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

Bilateral upper limb pain, isokinetic strength, grip strength, range of motion, and activities of daily living (ADL) performance were compared in 11 women with long term paraplegia and 11 activity-level matched able-bodied women of similar age, to determine whether long term wheelchair use is associated with pain and altered function in the upper extremities. The results suggest that the development of pain in the upper limbs is clearly associated with paraplegia in women (p less than 0.01). Pain was reported most frequently by the paraplegics in the shoulders and secondly in the wrists and hands. ADL where the paraplegics experienced pain most often were work/school, outdoor wheeling, household work/childcare, and loading the wheelchair to and from the car. Whilst paraplegics reported intermittent rather than constant pain, the groups' relatively young age (mean = 43 years) and average duration of injury of only 15 years suggests that preventative and management steps are required to ensure continued independence and quality of life of this group as they age.
Paraplegia 1991 Oct
PMID:The weight-bearing upper extremity in women with long term paraplegia. 177 58

In addition to the well known paraplegia or tetraplegia, lesions of the spinal cord frequently cause a series of disturbances of sensation in the segments around or distal to the lesion. Disturbances of sensation in spinal cord lesions are painful or non-painful. The painful and also the non-painful sensations may represent irritative and withdrawal phenomena. A series of central neurogenic pains seem to be best explained by spontaneous neuronal activity in sensory spinal cord neurones which have lost the peripheral, segmental and descending neuronal control from the nervous system. Surgical treatment of pain in cases of spinal cord lesions is rarely considered apart from root-avulsion where surgical lesion in the superficial part of the posterior horn is effective. No specific treatment is as yet available for pain and disturbances of sensation in cases of spinal cord injury. However, on the basis of our limited knowledge of the pathogenesis of these symptoms, future therapeutic strategy will be directed towards not only the peripheral but also the central points of attack. Treatment of painful conditions in patients with spinal cord injuries, as in other states of chronic pain, should also include social and psychological support.
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PMID:[Sensation disorders and pain in spinal cord lesions]. 177 78

A 47-year old female had a fever about 39 degrees C of unknown origin for 2 days. Soon she developed pain in the bilateral lower extremities followed by gait disturbance and vesicorectal disorder. Prednisolone was administered with an improvement. However, she developed paresthesia in the upper extremities 1 month later, and then gradually paraplegia another 5 month later. Nystagmus, painful tonic spasm, facial spasm, and visual disorder also appeared. These symptoms repeatedly exacerbated and remitted with administration of prednisolone. We examined this patient at age 53, CBC, blood chemistry, urinalysis, ECG and chest X-ray were normal. Serum IgG and IgA level were decreased. CSF protein content and IgG level were remarkably increased. EEG showed diffuse theta activities. MRI studies revealed high intensity signals in the putamen, deep frontal and periventricular white matter region. Pulse therapy of methylprednisolone was performed effectively for several times. She died of respiratory and heart failure 6 years after the onset. Autopsy revealed bilateral continuous cystic lesions along the lateral ventricles extending from the frontal tips of anterior horns to the occipital tips of posterior, and further, to the temporal tips of lateral horns; the caudate-callosal angeles (Wetterwinkel) were more severely and widely affected bilaterally. There were also old and fresh demyelinated lesions scattered in the cerebral white matter, brainstem, cerebellum, and spinal cord. Although this case is considered to have typical MS from clinical and pathological findings, there have been only a few reports of MS with such continuous cystic lesions in the cerebral hemispheres as seen in this case.
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PMID:[An autopsy case of multiple sclerosis with bilateral continuous cystic lesions along lateral ventricles and caudate-callosal angles (Wetterwinkel)]. 179 16

This is a review of the impact of spinal cord injury on female sexuality, which has received far less attention than male sexuality, and on menstruation, contraception and pregnancy, which have been reported more extensively. The few reports of sexuality in women after spinal cord injury suggests a wide range of adaptability, from 40% to 88% of the subjects achieving satisfactory sexual activity. Some women were able to adapt a positive body image and find new ways of stimulation to orgasm, despite altered body shape, bladder and bowel incontinence, spasticity, and lack of sensation often resulting from spinal injury. The pill, vaginal methods, and IUDs are not recommended, but condoms and possibly Norplant, are appropriate for these women. Menstruation, often ceasing for several months after injury, usually resumes. One study reported lack of menstrual pain, others did not. Many spinal injuries women have achieved 1 or more pregnancies. A few cases have been described of successful pregnancy when the injury occurred during gestation, as has 1 intrauterine death that was successfully delivered by induction. Premature cervical dilatation and labor and small-for-dates infants are more common than usual, but spontaneous abortion are not. Some of the typical problems in pregnancy are urinary tract infections, decubiti, anemia, pedal edema, weight transfer problems, thrombophlebitis, TIA episodes, and nausea. A more serious problem is management of labor, especially if the woman cannot perceive labor pains, or cannot bear down. Frequent check-ups and early hospitalization are recommended. A potentially fatal risk in those injured at T6 or above, is autonomic dysreflexia, stimulated by induction, labor, delivery, or even breast feeding. Autonomic dysreflexia can be treated with epidural anesthesia with lidocaine. Induction is contraindicated. Lactation may cease after 3 months or so because of lack of nipple stimulation.
J Am Paraplegia Soc 1991 Jul
PMID:The impact of spinal cord injury on female sexuality, menstruation and pregnancy: a review of the literature. 188 48

Diffuse, chronic, and dysesthetic pain following spinal cord injury (SCI) has been described by several authors under different terms. As illustrated by the two patients described here, central dysesthetic syndrome (CDS) can be mistaken for musculoskeletal, peripheral neuropathic or visceral disease in SCI patients. In these patients, an added clue to the central neuropathic nature of their symptoms was allesthesia and allodynia to light touch or tapping over areas rostral to the level of injury; this may be called the proximal tap or "central Tinel" sign.
J Am Paraplegia Soc 1991 Jul
PMID:The proximal tap or "central Tinel" sign in central dysesthetic syndrome after spinal cord injury. 188 51

The shoulder of the wheelchair dependent paraplegic is subject to overuse injury with subsequent pain. The major overuse syndromes observed include soft tissue injuries and secondary degenerative arthritis. This report presents a case in which bilateral osteonecrosis of the humeral heads was found to be the source of pain in the shoulders of an active paraplegic without any evidence of disease or medical treatment associated with the development of osteonecrosis. Osteonecrosis should be entertained in the differential diagnosis of overuse injuries of the shoulder in paraplegia.
Paraplegia 1991 Jul
PMID:Osteonecrosis: an overuse injury of the shoulder in paraplegia: case report. 189 22

The spontaneous spinal epidural haematoma (SSEH) is a rarity, but the severe and permanent motor disability underlines its importance. From 1957 seven cases of SSEH have been diagnosed and operated on in the National Institute of Neurosurgery, Budapest. These cases are analysed and discussed. The clinical picture began with local pain of the spine and radicular signs but some hours or days later paraparesis or paraplegia and incontinence developed. In the discussed cases the neurological deficit progressed to complete para- or tetraplegia in 5 cases. Only 2 patients had partial spinal transverse lesions on admission. All patients underwent myelography to detect the spinal space occupying lesion and were operated on soon. Three patients recovered completely, 2 remained partly and 2 totally paralysed. The outcome depended mainly on the timing of neurological deficiency. If the neurological signs existed less than 8 hours the patients recovered completely or fairly well while the prognosis was poor if the transverse lesion persisted longer than 24 hours. The authors stress the importance of correct and fast decisions at the first medical examination for the outcome of this disease, because only immediate transfer to a neurosurgical department gives a chance of good recovery.
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PMID:Spontaneous spinal epidural haematomas. 192 22

In early 1989, the Research Committee of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) established a subcommittee to develop methods to monitor academic progress in physical medicine and rehabilitation (PM&R) units in the US. To develop an indirect baseline of academic productivity in PM&R, the rates and types of publications by PM&R researchers were assessed in eight peer review medical journals. The journals selected consisted of all issues of the following (published in calendar years 1987 to 1989): Archives of Physical Medicine and Rehabilitation, American Journal of Physical Medicine and Rehabilitation, Physical Therapy, Archives of Neurology, Pain, Stroke, Paraplegia, and Arthritis & Rheumatism. The sampling frame consisted of 3,553 journal articles. Affiliation with a PM&R unit or other clinical science unit (other unit), extramural funding sources, and type of manuscript (eg, case report or scientific investigation) were identified and coded. Sixteen percent of all articles were authored by members of PM&R units. The prevalence of scientific reports written by other unit authors (71%) was comparable to that written by PM&R authors (67%) (chi 2[3] = 5.54; p less than .20). There was a greater prevalence of funding by the US Department of Education of studies written by PM&R authors (10%) than of studies written by members of other units (2%) (chi 2[1] = 79.4; p less than .0001). Reports authored by members of other units had a greater prevalence rate of funding from all other sources--federal and private (47% vs 33%; chi 2[1] = 41.2; p less than .0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Elements of academic productivity: a comparison of PM&R units versus other clinical science units. 192 3

In a two year period eight patients have presented with acute aortic occlusion and a poor outcome in seven. Initial failure to diagnose aortic occlusion, with a mean delay from presentation to diagnosis of 24 hours, was mainly responsible. All patients had varying degrees of paralysis on presentation which misled clinicians although other findings of acute ischaemia (pain, absent pulses, colour change and anaesthesia) were always present. Two patients were initially referred to a neurologist, another to a neurosurgeon, and the fourth to an orthopaedic surgeon. Even after diagnosis had been established, the need for urgent revascularization was not always recognized, the mean time from diagnosis to revascularization being 13 hours. Unnecessary aortography contributed to this delay in four patients. In two patients operative treatment was not undertaken while six were treated operatively by: aortic bifurcation graft (3), aortic thromboendarterectomy and femoropopliteal bypass (1), open aortic embolectomy (1) and bilateral femoral embolectomy (1). The causes of aortic occlusion were thrombosis of an atherosclerotic aorta (5), thrombosis of an aneurysm (2) and embolism (1). In the latter patient, the heparin induced thrombocytopenia syndrome (HITS) was primarily responsible. The outcomes in the eight patients were death (5), paraplegia (1), amputation (1), and uncomplicated recovery (1). The single patient who made an uncomplicated recovery had the shortest delay from presentation to revascularization of only 2 1/4 hours. Acute aortic occlusion rivals aortic rupture as a vascular emergency and demands immediate operative intervention.
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PMID:Acute aortic occlusion presenting with lower limb paralysis. 193 28

The intraspinal administration of morphine has been employed increasingly in the management of intractable pain of malignant as well as benign origin. We have encountered a previously unreported clinical complication: spinal cord compression by an inflammatory tissue mass surrounding a subarachnoid infusion catheter administering morphine, leading to paraplegia. The patient was referred to our institution after catheter and pump implantation for chronic, intractable pain associated with pre-existing lumbar arachnoid fibrosis, after multiple myelograms and surgeries. The patient may, therefore, have had an underlying propensity to foreign body reactions. We have encountered a similar phenomenon, however, in a canine laboratory model. The pathological features in both our patient and our laboratory preparation, with inflammatory tissue masses around the tip of the catheter but not around proximal subarachnoid segments, suggest an effect related to infusion, as opposed to infection or the presence of the catheter. We review the pathological features in both settings and the pertinent literature.
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PMID:Spinal cord compression complicating subarachnoid infusion of morphine: case report and laboratory experience. 196 14


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