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

The authors report a retrospective study of 76 solitary osteochondromas of the appendicular skeleton treated between 1981 and 1995. The ages of the patients ranged from 13 to 55 years with a mean of 21 years. The male/female-ratio was 1.37. Tumefaction with or without associated pain was the reason for consultation in 68 cases (89%). In 62 cases the osteochondroma was localized in the distal part of the femur or the proximal part of the tibia. All lesions were surgically resected; the resection was complete in all cases. Six patients were lost to follow-up; the other 70 were seen on a regular basis over a time period ranging from 1 to 12 years. The result from surgical treatment was assessed based on pain, joint motion, cosmetic consequences, nerve compression and recurrence of osteochondroma. The results were good in 68 cases and fair in two cases. Based on a review of previous experimental studies, the authors suggest a hypothesis to explain the rotation of a fragment of the growth plate which is needed for the development of osteochondroma. This rotation occurs as a result of the mechanical action from the periosteum under tension.
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PMID:[Solitary osteochondroma of the limbs. Clinical review of 76 cases and pathogenic hypothesis]. 1084 75

Pelvic cancer causes several types of pain, i.e., visceral, neuropathic, and somatic pain. Somatic pain is due to stimulation of nociceptors in the integument and supporting structures, namely, striated muscles, joints, periosteum, bones, and nerve trunks by direct extension through fascial planes and their lymphatic supply. In 60% of patients with malignant disease of soft tissues, nerve trunk, and sacral invasion from carcinoma of the cervix, uterus, vagina, colon, rectum, and other tissues in women, and from penile, prostate, and colorectal carcinoma and sarcoma in men, they have neuropathic pain. The infiltration of the perineal nerves results in lumbosacral plexopathies and complete destruction of the nerve, including perineural lymphatic invasions producing symptomatic sensory loss, causalgia, and deafferentation. Visceral pain is the result of spasms of smooth muscles of hallow viscus; distortion of capsule of solid organs; inflammation; chemical irritation; traction or twisting of mesentery; and ischemia, or necrosis, and encroachment of pelvis and presacral tumors. Pain of these types is managed by different modalities depending on the age of the patient, the expected life expectancy, availability of invasive and non-invasive pain control modalities, and the resources of the patient, community, and health care agencies. Patients with pelvic cancer can live with less pain due to better pain-control modalities that are available today with the help of dedicated and caring algologists.
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PMID:Pelvic cancer pain. 1113 74

We describe a comprehensive approach to the endoscopic treatment of calcaneal spur syndrome developed by the Arthroscopic Group of the Orthopedic Service of Hospital Hermanos Ameijeiras in Havana, Cuba. The surgical technique involves treatment of the heel spur and plantar fasciitis commonly found in calcaneal spur syndrome, but it also addresses adjacent calcaneal periostitis and allows decompression of the nerve to the abductor digiti quinti. Medial endoscopy and lateral instrumentation are used in a sequential approach with exposure and debridement of the posterior roof of the calcaneal arch, followed by removal of the calcaneal spur, lateral to medial release of the medial 75% of the plantar fascia, and if necessary, debridement of the calcaneal tuberosity periosteum. This technique was used in a prospective case series from June 1997 to May 1998 to treat a select group of 38 feet in 30 patients who reported unacceptable levels of pain despite 5 months of conservative treatment, which included an aggressive 8-week physical therapy program prescribed by the treating physician. Good to excellent results were obtained at 3 months postoperatively in all patients with regard to pain relief and return to normal activity, although 5 patients required a short course of physical therapy to resolve symptoms brought on by sports, trauma, or impact loading before 1-year follow-up, at which time all patients reported good to excellent results. Complications included 3 superficial wound infections cured by oral antibiotics and 2 transient lateral paresthesias that resolved with rest and nonsteroidal inflammatory medications. The described technique may provide a useful method for treating refractory heel spur syndrome and warrants further study.
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PMID:Endoscopic treatment of calcaneal spur syndrome: A comprehensive technique. 1133 20

Surgery in acute and/or chronic low back pain is still a matter of intensive and controversial discussions. A vast number of minimally invasive or so called semi-invasive procedures have been published in the last 3 decades, but evidence-based data on efficacy and benefit of most of these techniques are still lacking. However, empirical data suggest good or at least satisfactory clinical results for a limited number of procedures if they are applied under restrictive indication criteria. Discogenic low back pain and lumbar spinal stenosis belong to the most frequent diagnoses associated with low back pain. This article gives a survey on definitions, indication criteria and modern surgical or semi- invasive techniques used for the treatment of these two pathologic entities. Discogenic low back pain: This clinical and morphological entity is defined as low back pain arising mainly from disc degeneration. Pain generators are usually nociceptors in the cartilaginous endplates, in the outer anulus fibrosus as well as in the periosteum of the vertebral bodies. Clinical symptoms correlate with morphologic changes detected with MR-imaging (modic type I) or with contained disc protrusions mainly without neurological symptoms. Surgery is rarely indicated, spontaneous remissions occur in more than 60% of all cases. Spinal fusion has been the only surgical option in cases which did not respond to conservative therapy. Recently, electro-thermal modulation of the posterior anulus fibrosus has been published as a semi- invasive technique to relieve low back pain generated by fissures in the outer anulus and ingrowing nociceptors (intradiscal electro-thermal therapy, IDET(TM)). First results are promising, however, prospective randomised studies comparing this technique with conservative therapy are still lacking. The same is true for artificial nucleus pulposus replacement using hydrogel cushions implanted in the intervertebral space after removal of the nucleus pulposus from posterior or through an anterior approach (PDN, prosthetic disc nucleus(TM)). In cases with severe disc degeneration total disc replacement is another innovative option (ProDisc(TM)). Two metal endplates with titanium surface coating are implanted through a minimal invasive anterior approach (mini-laparotomy). A polyethylene inlay anchored in the caudal endplate holds the distance between the endplates and preserves the physiological range of motion between the two vertebral bodies. Degenerative lumbar spinal stenosis: Narrowing of the spinal canal due to degenerative changes of the disc, the facet joints and thickening of the yellow ligament is a geriatric disease which is diagnosed in increasing numbers within the last 10 years. More than 80% of the patients present with low back pain in association with neurogenic claudication. Neurological symptoms at rest are less frequently found. The spontaneous course shows progressive symptoms in more than 50% of all patients. More than 35% of the patients have associated diseases which might influence the perioperative course, complication rates and outcomes of surgery. Surgery is indicated in patients with progressive neurological symptoms, unacceptable decrease of quality of life or progressive intractable pain. In patients with mainly "leg symptoms" microsurgical mono- or multisegmental decompression is the procedure of choice. If low back pain is predominant and associated with degenerative instability such as degenerative spondylolisthesis or lumbar scoliosis, decompression must be combined with instrumented spinal fusion. In general a restrictive indication for surgery must be recommended especially for spinal fusion procedures. Non-fusion techniques such as intradiscal electro thermal therapy or spine arthroplasty with replacement of nucleus pulposus or total disc show promising early results; however, little is known about the long-term effect. It should be a principle to apply surgery in the least invasive way.
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PMID:[Discogenic low back pain and degenerative lumbar spinal stenosis - how appropriate is surgical treatment?]. 1179 55

Denervation of the canine hip joint capsule is described as a surgical therapy method in the treatment of canine hip joint dysplasia and arthrosis. The goal of this operation is a removal of the pain immediately and a reactivation of the dynamic active component of the hip joint in moving the body forward. Simple removal of the periosteum of the craniolateral acetabulum edge destroys the rami articulares of the cranial glutaeal nerve and the rami articulares dorsalis of the sciatic nerve. Within 10 years now we performed the denervation of the canine hip joint capsule. Evaluation of the post operative clinical course in 269 cases revealed an impressive improvement of lameness due to pain relief in almost 92% of the cases.
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PMID:[10 years experience with denervation of the hip joint capsule for treatment of canine hip joint dysplasia and arthrosis]. 1185 84

We investigated the clinical, arthroscopic and biomechanical outcome of transplanting autologous chondrocytes, cultured in atelocollagen gel, for the treatment of full-thickness defects of cartilage in 28 knees (26 patients) over a minimum period of 25 months. Transplantation eliminated locking of the knee and reduced pain and swelling in all patients. The mean Lysholm score improved significantly. Arthroscopic assessment indicated that 26 knees (93%) had a good or excellent outcome. There were few adverse features, except for marked hypertrophy of the graft in three knees, partial detachment of the periosteum in three and partial ossification of the graft in one. Biomechanical tests revealed that the transplants had acquired a hardness similar to that of the surrounding cartilage. We conclude that transplanting chondrocytes in a newly-formed matrix of atelocollagen gel can promote restoration of the articular cartilage of the knee.
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PMID:Transplantation of cartilage-like tissue made by tissue engineering in the treatment of cartilage defects of the knee. 1204 81

Although skeletal pain plays a major role in reducing the quality of life in patients suffering from osteoarthritis, Paget's disease, sickle cell anemia and bone cancer, little is known about the mechanisms that generate and maintain this pain. To define the peripheral fibers involved in transmitting and modulating skeletal pain, we used immunohistochemistry with antigen retrieval, confocal microscopy and three-dimensional image reconstruction of the bone to examine the sensory and sympathetic innervation of mineralized bone, bone marrow and periosteum of the normal mouse femur. Thinly myelinated and unmyelinated peptidergic sensory fibers were labeled with antibodies raised against calcitonin gene-related peptide (CGRP) and the unmyelinated, non-peptidergic sensory fibers were labeled with the isolectin B4 (Bandeira simplicifolia). Myelinated sensory fibers were labeled with an antibody raised against 200-kDa neurofilament H (clone RT-97). Sympathetic fibers were labeled with an antibody raised against tyrosine hydroxylase. CGRP, RT-97, and tyrosine hydroxylase immunoreactive fibers, but not isolectin B4 positive fibers, were present throughout the bone marrow, mineralized bone and the periosteum. While the periosteum is the most densely innervated tissue, when the total volume of each tissue is considered, the bone marrow receives the greatest total number of sensory and sympathetic fibers followed by mineralized bone and then periosteum. Understanding the sensory and sympathetic innervation of bone should provide a better understanding of the mechanisms that drive bone pain and aid in developing therapeutic strategies for treating skeletal pain.
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PMID:Origins of skeletal pain: sensory and sympathetic innervation of the mouse femur. 1212 94

We present three cases of central post-stroke pain after right hemorrhagic or ischemic stroke associated with severe impairment of cutaneous sensibility but preservation of stimulus-evoked pain from periosteum. This is the first such report of dissociation of cutaneous- from deep-tissue sensibility loss.
Pain 2002 Aug
PMID:Dissociation between cutaneous and deep sensibility in central post-stroke pain (CPSP). 1212 35

The authors report the influence of periosteum on healing of palatal defect based on more than 10 years of experience of harvesting hard palate mucosa. Between June of 1991 and May of 2001, the authors harvested 80 hard palate mucosae as graft material for skin and mucosa defects. All grafts were harvested from the center of the hard palate. Patients ranged in age from 10 to 82 years old. Of 80 mucosae, 54 were harvested with periosteum, and periosteum was not retained in the defect bed. The other 26 mucosae were harvested without periosteum, which was therefore retained in the defect bed. The healing time increased depending on the defect size in both groups of patients retaining and not retaining periosteum. There was a significant relationship between the defect size and healing time in both groups (Spearman's rank correlation test, p < 0.0001 in both groups). In the two groups, there was no significant relationship between patient age and healing time in the patients with defect smaller than 1.99 cm or larger than 2.00 cm2. There were no significant differences in the rate of patients with pain and bleeding between the groups retaining and not retaining periosteum. In the group not retaining the periosteum, all 54 patients showed a flat or atrophic smooth surface at more than 6 months after epithelization and had no discomfort. However, 17 patients showed flat or atrophic smooth surface in the group retaining the periosteum and the remaining 9 patients showed hypertrophy at more than 6 months after epithelization, with accompanying discomfort. The rate of the patients with hypertrophy in the group of patients retaining periosteum was significantly high as compared with that in the group of patients not retaining periosteum (p = 0.000013, Fisher's exact test). In 26 patients retaining periosteum, the age of the patients with hypertrophic surface was significantly younger than that of the patients with flat or atrophic surface (p = 0.0010, Welch's -test), and the defect size in the patient with hypertrophic surface was significantly smaller than that of the patients with flat or atrophic surface (p = 0.0028, Welch's t-test). In conclusion, our study demonstrated that the existence of periosteum in the palate donor bed does not contribute to reduced healing time or reduced pain. Rather, retaining the periosteum caused hypertrophy of the donor site, leading to discomfort, especially in young patients with a comparatively small defect.
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PMID:Influence of periosteum on donor healing after harvesting hard palate mucosa. 1254 5

The biologic action of extracorporeal shock wave application on the musculoskeletal system is poorly understood. To prove the hypothesis that alterations of tissue concentrations of substance P and prostaglandin E(2) are involved in the biologic action of shock waves, extracorporeal shock waves with energy flux density of 0.9 mJ/mm2 (1500 pulses at 1/second) were applied in vivo to the distal femur of rabbits. The concentrations of substance P and prostaglandin E(2) eluted from the periosteum of the femur were measured. Compared with the untreated contralateral hindlimbs, substance P release from the periosteum from the femur was increased 6 hours and 24 hours after extracorporeal shock wave application, but was decreased 6 weeks after extracorporeal shock wave application. By contrast, extracorporeal shock wave application did not result in altered prostaglandin E(2) release from the periosteum from the femur. Remarkably, there was a close relationship between the time course of substance P release found here, and the well-known clinical time course of initial pain occurrence and subsequent pain relief after extracorporeal shock wave application to tendon diseases. Accordingly, substance P might be involved in the biologic action of extracorporeal shock wave application on tissue of the musculoskeletal system. This is the first study providing insights into the molecular mechanisms of extracorporeal shock wave application to the musculoskeletal system.
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PMID:Substance P and prostaglandin E2 release after shock wave application to the rabbit femur. 1257 24


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