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

Though patient-controlled analgesia (PCA) has been in use for over a decade, it has been popularized only recently. Conventional techniques of intermittent intramuscular (IM) administration of analgesia have fallen short of meeting the needs of patients following major abdominal surgery. This has prompted a search for methods to improve postoperative pain management. Though PCA has been accepted in many hospitals, few studies comparing conventional IM administration of morphine with PCA have been performed. A prospective randomized study comparing IM- and PCA-administered morphine in 62 patients undergoing colon surgery was performed. A comparison of the efficacy of analgesia and extent of sedation using these approaches shows that PCA allows for analgesia with less sedation and less drug requirement than that of IM administration. No differences were noted in postoperative duration of ileus, duration of hospitalization, and total hospital costs. This study confirms the safety and efficacy of PCA, and should be considered the current optimal method of controlling pain following major colonic surgery.
Dis Colon Rectum 1988 Feb
PMID:Patient-controlled analgesia vs. conventional intramuscular analgesia following colon surgery. 333 48

Three hundred thirteen patients with signs of depression or spontaneous or evoked pain of coccygeal area were studied over six months. One hundred eighty (58 percent) had no spontaneous pain, 87 (28 percent) had moderate pain, and 46 (15 percent) a severe coccygodynia leading to consultation. In four of the latter group, no other sign of depression was found. Seventy-nine percent of the patients with spontaneous pain and 66 percent without spontaneous pain had coccygeal pain evoked by rectal digital examination (RDE). Seventy-one percent of the patients with spontaneous pain and 56 percent without spontaneous pain had paracoccygeal pain evoked by RDE. Among severely depressed patients (Group III), 76 percent had an evoked pain and 80 percent a coccygeal pain--either spontaneous or evoked. In 178 (57 percent), all signs disappeared when treated with various antidepressants in seven visits and within six months. Seven (2 percent) were failures; 44 (14 percent) were lost during follow-up; 84 (27 percent) did not return after the first consultation. After treatment in five patients was stopped, all signs recurred together and disappeared when adapted treatment was administered again. In 120 consecutive patients who had colonic roentgenologic examination and no depressive sign, two had coccygeal and muscular pain at rectal touch. A highly significant correlation was found between the following parameters: evoked pain and depressive status in noncoccygodynic patients, coccygodynia and evoked pain, coccygeal and paracoccygeal muscular pain. Severity of coccygodynia was not correlated with the number of depressive signs. Sex, age, and treatment efficiency were not correlated. The mechanism of depressive pain is discussed. RDE-evoked pain is proposed as an "objective" diagnostic sign for masked depression and as a means of evolution control. The frequency of the disease and efficiency of treatment are stressed.
Dis Colon Rectum 1988 Mar
PMID:Spontaneous and evoked coccygeal pain in depression. 334 77

Traumatic, clostridial myonecrosis is a rare and serious complication of wounds. Nontraumatic, metastatic, clostridial myonecrosis may be caused by carcinoma of the large intestine. Nontraumatic myonecrosis becomes evident with localized pain, generalized toxicity, local signs of inflammation, and crepitation. Serum creatine kinase determinations may be of help in diagnosing patients suspected of having acute myonecrosis. Immediate heroic surgical intervention, usually with demonstration of Clostridium septicum, is mandatory to control the myonecrosis. Appropriate antibiotic therapy is a valuable adjunct to surgical intervention, and penicillin in massive doses appears to be the agent of choice for the clostridia. Hyperbaric oxygen therapy may help in the optimal control. General supportive measures, including frequent blood transfusions, are most important. To save the life of the patient with nontraumatic, metastatic, clostridial myonecrosis, it is necessary, as soon as the patient's general condition permits, to diagnose and eliminate the cause of the myonecrosis. In addition to the case reported, 16 cases have been reported in the literature, making a total of 17. Five patients have survived (survival rate, 29 percent).
Dis Colon Rectum 1986 Dec
PMID:Carcinoma of the large intestine and nontraumatic, metastatic, clostridial myonecrosis. 353 58

Two hundred five patients with symptomatic first- and second-degree hemorrhoids were randomized to receive either conventional rubber band ligation or triple rubber band ligation. In conventional rubber band ligation, the hemorrhoids were ligated at one primary site per session at intervals of four weeks until symptoms were relieved or when all three hemorrhoids were ligated. In triple rubber band ligation, all three primary hemorrhoids were ligated in a single session. After completion of treatment, the patients were examined every three months, or earlier if symptoms recurred. Both methods were effective in the treatment of early hemorrhoids and the incidence of postligation pain and complications was similar. The advantages of having the treatment completed at the initial visit in triple rubber band ligation are obvious. Furthermore, less treatment sessions were required for triple rubber band ligation to control symptoms than for conventional rubber band ligation. Triple rubber band ligation is more cost-effective and therefore is recommended.
Dis Colon Rectum 1986 Dec
PMID:Conventional vs. triple rubber band ligation for hemorrhoids. A prospective, randomized trial. 353 57

Patients with squamous-cell carcinoma of the anal canal (n = 125) and its margin (n = 76) were divided into five groups: those with an erroneous diagnosis and a correct diagnosis made at first physician visit; those with a history of less than six months, between six and 18 months, and more than 18 months. Patients with canal tumors had an erroneous diagnosis made more frequently than patients with margin tumors. In both groups patients with an erroneous diagnosis had longer histories than patients with a correct diagnosis. Among patients with erroneously diagnosed canal tumor, pain, the feeling of a lump, anal discharge, and pruritus ani occurred less frequently than among correctly diagnosed patients. The prognosis was worse among patients with erroneously diagnosed canal tumors compared with correctly diagnosed patients. Such a difference could not be found among patients with margin tumors. There was a gradual worsening of the prognosis among patients with increasing length of history and canal tumors, in contrast to patients with margin tumors, in whom only a history of more than 18 months was associated with a worse prognosis.
Dis Colon Rectum 1987 May
PMID:Does an erroneous diagnosis of squamous-cell carcinoma of the anal canal and anal margin at first physician visit influence prognosis? 356 24

A squamous cell carcinoma arose in a skin-grafted ileostomy stoma 26 years after proctocolectomy for Crohn's colitis. The patient presented with peristomal ulceration and pain of several months' duration. Attention is drawn to this late complication of ileostomy which requires wide local excision and relocation of the stoma.
Dis Colon Rectum 1987 Jun
PMID:Squamous cell carcinoma occurring in a skin-grafted ileostomy stoma. Report of a case. 359 69

Paradoxical contraction of the puborectalis muscle during simulated defecation straining (anismus) has been cited as a cause of constipation. The functional specificity of this phenomenon was evaluated in 79 patients, 50 with constipation, 21 with idiopathic perineal pain, and eight with solitary rectal ulcer syndrome. Electromyogram evidence of paradoxical puborectalis contraction was observed in 38 (76 percent), ten (48 percent), and four (50 percent) of these patients, respectively. All patients with solitary rectal ulcer syndrome had difficulty defecating; defecation was normal in all patients with perineal pain. These observations suggest that paradoxical contraction of the puborectalis muscle is not a specific finding, and that it is not the sole cause of constipation in patients with anismus.
Dis Colon Rectum 1987 Sep
PMID:Is paradoxical contraction of puborectalis muscle of functional importance? 362 73

Forty-five patients with levator syndrome were treated by high voltage electrogalvanic stimulation of the levator ani by means of an intra-anal probe. Voltage varied from 150 to 400 volts, depending on patient tolerance. Negative electrodes and 80 cycles per second were used for 20 minutes every other day. An average of five treatments was needed for complete pain relief. Excellent results (total pain relief) were obtained in 36 patients, good results in five, fair results in two, and poor results (no relief) in two. High voltage electrogalvanic stimulation is the treatment of choice for levator syndrome because it can be standardized, is well tolerated, and is over 90 percent effective.
Dis Colon Rectum 1985 Jun
PMID:Levator syndrome. A treatment that works. 387 49

Band ligation of symptomatic internal hemorrhoids is a well-established and accepted outpatient procedure. The purpose of this paper is to alert the medical profession to potential complications and death following this procedure. Each of the four patients described in this report experienced pain and inability to urinate following banding. This report does not condemn banding but, rather, focuses on problems associated with a procedure perceived by many to be risk free.
Dis Colon Rectum 1985 May
PMID:Hemorrhoidal banding. A warning. 388 58

In 26 volunteers without anorectal complaints, and in 31 patients with anorectal problems such as hemorrhoidal disease, anal fissure, and proctalgia fugax, baseline resting anal canal pressures were recorded manometrically for 5 minutes at room temperature (23 degrees C). In 16 volunteers (Group A) and 21 patients (Group B) anorectal manometry was then performed while the anus was immersed in water at varying temperatures (5 degrees C, 23 degrees C, and 40 degrees C). In ten volunteers (Group A') and ten patients (Group B') resting pressures were recorded for an additional 30 minutes following immersion for 5 minutes at 40 degrees C. In all subjects (at least P less than 0.01), resting anal canal pressures diminished significantly from baseline after immersion at 40 degrees C, but remained unchanged in all subjects after immersion at 5 degrees C and 23 degrees C. In Group A', anal canal pressures remained significantly reduced for 15 minutes (P less than 0.02). In Group B', significant reduction in resting pressure lasted 30 minutes (P less than 0.02). Wet heat applied to the anal sphincter apparatus significantly and reproducibly decreased resting anal canal pressures over time, and therefore was likely to benefit patients after anorectal operations and those with anorectal pain.
Dis Colon Rectum 1986 Apr
PMID:Hot or cold in anal pain? A study of the changes in internal anal sphincter pressure profiles. 394 15


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