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

Brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues. In horses, traumatic brain injury occurs in three main settings: (1) poll impact in horses that flip over backwards; (2) frontal/parietal impact in horses that run into a fixed object, and (3) injury to the vestibular apparatus secondary to temporohyoid osteoarthropathy. Distinct forebrain, vestibular, midbrain, hindbrain, or multifocal syndromes may be encountered in horses with traumatic brain injury. The most important components of treatment are those consistent with principles of "evidence-based medicine". Accordingly,secondary brain injury can most effectively be prevented by establishing normal blood pressure, temperature, blood glucose concentration, and tissue oxygenation. Pain must be controlled and brain swelling may be treated with infusions of hypertonic saline or mannitol. Surgical procedures, including unilateral hyoid bone transaction or elevation of skull fracture fragments, are indicated in selected cases. Optional additional treatments include use of anti-oxidants, conventional doses of corticosteroids, magnesium sulfate and drainage of CSE There is no indication for the use of massive doses of methyl prednisolone sodium succinate.
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PMID:Brain injury after head trauma: pathophysiology, diagnosis, and treatment. 1506 65

Nerves have been identified in bone. Their function has recently become the focus of intense study. Metabolic control of bone is influenced by the nervous system. Potential transmitters of this influence include glutamate, calcitonin gene-related protein (CGRP), substance P, vasoactive intestinal peptide (VIP), pituitary adenylate cyclase activating polypeptide (PACAP), leptin, and catecholamines. Disorders of nerves - central or peripheral--can have substantial influence on bone health and repair. Specifically considered are the potential neural influences at work in such conditions as osteoporosis, fracture healing, Charcot osteoarthropathy, musculoskeletal pain syndromes, heterotopic ossification, skeletal growth and development, and obesity-related increased bone density. In this article, we review the current state of experimental and clinical evidence implicating the role of nervous tissue in regulating bone biology and discuss the current understanding of molecular signaling between nervous and osseus tissue in the homeostatic maintenance of the skeleton.
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PMID:Bone and brain: a review of neural, hormonal, and musculoskeletal connections. 1529 19

The bond between temporomandibular disorders and referred craniofacial symptomatology is more and more evident. In it subsists the prevailing necessity of understanding the temporomandibular disorders and the cranio-cervico-facial referred symptomatology from a neurophysiologic and muscle-skeletal perspective contained in the stomatognatic system. Diagnosis in head and neck areas is difficult because of its complex anatomy. Some painful craniofacial syndromes exhibit the same symptoms although they don.t seem objectively possible and that is what confuses the specialist and the patient. Pain in the head and the neck is one of the most complex to diagnose because of its varied origins that can be neurological, vascular, muscular, ligamental and bony. This article seeks to show some reasonable anatomical and pathophysiological connections of this muscle-skeletal disorder expressed with symptoms like tinnitus, otic fullness, otalgia and migraine among others. Disciplines in health such as neurology, the otolaryngology and dentistry share common anatomical and pathophysiological roads constructed in an increased muscular activity that generates muscle-skeletal disorders and is difficult to locate referred craniofacial symptomatology. This revision aspires to sensitize the medical specialist and the odontologist in the understanding of the important interdisciplinary handling in the detection of this disorder. This offers better tools in the conservative therapy phase of this craniofacial referred symptomatology.
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PMID:Temporomandibular disorders: referred cranio-cervico-facial clinic. 1580 Apr 64

We report on a 28-year-old man with known cystic fibrosis who presented with pain and cutaneous nodules in the elbow joints. His symptoms had appeared episodically in the previous months, they were always self-limiting, and independent of pulmonary exacerbations. A radiograph of the joints was unremarkable. These findings fit well with a special form of CF-related arthritis. As in the case of classical CF arthritis, the treatment to be considered is, in particular, symptomatic administration of non-steroidal anti-inflammatory drugs and possibly glucocorticoids. Also under discussion as a further possibility is the use of antibiotics. Our patient has always refused medication. The condition again proved to be self-limiting. In contrast to the classical form of CF arthritis, the special form is not associated with either joint swelling or local warmth. In the presence of arthritic symptoms in CF patients, consideration must always be given to a hypertrophic pulmonary osteoarthropathy. The latter, however, shows typical radiological changes and is exacerbated by lung infections. The presence of arthritic pathologies in a patient with CF further underscores the fact that CF is a multiorgan morbid condition.
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PMID:Arthropathy and cutaneous manifestations in a 28-year-old patient with cystic fibrosis. 1691 84

Various modalities for the treatment of hypertrophic pulmonary osteoarthropathy (HPOA) associated with lung cancer have been suggested since 1958. Although the etiology remains speculative, unilateral vagotomy on the side of the lung cancer achieves symptomatic relief. We report a case of a 50-year-old woman with disabling HPOA and inoperable lung cancer who experienced effective pain relief and regained full mobility after video-assisted thoracoscopic surgery was used to perform truncal vagotomy. This relatively safe and simple procedure should be considered for terminal lung cancer patients with intractable HPOA.
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PMID:Effective symptomatic relief of hypertrophic pulmonary osteoarthropathy by video-assisted thoracic surgery truncal vagotomy. 1725 17

The worst manifestation of neuro-osteoarthropathy of the pain-insensitive foot is the Charcot foot with its devastating osteoarticular destructions and irreversible deformities. New diagnostic tools such as MRI have revealed that mechanical injury and overuse is the origin of the condition. Traditionally, only feet with bone and joint damage apparent on plain radiographs (fracture and dislocation injuries) have undergone nonoperative treatment with off-loading and immobilization; however, treating painless, seemingly asymptomatic nonfracture injuries (bone bruise or bone marrow edema) with off-loading and immobilization has proven highly effective in preventing the Charcot foot. Whether pharmaceutical treatment has a role in terms of prevention or healing of osteoarticular destructions remains to be demonstrated.
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PMID:Nonoperative treatment of neuro-osteoarthropathy of the foot: do we need new criteria? 1761 87

Paget's disease of bone is a common skeletal disorder that often results in significant pain and disability. A number of bisphosphonates are currently available for treatment, however normalization of biochemical markers of bone turnover (the goal of treatment of Paget's disease) is rarely accomplished with currently available medications due to difficulty with administration, poor long-term adherence and possibly resistance to individual bisphosphonates. This review will focus on zoledronic acid, a potent intravenous bisphosphonate that appears to result in a higher percentage of patients with long-term normalization of markers of bone turnover than previously available drugs, thereby improving quality of life in patients with Paget's disease of bone.
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PMID:Zoledronic acid for Paget's disease of bone. 1817 73

Fibrous dysplasia (FD) is a benign skeletal disorder which may affect one or multiple bones. Lesions often involve long bones, ribs, and craniofacial bones and cause pain, fractures, and disfigurement. We describe an adolescent girl with mandibular FD who was successfully treated with bisphosphonates. She presented with a tumor-like lesion of the mandible. During the 2-year follow-up, the lesion expanded and caused significant disfigurement and pain necessitating psychiatric support. Treatment with bisphosphonate administered intravenously resulted in rapid pain relief, normalization of bone turnover, and cosmetic improvement. Management of FD has previously consisted of either conservative follow-up or surgery depending on disease activity and localization. Based on published reports and our experience, bisphosphonates should be considered in the treatment of symptomatic cases. This line of treatment may be suitable especially for craniofacial FD in which surgical treatment is particularly challenging.
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PMID:Bisphosphonate treatment in craniofacial fibrous dysplasia--a case report and review of the literature. 1824 80

Neuro-osteoarthropathy is accompanied by the destruction of single or multiple joints involving little or no pain. Diabetic patients suffering from symmetric distal polyneuropathy are the main risk group. The main location is the foot (Charcot foot). Inadvertent or repetitive trauma appears to be the main trigger mechanism for Charcot foot. Undiagnosed and untreated fractures and dislocations, foot and ankle deformities and instabilities with consecutive ulcerations may be the consequence, which again may increase the risk for later extremity loss due to the need for amputation or at least functional deterioration. Early diagnosis in the acute phase is of the utmost importance for the patient's prognosis. The primary strategy consists of unloading and immobilizing the foot and the corresponding extremity followed by stage-related protected remobilization until definite healing occurs. Surgical intervention is a key-stone in the treatment of complications at any stage. Surgery is an essential part of treatment and should be integrated into the overall treatment plan. The main indications for orthopedic reconstruction are non-plantigrade foot and ankle deformities or instabilities with concomitant ulcers that cannot be adequately addressed by non-operative measures, mainly in the chronic stage of Charcot foot. As such, surgical reconstruction can contribute to the long-term preservation of the affected foot and help to maintain or improve the patient's mobility and quality of life.
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PMID:[Charcot foot. Current situation and outlook]. 1836 79

Loss of pain perception is currently seen as a key factor in the development of diabetic foot ulcers. However, recent studies suggest that nerves play a central role in tissue homeostasis and can orchestrate complex reparative as well as destructive processes in the feet. Evidence is presented that suggests that denervation can result in altered capillary blood flow (in patients with type 2 diabetes), oxygen delivery, fluid filtration, and inflammatory responses. These processes could render the feet of diabetic patients with neuropathy more susceptible to tissue damage, infection and perhaps, in a subset of patients, to the development of acute Charcot neuro-osteoarthropathy (CN).
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PMID:Neurovascular control and neurogenic inflammation in diabetes. 1844 83


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