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

Syndromes characterized by persistent fatigue, musculoskeletal pain, sleep disturbance, and subjective cognitive impairment have been common problems in clinical practice for decades. The chronic fatigue syndrome case definition was created to standardize the patient population in research studies and to foster a systematic and comprehensive approach to the attempt to define the etiology and pathophysiology of these syndromes. The pathogenesis of chronic fatigue syndrome remains unknown, though it does appear to be associated with subtle neuroendocrine and immunologic abnormalities. Treatment of chronic fatigue syndrome is empirical. Significant palliation is often possible, though treatment success requires skillful practice of the art of medicine.
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PMID:Chronic fatigue syndrome: a review for clinicians. 960 20

Prior to surgery, 47 children (ages 8 to 17) with borderline to profound cognitive impairment were administered tasks to evaluate their understanding of the concepts of magnitude and ordinal position and their abilities to use a 0 to 5 numerical scale to rate pain levels in schematic faces. Of the 111 children (ages 4 to 14) without cognitive impairment, were administered the same tasks. Nurses conducting preoperative evaluations predicted whether children would understand the numerical scale. Fifty percent (n = 3) of children with borderline and 35% (n = 7) of children with mild cognitive impairment (and all children 8 years and older nonimpaired) correctly used the scale. Half of the children with cognitive impairment demonstrated skills (magnitude and ordinal position) that may allow them to use simpler pain rating methods. Nurses overestimated the abilities of cognitively impaired children (and younger children without cognitive impairment) to use the rating scale.
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PMID:Pain assessment in children with cognitive impairment. An exploration of self-report skills. 963 35

The purpose of this review was to discuss some newer rehabilitation techniques and their applications in MS. There are a number of other rehabilitation problems--bladder dysfunction, cognitive impairment, and pain, to name a few--that are important to address in the rehabilitation of a patient with MS, but that were not covered in this review. I would like to stress the principle that we need to adapt rehabilitation strategies to a progressive neurologic disease with an uncertain future course. That means we need to "overrehabilitate" MS patients with exacerbating and remitting unstable disease. As an example of what this means, consider a patient who has an EDSS of 4.5 and has a certain level of function. Suppose the patient receives a rehabilitative course and functions well. However the patient may have an exacerbation and become worse, going to an EDSS of 6.5, which may or may not improve. During this period, this patient needs to be able to function at his or her more impaired level. Therefore, it is important to train patients in therapeutic strategies they can use if they become temporarily worse. We need to remember that all organ system problems exist in a singular patient. Consequently, we must coordinate all of the treatments together, because the whole system must work for the patient as a whole.
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PMID:Rehabilitation principles for patients with multiple sclerosis. 969 86

We retrospectively reviewed 110 consecutive admissions to continuing palliative care units, which were designed as part of a regionalized, comprehensive palliative care program in Edmonton, Canada. Ninety-six patient charts met the criteria for evaluation. Demographic characteristics, and, when available, symptom profiles, cognitive status, and risk for a history of substance abuse were described. The medications on admission were tabulated, and in those 93 patients who had consults done by a palliative care consultant, these are compared to recommended medications. This study showed an older cohort of patient (mean +/- SD = 75 +/- 11 years) than had previously been described in a tertiary unit in the same community. Median length of stay was 21 days (range, 0-> 200 days). Cognitive impairment was higher than would be anticipated on the basis of age alone, with 32/47 [64% (confidence interval (CI) 55%-81%)] of patients who had had cognitive testing done on the day of consult being found to be cognitively impaired. Symptoms, as measured by the Edmonton Symptom Assessment Scale, were similar to those found for patients admitted to the tertiary palliative care unit. In the 93 patients who had palliative care consults done on admission, there were a total of 179 recommendations for medication or hydration changes. Overall compliance with these recommendations was 84% (CI, 79%-89%). The highest compliance was observed for recommendations to start hydration clysis [27/27, 100% (CI, 100%)], and the lowest rate was observed for altering or decreasing hypnotic medications [11/22, 50% (CI, 29%-71%)]. We conclude that the patients were of higher acuity than anticipated.
J Pain Symptom Manage 1998 Sep
PMID:Initial demographic, symptom, and medication profiles in patients admitted to continuing palliative care units. 976 18

Previous reports have found low levels of dehydroepiandrosterone sulfate (DHEA-S) in association with frailty in elderly patients. The mechanisms underlying these associations are not known. Therefore, psychiatric symptoms and disorders that are common in frail elderly patients were correlated with DHEA-S levels in a convenience sample selected from a nursing home population. Low DHEA-S levels were associated with high degrees of self-rated disability and insomnia. In women, low DHEA-S levels were also associated with increased numbers of pain sites. However, cognitive impairment was associated with higher DHEA-S levels in women. Thus, in frail elderly patients, there are contradictory relationships between DHEA-S and neuropsychiatric measures of frailty (cognitive impairment, disability, insomnia, and number of pain sites), and there may also be gender differences in these relationships.
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PMID:Dehydroepiandrosterone sulfate (DHEA-S) and psychiatric and laboratory measures of frailty in a residential care population. 979 75

We tested both pain thresholds and pain tolerance in patients with Alzheimer's disease (AD) by means of phasic and tonic noxious stimuli. In the first case, electrical stimulation was used, whereas in the second case arm ischemia was studied. By comparing AD patients with normal subjects of the same age, we found no differences in stimulus detection and pain thresholds, whereas a clearcut increase in pain tolerance was present in AD patients. The severity of AD was assessed by means of the Mini Mental State Examination test (MMSE) and the spectral analysis of the electroencephalogram (EEG). There was a straightforward correlation between MMSE scores and pain tolerance such that the more severe the cognitive impairment the higher the tolerance to pain. In addition, analysis of the EEG power spectra indicated that patients with low alpha and high delta peaks showed an increase in pain tolerance to both electrical stimulation and ischemia. These findings show that, whereas the sensory-discriminative component of pain is maintained in AD patients, pain tolerance is altered and depends on cognitive and affective factors. Thus, pain tolerance is tightly related to the severity of the disease according to the rule, 'the more severe the MMSE and EEG changes, the higher the tolerance to pain'.
Pain 1999 Mar
PMID:Pain threshold and tolerance in Alzheimer's disease. 1020 51

The authors tested the hypothesis that religious variables, such as a person's belief that his/her illness was God's will, would predict psychosocial adjustment in 50 patients who were predominantly Catholic Hispanic women attending a medical oncology clinic (42 women, 8 men). The patients were free of an Axis I mental disorder, cognitive impairment, and severe pain and were not undergoing intensive chemotherapy. By using the Psychosocial Adjustment to Illness Scale as the outcome measure, the authors found few associations with religious variables, but many to clinical variables.
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PMID:Religious and other predictors of psychosocial adjustment in cancer patients. 1034 38

Few studies have explored the phenomenon of pain in people with severe cognitive impairment. Pain assessment, which depends primarily on people's ability to describe dimensions of pain, becomes problematic when clients' cognitive impairment is so severe they cannot respond to pain assessment tools. The purpose of this study was to describe the phenomenon of pain for a subgroup of aggressive cognitively impaired nursing home residents who were enrolled in a larger study of aggressive behavior. To determine if pain was a possible factor influencing aggression, information was sought from five sources: family members, nursing assistant (NA) caregivers, medical record listings of pain-related diagnoses, use of analgesics, and observations of aggressive behaviors. Families reported pain in 44% of subjects, while NAs reported pain in 66% of subjects. Seventy-six percent of subjects had one or more pain-causing diagnoses. Sixty-four percent of subjects whose family members thought they may have pain were being treated with analgesics, compared to 44% of subjects whose NA reported they may be experiencing pain. Aggression scores were significantly higher in subjects who had two or more pain-related diagnoses and in subjects with arthritis. Nurses who are aware of a history of pain, reports of pain by families and caregivers, presence of pain-related medical diagnoses, and who realize pain may be a trigger for aggressive behavior may be more likely to recognize pain in cognitively impaired older adults. Better pain assessment should lead to improved treatment of pain in this population.
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PMID:Examining pain in aggressive cognitively impaired older adults. 1039 90

The concept of health-related quality of life (QOL) is differentiated from generalized QOL. If we are to understand attitudes and behavior of older people regarding the end of life, we need to take account not only of the distress and impairments resulting from poor health, but also of the positive features in the non-health-related areas of their lives that may make them wish to endure the negative aspects of poor health and its treatment side effects. The concept of Valuation of Life is suggested as the mental process that intervenes between negative and positive aspects of daily life on the one hand and older people's wishes for prolonged life and life-extending treatment on the other hand. Research is described which yielded a Valuation of Life Scale. Although many facets of good and poor physical and mental health were related to Valuation of Life, it was primarily positive aspects such as relationships with friends, meaningful time use and positive emotion that were independently associated with Valuation of Life. Valuation of Life was, in turn, the major independent predictor of the number of years people wished to live under a number of conditions of good health, disability, cognitive impairment and pain. It is concluded that both individual treatment decisions and social policy based on QOL associated with health and illness be informed by knowledge that positive aspects of life other than in the health sector are important considerations.
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PMID:Quality of life in chronic illness. 1039 72

This review presents evidence of the undertreatment of pain for people with cognitive impairment and explores reasons for this, emphasizing inadequate detection due to lack of suitable pain assessment protocols. Implications for practice and suggestions for further research are made.
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PMID:Assessing the pain of people with cognitive impairment. 1039 50


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