. Spinal anaesthesia was also associated with changes in pain distribution and altered sensation. A spinal anaesthetic-induced sensory level could not be achieved cephalad to the sensory level of neurological injury in 5 patients who presented with spinal canal obstruction. This study has demonstrated that response to diagnostic spinal anaesthesia in chronic SCI pain is complex, requiring individual interpretation in each patient and consideration of the following factors; symptomatology, etiology, pain perception, spinal canal anatomy, CSF chemistry and local anaesthetic pharmacology.
Paraplegia 1991 Jan
PMID:Diagnostic spinal anaesthesia in chronic spinal cord injury pain. 170 59

The purpose of this study was to determine the prevalence of upper extremity (UE) pain in outpatients with chronic spinal cord injury (SCI). A total of 239 SCI outpatients (136 with quadriplegia and 103 with paraplegia) were interviewed for the presence of UE pain at the shoulder, elbow, wrist, and hand. The average age of the subjects at the time of interview was 37.4 years, and the average time since onset was 12.1 years. Subjects who reported pain were referred to SCI clinics to determine the etiology. Fifty-five percent of the patients with quadriplegia reported UE pain, most commonly at the shoulder. Prevalence of reported pain was highest for subjects in the first five years postinjury. Sixty-four percent of patients with paraplegia reported UE pain. Complaints related to carpal tunnel syndrome were the most common, followed by those related to shoulder pain. This study documents the prevalence and nature of UE pain in chronic SCI patients and emphasizes the need for further research to develop strategies for prevention and treatment of pain syndromes.
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PMID:Upper extremity pain in the postrehabilitation spinal cord injured patient. 172 73

Chronic pain is a problem among patients with spinal cord injuries, but the psychosocial factors associated with spinal cord injury (SCI) pain are not well understood. To understand SCI pain further, 54 patients (19 with quadriplegia and 35 with paraplegia) completed the Beck Depression Inventory, State-Trait Anxiety Inventory, Profile of Mood States, Acceptance of Disability Scale and SCI Interference Scale. Forty-two patients stated they had SCI pain and completed the Multidimensional Pain Inventory and the Pain Experience Scale. Results revealed that anger and negative cognitions were associated with greater pain severity. Patients who reported pain in response to a general prompt experienced more severe pain than patients who reported pain only when directly questioned about the presence of pain, but these different reporting groups did not differ on emotional variables. Those who were less accepting of their disability reported greater pain severity. Additionally, patients who perceived a significant other expressing punishing responses (e.g., expressing anger at the patients or ignoring the patients) to their pain behaviors reported more severe pain. Level of lesion, completeness of injury, surgical fusion and/or instrumentation and veteran status were not associated with pain severity. Finally, pain was associated with emotional distress over and above the distress associated with the SCI itself. Overall, psychosocial factors, not physiological factors, were most closely associated with the experience of pain. Multidimensional aspects of pain are used to explain these findings and suggest that treatment should be directed at the emotional and cognitive sequelae of chronic SCI pain.
Pain 1991 Nov
PMID:Psychosocial factors in chronic spinal cord injury pain. 781

Spinal epidural hematoma is a rare clinical entity, and the literature provides reports of 29 cases so far in Japan. A case of spinal epidural hematoma associated with idiopathic thrombocytopenic purpura diagnosed by CT scan and MRI is reported in detail with references to the literature. A 56-year-old female was admitted to our hospital on April 22, 1990, because of sudden onset of nuchal pain and right hemiparesis. Her consciousness was alert, but the deep tendon reflex was depressed, and pathological reflex such as Babinski's reflex was positive on the right side. Nuchal stiffness was observed. CT scan of the head revealed no abnormality, but the scan of cervical area showed an abnormal high density area in the right posterior region of the spinal cord at C2 - 3 level. MRI also revealed a low intensity area in the same region both in T1 and T2 weighted images. On admission, the platelet count was 10,000/microliters, and the bone marrow aspirate showed abundant megakaryocytes. The patient was diagnosed as having spinal epidural hematoma associated with idiopathic thrombocytopenic purpura. The patient was initially treated with a corticosteroid and a hyperosmotic agent. About 15 hours after the onset, her motor function began improving. Conservative therapy was continued, and she could walk 2 weeks after the onset. Spinal epidural hematoma is an uncommon disease commencing with back and radicular pain, paraplegia and rectovesical insufficiency. Early diagnosis and surgical decompression is generally imperative, although an exceptional remission without operation such as was observed in this case may occur.
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PMID:[A case of spinal epidural hematoma associated with idiopathic thrombocytopenic purpura]. 176 46


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