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

Spinal cord injury (SCI) can cause paralysis; sensory impairment; autonomic nervous system dysfunction; and bowel, bladder, and sexual dysfunction. These impairments may lead to immobility, physical dependence, and alterations in lifestyle and self-esteem. The addition of chronic, intractable pain to these impairments can be truly devastating. Chronic pain superimposed on spinal cord injury can virtually drain the individual of strength, motivation, and will. For the spinal cord injury survivor who already faces functional loss, severe pain can further restrict even the diversional activities that are available. Thus, it may become impossible for the individual to escape his or her pain even temporarily. The various medical, physical, and surgical treatments considered to be efficacious in treating this pain are reviewed. However, although chronic pain in SCI may be managed by these therapies, a permanent cure may not result.
Clin J Pain 1992 Jun
PMID:Clinical management of chronic pain in spinal cord injury. 163 73

Somatic symptoms are one of the leading reasons for medical outpatient clinic visits, with the most common symptoms having a prevalence of 10% or more. However, the usual diagnostic workups are often unproductive, with less than 1 in 5 symptoms having an organic explanation after the initial physical examination and laboratory testing. Therapy appears more effective for some symptoms than for others. Of patients with unspecified pain or gastrointestinal complaints, greater than 70% state that some type of treatment has been helpful, whereas less than 50% of individuals with fatigue, dizziness, numbness, insomnia, sexual dysfunction, anxiety, or depression report any relief. Future educational efforts and research need to focus on that majority of symptoms that are either psychiatric or unexplained, in order to improve our current evaluation and management strategies.
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PMID:Symptoms in medical patients: an untended field. 173 31

To ensure good exposure of operative field and to reduce the complications of low anterior resection of rectal carcinoma with transpubic approach, we modified Ackerman's method and operated on 18 patients with middle and lower rectal carcinoma at the level of 4-8 cm above the anus. 1cm width of the inferior part of the pubic symphysis was preserved. Results were compared with 19 patients operated on in the original way. Dissection of the arcuate ligament, penis suspensory ligament and penis nerve under the lower pubic margin was avoided, so that cyanosis of the penis, perineum and occurrence of sexual dysfunction were reduced, and the period of postoperative pain was shortened. 89% of patients operated in this way enjoyed good defecating function. We suggest that this procedure is indicated in all patients with rectal carcinoma located 4-7 cm above the anus with the exception of mucinous carcinoma.
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PMID:[Modified super anterior resection of rectal carcinoma with transpubic approach]. 181 54

Many patients with cancer enjoy long-term survival and are cured; others may live for extended periods while receiving specific treatment for cancer. This has been accomplished with increasingly complex and multimodal therapy, along with heightened toxicity and longer treatment. Cancer has become a chronic disease for many patients. Contemporary cancer rehabilitation provides a coordinated approach that addresses the physical, psychosocial, vocational, and economic concerns of the patient. Key components of a cancer rehabilitation program should include initial needs assessment with periodic reassessments, direct provision of specific interventions, and referrals to appropriate community resources. Almost all patients with cancer can benefit from a rehabilitation assessment and intervention. Important rehabilitation issues include the physical toxicity of treatment, psychosocial concerns, sexual dysfunction, diet and nutritional concerns, pain management, and vocational and economic problems. Patient groups with unique rehabilitation problems include patients with head and neck cancer or breast cancer, and patients who have undergone osteotomies or amputations. Long-term cancer survivors also have special rehabilitation needs that relate to the delayed effects of treatment on normal tissues, gonadal dysfunction, second neoplasms, employment discrimination, and difficulties obtaining health and life insurance coverage. Rehabilitation assessment and intervention should be incorporated into the routine health care of patients with cancer.
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PMID:Current issues in cancer rehabilitation. 210 32

A retrospective review of 64 rectocele repairs done over a four-year period was performed. The most common indication for repair was constipation. Thirty-five patients were repaired transanally, and 29 were repaired transvaginally. The overall morbidity was 34 percent, and the overall mortality was 0 percent. The most common complication was urinary retention in 12.5 percent. There was no difference in complications between techniques. Of 46 patients contacted for follow-up, 25 (54 percent) still complained of constipation, 17 (34 percent) had partial incontinence, 8 (17 percent) noted persistent rectal pain, 15 (32 percent) mentioned occasional rectal bleeding, and 10 (22 percent) complained of vaginal tightness or sexual dysfunction. Thirty-seven (80 percent) patients stated that they had improved after surgery. Except for persistent rectal pain, there was no difference in results between transanal and transvaginal repairs. Those undergoing transvaginal repair had a much greater problem with pain. Our relatively poor results may be due to an unselective approach to rectocele repair. The presence of both constipation and a rectocele does not imply an association, and a complete anorectal physiologic examination should precede repair. There is no functional difference between transvaginal and transanal rectocele repair.
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PMID:Rectocele repair. Four years' experience. 237 25

Common symptoms account for substantial patient disability and health services utilization. To determine the prevalence of 15 symptoms and the adequacy of therapy, 500 medical outpatients were surveyed. The 410 respondents indicated which symptoms were "major problems" and what therapy, if any, had been helpful. Each symptom was present in at least 10% of patients, with the most prevalent symptoms being fatigue (33%) and back pain (32%). Patients were clustered into three groups: (1) 140 were asymptomatic or monosymptomatic, (2) 135 reported 2 or 3 symptoms, and (3) 135 had 4 or more symptoms. The majority (77%) of these symptoms had been previously reported to a physician. Whereas 80% of patients with pain syndromes and gastrointestinal complaints had obtained some therapeutic benefit, only 39% of the individuals with fatigue, dyspnea, dizziness, insomnia, sexual dysfunction, depression, and anxiety reported any relief. Better therapy is needed for these common outpatient complaints.
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PMID:The prevalence of symptoms in medical outpatients and the adequacy of therapy. 1132 37

The incidence and etiology of sexual difficulties for women with survivable cancer were studied. Women with early stage gynecologic cancer (n = 47) were assessed after their diagnosis but prior to treatment and then reassessed at 4, 8, and 12 months posttreatment. Sexual and medical outcomes were compared with data from members of two matched comparison groups who were also assessed longitudinally: women diagnosed and treated for benign gynecologic disease (n = 18) and gynecologically healthy women (n = 57). Global sexual behavior disruption did not occur, but the frequency of intercourse declined for women treated for disease, whether malignant or benign. In relation to the sexual response cycle, diminution of sexual excitement is pronounced for women with disease; however, this difficulty is more severe and distressing for women with cancer, possibly due to significant coital and postcoital pain, premature menopause, treatment side effects, or a combination. Changes in desire, orgasm, and resolution phases of the sexual response cycle may also occur, but they are of lesser magnitude or duration or both. Approximately 30% of the women treated for cancer were diagnosed with a sexual dysfunction. The nature, early timing, and maintenance of sexual functioning morbidity suggest the instrumental role that cancer and cancer treatments play in these deficits (particularly arousal problems) and suggest that preventive therapies are necessary.
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PMID:Controlled prospective longitudinal study of women with cancer: I. Sexual functioning outcomes. 260 Feb 38

The object of the study was to investigate the frequency of physiological sexual dysfunction in a population of men with spinal cord injury (SCI). A questionnaire-based survey of admissions during 1980-84 was undertaken at a regional spinal cord injury rehabilitation unit. Male patients aged 20-63 years with complete or incomplete tetraplegia or paraplegia living in their own homes were included in the study; 43 complied with inclusion criteria, and 38 answered the questionnaire. Ninety-five per cent of the patients stated that they could obtain an erection, 61% on a purely reflex basis; 66% stated that erection was sufficient for coitus, and 45% that they could obtain ejaculation/emission. More patients with incomplete than complete lesions reported ability to obtain ejaculation/emission. Significantly, more of the patients aged below 30 years reported erection sufficient for coitus (p less than 0.05). Forty-five per cent of the patients experienced complications of sexual activity, mainly in the form of bladder dysfunction and pain or spasms. In conclusion, SCI is usually accompanied by considerable sexual dysfunction, but most patients are still capable of functioning sexually. Thus, in the rehabilitation process after SCI, sexual counselling and information may be valuable.
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PMID:Erectile and ejaculatory function of males with spinal cord injury. 263 May 55

Clonazepam is a high-potency benzodiazepine labeled for use as an anticonvulsant. Increasingly, clonazepam has been used in the treatment of a variety of psychiatric disorders. The authors discuss its potential clinical applications, including (1) use as an adjunct to neuroleptics for treating psychosis, (2) management of specific psychotropic side effects, (3) alternative treatment for certain pain syndromes, and (4) a primary treatment for severe agitation, atypical psychosis, and anxiety disorders. Apparent treatment-emergent side effects including depression, disinhibition, and sexual dysfunction are also discussed.
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PMID:Clonazepam: new uses and potential problems. 288 24

The purpose of this study was to examine the frequency and nature of sexual dysfunction present in a population with traumatic hand injuries. One hundred twenty patients were seen for psychological evaluation during the first two months postinjury. Forty-nine percent (59) reported sexual dysfunction during the initial two months. Six months postinjury 19% (23) continued to have sexual dysfunction. At that time a more extensive sexual history was obtained. Three categories of sexual dysfunction were identified following interviews: (1) impotence (35% or 8 patients), (2) reduced sexual desire (65% or 15), and (3) rejection of sexual contact by the partner (39% or 9). Four major causes of impaired sexual functioning were reported: (1) pain (22% or 5 patients), (2) deformity anxiety (52% or 12), (3) replant anxiety (9% or 2), and (4) contagious anxiety (39% or 9). The results of this study indicate that persistent sexual dysfunction may be a major difficulty following hand trauma. The type of dysfunction as well as the perceived cause of dysfunction are not the same for each case. Consideration of each is necessary to design efficacious intervention strategies.
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PMID:Sexual dysfunction following traumatic hand injury. 342 54


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