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

To determine and compare short- and long-term effects of aerobic exercise (AE), stress management treatment (SMT), and treatment-as-usual (TAU) in fibromyalgia, 60 patients were randomized to 14 weeks of treatment by either AE, SMT or TAU. Outcome measures at baseline, midway through treatment, at treatment completion, and at 4 year follow up included a patient made drawing of pain distribution, dolorimetry of tender points, ergometer cycle test, global subjective improvement, and VAS registrations of: pain, disturbed sleep, lack of energy, and depression. Both AE and SMT showed positive short-term effects. AE was the overall most effective treatment, despite being subject to the most sceptical patient attitude prior to the study. At follow up, there were no obvious group differences in symptom severity, which for AE seemed to be due to a considerable compliance problem.
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PMID:Effects of aerobic exercise versus stress management treatment in fibromyalgia. A 4.5 year prospective study. 861 71

The purpose of this study was to describe the nature and frequency of sleep pattern disturbances in patients post coronary artery bypass (CABG) surgery. An exploratory design using telephone interviews at one week, one month, three months and six months was used to describe the incidence and nature of sleep disturbances post CABG surgery. Forty-nine patients completed all four measurement times. More than half of the patients reported sleep disturbances at each measurement time. Sleep disturbances during the first month post CABG were reported to be the result of incisional pain, difficulty finding a comfortable position and nocturia. Although less frequent over time, these problems persisted for six months. The authors propose nursing interventions to improve sleep post CABG surgery. Implications for continuing research are discussed.
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PMID:Sleep disturbances post coronary artery bypass surgery. 865 13

The possibility that a patient during general anaesthesia is aware of the operation going on and aware of severe pain that might be remembered postoperatively must be very alarming to patients and anaesthetists alike. Furthermore, there is experimental evidence showing that conscious recall of intraoperative events is only the tip of an iceberg; it seems very probable that there is even a higher incidence of unconscious perception during general anaesthesia. Therefore, the following stages of intraoperative awareness must be distinguished: (1) conscious awareness with explicit recall and with severe pain; (2) conscious awareness with explicit recall but no complaints of pains; (3) conscious awareness without explicit recall and possible implicit recall; (4) subconscious awareness without explicit recall and possible implicit recall; (5) no awareness. The incidence of conscious awareness with explicit recall and severe pain has been estimated at less frequent than 1/3000 general anaesthetics. Conscious awareness with explicit recall but no complaints of pain has been reported in the literature with an incidence of 05-2%. With 7-72%, conscious awareness without explicit recall and possible implicit recall shows a very wide range of variation and its occurrence probably depends on the anaesthetic drugs used. Subconscious awareness with possible implicit recall has an incidence of up to 80%, but there are many methodological problems in demonstrating implicit memory of intraoperative events. Reports of intraoperative awareness do not come exclusively from cardiac surgery and obstetrics, but also from all other operative specialties. Postoperatively, patients who experience intraoperative awareness may develop a so-called post-traumatic stress syndrome. Symptoms involve re-experiencing the event awake or in dreams, sleep disturbances, depression, avoidance of stimuli associated with the event. The probability of the development of the post-traumatic stress syndrome seems to coincide with the experience of severe pain. When a patient complains of intraoperative awareness postoperatively the anaesthesiologist should discuss the event frankly with the patient. When the symptoms of the post-traumatic stress syndrome persist a psychotherapy should follow. Causes for intraoperative awareness may be: equipment failure, too-light anaesthesia, e.g. for a caesarean section or for emergency surgery in severely injured or polytraumatized patients, during cardiac surgery, bronchoscopy of difficult intubation. There is interindividual variability in anaesthetic effect; for example, chronic drug or alcohol abuse or overweight may make increased anaesthetic doses necessary. They are at risk for intraoperative awareness. Some general anaesthetics or anaesthetic procedures, e.g. the combination of a relaxant and N2O, opioid mono-anaesthetics, or opioids combined with benzodiazepines, seem to involve a higher risk of intraoperative awareness than do volatile anaesthetics. The bases of litigation are medical malpractice, breach of contract by the anaesthesiologist or lack of informed consent from the patient. Therefore, patients who are at risk of intraoperative awareness should be given detailed information on this special risk before the operation.
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PMID:[Awareness during general anesthesia. Definition, incidence, clinical relevance, causes, avoidance and medicolegal aspects]. 867 65

A computerised self-assessment instrument was used to capture data on the distress caused by symptoms in 110 patients treated with radical radiotherapy. Patients selected symptoms from a list of 34 problems and then quantified the distress associated with each problem using a linear Analogue self assessment (LASA)-type scale. The test instrument was feasible: 90% of assessments were completed in under 14 min. There was a significant increase in tiredness and significant decrease in anxiety and worries about the family, during treatment. Menopausal symptoms and post-surgical problems were important causes of distress in the patients with breast cancer. When the area under the curve method was used to quantify distress in the patients with breast cancer, difficulty concentrating, pain and sleep disturbances emerged as significantly troublesome problems. Computerised self-assessment may have a useful role in quantifying the distress caused by treatment with radiotherapy.
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PMID:A quantitative approach to the distress caused by symptoms in patients treated with radical radiotherapy. 876 83

Empirical results from epidemiological studies on pain-depression comorbidity in primary care and population samples have shown that: (a) pain is as strongly associated with anxiety as with depressive disorders; (b) characteristics that most strongly predict depression are diffuseness of pain and the extent to which pain interferes with activities; (c) certain psychological symptoms (low energy, disturbed sleep, worry) are prominent among pain patients, while others (guilt, loneliness) are not; (d) depression and pain dysfunction are evident early in the natural history of pain, but dysfunction and distress are often transient; and (e) among initially dysfunctional pain patients whose dysfunction is chronic, depression levels do not improve but neither do they increase over time with chronicity alone. These results seem consistent with these mechanisms of pain-depression comorbidity; (1) a trait of susceptibility to both dysphoric physical symptoms (including pain) and psychological symptoms (including depression), and a state of somatosensory amplification in which psychological distress amplifies dysphoric physical sensations (including pain); (2) psychological illness and behavioural dysfunction being interrelated features of a maladaptive response to pain evident early in the natural history of the condition, and often resolving during an early recovery phase; (3) pain constituting a significant physical and psychological stressor that may induce or exacerbate psychological distress. Thus, pain and psychological illness should be viewed as having reciprocal psychological and behavioural effects involving both processes of illness expression and adaption, as well as pain having specific effects on emotional state and behavioural function.
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PMID:The relationship between pain and depression. 886 55

Application and feasibility of automated ambulatory blood pressure measurement (ABPM) in the elderly are comparable to younger age groups. Major side-effects are sleep disturbances and pain during cuff-inflation. The main indications for ABPM are diagnosis and control of treatment in hypertensive patients. Further indications are the diagnosis of syncope or hypotensive disorders and the diagnostic work-up of symptoms like vertigo, dizziness and dyspnea. In hypertensives, ABPM can easily assess the "white coat" effect and cases of "white coat" hypertension (prevalence in the elderly 15-25%). The prognostic implications of "white coat" hypertensions remain to be determined. Recording of the total 24-h blood pressure profile with analysis of circadian blood pressure changes, the day-night difference and the early morning surge raises the possibility to assess age-specific patterns. The drop in blood pressure at night (during sleep) is usually decreased and less frequently observed in elderly hypertensives. Possible explanations include decreased daytime activity, an altered sleep pattern in the elderly and secondary forms of hypertension. So-called "non-dippers", with no adequate drop in night-time blood pressure, show a significant increase in cardiovascular complications. Control of treatment via ABPM can assess non-responders and cases of overtreatment, and permits a fairly objective analysis of side-effects. Episodes of transient myocardial ischemia and possible trigger mechanisms can be assessed by simultaneous application of ABPM and Holter monitoring. The insufficient control of hypertension in the majority of elderly patients and the current lower target blood pressures in the elderly call for new methods to improve the level and quality of antihypertensive treatment. Although ABPM provides a closer correlation to target organ damage than measurement of office (casual) blood pressure, and ABPM frequently improves or at least facilitates the care of elderly hypertensive patients, it remains to be determined whether ABPM can finally improve the long-term outcome of these patients.
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PMID:Automated blood pressure measurement (ABPM) in the elderly. 889 6

Forty-four fibromyalgia patients were followed through 4.5 years to assess the extent to which symptom duration, physical activity level, disability pensions, and the occurrence of critical life events would predict long-term outcome. Outcome measures included pressure tenderness (dolorimeter score), work capacity (ergometer cycle test), global subjective improvement (verbal rating scale), and visual analogue scale ratings of pain, disturbed sleep, lack of energy, and depression. Significant outcome predictors were identified by means of separate multiple regression analyses on each outcome measure at follow-up, using symptom duration, physical activity level, disability pension status, and occurrence of critical life events as independent variables, together with baseline symptom intensity and age, which were adjusted for. An adequate physical activity level and increasing age predicted a positive outcome, while receiving a permanent disability pension or having experienced an excess of major negative life events predicted a negative outcome. Symptom duration did not affect outcome.
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PMID:Fibromyalgia outcome: the predictive values of symptom duration, physical activity, disability pension, and critical life events--a 4.5 year prospective study. 891 Feb 46

This article reviews the chronic fatigue syndrome (CFS), a disorder whose etiology is unknown. The diagnostic criteria proposed in 1994 by the CDC and the International Chronic Fatigue Syndrome Study Group are introduced. In contrast to widespread belief, there are no laboratory tests available to underpin the diagnosis of CFS; the diagnosis is made solely on the basis of clinical criteria. In the differential diagnosis, the exclusion of other conditions that can cause chronic fatigue, such as neuropsychiatric or sleep disorders, is of critical importance. In this context, the question as to whether CFS is a clinical entity that can be differentiated from psychiatric diagnoses, such as depression, somatoform disorder, or neurasthenia, is discussed. At the moment, there is no specific therapy for CFS. Therefore, therapeutic approaches are limited to symptomatic management of the concomitant sleep disturbances, pain, or psychiatric symptoms, such as depression. Patients may benefit from cognitive behavioral therapy, as this may help then to identify and exclude factors contributing to and maintaining chronic fatigue. An integrated medical and psychological approach should be adopted, with the aim of preventing significant secondary negative results of the illness, such as interpersonal conflicts or chronic disability.
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PMID:[Chronic fatigue syndrome. Definition, diagnostic measures and therapeutic possibilities]. 973 40

Sleep disorders occur in 74-98% of patients with idiopathic Parkinson's disease (PD), adversely affecting their quality of life. Sleep disruption takes the form of sleep fragmentation with frequent and prolonged awakenings and daytime sleepiness. Nocturia, difficulty in turning over in bed, painful leg cramps, vivid dreams/nightmares, back pain, limb/facial dystonia and leg jerks are the main causes of nocturnal awakening in PD patients. Sleep disturbance gradually worsens with disease progression, suggesting that it is related to the severity of the disease. Sleep disturbances may be generally considered as part of the normal aging process, being more common in the elderly. However, no significant associations between sleep disturbances and either age or disease duration was found in a survey of 100 PD patients. Disturbed sleep maintenance in PD patients was more severe than in age-matched controls, and nocturnal awakening was frequently caused by nocturia, pain, stiffness and difficulty in turning over in bed. Sleep disturbance is also a complication of chronic levodopa therapy. Recent data suggest that controlled-release levodopa is less likely to cause nocturnal symptoms than standard levodopa, particularly in mild-to-moderate disease. Depression, which is common in PD patients, contributes to sleep disturbance but has a lesser influence than the disease process itself. Hypnotic and sedative agents, as well as anti-depressants if required, are useful in ameliorating sleep disturbances in PD patients; intranasal desmopressin appears to be effective in reducing nocturia.
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PMID:Sleep disorder related to Parkinson's disease. 911 82

Cerebrolysin is a peptide solution with free amino acids and biologically active peptides showing neurotrophic efficiency. In a placebo-controlled longitudinal study we investigated the effect of that drug for treatment of painful diabetic neuropathy in 20 type-II diabetic patients (9 women, 11 men, mean age 63 +/- 9 years, duration of diabetes 14 +/- 7 years). Patients received daily a cerebrolysin-infusion (20 ml in 500 ml Ringer) over a period of 10 days. In an age- and diabetes-duration matched placebo group of 10 type-II diabetic patients (7 women, 3 men, age 66 +/- 9 years, duration of diabetes 12 +/- 5 years) vitamin B infusion was administered (5 ml vitamin B complex in 500 ml Ringer) during 10 days. We compared a five-item symptom score scale (FIS) for pain, dysesthesia, paresthesia, nightly exacerbation, and sleep disturbances (grade 0 to 3) and a graphic visual analogue rating scale (VAS) for recording the magnitude of the pains (scale 0 to 100 mm) at the beginning and the end of the infusion therapy as well as 6 weeks later. Cerebrolysin was associated with a significant decrease in total FIS score from 8.7 +/- 1.9 at the start of therapy to 5.1 +/- 2.2 after 6 weeks (p < 0.001), and to a reduction of the VAS score from 4.2 +/- 0.8 to 2.8 +/- 0.9 (p < 0.001) during the same period of observation. In contrast in the placebo group the total FIS score decreased only from 7.9 +/- 1.2 at the beginning to 6.6 +/- 1.1 (p < 0.05) 6 weeks later and the VAS score from 4.5 +/- 0.6 to 4.0 +/- 0.5 (NS). Thus cerebrolysin led to a significant subjective improvement of painful diabetic neuropathy in type-II diabetic patients at least for a period of 6 weeks.
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PMID:[Cerebrolysin in treatment of painful diabetic neuropathy]. 917 75


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