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

A 47-year-old woman developed radiating right lower extremity pain with weakness in the L5 myotomes. A CT scan, subsequent myelogram, and postmyelogram CT scan were reported as negative. Two months of bed rest diminished the radiating symptoms, but the weakness persisted. Three months post onset a severe burning dysesthesia developed in the right foot, and the patient became unable to bear weight on that extremity. Physical examination revealed 4-/5 weakness of the ankle dorsiflexors, foot evertors, toe extensors, and hip abductors. The entire right foot was swollen and had a red, mottled discoloration. An EMG was equivocal, and a three-phase bone scan was positive in the right foot in all three phases, which is characteristic of reflex sympathetic dystrophy. A repeat CT scan and review of the earlier scans revealed a high lateral disc fragment at the exit foramina of the L5 nerve root. Upon laminectomy, a free disc fragment at the exit foramina was removed, and the patient's symptoms resolved completely. Reflex sympathetic dystrophy syndrome is very rarely reported in association with lumbar radiculopathy. This case emphasizes the need to carefully evaluate the far lateral exit foramina on CT scan in patients with symptoms of radiculopathy. Myelogram is characteristically normal in these cases.
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PMID:Reflex sympathetic dystrophy syndrome secondary to L5 radiculopathy. 205 41

We studied 300 patients, 61% women, with mean age 49.7 years and mean duration of dystonia 7.8 years, to determine the demographic and clinical characteristics of cervical dystonia (CD) and its relationships to other movement disorders. Torticollis was present in 82%, laterocollis in 42%, retrocollis in 29%, and anterocollis in 25%; however, the majority (66%) had a combination of these abnormal postures. Scoliosis was present in 39%, local pain reported by 68%, and 32% had evidence of secondary cervical radiculopathy. In addition to CD, 16% of patients had oral dystonia, 12% mandibular dystonia, 10% hand/arm dystonia, and 10% had blepharospasm. Tremor was noted in 71% of patients; head-neck tremor was present in 60%, and tremor in other body regions was present in 32%. A family history of a movement disorder was present in 44% of the CD patients. Tardive dystonia was the cause in 6%; 11% had posttraumatic dystonia. Anticholinergic drugs provided moderate improvement in 33% of patients, but local intramuscular botulinum toxin injections relieved CD, local pain, or both in over 90% of all treated patients.
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PMID:Cervical dystonia: clinical findings and associated movement disorders. 206 38

The results of a three-year study of patients with herniated nucleus pulposus and radiculopathy are presented. Nonoperative treatment options for these lumbar disorders, ie, an aggressive physical rehabilitation program, pain control methods, exercise training designed to eliminate repetitive intervertebral disc or facet joint injury, and dynamic muscular lumbar stabilization techniques, were utilized. Successful outcomes were achieved in 50 of the 52 (96%) nonoperatively treated patients. A subcategory of patients with extruded nuclear fragments had an 87% success rate. Ninety-two percent of the overall study population was able to return to work.
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PMID:Dynamic muscular stabilization in the nonoperative treatment of lumbar pain syndromes. 214 45

Four patients (two men and two women, aged between 54 and 75 years), known to have type II diabetes since two to twenty years, had for several months been suffering from segmental pain of thoracoabdominal or lumbosacral distribution. Diabetic radiculopathy was confirmed by paravertebral electromyography. Analgesics having brought insufficient relief, treatment with an insulin infusion pump was commenced. The pains disappeared within 2-14 days. Even when the infusion treatment was no longer used, pains did not recur under an euglycaemic regimen. These results suggest that the transitory use of insulin infusion by pump can be a worthwhile therapeutic alternative in diabetic radiculopathy.
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PMID:[Diabetic radiculopathy]. 214 5

Cytokines of rabbit synovial origin were injected into 6 rats under the epineurium of the sciatic nerve. Five controls were injected with similar preparations lacking cytokines. After injection, rats were examined for a period of 7 days. For neurophysiological evaluation the tibial branch of the sciatic nerve was stimulated with supramaximal voltage impulses of constant duration. The responses were recorded at the dorsal root entry zone L1. F-wave latencies were recorded at the distal hind paw after stimulation of the tibial nerve. Filters were set at LF: 20 Hz, HF: 10 kHz. Synovial cytokines caused a significant decrease in amplitude and increase in latencies of the recorded nerve potentials. Our results indicate that interleukin-1, which is a major component of the synovial cytokine preparation, could play an important role in degenerative spine disease through a damaging effect on nerve function. This action would explain why radiculopathy and pain can develop without signs of nerve compression. The results are also relevant to patients suffering from osteoarthritis and rheumatoid arthritis.
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PMID:[The interaction between synovial cytokines and peripheral nerve function: a potential element in the development of radicular syndrome]. 214 30

The purpose of this study was to evaluate the natural history of morphologic changes within the lumbar spine in patients who sustained lumbar disc extrusions. All patients in this study were treated nonoperatively for radicular pain and neurologic loss. The following questions were addressed: 1) Does perithecal or perineural fibrosis result when extrusions are not removed surgically, and 2) Do disc extrusions spontaneously resolve, and, if so, how rapidly? The study population consisted of 11 patients with extrusions and radiculopathy. All patients were successfully treated nonoperatively. All had a primary complaint of leg pain and all had positive straight leg raising reproducing their leg pain at less than or equal to 60 degrees. Additionally, 87% had muscle weakness on a neurologic basis in a root level distribution corresponding to the site of disc pathology. Computed tomographic (CT) examinations were obtained on all patients at the inception of treatment. These studies were compared with follow-up MRI studies. The initial CT scans were evaluated for the following criteria: disc size and position, thecal sac effacement, nerve root enlargement or displacement, and evidence of central or intervertebral canal stenosis. In addition to the pathomorphology evaluated on the CT scans, follow-up MRI studies also evaluated disc hydration at the herniated and contiguous levels, and the presence of perithecal or perineural fibrosis. The following grading system was used to evaluate change in fragment size on the follow-up studies: Grade 1-0 to 50% decrease in size; Grade 2-50 to 75% decrease in size; Grade 3-75 to 100% decrease in size.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The natural history of lumbar intervertebral disc extrusions treated nonoperatively. 221 16

Lumbosacral and associated leg pain and paresthesias arousing patients from a sound sleep, or Vesper's curse, has been previously reported. An increase in right atrial filling pressure reflected in elevated paraspinal venous volumes within the reduced confines of a stenotic lumbar spine has been cited as the cause of this syndrome. Six cases of concomitant nocturnal calf cramps and fasciculations associated with the night pain and paresthesias are reported. In all cases a reduction in cardiopulmonary compliance was noted, with clinical and electromyographic evidence of paraspinal and lower extremity fasciculations increasing at night. Symptoms were relieved by assuming an erect or semi-reclining sleep position. In five of the six reported cases of lumbar spinal stenosis, spondylolisthesis was also present. The motor equivalent of Vesper's curse was evaluated by electromography, evoked potentials, CAT scan, and myelography. The multiple factors involved in the pathomechanics and pathophysiology of lumbar radiculopathy, and spinal stenosis and the role of the paravertebral plexus of veins are reviewed as they relate to the genesis of the restless legs syndrome.
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PMID:Restless legs syndrome associated with diminished cardiopulmonary compliance and lumbar spinal stenosis--a motor concomitant of "Vesper's curse". 233 80

We describe a case where transcutaneous electrical stimulation of the right sciatic nerve in a patient with right L5 radiculopathy reproduced the patient's pathological pain in the leg. Following a right ankle block with 0.5% bupivacaine, the sciatic nerve stimulation induced pain in the thigh and the calf but not in the foot. Despite an increase in the magnitude of stimulation by 50% (compared with the stimulation before the block) the pain was not perceived below the level of blockade. We suggest that in this case the electrical stimulation generated impulses propagated antidromically into the leg and activated nociceptors in it. The bupivacaine blockade prevented antidromic propagation of impulses into the foot, therefore pain in this region was not perceived.
Pain 1990 Jan
PMID:Does antidromic activation of nociceptors play a role in sciatic radicular pain? 208 38

The causes of ipsilateral arm pain were analyzed in a consecutive series of 38 patients with breast cancer. A lesion of the brachial plexus was diagnosed in 17 patients, of whom 8 had tumor involvement, 5 had radiation fibrosis, 1 had lymphedema entrapment, and 3 had a probable transient neuritis of the plexus. In four patients, a cervical radiculopathy was found; two of these patients had a Horner's syndrome. A carpal tunnel syndrome was seen in four patients and could possibly be attributed to lymphedema in two patients. In five patients, a pericapsulitis of the shoulder joint was seen. Seven of eight patients with a postsurgical pain had a neuropathic pain related to damage of the intercostobrachial nerve induced by a postaxillary dissection. These diagnoses probably indicate the most common causes of ipsilateral arm pain in breast cancer. A postaxillary dissection pain seems the most frequent type of postsurgical pain in breast cancer.
J Pain Symptom Manage 1990 Apr
PMID:Arm pain in the patient with breast cancer. 234 86

Initially, the Center for Pain Control designed and implemented multiple measures to indicate treatment efficacy in an outpatient setting. Decreased use of medical care at 1 year after treatment was one of five measures used. Economic concerns, both in the health and the insurance industries, mandated greater emphasis on cost effectiveness at a primary success determinate. Cost effectiveness was measured through broad diagnostic categories: lumbar pain with or without radiculopathy, cervical pain with and without radiculopathy, and a combination of lumbar and cervical pain. Cost for surgical treatment was determined using community-based charges. This cost was compared to actual cost incurred by outpatient pain treatment together with 6 months aftercare. Significant savings is indicated by the above cost comparison.
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PMID:Determining successful pain clinic treatment through validation of cost effectiveness. 245 52


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