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

This study was designed to document the clinical and health status of patients with recent-onset rheumatoid arthritis (RA). Three groups were studied: 108 patients who had had RA for greater than 1 year (established RA group), 313 patients who had had RA for less than or equal to 1 year (recent-onset RA group), and 188 healthy friend of the patients with recent-onset RA (no RA group). Clinical status was measured using tender joint count, erythrocyte sedimentation rate, and overall physician assessment. Health status was measured using the physical, psychological, pain, and arthritis impact scores of the Arthritis Impact Measurement Scales. Scores on all clinical and health status measures indicated substantial disease effects in the group with recent-onset RA. For most of these measures, effect size analysis indicated that clinical and health status impacts in the recent-onset RA group were similar in magnitude to those found in the groups with more established disease, with scores in both groups being substantially different from those found in the no RA group. These results document the magnitude of the clinical and health status impacts in recent-onset RA. They lend support to recent arguments advocating aggressive therapy earlier in the course of this frequently disabling disease.
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PMID:The clinical and health status of patients with recent-onset rheumatoid arthritis. 205 22

Previous reviews of psychological factors in arthritis have emphasised the methodological weaknesses of many studies, especially those attempting to measure personality after years of disabling disease. To make sense of the published reports three factors need to be considered separately: previous personality, social stresses, and current mental state. Each can now be measured reliably and independently of symptoms which might be directly attributable to the arthritis. There is a growing consensus that the normal range of personality is represented among patients with early arthritis, that the prevalence of depression is similar to that of patients with other medical conditions, and that social stress is more closely related to depression than activity and the disabling effect of arthritis. Longitudinal studies are now required to examine which social stresses can be attributed to the disabling effect of arthritis. Depression and social stress often manifest themselves to the rheumatologist as excessive complaints of pain and frequent clinic attendances so appropriate psychosocial treatments may reduce this behaviour.
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PMID:Psychological disorders in rheumatoid arthritis: a growing consensus? 224 Dec 74

The standardized interviews of 26 chronic back pain patients from central Europe (Switzerland, Germany, Poland) were compared with those of 28 patients from Mediterranean countries (Italy, Spain, Yugoslavia, Turkey), all of whom had been referred for participation in an integrated treatment program for chronic back pain. The two samples differed significantly in most of the psychosocial aspects studied. Patients from Mediterranean countries had a significantly lower level of education and were mostly employed as unskilled workers, while patients from central Europe were mostly housewives or skilled workers with higher levels of education. In the Mediterranean sample the back pain had generally developed much faster into a disabling disease with the attendant consequences (sick leave, loss of job, litigation). More than one third of the Mediterranean patients lived with a partner who was also sick and unable to work. These patients also adopted a more passive stance towards their illness by rarely using self-help, and showed poor readiness to participate in the self-monitoring orientated treatment program proposed to them. They were less aware of the influence of their own behaviour on pain and of any relation between the illness and their present or previous life situation. They complained less of a broken home in their childhood or earlier medical problems, but more frequently reported suffering from poverty in their childhood. The uneven composition of the two samples reflects the special social situation of foreign workers from Mediterranean countries in central Europe. Unskilled workers are significantly overrepresented in the latter segment of the adult working population of the study area (city of Basel, Switzerland). This overrepresentation is similar to that in our patient sample. The special situation of foreign workers from Mediterranean countries seems to account for their high incidence of chronic intractable back pain.
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PMID:[Chronic backache in migrant workers from Mediterranean countries in comparison to central European patients: demographic and psychosocial aspects]. 252 49

Benign papillary disease is an uncommon entity. For the small percentage of the population afflicted, however, it is a very real, incapacitating disease. In an attempt to alleviate the distressing pain associated with papillary disease, we performed a transampullary septectomy on 105 patients, between the years of 1972 to 1985. There were no operative deaths, and only five serious complications. The findings at exploration were almost equally distributed between stenosing papillitis (53), and septitis (45). The papilla was normal in 7. Histologic findings of inflammation were more common in the former, while fibrosis was seen more frequently with the latter. Long term follow-up (1 to 13 years) in 94 patients revealed complete pain relief in 50 per cent and improvement in 75 per cent Gallstones, pancreatitis, and peptic ulcer appeared to play a role in the pathogenesis of this obscure, rare, and disabling disease.
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PMID:Pathogenesis and treatment of inflammatory lesions of the papilla of Vater. 407 40

From 1973 to 1981, 94 patients suffering from low-back pain, with or without spread into the lower extremities, were candidates for therapeutic spinal cord stimulation. The etiology of pain in all cases was lumbosacral spinal fibrosis due to multiple myelographies and surgical interventions on the lumbar spine. The long-term results, based on a four-year follow-up, reveal a 60% subjective improvement of pain, a 40% substantial reduction of medication, and a 26% increase in working capacity. The concept of spinal arachnoiditis is reviewed and the term lumbosacral spinal fibrosis proposed. The treatment of this chronic painful and disabling disease is discussed.
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PMID:Lumbosacral spinal fibrosis (spinal arachnoiditis). Its diagnosis and treatment by spinal cord stimulation. 622 17

Reflex sympathetic dystrophy syndrome (RSDS) is a multisymptom, disabling disease that can involve peripheral nerve, muscle, bone, blood vessel and skin changes. Pain is the only common denominator among all patients. Two cases presented in this article describe patients with RSDS and demonstrate differences in symptoms and patient response. One treatment modality for RSDS is the stellate ganglion block, performed in the PACU by the anesthesiologist. Important postanesthesia nursing assessment parameters after this procedure are discussed.
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PMID:Reflex sympathetic dystrophy syndrome: two case studies. 810 89

Emphysema is a disabling disease, for which there is no curative therapy available today. Lung transplantation offers a valuable option for a very selected number of patients, however, due to the enormous organ shortage, only few patients can be offered such a therapy. Recently there has been important resurgence of interest in lung volume reduction surgery and as a consequence, we have embarked in such a program since may 1997. We have now performed unilateral lung volume reduction surgery in 29 emphysema patients (25 on the right and 4 on the left side). Twenty-four patients were already discharged home. There has been no perioperative mortality. The mean hospital stay was 19.8 +/- 11.4 days (range, 8-47 d). Twenty patients of whom we already have follow-up data during 6 months (m) form the further basis of this report. Six weeks after the procedure the FEV1 increased from 0.82 +/- 0.28 L (28 +/- 8%) to 1.05 +/- 0.39 L, a mean increase of 28%. There was a further increase of the FEV1 to a maximum of 1.06 +/- 0.42 L at 6 m, a mean maximum increase of 29% (p = 0.0046, ANOVA). Similarly, the FVC increased from 2.80 +/- 1.10 L to 3.15 +/- 1.00 L, a mean increase of 12.5%. A further increase was also obtained at 6 m and was 19.6% (3.35 +/- 1.05 L, p = 0.014, ANOVA). The maximum decrease in RV was obtained at 3 m (from 5.91 +/- 1.37 L to 4.37 +/- 0.85 L (p = 0.0001, ANOVA), a mean decrease of 26%. The maximum TLC decrease was demonstrated at 3 m (from 8.71 +/- 1.71 L to 7.60 +/- 1.56 L (p = 0.002, ANOVA), a mean decrease of 12.8%. Afterwards there was again a gradual raise of the TLC. The six minute walking distance increased from 231 +/- 31 m to 272 +/- 34 m (p = NS) after pulmonary rehabilitation and to 416 +/- 77 m at 3 m and 415 +/- 18 m at 6 m (p = 0.0002, ANOVA) after the operation. The quality of life (measured with a standardized questionnaire, the Nottingham Health Profile) improved significantly in several domains (e.g. mobility, pain, energy, emotions and social) at 3 m postoperatively. There was one late death (at 6 m) due to an unknown cause. The actuarial survival rate was therefore 100% at 3 m and 95% at 12 m. In conclusion, unilateral thoracoscopic lung volume reduction surgery is a new and safe treatment modality for patients suffering from severe end-stage emphysema. The objective and subjective improvement is marked and the mortality is very low. Rigid selection criteria are, however, necessary to be able to guarantee an optimal result.
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PMID:Lung volume reduction surgery (LVRS) for emphysema: initial experience at the University Hospital Gasthuisberg. Leuven LVRS Group. 1098 23

Complex regional pain syndrome (CRPS) is a disabling disease characterized by the classic symptoms and signs of inflammation. In this study we investigated the innate cytokine profile in patients with CRPS to determine a possible role of the immune system in the pathophysiology of CRPS. The cytokine profile before and after lipopolysaccharide and thrombin stimulation was determined in 26 severely affected CRPS patients and 20 healthy controls. No difference in the production of pro- and anti- inflammatory cytokines between patients and controls was found. Hence, our results do not support a role of genetic factors responsible for the cytokine profile in the pathophysiology of CRPS. These findings encourage further investigations of mechanisms responsible for neurogenic-induced inflammation.
Pain 2001 Apr
PMID:Innate cytokine profile in patients with complex regional pain syndrome is normal. 1127 82

Reflex sympathetic dystrophy (RSD), also known as complex regional pain syndrome type I (CRPS I), is a disabling neuropathic pain syndrome. Controversy exists about the effectiveness of therapeutic interventions for the management of RSD/CRPS I. In order to ascertain appropriate therapies we conducted a review of existing randomized controlled trials of therapies for this disabling disease. Eligible trials were identified from the Cochrane, Pubmed, Embase and MEDLINE databases from 1966 through June 2000, from references in retrieved reports and from references in review articles. Twenty-six studies concerning treatment modalities were identified. Eighteen studies were randomized placebo-controlled trials and eight studies were randomized active-controlled trials. Three independent investigators reviewed articles for inclusion criteria using a 15-item checklist. Seventeen of the trials were of high quality according to the 15-item criteria. There was limited evidence for the effectiveness of these interventions because of the heterogeneity of treatment modalities. The search for trials concerning prevention of RSD/CRPS I resulted in two eligible studies. Both were of high quality and dealt with different interventions. There is limited evidence for their preventive effect.
Eur J Pain 2002
PMID:Treatment of complex regional pain syndrome type I. 1190 Apr 71

Rheumatoid arthritis (RA) is a systemic, inflammatory autoimmune disorder that presents as a symmetric polyarthritis associated with swelling and pain in multiple joints, often initially occurring in the joints of the hands and feet. Articular inflammation causes activation and proliferation of the synovial lining, expression of inflammatory cytokines, chemokine-mediated recruitment of additional inflammatory cells, as well as B cell activation with autoantibody production. A vicious cycle of altered cytokine and signal transduction pathways and inhibition of programmed cell death contribute to synoviocyte and osteoclast mediated cartilage and bone destruction. A combination of targeted interventions at various stages in the pathogenesis of RA will likely be required to control symptoms in certain patients with this complex and potentially disabling disease. The regulation of rheumatoid synovial inflammation will be reviewed, followed by a brief summary of the therapeutic implications of these advances, including strategies targeting key cytokines, signal transduction molecules, co-stimulatory molecules, B cells, chemokines, and adhesion molecules.
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PMID:Rheumatoid arthritis: regulation of synovial inflammation. 1468 14


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