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

A 48-year-old laborer presented with a 1-year history of low-back pain radiating into the posterior aspects of both thighs. Two weeks before admission, acute exacerbation resulted in signs and symptoms of compressive radiculopathy at L-5. Myelography revealed concentric constriction of the lower thecal sac due to abundant fat, as shown by computerized tomography. Laminectomy produced immediate relief of pain. The significance of these findings and a review of the literature are presented.
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PMID:Extradural lipomatosis simulating an acute herniated nucleus pulposus. Case report. 621 40

Pain is determined by the neurologic properties of receptor organs, neurons, and their interconnections. These may become supersensitive or hyperreactive following denervation (Cannon's Law). A common cause of denervation in the peripheral nervous system is neuropathy or radiculopathy as a sequel to spondylosis. Spondylosis in its early stage may be "asymptomatic" or painless and hency unsuspected, because small-diameter pain fibers may not initially be involved despite the attenuation of the other component fibers of the nerve. The term "prespondylosis" is introduced here to describe this presently unrecognized phase of insidious attrition to the other functions of the nerve, especially the trophic aspect. It is postulated that many diverse pain syndromes of apparently unrelated causation may be attributed to abnormal noxious input into the central nervous system from supersensitive receptor organs (nociceptors) and hyperreactive control systems at internuncial pools. Furthermore, trauma to a healthy nerve is usually painless or only briefly painful, unless there is preexisting neuropathy. Some pain syndromes in muscle (eg, trigger points and myofascial pain syndromes) and nerve (eg, causalgia and diabetic neuropathy) that may be related to denervation are discussed.
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PMID:"Prespondylosis" and some pain syndromes following denervation supersensitivity. 624 68

Patients with pain or discomfort in the legs during exercise which is relieved by rest should not automatically be labelled as having intermittent claudication due to vascular insufficiency; the greatest imitator of this condition is radiculopathy associated with a narrow lumbar spinal canal. Problems involved in differentiating the neurogenic and vascular components in such cases are described on the basis of experience in the Department of Neurosurgery at Groote SChuur Hospital.
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PMID:Combined neurogenic and vascular claudication. 644

An attempt has been made to identify and manage patients symptomatic from both cervical and lumbar spinal stenosis. The order of operative intervention was related to the degree of myelopathy and radiculopathy. Patients requiring cervical surgery first had absolute stenosis with a spinal canal equal to or less than 10 mm in anteroposterior diameter. Those requiring lumbar surgery first presented with stenosis and a canal between 11 and 13 mm in depth. In the latter group, patients presented with radiculopathy in their upper and lower extremities. A significant portion (50%) had intermittent neurogenic claudication (INC). Motor and sensory changes were severe in those with absolute as compared to relative stenosis. After cervical laminectomy, myelopathy improved or stabilized, and the subsequent lumbar decompression could be completed with less risk. Cervical cord decompression often resulted in improvement in lumbar symptoms with resolution of pain, spasticity, and sensory deficits of myelopathic origin. However, latent symptoms of INC caused by lumbar stenosis were not affected by cervial decompression and increased in severity. Electrodiagnostic studies were helpful in that somatosensory evoked potentials showed conduction delays in the cervical cord in patients with significant disease. The identification of motor neuron disease and peripheral neuropathies was essential. The surgical management included extensive, multiple level laminectomy, unroofing of the lateral recesses, and foraminotomy. Neurolysis and untethering of the spinal cord was essential. Significant improvement was shown by 90% of these patients.
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PMID:Coexisting cervical and lumbar spinal stenosis: diagnosis and management. 649 58

Rheumatic pain is usually generalized, but in a variety of conditions it may present as localized and often remain so. These conditions include palindromic rheumatism, osteoarthritis, gout or pseudogout, seronegative spondyloarthropathy, septic arthritis, tendinitis and bursitis, radiculopathy and nerve entrapment, nodular growth, and tendon enlargement. When the presenting feature is focal pain in muscles, joints, or fibrous tissue, the differential diagnosis should include these considerations.
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PMID:Localized rheumatologic diseases. Common diagnostic challenges. 660 May 15

Four patients aged 41 to 73 years, who had had rheumatoid arthritis for eight to 25 years, had signs and symptoms of cervical myelopathy and radiculopathy due to either atlantoaxial dislocation with herniation of the odontoid through the foramen magnum, or subluxation of the middle to lower cervical vertebrae. Spastic paraparesis or quadriparesis, severe nuchal immobility and pain, and flaccid paresis of the upper limbs necessitated anterior medullary decompression and posterior cervical fusion. Postmortem examination disclosed old ischemic necrosis, atrophy, and gliosis in the low medulla and cervical cord. Anterior and posterior gray horns and contiguous posterior and lateral funiculi bore the brunt of the damage. Ascending and descending wallerian degeneration and atrophy of the cervical nerve root were evident. In three cases, anterior spinal or radicular arteries demonstrated intimal fibrosis with moderate stenosis; two cases depicted chronic phlebitis or subarachnoid vessels. Previous reports have infrequently provided evidence of a vasculopathy.
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PMID:Cervical myelopathy due to atlantoaxial and subaxial subluxation in rheumatoid arthritis. 668 27

Lumbar myelographic defects consistent with herniated disc were found in 108 asymptomatic patients undergoing myelography for other reasons. Within 3 years, 64% of these patients developed symptoms of lumbosacral radiculopathy. The clinical features of these patients comprise a syndrome significantly different from that typically associated with classical lumbar disc herniation: the syndrome described here carries a much higher incidence of silent root compression with minimal pain. Incidental lumbar myelographic defects are not necessarily benign findings, and patients in whom they are encountered deserve close clinical follow-up review and appropriate treatment if the defects become symptomatic.
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PMID:Syndrome of the incidental herniated lumbar disc. 686 67

Conventional transcutaneous electrical nerve stimulation was applied to 114 patients diagnosed as having peripheral neuropathy (N = 18), peripheral nerve injury (N = 21), radiculopathy (N = 36) and musculoskeletal disorders (N = 39) to determine optimal electrode placements and stimulation parameters for pain relief. Treatment outcomes were assessed primarily through evaluation of the present pain intensity (PPI) rating scale, Immediate improvements in PPI scores occurred in patients in all these diagnostic categories. One month follow-up data on 25 subjects showed that improvement was of limited duration. No clear correlation between stimulation parameters or electrode placements and pain relief was ascertained. In certain instances (subjects with radiculopathy or peripheral nerve injury) a positive relationship existed between higher intensity stimulation and amelioration of pain. Greater pain relief was reported among patients with minimal previous medical or surgical treatment in every diagnostic group.
Pain 1981 Aug
PMID:Examination of electrode placements and stimulating parameters in treating chronic pain with conventional transcutaneous electrical nerve stimulation (TENS). 697 58

The challenge of failed back surgery is in the decision of when to operate and how to do it competently. Specific neuroanatomic indications as a basis for surgical treatment should reduce surgical failures. One source of failure is a "battered root" and the arachnoiditis which may follow limited or inadequate interlaminar exposure. Even with adequate interlaminar exposure, hemostasis may be difficult if preoperative positioning of the patient to diminish intra-abdominal pressure has not been performed. Bleeding can obscure the operative field and the surgeon's ability to visualize and deal with the problem at hand. A less common cause of failure is segmental instability. This may be pre-existing and related to facet tropism. It may also be a consequence of surgical removal of posterior vertebral elements, thus creating a loss of stability with or without a discernable change in vertebral alignment. The surgeon should try to: avoid becoming enmeshed in the psychodynamic problems of patients. He should use specific diagnostic tests, e.g., nerve blocks or facet injections, in an effort to localize specific sources of pain; recognize that prognosis is adversely affected by additional surgery; and avoid "exploratory" operations. Furthermore, neurolysis without spatial decompression, bony or otherwise, is eventually futile. All patients with failed back surgery have a psychodynamic component to their pain. This article will have achieved its purpose if it promotes recognition that a small percentage of patients with failed back surgery can be helped. These are individuals in whom specific diagnostic tests or clinical acumen uncover a surgically correctable lesion, be it compressive or radiculopathy or segmental instability. In such instances an adverse psychologic profile need not necessarily be a deterrent to surgical treatment.
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PMID:Failed lumbar disc surgery: cause, assessment, treatment. 706 9

An adult female presenting with clinical impressions of cervical myositis with radiculopathy which began three days earlier following a motor vehicle accident, was referred for dental consultation because of tenderness over the left temporomandibular joint; response of the cervical spine pain to manipulation and physical therapy, including transcutaneous electrical nerve stimulation (TENS), was minimal. Dental examination revealed a malocclusion and following treatment with an intraoral orthotic device, along with chiropractic care, the patient's cervical spine pain was completely relieved. It was concluded that cervical spine pain of this nature may be interrelated with temporomandibular joint syndrome due to malocclusion and that when such cervical spine pain is not satisfactorily responsive to routine chiropractic care, dental examination may be indicated.
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PMID:Treatment of temporomandibular joint syndrome for relief of cervical spine pain: case report. 711 96


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