Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Men with locally advanced prostate cancer face a high risk of disease progression and cancer-related death. The traditional active treatment options for locally advanced disease, either following failure of treatment of primary curative intent or newly diagnosed, are radiotherapy and castration. Radiotherapy alone has a high failure rate, although outcome can be improved by adjuvant hormonal therapy. Castration is associated with loss of libido, sexual dysfunction, osteoporosis and hot flushes, which are significant drawbacks when patients may receive treatment for several years. Monotherapy with a non-steroidal antiandrogen offers potential benefits with respect to quality of life. Studies in the adjuvant setting are in progress. In the setting of previously untreated locally advanced disease, pooled mature data (56% deaths) from two major studies indicate no significant difference in survival outcome between bicalutamide ('Casodex') 150 mg and castration. Bicalutamide 150 mg offers quality of life benefits with respect to sexual interest and physical capacity. Preliminary data suggest that bicalutamide maintains bone mineral density. Bicalutamide 150 mg is well tolerated; gynaecomastia and breast pain, common side effects of antiandrogen monotherapy, may be managed by prophylactic irradiation or surgery. Bicalutamide 150 mg monotherapy is an alternative to castration for locally advanced prostate cancer.
 ...
PMID:Treatment of locally advanced prostate cancer--a new role for antiandrogen monotherapy? 1111 97

The majority of patients with multiple sclerosis (MS) experience genitourinary and bowel dysfunction over the course of their illness. Lower extremity pyramidal signs are excellent predictors of concurrent bladder dysfunction. Constipation is the most common bowel dysfunction, which results from a range of causes including pelvic floor spasticity, decreased gastro-colic reflex, inadequate hydration, medications, immobility, poor physical conditioning, and weak abdominal muscles. Despite the advent of new therapeutic modalities, the physician and patient commonly overlook sexual dysfunction. A detailed history of the patient is crucial to determine the cause of the dysfunction. Fatigue, pain, mood disorders, spasticity, bowel, and bladder dysfunction can all interfere with normal sexual functioning, and these subjects should be explored in detail in order to plan for proper treatment. Integrated treatment plans, often in conjunction with an urologist, can lead to amelioration of symptoms.
 ...
PMID:Bladder, Bowel, and Sexual Dysfunction in Multiple Sclerosis. 1128 36

This article presents and evaluates the symptoms, presentation, diagnosis, and treatment of men with interstitial cystitis (IC). A retrospective chart review and an interview of all men in our practice diagnosed with IC since 1990 was performed. The patients' presenting symptoms, physical findings, clinical evaluation, and responses to therapy were reviewed. A total of 52 men were identified during the study who met the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) criteria for diagnosis of IC. The most common referral diagnosis was prostatitis with the most common predominant symptoms being suprapubic pain with urinary frequency and dysuria. A significant number of male patients also developed sexual dysfunction. All patients met the NIDDK criteria for a diagnosis of IC. Multiple therapies were used for the treatment of these patients over the study period. Five patients were initially treated with dimethyl sulfoxide (DMSO) as a sole agent; however, all intravesically treated patients eventually failed this form of therapy. A total of 37 of 52 patients were treated with multidrug oral therapy. Findings showed that 80% of patients achieved >75% improvement in their symptomology at 6 months of follow-up with a durable response at 1 year. IC in men is probably underdiagnosed and is most commonly misdiagnosed as prostatitis. The patient's presentation is analogous to that in the female population allowing for gender differences. The patients responded well to multidrug oral therapy.
 ...
PMID:Observations on the presentation, diagnosis, and treatment of interstitial cystitis in men. 1137 46

Objective: The frequency of self reported sexual difficulties was examined in a group of 322 individuals with traumatic brain injury (TBI) ($N = 193$ men; 129 women) and contrasted with reports of sexual difficulties in 264 individuals without disability (152 men; 112 women) residing in the community. Physiological, physical, and body images problems impacting sexual functioning were examined individually and then summed into a sexual dysfunction score. Mood, quality of life, health status and presence of an endocrine disorder were examined as predictors of sexual difficulties post TBI. Study design: In this retrospective study, data about sexual difficulties were analyzed separately for men and women with TBI and without disability. ANOVAs with post hoc analysis for continuous variables, chi-square analyses for categorical variables, and ANCOVAs for predictors of sexual difficulties were utilized. Results: When contrasted to individuals without disability, individuals with TBI reported more frequent: (1) physiological difficulties influencing their energy for sex, sex drive, ability to initiate sexual activities and achieve orgasm; (2) physical difficulties influencing body positioning, body movement and sensation, and (3) body image difficulties influencing feelings of attractive and comfort with having a partner view one's body during sexual activity. Additional gender specific TBI findings were observed. In comparison to gender matched groups without disability, men with TBI reported less frequent involvement in sexual activity and relationships, and more frequent difficulties in sustaining an erection; women with TBI reported more frequent difficulties in sexual arousal, pain with sex, masturbation and vaginal lubrication. While groups differed in core demographic variables, age was the only demographic variable that was related to reports of sexual difficulties in individuals with TBI and men without disability. Age at onset and severity of injury were negatively related to reports of sexual difficulties in individuals with TBI. In men with TBI and without disability, the most sensitive predictor of sexual dysfunction was level of depression. For women without disability, an endocrine disorder was the most sensitive predictor of sexual dysfunction. For women with TBI, an endocrine disorder and level depression combined were the most sensitive predictors of sexual difficulties. Conclusion: Individuals post TBI report frequent physiological, physical and body images difficulties which negatively impact sexual activity and interest. For men post TBI, predictors of sexual difficulties included age at interview, age at injury, and having milder injuries, however, depression was the most sensitive predictor of sexual dysfunctions. For women post TBI, predictors of their sexual difficulties included age at injury and having milder injuries, however, depression and an endocrine disorder combined were the most sensitive predictors of sexual dysfunction. Implications of this study include the need for broad-based assessment of sexual dysfunction, and the implementation of treatment studies to enhance sexual functioning post TBI.
 ...
PMID:Sexual dysfunction after traumatic brain injury. 1145 88

Acute and chronic radiotherapy-related fatigue occurs in up to 80% and 30%, respectively, of patients undergoing irradiation for cancer. Frequently, the symptom is not expected by the patients and is underestimated by medical and nursing staff. Fatigue can affect global quality of life more than pain, sexual dysfunction and other cancer- or treatment-related symptoms. Its etiology and correlates are not clear. Published reports are mainly descriptive, and in many of them numerous methodological biases are present. One of the limitations is lack of a standard method of assessment that could simplify the comparison between different series. In the last decade, modern instruments have been designed to measure fatigue. They include uni- and multidimensional tools. Use of these specific instruments is highly recommended for research on radiation-related fatigue. In daily practice when time is limited, simple assessment is necessary. For example, systemic use of plain and easily understandable questions about fatigue, its level and impact on daily life could be sufficient and reliable. Therapeutic strategies for radiotherapy-induced fatigue have not yet been clearly defined, but a few randomized studies have been recently published. Physical exercise, group psychotherapy and relaxation therapy have been demonstrated to be effective. Moreover, pharmacological treatment of concomitant disturbances (anemia, pain, insomnia, depression, dehydration, infection, malnutrition) and other radiotherapy side effects (diarrhea, hormonal insufficiency etc.) should be considered. Further methodologically correct studies are warranted to better define the causes, optimal prevention, assessment and management of this symptom.
 ...
PMID:Radiotherapy-related fatigue: how to assess and how to treat the symptom. A commentary. 1150 69

Vulvodynia is a clinical syndrome that may include unexplained vulvar pain, sexual dysfunction, and psychological disability. It is a multifactorial syndrome that should be diagnosed, if possible, with an intradisciplinary approach. This article discusses the diagnosis and treatment of vulvodynia, starting with a summary of the complex nervous system within the pelvis. Different clinical pictures and different subtypes of the syndrome have been described in order to identify the etiologic aspects that are essential for diagnosis and subsequent treatment. Clinical evaluation should stress attention to detailed "pain-mapping" and evaluation of past and present history. The gynecological examination should be an overall patient evaluation, incorporating global physical impression, change in posture due to pain and careful examination of the pelvic floor. Examination of the pelvic floor is frequently omitted. Leading to an incorrect diagnosis of psychogenic pain. Such a misdiagnosis can result in the dismissal of appropriate treatment. Proper evaluation requires a comprehensive, multidisciplinary approach that includes medical, rehabilitative, and psychological issues.
 ...
PMID:Vulvodynia: the challenge of "unexplained" genital pain. 1155 12

Quality of life considerations are becoming increasingly important in prostate cancer management, particularly with the trend for patients to be diagnosed at an earlier age and at an earlier stage of disease. A rising serum prostate-specific antigen (PSA) level in the absence of symptoms can cause anxiety to many patients. Patients in this situation must weigh the benefits of treatment, such as delay in time to progression and increased time without pain, against the onset of adverse events that may affect quality of life. Traditionally, the active treatment options for locally advanced disease, following either new diagnosis or failure of treatment of primary curative intent, are radiotherapy and castration (medical or surgical). Radiotherapy may affect sexuality and bowel functioning, and castration is particularly associated with loss of libido and sexual dysfunction. Studies have shown that treatment-associated side effects extending over many years are of great concern to many patients. Therefore, for treatments with similar outcomes in terms of survival or time to progression, there is good reason to consider introducing new measures of efficacy based on quality of life endpoints. Data from two large studies of bicalutamide ('Casodex') therapy in patients with locally advanced prostate cancer show that this non-steroidal antiandrogen is not only associated with comparable survival outcomes but significant health-related quality of life benefits, compared with castration. In addition, a large early prostate cancer trial has demonstrated that bicalutamide as immediate therapy, either alone or as adjuvant to treatment of curative intent, significantly reduces the risk of disease progression in patients with localized or locally advanced prostate cancer. Moreover, bicalutamide treatment was associated with fewer adverse events relating to sexual function. The risk of treatment-related side effects or influence on the total quality of life must be considered carefully for each individual patient in order to assess the most appropriate treatment option.
 ...
PMID:Quality of life aspects of treatment options for localized and locally advanced prostate cancer. 1168 61

In this review, we briefly discuss recently published data on female sexual desire, arousal, orgasm and pain, and on medical/iatrogenic factors associated with female sexual function. The studies reviewed highlight a number of important methodological and etiological issues in the study of female sexual function. Researchers are urged to use standardized methods for defining sexual disorders and for selecting patient samples. Placebo-controlled studies are essential for examining the pharmacological aspects of female sexual dysfunction. Evidence suggests that free testosterone levels may be associated with sexual desire in women. Sildenafil citrate increases genital blood flow but may not impact on subjective reports of arousal. Past research implicated the serotonin 5-hydroxytryptamine 2 and 5-hydroxytryptamine 1A receptors in female sexual function, while recent data suggest a role for the 5-hydroxytryptamine 3 receptor. Increasing attention is being paid to medical/health conditions that impact sexual function (e.g. neurological conditions, cancer, hysterectomy, and cardiovascular disease).
 ...
PMID:Update on female sexual function. 1173 97

Eighty-eight patients (58 women and 30 men; mean age 53.4 years) with chronic non-cancer pain present on average for 9.8 years were evaluated following treatment with intrathecal opioids for an average duration of 36.2 months. Outcome measures were global pain relief, physical activity levels, medication consumption, work status, intrathecal opioid side-effects, proportion of patients who ceased therapy and patient satisfaction. The most common diagnosis in this group was lumbar spinal or radicular pain after failed spinal surgery (n= 55, 63%). At the time of follow-up, mean pain relief was 60% with 74% of patients (36 of 49) reporting increased activity levels. Oral medication intake was significantly reduced (Medication Quantification Scale Score prior to implantation 31.0+/-2.6 and at follow-up 12.7+/-1.4; n= 48; p< 0.0001). These gains were not accompanied by a change in work status (43 of 50 working age patients not working at follow-up). There were frequent reports of opioid side-effects, including sexual dysfunction and menstrual disturbance. Technical complications occurred with the drug administration device, most often catheter related, requiring at least one further surgical procedure in 32 patients (40%). Patient satisfaction with intrathecal opioids was high, with 45 of 51 (88%) reporting satisfaction. Mean intrathecal morphine dose increased from 9.95+/-1.49 mg/day (mean+/-SEM) at 6 months to 15.26+/-2.52 mg/day 36 months after initiation of therapy. Drug administration systems were permanently removed in five patients (6%). Intrathecal opioid therapy appears to have a place in the management of chronic non-cancer pain. Therapy does not seem to be significantly inhibited by the development of tolerance.
Eur J Pain 2001
PMID:Outcome of intrathecal opioids in chronic non-cancer pain. 1174 1

Radiotherapy-induced fatigue is a common early and chronic side-effect of irradiation, reported in up to 80 and 30% of patients during radiation therapy and at follow-up visits, respectively. It is frequently underestimated by medical and nursing staff, only about 50% of patients discuss it with a physician and in one fourth of cases any intervention is proposed to the patient. The patients rarely expect fatigue to be a side-effect of treatment. The etiology of this common symptom, its correlates and prevalence are poorly understood. In numerous studies the level and time course of fatigue was demonstrated to depend on the site of tumor and treatment modalities. For example, psychological mechanisms have been proposed to explain fatigue in women receiving irradiation for early breast cancer, whereas decline in neuromuscular efficiency rather than psychological reasons can lead to the fatigue observed in patients undergoing radiotherapy for prostate cancer. Fatigue can affect global quality of life more than pain, sexual dysfunction and other cancer- or treatment-related symptoms. Several interventions have been tested in the management of radiotherapy-related fatigue and some randomized studies have been recently published. Although an optimal method has not yet been established, some promising results have been reported with relaxation therapy, group psychotherapy, physical exercise and sleep. Further methodologically correct studies are warranted to define better the causes, optimal prevention and management of this symptom.
 ...
PMID:Radiotherapy-related fatigue. 1188 Feb 7


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>