Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of thoracic spine spasms secondary to a bleeding duodenal ulcer is presented. A 41-year-old male with 14-week history of thoracic spine spasm was treated with bed rest, spinal manipulation, physical therapy, medication, and a thoracolumbar brace. Subsequently, a provocative thoracic discogram performed at T9-T10 created periscapular pain and also reproduced the presenting thoracic spasms. Intradiscal electrothermal annuloplasty (IDET) was performed at the T9-T10 level, but without sustained relief. The patient presented to a spine center for evaluation. The diagnosis of thoracic discogenic disease was suspected. A second provocative thoracic discogram was performed and failed to reproduce his thoracic spasms. Three weeks after being referred to a chronic pain management physician, the patient presented to a local emergency room with hema-temesis. An endoscopic evaluation revealed a bleeding duodenal ulcer. Following medical treatment of the duodenal ulcer with a proton pump inhibitor the patient had complete resolution of his thoracic spasms. This represents the first reported case of thoracic spine spasms as an initial presenting symptom of a bleeding peptic ulcer.
Pain Physician 2001 Jan
PMID:Thoracic spine spasms secondary to hemorrhagic intestinal ulcer. 1690 Feb 59

Patients with unexplained chest pain remain a difficult and perplexing challenge for the gastroenterologist. Despite exclusion of a cardiac origin many patients remain disabled by pain. In these, a diligent search for an esophageal cause-gastroesophageal reflux disease, motility abnormalities, or esophageal hypersensitivity using all available diagnostic (therapeutic) tools-results in a positive outcome. Appropriate use of a diagnostic trial of therapy, ambulatory pH monitoring and/or esophageal manometry, necessitates understanding of the respective benefits. The recent literature examines the value of a short course of high-dose proton pump inhibitors in establishing a diagnosis of gastroesophageal reflux disease-associated chest pain, the use of tricyclic antidepressants, and behavioral therapy in the management of these difficult patients with nonreflux, noncardiac chest pain.
 ...
PMID:Chest pain of esophageal origin. 1703 Nov 3

Chest pain of esophageal origin or noncardiac chest pain is reported by at least a fifth of the general population. Recent literature focused on further understanding mechanisms of chest pain in subset of patients with functional chest pain of presumed esophageal origin. Studies have demonstrated concurrent visceral and somatic pain hypersensitivity, and amplified secondary allodynia, in patients with noncardiac chest pain (NCCP), suggesting central sensitization. Other studies have demonstrated abnormal cerebral processing of intraesophageal stimuli. However, gastroesophageal reflux disease (GERD) has remained the most common esophageal cause of NCCP. The introduction of the proton pump inhibitor test, a highly sensitive and cost-effective diagnostic strategy, simplified our diagnostic approach toward patients with GERD-related NCCP. For patients with positive proton-pump-inhibitor test results, long-term treatment with antireflux medication is warranted. For patients with non-GERD-related NCCP, pain modulators remain the cornerstone of therapy.
 ...
PMID:Chest pain of esophageal origin. 1703 Nov 86

Chest pain of esophageal origin is the most common atypical/extraesophageal manifestation of gastroesophageal reflux disease (GERD). We are increasingly recognizing the important role of the cardiologist in making the diagnosis. Studies continue to focus on the mechanisms of pain in this challenging group of patients. Factors that determine the development and persistence of visceral hypersensitivity are currently under investigation. Invasive diagnostic studies have been replaced by therapeutic trials or empirical therapies. Proton pump inhibitors have been demonstrated to be the most effective treatment for GERD-related noncardiac chest pain (NCCP). Pain modulators remain the primary therapy for non-GERD-related NCCP. Sertraline is the first selective serotonin reuptake inhibitor to demonstrate a significant improvement in chest pain symptoms.
 ...
PMID:Chest pain of esophageal origin. 1703 22

The literature has well established that nonsteroidal anti-inflammatory drugs (NSAIDS) are very effective in treating pain and inflammation, but these drugs are associated with significant gastrointestinal (GI) toxicity. This is especially true in the elderly patient population. Selective cyclooxygenase-2 (COX-2) inhibitors (coxibs) were developed to decrease the incidence of GI adverse events. Nevertheless, recent concerns regarding coxibs and their association with adverse cardiovascular events have led physicians to re-examine the appropriate use of all NSAIDs. Part 1 of this two-part article reviews essential data related to adverse GI events to help physicians select appropriate patients to receive nonselective NSAIDs or coxibs. Other considerations, such as the benefits of proton pump inhibitors (PPIs) and the mitigating effects of concurrent aspirin use, are also discussed. Our clinical use pathway or algorithm will frame the discussion and guide clinicians through what has become a difficult decision in daily practice.
 ...
PMID:Choosing nonselective NSAIDs and selective COX-2 inhibitors in the elderly. A clinical use pathway. 1729 Nov 40

Chronic idiopathic singultus (hiccup) is a debilitating condition affecting mostly elderly males. While in the past, pharmacologic singultus treatment was mostly "trial and error," more recently, treatment has become both more evidence based and pathophysiology guided. A combination of an acidity-reducing drug (H(2)-receptor blocker or proton pump inhibitor) with baclofen (gamma-amino-butyric-acid receptor type B agonist) has become the most widely used regimen. Some clinicians replace or supplement baclofen with gabapentin. We present three cases of chronic idiopathic hiccup managed with gabapentin or another alpha-2-delta ligand, pregabalin. This is the first reported use of pregabalin for this indication.
J Pain Symptom Manage 2007 Jun
PMID:Alpha-2-delta ligands for singultus (hiccup) treatment: three case reports. 1736 Jan 49

After treatment of millions of patients suffering from gastroesophageal reflux disease (GERD) and other acid-related ailments with proton pump inhibitors, there are still unmet medical needs such as rapid and reliable pain relief, especially for nocturnal acid breakthrough. In this work, we introduce and characterize the biochemistry and pharmacology of the potassium-competitive acid blocker (P-CAB) soraprazan, a novel, reversible, and fast-acting inhibitor of gastric H,K-ATPase. Inhibitory and binding properties of soraprazan were analyzed together with its mode of action, its selectivity, and its in vivo potency. This P-CAB has an IC(50) of 0.1 microM if measured with ion leaky vesicles and of 0.19 microM in isolated gastric glands. With a K(i) of 6.4 nM, a K(d) of 26.4 nM, and a B(max) of 2.89 nmol/mg, this compound is a highly potent and reversible inhibitor of the H,K-ATPase. Soraprazan shows immediate inhibition of acid secretion in various in vitro models and in vivo and was found to be more than 2000-fold selective for H,K-ATPase over Na,K- and Ca-ATPases. Soraprazan is superior to esomeprazole in terms of onset of action and the extent and duration of pH elevation in vivo in the dog. Rapid and consistent inhibition of acid secretion by soraprazan renders the P-CABs a promising group of compounds for therapy of GERD.
 ...
PMID:Soraprazan: setting new standards in inhibition of gastric acid secretion. 1736 84

Approximately 10% of Japanese patients with reflux esophagitis (RE) are refractory to a standard dose of proton pump inhibitor(PPI) and most refractory patients have severe RE. Lack of response may be due to inadequate gastric acid suppression in conjunction with CYP2C19 genotype status and nocturnal acid reflux. Twice-daily dosing of PPI for inadequate gastric acid suppression and the administration of H2-receptor antagonist before bedtime for nocturnal acid reflux, is effective in most cases. The response to a standard dose of PPI in patients with non-erosive reflux disease (NERD) is approximately 50%. The reasons for a lower response rate, compared with RE patients, are not clear but may relate to an acid-hypersensitive esophagus, inadequate gastric acid suppression, non -acid reflux and emotional or psychological abnormality. High dose PPI therapy, endoscopic or surgical anti-reflux therapy, or/and pain modulators may be effective in some patients.
 ...
PMID:[Management of gastroesophageal reflux disease (GERD) with refractory to standard dose of proton pump inhibitor]. 1751 Dec 33

Proton pump inhibitors (PPI) are efficient for ex juvantibus diagnostics of non-coronary chest pain (NCCP) of gastroesophageal reflux origin as well as for its course treatment. The aim of this randomized cross-over study was to compare the efficiency of rabeprasol and omeprasol as means of both diagnostics and long-term treatment. In rabeprasol group the symptoms disappeared more quickly, and the maximum effect was achieved by day three, while in omeprasol group the best results were achieved only by day six (p < or = 0.05). The sensitivity and specificity of rabeprasol test was 81.6% and 80.6%, respectively, while those of omeprasol test were 73.5% and 77.4%, respectively. By the end of the 12th week of treatment pain syndrome had been completely or partly coped with in 92% of rabeprasol patients, and 76% of omeprazol patients (p < 0.05). Thus, response to rabeprasol takes place twice as quick as response to omeprasol, which makes it possible to shorten the time of NCCP diagnostics. Furthermore, rabeprasol test is more sensitive and specific. Course treatment with high doses of PPI increase the number of patients with eliminated pain syndrome, and rabeprasol here is more efficient than omeprasol.
 ...
PMID:[Rabeprazole test and comparison of the effectiveness of course treatment with rabeprazole in patients with gastroesophageal reflux disease and non-coronary chest pain]. 1752 Aug 89

A complex study of 147 patients who were taking non-steroid anti-inflammatory drugs (NSAIDs) revealed gastric lesions in 120 patients (81.6%). H2 blocker (ranitidine) was used for treating 40 patients with NSAID-induced gastropathy, proton pump inhibitor (omeprazole) was used for 40 patients, and Gastrozepin combined with Misoprostol--for 40 patients. Pain syndrome and dyspepsia were eliminated in most of the patients as a result of the treatment. Using Gastrozepin and Misoprostol produced an active effect on the trophic processes in the gastric mucous coat and caused erosion and ulcer healing. As compared to ranitidine and omeprazole, Gastrozepin used in combination with Cytotec produces a lower effect on the reduction of the acid-producing stomach function, yet it has a considerably greater effect on the normalization of the gastric mucus structure and restoration of metabolism of the gastric mucous coat collagen.
 ...
PMID:[Experience of treatment of patients with gastropathy induced by non-steroid anti-inflammatory drugs]. 1754 16


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>