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

The causal relationship between alcohol abuse and pancreatitis is undisputed. However, why some alcoholics manifest pancreatitis whereas others do not remains unexplained. Epidemiological data increasingly point toward an adjuvant role for genetic, dietary, and environmental factors. Significant advances have taken place in the last several years in the characterization of the pathophysiology of both experimental and human alcoholic pancreatitis. However, the pathogenesis of alcoholic pancreatitis remains unsettled. Toxic effects of alcohol on pancreatic acinar cells, "plugging" of pancreatic ductules by proteinaceous material, and reflux of bilio-duodenal juice into the pancreatic ducts have been suggested as putative pathogenetic mechanisms. Whereas at the present time only hypotheses can be formulated, it seems likely that the genesis of alcohol-related pancreatitis follows one or several of these proposed mechanisms. Pain in alcoholic pancreatitis is common and yet unexplained. Understanding the mechanism of pain in such patients is the key to our ability to manage it successfully. In this review, I have attempted to summarize and critically analyze our current understanding of these challenging problems.
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PMID:The pathophysiology of alcoholic pancreatitis. 355 24

Out of 400 patients who underwent posterolateral or purely dorsal spondylodesis of the lumbosacral joint with a divided sacral strut or sacral knee using distracting Harrington struts, a total of 68.5% were free of complaints--100% in cases of fractures and destruction, spondylarthroses and osteochrondroses, 73% in cases of spondylolyses with and without spondylolistheses, and only 49% among the so-called "failed-back" patients who had already undergone one or more previous operations. Where results were poor, particularly in the group of failed-back patients, when surgical error, pseudarthroses, or inadequacies of instruments were ruled out, it could be assumed in approximately 80% of the cases that these patients simultaneously had a pension claim under review or had attempted to institute proceedings at a social insurance tribunal. In such cases the goal of treatment desired by the surgeon, i.e., pain-free stability, cannot be the aim of the patients. Freedom from pain means ability to work, and loss of the pension or the pension litigation. It is almost endemic among these patients to put the blame on the same exogenous mechanisms, as far as both time and cause are concerned, in order to obtain certification of their inability to work. The suspicion that they use the operation to prove the severity of their disability is in many cases justified. The high incidence of psychosocial problems is at least a partial explanation of why the measures we took in our efforts to improve the results of surgery failed. We changed the position of the patient, extended the duration of hospitalization, revised our implantation method, verified plasters and braces. To no avail. Essentially, the result of surgery was influenced by four factors: the number of previous operations, drug and alcohol abuse, pseudarthrosis, and simultaneous pension claims. In 1983 and 1984 the number of patients without pain soared. Basically, this is probably due to the fact that in the light of the results of this investigation, more stringent criteria were applied with regard to the selection of patients. If the patient has a claim against a social insurance institution, a private insurer, or physicians who have treated him/her previously (!!!) we refuse to operate. It is unlikely that these patients will be pain-free before the proceedings in question are terminated. This much we have learned from this analysis.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Stabilization of the lumbosacral segment by distracting posterolateral spondylodesis using the Zielke divided sacral strut. Analysis of 400 cases based on indications, results and cause of errors]. 356 37

Two distinct patterns of somatization were identified in 807 Swedish adopted men, using comprehensive lifetime psychiatric and sick-leave records. "Diversiform" somatizers had a high frequency of brief sickness occasions for a wide diversity of complaints, particularly pain in the head, joints, and abdomen. "Asthenic" somatizers had a lower frequency and diversity of complaints. They recuperate more slowly, however, and were more often disabled by fatigue, weakness, and minor illnesses such as upper respiratory infections. Both types of somatizers had associated psychosocial maladjustment, but they had discrete clinical patterns, with infrequent overlap. Diversiform somatizers had a higher risk of alcohol abuse, psychiatric hospitalization, and substandard income than either asthenic somatizers or non-somatizers. Asthenic somatizers had a higher risk of divorce than either diversiform somatizers or non-somatizers. Men with prominent somatization had an excess of psychiatric treatment for alcoholism or anxiety disorders, but, unlike female somatizers, no excess of criminality. These clinical differences suggest that the psychiatric processes associated with somatization may be qualitatively different in men and women. The method used here is generally applicable in genetic epidemiology to identify natural clinical subtypes within a heterogeneous phenotype.
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PMID:Symptom patterns and causes of somatization in men: I. Differentiation of two discrete disorders. 372 Nov 94

Two hundred and eighty-three chronic pain patients, consecutive admissions to the Comprehensive Pain Center of the University of Miami School of Medicine, received an extensive psychiatric evaluation based upon the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria and flowsheets. All patients received the following type of diagnoses: DSM-III axis I; DSM-III axis II, and personality type. The distribution of assigned diagnoses for the entire patient sample was reviewed and a statistical comparison between male and female patients was performed with regards to the prevalence of each diagnosis. Anxiety syndromes and depression of various diagnostic types were the most frequently assigned axis I diagnoses with over half the patient sample receiving each of these diagnoses. Males were significantly overrepresented in the axis I diagnoses of intermittent explosive disorders, adjustment disorders with work inhibitions, and alcohol abuse and other drug dependence, while females were significantly overrepresented in disorders of current depression of various diagnostic types and somatization disorders. 58.4% of the patients fulfilled criteria for axis II personality disorder diagnoses. The most frequently personality disorders found in the patient group were dependent (17.4%), passive aggressive (14.9%), and histrionic (11.7%). Males were significantly overrepresented in paranoid and narcissistic disorders while females were overrepresented in histrionic disorder. The most frequent personality types found in the patient group were compulsive (24.5%) and dependent (10.6%). All personality types were similarly distributed between the sexes. The results of the present study were compared to a previous study of DSM-III diagnoses in chronic pain patients and are discussed in terms of the prevalence of DSM-III diagnoses in the general population. Questions are raised as to the applicability of certain DSM-III diagnoses in the chronic pain population.
Pain 1986 Aug
PMID:Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. 376 32

A group of 47 patients suffering from chronic recurrent duodenal ulcers was subdivided into two groups according to whether the first manifestation of the disorder occurred early or late in the life of each individual. A comparison of the two groups revealed that the patients in group I (early manifestation) had a larger number of constitutional handicaps along with a higher incidence of dispositional prior experience with regard to object loss and that they assumed social responsibility at an early age. Group II (late manifestation) was characterized by a larger number of depressive psychoses, a higher incidence of alcohol abuse, and by attempts at suicide. Apart from this, the patients in group II often complained of muscular pain syndromes. Patients in group I frequently exhibited the characteristics of the ulcer type described by Alexander as well as chronic anger. Patients in group II most often had the personality structure of so-called psychosomatic patients or suffered from depressive disorders affecting their personalities and from chronic anxiety. The two characteristics which were most typical for recidivation were: 1. Actualization of experienced bereavement and 2. unspecific activation as a result of the will to assert themselves in stress situations. In 41% of the cases there was evidence of somatic factors as e.g. starvation, abuse of alcohol or abuse of analgetics. Long-term prophylaxis has been effected by psychopharmacological agents as well as by psychotherapeutic techniques.
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PMID:[Ulcer disease. Studies of patients with chronic recurrent duodenal ulcer in an attempt to differentiate subgroups based on age at disease onset, psychopathologic and biographical data]. 376 11

The social network, family functioning, and health-protective behaviors of 77 osteoarthritis patients treated for 12 weeks by a multidisciplinary team were assessed. Measures included assessments of social network using components of the OARS, family satisfaction using the APGAR, family cohesion and adaptability using the FACES II, alcohol abuse using the CAGE, and indicators of health-protective behaviors. Participants were generally socially active, socially integrated, and satisfied with family relationships. Reported health-protective behaviors were low, indicating the need for assistance in improving preventive health practices. Few of the patients appeared to be at risk for alcoholism. Improvements in pain and activities of daily living were not correlated with changes in social functioning. Social functioning appeared to be relatively stable and not altered by short-term improvements in osteoarthritis. Social workers can play an important role in facilitating individual and family adjustment to the limitations imposed by osteoarthritis and in the rehabilitation process for osteoarthritis patients.
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PMID:Psychosocial aspects of the multidisciplinary assessment of osteoarthritis. 382 97

The practical implications of the new Marseilles classification (1984) of pancreatitis are discussed and the present-day diagnostic methods critically reviewed. The new classification distinguishes between two typical long-term profiles, i.e. acute (reversible) and chronic (progressive) pancreatitis. Modern diagnostic tests such as sonography, CT, ERCP and the secretin-CCK test do not provide a "gold standard" for early chronic pancreatitis. Thus, long-term studies of function and morphology are needed to differentiate chronic pancreatitis (progressive dysfunction, calcification, ERP changes) from acute (reversible) pancreatitis. The etiology is a helpful prognostic guide since gallstone pancreatitis virtually never becomes chronic. However, alcoholic "acute" pancreatitis may not always progress to chronic pancreatitis. Drug or surgical treatment of pain is symptomatic and empirical, since the pathomechanisms of pain are poorly understood. A prerequisite for optimum therapy is exact staging of the disease into: uncomplicated early stages with short, self-limiting episodes of pancreatitis: conservative therapy, persistent pain, mainly due to pseudocysts (diagnosis by morphological tests): surgical therapy, advanced painless forms of chronic pancreatitis associated with diabetes and/or steatorrhea: diet and substitution therapy. After successful surgical drainage persistent pain subsides, but postoperative episodic recurrences of pancreatitis are common in the early stages of the disease and in association with continued alcohol intake. However, spontaneous pain relief occurs in all cases in the late stages of the disease and with progressive pancreatic dysfunction (despite continued alcohol abuse).
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PMID:[Diagnosis and therapy of chronic alcoholic pancreatitis. A critical review of the status]. 390 86

The clinical significance of celiac artery compression by the median arcuate ligament of the diaphragm remains unsettled. The controversy stems from an undefined pathophysiologic mechanism and the existence of celiac compression in asymptomatic patients. This study was therefore conducted to evaluate the late results of operative therapy among our patients and possibly to identify parameters that might correlate with sustained symptom relief. Among 51 patients (12 men and 39 women) (mean age 47 years) who underwent operative treatment for symptomatic celiac artery compression, 44 (86%) were available for late follow-up. Their clinical status was determined between 1 and 18 years postoperatively (mean 9.0 years) by patient interview (36) or chart review (7). Operative treatment consisted of celiac axis decompression only (16 patients), celiac decompression and dilatation (17 patients), or celiac decompression and reconstruction by primary reanastomosis or interposition grafting (18 patients). Sustained symptom relief occurred more often with a postprandial pain pattern (81% cure), age between 40 and 60 years (77%), and weight loss of 20 pounds or more (67%). A negative correlation with clinical improvement was demonstrated for an atypical pain pattern with periods of remission (43% cure), a history of psychiatric disorder or alcohol abuse (40%), age greater than 60 years (40%), and weight loss of less than 20 pounds (53%). Eight of 15 patients (53%) treated by celiac decompression alone remained asymptomatic at late follow-up in contrast to 22 of 29 patients (76%) treated by celiac decompression plus some form of celiac revascularization. Late follow-up arteriograms (18 studies) showed a widely patent celiac artery in 70% of asymptomatic patients but a stenosed or occluded celiac axis in 75% of symptomatic patients. These findings suggest that persistent clinical improvement in patients with symptomatic celiac axis compression can be achieved by an operative technique that ensures celiac axis patency. Although some clinical features are identified that correlate with long-term benefit, reliable diagnosis of the symptomatic patient awaits definition of the pathophysiologic mechanisms involved in this syndrome.
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PMID:Late results following operative repair for celiac artery compression syndrome. 396 62

Thirty-seven patients with chronic pain admitted to a 3-week inpatient pain program were interviewed using the NIMH Diagnostic Interview Schedule and the family history method. The most frequent psychiatric diagnoses were major depressive disorder (current episode = 32.4%, past episode = 43.2%) and alcohol abuse (40.5%). More than half of the patients had a history of one or more episodes of major depression and/or alcohol abuse before the onset of their chronic pain. Family history revealed that 59.5% of the patients had at least one first-degree family member with chronic pain, 29.7% had a family member with affective illness, and 37.8% had a family member with alcohol abuse.
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PMID:Chronic pain: lifetime psychiatric diagnoses and family history. 403 26

The possible association of hepatocellular carcinoma with oral contraceptive (OC) use is supported by the case of a 33-year old black female, gravida 5, para 4. She presented in April 1978 with right upper quadrant pain, nausea, vomiting, and fatty food intolerance. The case had been taking norethindrone, 1 mg with mestranol 0.05, for 2 years. There was no history of liver disease, alcohol abuse, or exposure to chemical toxins. The preoperative diagnosis was subacute cholecystitis; however, an unresectable primary liver tumor of both lobes was detected on surgery. OC use was discontinued, and the case refused chemotherapy. On December 1, 1978, she presented with a 9-week pregnancy which was aborted. Physical examination revealed an enlarged liver and mass in the upper right quadrant. The patient was readmitted December 11 with intractable pain and discharged. She died December 28, 1978. At autopsy the liver tumor appeared as a moderate to poorly differentiated hepatoma with irregular hyperchromatic nuclei. There was no evidence of coexistent benign lesions. The rapid progression of the disease following pregnancy suggests that hepatic growth was stimulated by the high estrogen levels of pregnancy. Earlier diagnosis and improved management are required in such cases. Ultrasonography can be used to confirm the presence of a mass, and liver scan or hepatic angiogram may be useful. Liver biopsy is required for definitive diagnosis. Treatment involves discontinuation of OC use and complete excision of the tumor where possible. If tumors have progressed beyond the stage of resectability, as in this case, the prognosis is poor.
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PMID:Hepatocellular carcinoma associated with oral contraceptive use and pregnancy. 629 72


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