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

Motor vehicle accidents with a whiplash mechanism of injury are one of the most common causes of neck injuries, with an incidence of perhaps 1 million per year in the United States. Proper adjustment of head restraints can reduce the incidence of neck pain in rear-end collisions by 24%. Persistent neck pain is more common in women by a ratio of 70:30. Whiplash injuries usually result in neck pain owing to myofascial trauma, which has been documented in both animal and human studies. Headaches, reported in 82% of patients acutely, are usually of the muscle contraction type, often associated with greater occipital neuralgia and less often temporomandibular joint syndrome. Occasionally migraine headaches can be precipitated. Dizziness often occurs and can result from vestibular, central, and cervical injury. More than one third of patients acutely complain of paresthesias, which frequently are caused by trigger points and thoracic outlet syndrome and less commonly by cervical radiculopathy. Some studies have indicated that a postconcussion syndrome can develop from a whiplash injury. Interscapular and low back pain are other frequent complaints. Although most patients recover within 3 months after the accident, persistent neck pain and headaches after 2 years are reported by more than 30% and 10% of patients. Risk factors for a less favorable recovery include older age, the presence of interscapular or upper back pain, occipital headache, multiple symptoms or paresthesias at presentation, reduced range of movement of the cervical spine, the presence of an objective neurologic deficit, preexisting degenerative osteoarthritic changes; and the upper middle occupational category. There is only a minimal association of a poor prognosis with the speed or severity of the collision and the extent of vehicle damage. Whiplash injuries result in long-term disability with upward of 6% of patients not returning to work after 1 year. Although litigation is very common and always raises questions of secondary gain in patients with persistent symptoms, most patients are not cured by a verdict. Acute treatment of neck pain consists of ice for 24 hours followed by heat applications, pain pills, NSAIDs, and muscle relaxants. Trigger point injections can be beneficial in both the acute and the persistent phases. Use of cervical collars should probably be kept to a minimum during the first 2 to 3 weeks after the injury and then avoided. Early passive mobilization and range of motion exercises may accelerate recovery. Physical therapy and transcutaneous nerve stimulators may be helpful in reducing pain and improving movement.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Some observations on whiplash injuries. 143 66

Chronic cervical pain is not always attributable to radiculopathy. Pain may derive from peripheral myofascial syndromes and/or central inflammatory root irritation from degradation of discal proteoglycans. This concept is presented with its application in 30 patients with follow-up observations up to 30 months. Twelve of twenty-five achieving a pain level of 0 (out of a possible 10), ten of twenty-five had a pain level of 2, and three of twenty-five had a pain level of 4. Five cases were considered to be failures because of patient noncompliance. Treatment was multidisciplinary: aggressive physical medicine, behavioral medicine, vocational, and recreational rehabilitation with the goal of a return to socioeconomic productivity or previous lifestyle, secondary to which pain relief or control follows. Emphasis was placed on the restoration of musculoskeletal physiology to normal with behavioral modification, good body mechanics and the application of engineering/ergonomic principles at work or recreation.
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PMID:Chronic cervical pain: radiculopathy or brachialgia. Noninterventional treatment. 144 30

Twelve patients treated with cervical traction for complaints of cervical radicular pain subsequently developed lumbar radicular discomfort. Intermittent cervical traction therapy had been initiated at 15 pounds and increased to 30 pounds. Lumbar spine roentgenographs in four patients demonstrated a transitional lumbar vertebrae and ten patients had evidence of spinal osteoarthritis with associated degenerative changes. Abnormal electroneuromyographs were found in four patients. In two additional patients with normal electromyographs, the spinal evoked potentials were asymmetrically slowed suggesting chronic lumbar root compromise. The onset of lumbar radiculopathy after intermittent cervical traction suggests that axial tension induced in the spinal cord's dural coverings can be transmitted to lumbar nerve roots. When these structures are tethered by anatomic variants and/or associated degenerative changes, spinal root excursion may be limited, and lumbar pain may be precipitated by traction.
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PMID:Intermittent cervical traction: a progenitor of lumbar radicular pain. 153 17

Verbal pain description and assessment of functional limitations are key components in the clinical evaluation of patients with low back pain syndromes. Using the McGill Pain Questionnaire (MPQ) to quantify the pain experience and the Oswestry Disability Questionnaire (ODQ) to quantify functional disability, a study was undertaken to determine the efficiency with which the MPQ and ODQ were capable of enhancing the differential diagnosis of three broad categories of low back syndromes. Three discriminative models were employed. The combined discriminant model (MPQ/ODQ) yielded the highest accuracy, 0.90, and it was the only model with acceptable predictive power. The greatest utility of the discriminant models was found to be ruling out nonspecific low back pain and ruling in radiculopathy, with and without neurological deficits. Subjective pain and disability appear to have the potential for successfully differentiating broad categories of low back pain. Further studies need to be performed to assess the discriminant power of the MPQ and ODQ for specific diagnostic entities.
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PMID:Diagnostic utility of the McGill Pain Questionnaire and the Oswestry Disability Questionnaire for classification of low back pain syndromes. 153 78

From December 1973 through November 1988, we cared for 11 patients who presented with acute radicular pain and in whom radicular compression was ruled out by imaging techniques. Eventually, multiple sclerosis was diagnosed and judged to be responsible for the acute radiculopathy. The patients (seven women, aged 18 to 40 years; median, 32 years) and four men (aged 23 to 34 years; median, 29 years) were followed up from 6 months to 15 years (mean, 4 years 11 months). They represent 3.9% of 282 newly diagnosed cases of multiple sclerosis during the same 15 years. A retrospective analysis of the characteristics of their illness and its evolution was conducted. Six had lumbosacral radiculopathies; three, cervical and two, thoracic. In six of the 11 patients, symptoms occurred in close relationship to trauma; seven had recurrent radicular pain; four had other pain syndromes; and three others, paroxysmal symptoms. One patient died of complications from multiple sclerosis 3 years after diagnosis. Three others were rated five or greater in the extended Kurtzke disability status scale during follow-up.
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PMID:Acute radicular pain as a presenting symptom in multiple sclerosis. 153 27

Unilateral enlargement of the tibialis anterior muscle associated with complex repetitive discharges occurred over several months in two patients and was preceded by pain and numbness in the lower leg. Neuroradiologic investigations excluded a compressive radiculopathy, but pharmacologic and neurophysiologic studies suggested a neurogenic basis for the muscle hypertrophy. Botulinum toxin A injection into the hypertrophied muscles led to a decreased muscle volume and cessation of muscle pain.
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PMID:Persistent unilateral tibialis anterior muscle hypertrophy with complex repetitive discharges and myalgia: report of two unique cases and response to botulinum toxin. 129 16

The article presents a retrospective study of a series of 213 patients treated for cervical spondylotic radiculopathy by anterior surgery. The follow-up period ranged from 2-8 years. The overall functional outcome of surgery showed a rate of improvement of 91.5% at late follow-up. In 8.5% of the patients there was no change, and none considered themselves as being worse than before surgery. The various selective symptoms and signs were analyzed. Improvement of root pain was obtained in 93.4% of the patients, of sensory deficits in 90.7% and of motor deficits in 81.8%. The rate of improvement for neck pain was 44.6%. In this series, mortality was zero and there was no peroperative neurological deterioration. 3.3% of the patients were re-operated at the previous level. A second operation at another level or levels was necessary in 5.2% of the patients. Early surgical treatment, and possibly the degree of neurological deficits, were the only factors found to influence overall functional recovery. In contrast to the overall results, and in spite of large individual variations, neither sensory nor motor deficits, nor root pain, were statistically influenced by degree of root deficits or duration of symptoms.
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PMID:[Cervical disk defects. Results of surgical treatment of cervical vertebral radiculopathy]. 155 53

In 234 consecutive CT examinations of the lumbar spine, gas collection was observed in 4 cases with disk herniation, and in 6 cases of disk protrusion. In 3 cases free gas was found in the epidural space, and one patient presented an intraspinal gas-filled "bleb". Gas collection in intervertebral disk spaces and facet joints was found in a total of 60 patients. The CT findings and surgical results were compared to determine whether gas collection contributes to clinical symptoms. In most cases the presence of gas was not clinically important, but in one patient it presented as a spinal mass, causing pain and radiculopathy.
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PMID:Spinal gas collection demonstrated at CT. 156 16

Between 1974 and 1989 350 patients were submitted to surgery for the treatment of stenosis of the lumbar canal; in 280 of these cases a minimum two-year follow-up was obtained. In all of the cases there was significant stenosis of the spinal canal, which was furthermore secondary to hypertrophy of the facet joints of degenerative nature. In 67% of the cases neurogenic claudication was present; in 57% there was monolateral radiculopathy, in 43% bilateral radiculopathy. The lesions extended from L4 to S1 in 39.2% of the cases, L3 to S1 in 36.3%, L5 to S1 in 8.5%, L2 to S1 in 7.2%, L4 to L5 in 4.6%, and L3 to L4 in 2.1%. Radiological diagnosis was confirmed by myelography and CT scan. Surgery involved laminectomy leaving intact at least 6 mm of the posterior facet joints in order to avoid destabilizing the spine; moreover, the anteromedial portion of the joint osteophytes was removed in order to release the lateral recess and, when necessary, decompression was extended to the intervertebral foramen. During the first years of our experience fusion of the posterior joints with osteosynthesis using plates and pedicular screws was associated with decompression in 43% of the cases. Thereafter, fusion was performed in only 17% of the cases. From a subjective point of view the results obtained in radiculopathies were satisfactory in only 87% of the cases, objectively in 72%. The results obtained with treatment of lumbar pain was better in patients in whom lumbosacral fusion was associated as compared to cases treated with laminectomy alone (85% vs. 65%). Complications were rare and mild.
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PMID:Lumbar stenosis surgery: the experience of the orthopaedic surgeon. 158 57

This case is presented to emphasize that late infection should be considered in all postoperative patients as a cause of pain. A psoas abscess may remain dormant for many years after an anterior spinal procedure. It should be considered in the differential diagnosis of back pain and lumbar radiculopathy after anterior spinal fusion. The lumbar nerve plexus lies within the psoas muscle, and referred pain patterns may occur in the lumbar nerve distribution. In this case, dysesthesias occurred in the distribution of the genitofemoral nerve. The diagnosis and treatment of a psoas abscess has been greatly aided by use of CT and ultrasound. Either of these modalities may be used for directed percutaneous drainage of the abscess. The presence of metal fixation devices necessitates removal of the hardware in order to ensure eradication of the infection.
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PMID:Latent psoas abscess after anterior spinal fusion. 162 Nov 60


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