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

Motor evoked responses were recorded bilaterally in the tibialis anterior and soleus muscles after lumbar spinal stimulation in 45 patients suffering from L5 or S1 radiculopathies due to disc protrusion, and in 25 healthy controls. A significant prolongation (P less than 0.01) of motor evoked response latency was observed in 72% of the patients with L5 radiculopathy and in 66% of the patients with S1 radiculopathy. These anomalies were observed in patients with objective neurological signs as well as in patients free of objective signs. These findings indicate that subclinical compressive radiculopathy can be detected by this method which represents a useful adjunct in the assessment of radicular pain of discopathic origin.
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PMID:Motor evoked responses after lumbar spinal stimulation in patients with L5 or S1 radicular involvement. 246 99

In 14 patients, spinal cord stimulation in lumbar radiculopathy follow multiple exploration or iterative surgery. For 10 out of this 14 patients treatment was successful; pain relief lasted a mean time of 12.7 months in 9 out of them.
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PMID:[Posterior spinal cord neurostimulation in lumbar radiculitis pain. Apropos of 14 cases]. 252

Chronic intractable benign pain (CIBP) is defined as non-neoplastic pain of greater than 6 months duration without objective physical findings and known nociceptive peripheral input. To test the CIBP concept, 283 consecutive chronic pain patients were examined independently by a neurosurgeon and physiatrist and only congruent physical findings were coded. Because they did not fit the CIBP definition, patients with the following primary treatment diagnoses were eliminated: degenerative disease of the spine and spinal stenosis; degenerative disease of the hips; radiculopathy; malignancy; deafferentation pain; and miscellaneous. Eliminated, also, were patients with any one finding indicative of a root compression syndrome, leaving 90 low back and 34 neck patients. These patients had abnormal physical findings in 7 categories: tender points/trigger points; decreased ranges of motion in back or neck; non-anatomical sensory loss; rigid musculature; decreased range of hip motion; gait disturbance; and miscellaneous non-neurologic signs. Low back CIBP patients had the following distribution among the 7 categories: 0% had findings of all 7; 1.1% had 6; 13.3% had 5; 24.4% had 4; 25.6% had 3; 26.7% had 2; 8.9% had 1; and 0% had none. Neck CIBP patients, in which only the first 4 categories of physical findings were applicable had the following distribution: 2.9% had 4; 41.2% had 3; 35.3% had 2; 20.6% had 1; and 0% had none. It was concluded that CIBP patients do have abnormal physical findings indicative of musculoskeletal disease: possibly fibrositis and/or specific myofascial syndromes, as sources of peripheral nociception. These findings question the validity of the CIBP concept and point to the need for a careful, all-inclusive physical examination as a basic initial requirement in the classification of chronic pain patients.
Pain 1989 Jun
PMID:Physical findings in patients with chronic intractable benign pain of the neck and/or back. 263 5

Fifty-one cases of patients with back problems plus radiculopathy following the standard laminotomy or laminectomy for disc or spur excision were subjected to spinal meningeal denervation procedures. The results have been satisfactory. An autopsy finding on a patient with two previous disc surgeries was reported. There was considerable anatomical disruption of the meningeal nerves with myxoid intrafascicular changes similar to a Morton's neuroma (perineural fibromatosis), but with intact intradural spinal nerves, indicating that the damage to meningeal nerves may have been the cause of her pain.
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PMID:Further observations on spinal meningeal nerves and their role in pain production. 261 17

In dealing with foot pain of a radicular nature, it is important to interpret the clinical signs and symptoms of the pathology carefully and arrive at an adequate diagnosis. All appropriate ancillary aids should be used to help confirm the diagnosis. Appropriate treatment plans will follow; most often they will include referrals to qualified orthopedic specialists. In this sense, the treatment of lower-extremity radiculopathy is seen as a multidisciplinary problem. The podiatrist has the opportunity to make the diagnosis, explain the problem to the patient, and perhaps deal with the resolution of the pathology. This article attempted to present a differential diagnosis of a structural radiculopathy presenting in the lower extremity. It is hoped that the discussion of symptomatology, diagnostic aids, and numerous illustrations help to add to the knowledge of this disease process.
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PMID:Radiculopathies of structural origin. 268 43

The functions of autonomic nervous system were systematically evaluated in a case of causalgia in the upper limbs after neck trauma. A 14-year-old boy had had hard blow on his nucha in a rough fight. After one week, a sustained burning pain, swelling and skin color change developed in the left upper limb. These symptoms also appeared in the right upper limb after 6 weeks. The physical examinations disclosed edema, reddish moist skin, and atrophic nail in the upper limbs. The neurological examinations showed a radiating pain to the upper limbs caused by the neck movement or pressure on the supraclavicular fossae, weakness of the upper limbs and left lower limb, and loss of sensation in the 5th to 8th cervical and first thoracic dermatomal segments. Deep tendon reflexes were diminished in the upper limbs and exaggerated in the lower limbs. Neither Horner syndrome nor sphincter disturbance was observed. He was diagnosed as being the cervicothoracic radiculopathy and cervical myelopathy due to the mechanical force. The burning pain disappeared with oral administration of guanethidine. On the examinations of the autonomic functions, the sweating response to the thermal stimulation was absent above the 5th thoracic dermatomal segment. The sweating response to the intradermal acetylcholine was decreased in the second and third thoracic dermatomal segments. The systolic hypotension with increasing pulse rate occurred on standing. The reactive elevation of the blood pressure to the intravenous tyramine was absent. The excessive elevation of the systolic blood pressure was induced by the subcutaneous injection of epinephrine. These results indicated the dysfunction of the sympathetic postganglionic sudomotor and vasomotor fibers.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Causalgia in the upper limbs following neck trauma: existence of widespread dysfunction of sympathetic postganglionic fibers]. 268 35

The functional outcome of patients with lumbar herniated nucleus pulposus without significant stenosis was analyzed in a retrospective cohort study. Inclusion criteria were as follows: 1) a chief complaint of leg pain, primarily; 2) a positive straight leg raising (SLR) at less than 60 degrees reproducing the leg pain; 3) a computed tomography (CT) scan demonstrating a herniated nucleus pulposus without significant stenosis by a radiologist's reading, which was also confirmed by the authors; 4) a positive electromyogram (EMG) demonstrating evidence of radiculopathy; and 5) response to a follow-up questionnaire. All patients had undergone an aggressive physical rehabilitation program consisting of back school and stabilization exercise training. Of a total of 347 consecutively identified patients, 64 patients with an average follow-up time of 31.1 months met the inclusion criteria and constituted the study population. They were sent questionnaires that inquired about activity level, pain level, work status, and further medical care. The patients with neurologic loss, extruded discs, and those seeking a second opinion regarding surgery were identified and subgrouped. Results for the total group included 90% good or excellent outcome with a 92% return to work rate. For the subgroups with extruded discs and second opinions, 87% and 83% had good or excellent outcomes, respectively, all (100%) of whom returned to work. Sick leave time for these subgroups was 2.9 months (+/- 1.4 months) and 3.4 months (+/- 1.7 months), respectively. These results compared favorably with previously published surgical studies. Four of six patients who required surgery were found to have stenosis at operation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy. An outcome study. 271 47

Extruded lumbar intervertebral disks traditionally have been classified as posterior or central in location. A retrospective review of 250 MR imaging examinations of the lumbar spine that used mid- and high-field imagers revealed 145 positive studies, which included a significant number of extrusions extending anteriorly. With the lateral margin of the neural foramen/pedicle as the boundary, 29.2% of peripheral disk extrusions were anterior and 56.4% were posterior. In addition, a prevalence of 14.4% was found for central disk extrusions, in which there was a rupture of disk material into or through the vertebral body itself. The clinical state of neurogenic spinal radiculopathy accompanying posterior disk extrusion has been well defined; however, uncomplicated anterior and central disk extrusions also may be associated with a definite clinical syndrome. The vertebrogenic symptom complex includes (1) local and referred pain and (2) autonomic reflex dysfunction within the lumbosacral zones of Head. Generalized alterations in viscerosomatic tone potentially may also be observed. The anatomic basis for the mediation of clinical signs and symptoms generated within the disk and paradiskal structures rests with afferent sensory fibers from two primary sources: (1) posterolateral neural branches emanating from the ventral ramus of the somatic spinal root and (2) neural rami projecting directly to the paravertebral autonomic neural plexus. Thus, conscious perception and unconscious effects originating in the vertebral column, although complex, have definite pathways represented in this dual peripheral innervation associated with intimately related and/or parallel central ramifications. It is further proposed that the specific clinical manifestations of the autonomic syndrome are mediated predominantly, if not entirely, within the sympathetic nervous system. The directional differentiation of lumbar disk extrusions by MR, together with a clarification and appreciation of the accompanying clinical somatic and autonomic syndromes, should contribute both to understanding the specific causes as well as to establishing the appropriate treatment of acute and chronic signs and symptoms engendered by many nonspecific disease processes involving the spinal column.
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PMID:The anatomic basis of vertebrogenic pain and the autonomic syndrome associated with lumbar disk extrusion. 271 65

A patient with C6 cervical radiculopathy reported that sustained shoulder abduction significantly diminished this upper extremity pain. The patient was instructed to adopt this position for prolonged periods during rest and at work. Pain relief was temporary and lasted as long as the arm was in abduction. Relief of pain, induced by arm abduction, may be observed in cervical radiculopathy in which the lower cervical roots are involved. Reduced tension at the nerve root is the probable underlying mechanism that leads to pain relief. Shoulder abduction can be used not only as a diagnostic sign but also may be incorporated in the conservative management of patients suffering from cervical radiculopathy affecting the lower cervical roots.
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PMID:The shoulder abduction relief sign in cervical radiculopathy. 259 70

We report three patients who presented pain in the sciatic-crural region as presenting feature of an aneurysm of the abdominal aorta. The first patient developed a fullblown plexopathy with bad condition due to a large aneurysm of common iliac artery. The remaining two patients had abdominal aneurysms each that manifested as femoral neuropathy in one case and as L5-S1 radiculopathy in the other patient. The mechanism of neural involvement is discussed and those clinical and radiologic findings which may prompt us to think of such etiology in front of painful clinical pictures in this region are emphasized.
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PMID:[Lumbosacral plexopathy caused by aneurysms of the abdominal aorta]. 273 74


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