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)

In some forms of cerebrovascular disease, such as intracranial hemorrhage, headaches are well known as a prominent symptom and often are a valuable clue to diagnosis. There are difficulties, sometimes, in distinguishing between a small subarachnoid hemorrhage and a severe migraine headache, but these can be resolved using clinical observations, CT scan, and lumbar puncture. It seems less well known that headaches may accompany or precede cerebral thrombosis and embolism. When these headaches are recognized as a forerunner to stroke, they may allow an opportunity for preventive treatment.
Clin J Pain 1989
PMID:Headache as a symptom of cerebrovascular disease. 252 Mar 91

Twenty-eight patients were studied after uncomplicated aortocoronary bypass surgery with hypothermic cardiopulmonary bypass (CPB). In all patients residual hypothermia was effectively treated by the use of extended rewarming during CPB and postoperatively by an external heat source. This treatment almost eliminated postoperative shivering, and it resulted in the lowering of oxygen uptake, carbon dioxide production, and required ventilatory volumes to stable levels where spontaneous breathing could be used safely. The patients were divided into two groups. In group I (n = 12), intraoperative anesthesia was based on an intravenous (IV) opioid (phenoperidine), which caused persistent respiratory depression and made mechanical ventilation necessary for a mean postoperative time period of 10.7 +/- 3.8 hours even with the rewarming. In group II (n = 16), thoracic epidural analgesia and intraoperative general anesthesia with enflurane were used. In this group, postoperative metabolic and ventilatory requirements were stable and low, finger skin temperature was normalized earlier, systemic vascular resistance was lower, and stroke index was higher. Emergence from anesthesia was uneventful and was achieved early postoperatively in Group II. The patients had good pain relief and were mentally alert. Adequate spontaneous breathing was resumed quickly and endotracheal extubation was performed within the first two postoperative hours (1.6 +/- 0.5 hours). No complications or increased morbidity occurred, and no patient needed to be reintubated in Group II.
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PMID:Early extubation after coronary artery surgery in efficiently rewarmed patients: a postoperative comparison of opioid anesthesia versus inhalational anesthesia and thoracic epidural analgesia. 252 Sep 17

Though it occurs infrequently, thalamic pain syndrome (TPS) can be devastating. Producing a sensation described as burning, TPS is activated by cutaneous stimulation and temperature changes. The syndrome can occur immediately, or even many months after stroke. The pain is unaffected by analgesics or narcotics and surgical intervention has demonstrated minimal success. Studies testing the efficacy of tricyclic antidepressants have shown a positive response. It is the goal of the nurse to maintain a tolerable pain level for the patient and promote the highest level of function and well-being.
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PMID:Thalamic pain syndrome. 253 70

A young woman presented with a 4-month history of retinal and vertebrobasilar ischemia. Angiography demonstrated narrowing of major branches of the aortic arch. Intractable, severe retroorbital pain of the right eye developed after a middle cerebral artery stroke. During 4 weeks of aggressive immunosuppressive therapy including IV high dose bolus corticosteroids and pulse cyclophosphamide, her neurologic deficit improved transiently, but her retroorbital pain persisted. She died of staphylococcal sepsis and pneumonia. An autopsy demonstrated thrombotic or fibrous occlusion, with minimal inflammation, of extracranial arteries.
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PMID:Takayasu arteritis presenting as retinal and vertebrobasilar ischemia. 257 Jan 49

A collaborative study was undertaken to assess the efficacy of multifactor prevention of myocardial infarction and cerebral stroke. A representative group of 5951 males aged 40-50 years was examined in Kaunas. Coronary heart disease (CHD) was detected in 11.1%, including 2.7% who had a history of myocardial infarction, 2.5% had exertional angina, its painless type was found in 5.9%. In males with CHD, arterial hypertension, hypercholesterolemia, obesity were more common and smoking was more infrequent than in those without the disease. The results of the 5-year follow-up showed that CHD males had higher total and cardiovascular mortality and myocardial infarction morbidity rates than males without CHD. Males with prior MI and pain-free CHD significantly differed from those from the control group in total and cardiovascular mortality rates. No statistically significant difference was found in MI mortality and morbidity rates between male patients with exertional angina and controls.
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PMID:[Prevalence of risk factors and indicators of mortality among males 40-59 years of age with various forms of ischemic heart disease (data of a 5-year prospective study)]. 258 60

Vascular headaches are among the most prevalent yet poorly understood problems in clinical neurology. Headaches may develop in association with hypertension, seizures, stroke or without a recognizable pathophysiology such as during migraine and cluster headaches. Cephalic blood vessels (pial and dural vessels) are implicated as the most important source for all headaches and are innervated by sensory fibers which arise from ganglia innervating the forehead, scalp and neck. Sensory fibers contain vasoactive neuropeptides which become released from peripheral (perivascular) and central terminations to mediate vasodilation and pain, respectively. The presence of vascular headache implies activation of this final common pain pathway which we have termed the trigeminovascular system. The presence of vascular headache implies activation of this final common pain pathway which we have termed the trigeminovascular system. The existence of such a system a) clarifies certain pain patterns which develop following stimulation of cephalic blood vessels, b) suggests a mechanism to explain the referral of pain to the forehead, c) provides a mechanism to explain the action of certain antimigraine drugs, d) suggests a local mechanism which enhances blood flow under certain pathological conditions. Hence, this review will update existing knowledge about the trigeminovascular system and its role in headache pathophysiology.
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PMID:Pain mechanisms underlying vascular headaches. Progress Report 1989. 266 74

LOCAs offer significant advantages in certain situations, but in others their advantages are either absent or unproved. On the basis of current knowledge and practice, there is no legal mandate to use these agents. Clear advantages to the use of LOCAs are (a) decreased pain and discomfort in painful examinations (in this regard, however, they are equivalent to dilute HOCAs in intraarterial digital subtraction angiography), (b) decreased myocardial and generalized hemodynamic effects, and (c) decreased osmotic load, perhaps important in infants or severely dehydrated patients. LOCAs may be helpful in examinations of patients with alteration of the blood-brain barrier (major trauma, tumor, or stroke), prior contrast media reactions, and marked anxiety. However, in the following areas, there are, as yet, no clear answers about the use of LOCAs: (a) reduction of overall mortality, (b) reduction of morbidity in elderly patients, and (c) reduction of the risk of nephrotoxicity in patients either with or without specific risk factors such as diabetes mellitus or renal failure.
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PMID:Guidelines for use of low-osmolality contrast agents. 267 4

Experimental and clinical data clearly demonstrate that calcium antagonists (CA) may have an action on the central nervous system (CNS). The cerebrovascular action of CA justifies their use in cerebral ischaemia, vasospasm and hypoxia. Several clinical trials have demonstrated such beneficial effects. On the other hand a number of reports indicate that CA may have a direct neuronal effect, although most of such trials have not been verified or are mere case reports. In addition, the large number of conditions susceptible to being corrected by CA is impressive: epilepsy, pain, dystonia, dyskinesia, psychiatric conditions, etc. Other papers are disconcerting that report extrapyramidal disorders induced by flunarizine and cinnarizine in the elderly, whereas nicardipine does not produce such side effects and may even alleviate some parkinsonian symptoms. In various experimental models (e.g. stroke, oedema), pharmacological effects have been shown to vary from one compound to the other. Two main questions are yet to be answered: 1) has the direct neuronal effect of CA been clearly established? 2) are the multiple clinical effects on the CNS really linked to calcium antagonism?
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PMID:Clinical neuropharmacology of calcium antagonists. 269 95

Cost effective treatment is needed for common self limiting rheumatological conditions. Periarthritis of the shoulder is an example. There is no consensus for one type of treatment, though local steroids or physiotherapy are conventionally used. Their cost and efficacy were compared in a prospective randomised observer-blind trial--in essence a medical audit of the treatment of a common rheumatological problem. Sixty two consecutive patients presenting with a painful stiff shoulder were studied. Patients with coexistent diseases like cervical spondylosis or a stroke were excluded. They were randomly allocated to receive local steroids, six weeks' physiotherapy, or both. The three groups were of similar age, sex, and disease severity. Assessments of pain and shoulder movement were made initially, at six weeks, and at six months by a 'blinded' observer. Physiotherapy was given by one therapist and injections by one physician. All three groups showed significant improvements by six weeks, with further improvement at six months. Improvements were identical in all three groups. No treatment gave complications. The costs of treatment varied: an injection of triamcinolone cost 2.10 pounds; a six week course of physiotherapy cost 48.50 pounds; combination treatment cost 50.60 pounds. Patients expect treatment for a painful stiff shoulder. The results show that local steroid injections are as effective as physiotherapy alone or a combination. They provide rapid treatment and are less expensive. In the uncomplicated case a local steroid injection is the most cost effective treatment.
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PMID:Injections and physiotherapy for the painful stiff shoulder. 271 13

A stroke with a somewhat unusual neurologic formula was correlated with a small linear high-intensity T2 focus in the lateral tegmentum of the lower third of the pons. The clinical features included dysarthria, staggering gait, incoordination of handwriting, right facial weakness, nystagmus, ocular overshoot, right appendicular ataxia, and left-sided dissociated sensory loss for pain and temperature. Lacunar lesions of the tegmentum in the region of the pontomedullary junction, while not uncommon, have not been studied pathologically and have not been reported in the magnetic resonance imaging literature, to my knowledge.
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PMID:Lacunar infarct of the tegmentum of the lower lateral pons. 271 52


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