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

The anatomy, physiology, and pharmacology of nociception and its modification by analgesic drugs have been studied extensively in the past decade. Although the neural mechanisms of nociceptors and the stimuli that activate them are much better understood, it must be emphasized that the perception of pain, as well as the meaning of pain to the individual, is a complex behavioral phenomenon and involves psychologic and emotional processes in addition to activation of nociceptive pathways. Pain related to malignant disease can be classified as somatic, visceral, and deafferentation in type. Somatic pain and visceral pain involve direct activation of nociceptors and are often a complication of tumor infiltration of tissues or injury of tissues as a consequence of cancer therapy. The management of this type of pain is typically accomplished by treating the tumor (with surgery, chemotherapy, and/or radiation therapy) and by using the appropriate non-narcotic, narcotic, and adjuvant analgesic agents. Neuroablative therapies may be helpful in specific circumstances. For example, cordotomy may be helpful for unilateral pain below the waist in patients with somatic and visceral pain. This procedure may also be helpful for early deafferentiation pain (i.e., lumbosacral plexopathy) in which peripheral nerves are compressed but not infiltrated or destroyed by metastatic tumor growth. Deafferentiation pain may be a complication of tumor infiltration of peripheral nerve or of cancer therapy that injures neural tissue. This type of pain is often poorly tolerated and difficult to control, particularly if not treated early and aggressively. Although incompletely understood, the pathophysiology of deafferentation pain appears to be different from that of somatic or visceral pain, and the treatment approaches may be different. Management approaches to deafferentation pain usually emphasize treatment of the pain, because injury to the nervous system may be difficult to reverse, even if one can successfully treat the underlying malignancy, and many deafferentation pain syndromes occur as a complication of cancer therapy. The role of narcotic analgesics in the management of deafferentation pain is not clear, although the published experience suggests that they are less useful than in somatic or visceral pain.
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PMID:Anatomy, physiology, and neuropharmacology of cancer pain. 354 78

After radiotherapy, 20 patients, 18 with documented progression of malignant glioma and 2 with Grade II astrocytoma, received a total of 52 courses of intracarotid 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) at a dose of 150 mg/m2 dissolved in 5% dextrose in water. The patients were treated at 6-week intervals for a maximum of five courses of chemotherapy per patient. Response to treatment was analyzed on computed tomographic scans by measuring the volume of the enhancing tumor and any central low density. From these data, tumor doubling times ranging from 110 to 968 days were obtained. An 11 to 60% reduction in enhancing tumor volume was noted in 8 patients, 2 of whom had a greater than 50% decrease in tumor volume. One patient had no change in tumor volume 110 weeks after the initiation of BCNU chemotherapy. Four patients had tumor in more than one vascular territory; tumor growth was arrested in the perfused territory, but continued in the nonperfused area. In 1 of the 4 patients, tumor also grew along a shunt catheter tract and spread over the surface of the ipsilateral hemisphere. One patient developed clinically asymptomatic leukoencephalopathy after five courses of BCNU. Two patients had postradiation leukoencephalopathy before BCNU treatment. Seventeen patients had peritumoral low density with mass effect after BCNU; thus, the true incidence of BCNU-related leukoencephalopathy could not be determined. All patients experienced transient unilateral orbital pain during the infusion and scleral erythema that lasted for several hours afterward. Loss of vision was noted in 2 patients, although it seemed to be related to the therapy in only 1 patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Intracarotid chemotherapy with 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) in 5% dextrose in water in the treatment of malignant glioma. 358 50

In patients with big, tumorous changes in the vertebral bodies, conservative measures like radiotherapy, medical therapy, and external support measures are often no longer applicable. As a result of the instability of the spinal column, most of the patients are bedridden and in great pain. Signs of root compression occur frequently, as do incipient or incomplete transverse lesions. On the one hand, these signs result from tumor growth and on the other from collapse of the vertebral bodies with kyphosis and fragment dislocation in the spinal canal. In these patients the procedure of choice is "ventral" tumor removal, decompression of the spinal cord and roots, followed by stabilization. By the "dorsal" operative method, it is not possible to overcome the major cause of the instability and pain. On the basis of the results obtained in 100 "ventral" resections of the vertebral bodies, the treatment strategy is presented, ranging from the preliminary examination to the postoperative period.
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PMID:[Treatment strategy of malignant bone tumors of the spine]. 369 19

Skeletal involvement of non-Hodgkin's lymphoma is found in 11-16%, in Hodgkin's disease in 7.6-34%. Primary lymphoma of bone has an incidence of 1-50% among all non-Hodgkin's lymphoma. The occurrence of skeletal lesions is higher in infants and children than in adults. Skeletal lesions caused by Hodgkin's and non-Hodgkin's lymphoma are mostly seen in the axial skeleton including the skull, whereas the primary lymphoma of bone seems to prefer a more peripheral site. The aggressiveness of the tumor growth can be measured by the method of Lodwick, by judging the edge characteristic, the penetration of the cortex, the periostal and sclerotic reaction. 3 examples illustrate this method. Conventional radiographs need only be performed when there is reason to believe a lesion is located in an area of structural importance, such as the neck of the femur, and in cases of skeletal pain of unknown origin.
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PMID:[Evaluation of bone lesions in malignant lymphomas]. 408 75

Today the indication for palliative embolization of inoperable renal carcinoma is more restricted than several years ago. Reviewing 31 own palliative occlusions of the renal artery in 29 patients over a period of 5 1/2 years two main reasons for this attitude are presented: 1. Because of collateral or parasitic vascular supply of kidney tumors the occlusion of the renal arteries only results in a retarded tumor growth rate and does not seem to prolong patient survival. 2. the "postembolization syndrome" after tumor occlusion has a relatively high complication rate and lethality (20% serious side effects, 3% deaths directly related to embolization). Therefore embolization of inoperable renal carcinomas is justified only in patients whose remaining lifetime can be alleviated by this measure. Certain indications are: massive hematuria, severe local pain due to the tumor and life endangering endocrine tumor activity, e.g. hypercalcemia. Uncertain indications such as recurring but not perilous hematuria causing progressive anemia and refusal of tumor surgery should be carefully balanced against the hazards of embolization.
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PMID:[Limitations and hazards of palliative renal tumor embolization]. 618 73

On the basis of our own patients, the anamnestic data and the neurological constellation in late radiogenic paresis (the most frequent peripheral nervous condition in treatment of mammary carcinoma) are described. A comparison with the situation in metastatic infiltration of the brachial plexus shows the great difficulties in differential diagnosis. Pain can be observed more frequently in metastatic plexus infiltration. The presence of a Horner syndrome can be regarded as decisive evidence for recurrent growth of a carcinoma. If a Horner syndrome is absent, tumor growth can be demonstrated conclusively only by biopsy or surgical exploration. The most frequent condition which is not connected with mammary carcinoma and its followup treatment, but which can stimulate a late radiogenic paresis of the brachial plexus is the carpal tunnel syndrome. Whereas a certain differentiation is not always possible on the basis of the anamnesis and clinical findings, a clear discrimination is possible by means of electrophysiological investigation techniques.
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PMID:[Lesions of the peripheral nervous system in the treatment of breast cancer]. 618 90

Portions of the brain stem seem normally to inhibit pain. In man and laboratory animals these brain areas and pathways from them to spinal sensory circuits can be activated by focal stimulation. Endogenous opioids appear to be implicated although separate nonopioid mechanisms are also evident. Stress seems to be a natural stimulus triggering pain suppression. Properties of electric footshock have been shown to determine the opioid or nonopioid basis of stress-induced analgesia. Two different opioid systems can be activated by different footshock paradigms. This dissection of stress analgesia has begun to integrate divergent findings concerning pain inhibition and also to account for some of the variance that has obscured the reliable measurement of the effects of stress on tumor growth and immune function.
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PMID:Intrinsic mechanisms of pain inhibition: activation by stress. 650 91

The role of nutrition support as an adjunct to cancer treatment is discussed. Many patients with advanced cancer have demonstrable nutritional deficits, the reason is still unclear. Anorexia, taste abnormalities, pain and obstruction of the gastrointestinal tract can lead to malnutrition. Different modes of therapy, like surgery, radiotherapy and chemotherapy, sometimes deteriorate nutritional status. Several investigators have indicated, that nutritional support provides some benefit. There is no indication at the present time of any disadvantage of this method of treatment in relation to tumor growth. The potential indications and methods of nutritional support are pointed out.
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PMID:[The role of enteral and parenteral feeding in cancer therapy]. 680 86

1 out of 4-5 women develop uterine leiomyomata, the most common solid pelvic tumors in women. This paper assesses the reports of 4714 myomectomies and records of 59 personal cases. Townsend et al. suggested that leiomyomata are unicellular in origin. Estrogen, growth hormone, and progesterone may influence the growth of the tumors. In the performance of myomectomy, the 2 major technical concerns are the minimization of blood loss and the prevention of postoperative adhesions. Although most leiomyomata are asymptomatic and grow slowly, 20-50% of the tumors are estimated to produce symptoms, the severity of which depends upon the number, size, and location of the tumors. The symptoms include menorrhagia, infertility, fetal wastage, pelvic pain/pressure, polycythemia, ascites, impingement, and related complications (e.g., ulceration and infection, fever, pain, uterine inversion, sarcomatous change). Asymptomatic patients with uteri of less than 10-12 weeks' gestational size require no more than observation at 6-month intervals regardless of fertility status. For women with uteri of 10-12 weeks gestational size or longer, management will depend on the patient's desire for fertility. Women desirous of fertility should have a 6-12 month trial for conception. If tumor growth is rapid, myometomy may be performed earlier. Women not desirous of fertility (e.g., pre- and post-menopausal) should have total abdominal hysterectomy and bilateral salpingo-oophorectomy. For symptomatic patients desirous of fertility, myomectomy using the transabdominal approach or hysteroscopy should be performed. For symptomatic patients not desiring fertility, dilatation and curettage and hysterectomy should be performed. With regard to oral contraceptive use, no studies have yet demonstrated that women on oral pills are at increased risk for growth of these tumors. Low-dose contraceptives should not be contraindicated in patients with leiomyomata if they desire to use this form of contraceptive. With IUD users, the device should be discontinued if bleeding occurs.
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PMID:Uterine leiomyomata: etiology, symptomatology, and management. 702 95

Pain is a frequent and complex symptom in cancer patients. For successful treatment, it is necessary to recognize the exact origin. Pain is often the direct or indirect consequence of neoplastic spread to osseous or peripheral nervous tissues. But for one patient out of five, it is induced by previous treatments and rarely is unrelated to the cancer. Surgery, radiotherapy, hormonotherapy and chemotherapy often improve, temporarily at least, painful symptoms induced by tumor growth. For chronic persisting pain, the oncologist may use peripheral analgesics, anxiolytics, morphinics, local and neurosurgical treatment. Moreover the specific indications of each modality must be recognized and if necessary combined if the analgesic effect is inadequate or too brief.
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PMID:[Pains in cancer patients (author's transl)]. 744 44


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