Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe two patients who developed neurological side effects as part of the spectrum of nitritoid reactions. Both reactions occurred late in the course of treatment. The first patient developed mild nitritoid symptoms and pain in a band-like distribution, corresponding to T10-T12 dermatomes, shortly after gold sodium thiomalate (GSTM) injection. Further injections were followed by similar symptoms in addition to paraesthesiae and altered pin-prick sensation of anterior thigh and legs with no residual deficit. She has had no further episodes since substitution of aurothioglucose. The second patient experienced mild nitritoid symptoms following several GSTM injections prior experiencing a cerebrovascular accident within several hours of her next injection. She subsequently haemorrhaged into the infarcted area with residual neurological deficits. These cases highlight that nitritoid reactions can be severe and may be heralded by milder symptoms. Patients who develop these reactions whilst receiving GSTM can be successfully changed to aurothioglucose.
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PMID:Neurological side effects in two patients receiving gold injections for rheumatoid arthritis. 758 10

To study post-operative analgesia with epidural midazolam, 30 patients who had undergone upper abdominal surgery were divided into two equal groups. When patients complained of pain, they were given either 6 microliters 0.25% bupivacaine (control group) or 6 microliters 0.25% bupivacaine + 0.05 mg kg-1 midazolam (midazolam group) epidurally at a single level between T7 and T12. Blood pressure and heart rate were similar in the two groups. Sedation was significantly greater in the midazolam group 10 min after administration. The area of analgesia was significantly larger in the midazolam group 10 and 30 min after administration and involved the entire spinal area and the head and face 10 min after administration in six patients. Amnesia was observed in 14 patients in the midazolam group but in only one in the control group. Epidural midazolam together with bupivacaine adds central analgesic, sedative, and amnesic effects to spinal analgesia and is useful for managing post-operative pain.
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PMID:The post-operative analgesic action of midazolam following epidural administration. 758 66

The present study tested the hypothesis that patients receiving epidural bupivacaine before surgery would require less morphine postoperatively and/or report less intense pain than patients receiving epidural bupivacaine after incision but before the end of surgery. Forty-two patients (ASA class I-III) scheduled for lower abdominal surgery were randomly assigned to 1 of 2 groups of equal size and prospectively studied using a double-blind, placebo-controlled crossover design. Epidural catheters were placed in the T12-L1 or L1-L2 interspaces pre-operatively, the position of the catheter was confirmed with 3% chloroprocaine with epinephrine 1:200,000, and sensory testing was carried out until levels had receded to below T12. Group 1 received 15 ml of 0.5% epidural bupivacaine injected 35 min before incision followed by 15 ml of epidural normal saline 30 min after incision. Group 2 received 15 ml of epidural normal saline injected 37 min before incision followed by 15 ml of 0.5% epidural bupivacaine 30 min after incision. General anaesthesia was induced with thiopental (4-6 mg/kg) and maintained with N2O/O2 and isoflurane. Paralysis was achieved with pancuronium (0.1 mg/kg). Opioids were not used as pre-medication or during surgery. Postoperative analgesia consisted of patient-controlled (PCA) intravenous morphine. Visual analogue pain scores (VAS) (at rest and after standardized mobilization) did not differ significantly between the 2 groups but McGill Pain Questionnaire (MPQ) pain ratings were significantly lower in group 1 at the 24 and 72 h assessments. Group 1 used significantly less morphine than did group 2 between 12 and 24 h after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
Pain 1994 Dec
PMID:Pre-emptive lumbar epidural anaesthesia reduces postoperative pain and patient-controlled morphine consumption after lower abdominal surgery. 770 14

Activation of the c-fos proto-oncogene following mechanical or chemical noxious stimulation of the urinary bladder was studied at T12-L2 and L5-S1, the spinal cord segments of projection of the hypogastric nerve (HGN) and pelvic nerve (PN) fibers, respectively. In intact adult rats, c-fos expression was found at T12-L2 only in lamina I. At L5-S1, Fos cells occurred in lamina I, the intermediolateral gray matter (ILG), and the dorsal commissure (DCM). These two areas contained the highest number of immunoreactive cells. Although more Fos cells were induced by mechanical than by chemical stimulation, the distribution of the reactive neurons was similar after both types of stimuli. In adult rats that had been treated neonatally with capsaicin, there was a marked fall in c-fos activation by mechanical or chemical noxious stimuli in all immunoreactive areas. The loss of Fos cells was more pronounced in ILG and DCM at L5-S1 (95%) than in lamina I at the two spinal domains (70%). The confinement of c-fos activation to lamina I at T12-L2, the spinal cord domain of the HGN, suggests that the input carried from the bladder by this nerve is preferentially used for pain perception. The same function is expected for noxious input reaching lamina I at L5-S1, the spinal cord territory of termination of the PN. However, the striking number of Fos cells in ILG and DCM supports the important role played by this nerve in the control of the micturition reflex.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Activation of the c-fos proto-oncogene in the spinal cord following noxious stimulation of the urinary bladder. 777 9

The purpose of this study is to investigate the mechanisms of the effect of hyperventilation on the spinal pain modulating system by using phentolamine. Under enflurane anaesthesia, cats received mid-collicular decerebration and lumbar laminectomy. The spinal cord was transected at T12-L1. WDR cells, responding primarily to noxious peripheral stimuli, were sampled with a microelectrode at the depth of 2,000 microns from the cord dorsum. Following the control period, ventilation was changed to induce hypocapnia of PCO2 20-25 mmHg. After activities were well suppressed, phentolamine 0.5 mg with normal saline 1.0 ml was injected on the spinal cord. Changes of firings were investigated. When normocapnia was resumed, recovery followed. Hypocapnia of PCO2 20-25 mmHg significantly suppressed the activities of WDR cells. Phentolamine significantly antagonized the suppressive effects of hyperventilation upon the activities of WDR cells. Our results suggest that the hyperventilation has suppressive effects on single-unit activity of WDR cell and the mechanisms of those suppressive effects are related to adrenergic pain modulating system.
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PMID:[Effects of hyperventilation upon the spinal pain modulating system (third report)]. 781 94

In this prospective, randomized study, 23 patients having spinal anaesthesia for transurethral prostatectomy (TURP) were evaluated for the adequacy of their block using a visual analog pain score (VAPS). Each patient with a "standard" (> or = T10) block level (n = 5) or "intermediate" (L1 or T12) block level (n = 5) found the block adequate. Sixty-two percent (8/13) of patients with a "low" (< or = L3) block level found their block adequate. The VAPS was assessed every five minutes or whenever pain abruptly increased during TURP; an "inadequate block" was defined as a VAPS > or = 5/10 during prostatic resection. Intravesical pressure was monitored and kept < 15 mmHg to distinguish between pain from bladder distension and from prostatic resection. "Low" block patients (LBP) who found their block inadequate (n = 5) received supplemental intrathecal local anaesthetic given through a spinal catheter. The subsequent L1 block level was adequate for TURP. In LBP, who found their block adequate (n = 8), a higher (P < 0.01) VAPS was observed than in patients with a "standard" block level. However, a smaller (P < 0.05) maximum percent decrease in diastolic blood pressure was found in LBPs, than in "intermediate" or "standard" block patients. It is concluded that a spinal block > or = L1 is adequate during TURP when bladder pressure is monitored and kept low. Mid-lumbar block levels should be reserved for patients in whom the benefit of minimizing haemodynamic changes outweighs the risk of a "less complete" anaesthetic.
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PMID:Does a mid-lumbar block level provide adequate anaesthesia for transurethral prostatectomy? 795 98

The present study was undertaken to clarify if needle positioning in percutaneous partial rhizotomy in the thoracic area based on bony landmarks and guided by fluoroscopic control leads to adequate placement in or at the targeted nervous tissue, i.e., the dorsal root ganglion (DRG), and to determine if needle localization by CT is more reliable than by fluoroscopic control. An investigation was performed in 2 cadavers, simulating the clinical setting as much as possible. At the levels T1-T8 a drill hole was made in the vertebral arc with a Kirschner wire. At the levels T9-T12 the "classic" dorsolateral technique was used. In 46 procedures the position of the needle tips was compared using hard copies of the fluoroscopic images, CT images at 1.5 mm intervals, surface photographs, and stained 25 microns sections obtained by a multirange heavy duty cryomicrotome. The position of the DRG in the foramen, and its size, were measured. In the sections, considered as the "golden standard", in 28 cases (60.9%) the needle tip was found in the DRG and in the extradural dorsal root in 14 cases (30.4%). In 4 cases (8.7%) no nervous tissue was encountered. In 8 of 32 "drill hole procedures" the facet joint was pierced. No accidental pleural puncture occurred in any of the procedures. The needle position was imaged more accurately by fluoroscopy. It is concluded that fluoroscopic control is a reliable guide to needle placement in percutaneous partial rhizotomy and permits standardization of the technique with the help of bony landmarks.
Pain 1994 May
PMID:Electrode positioning in thoracic percutaneous partial rhizotomy: an anatomical study. 809 May 19

The purpose of this study is to investigate the effect of hyperventilation on the spinal pain modulating system by using naloxone. Under enflurane anaesthesia, cats were prepared with midcollicular decerebration and lumbar laminectomy. The spinal cord was transected at T12-L1. WDR cells, responding primarily to noxious peripheral stimuli, were sampled with a microelectrode at the depth of 2,000 microns from the cord dorsum. Following the control period, ventilation was adjusted to produce hypocapnia of PCO2 20-25 mmHg. After activities of WDR cells were well suppressed, naloxone 0.1 mg.kg-1 was given intravenously. Changes of firings of WDR cells were investigated. Returning to normocapnia, recovery of firings was followed. Hypocapnia of PCO2 20-25 mmHg significantly suppressed the activities of WDR cells. Naloxone significantly antagonized the suppressive effects of hyperventilation upon the activity of WDR cell. Our results suggest that the hyperventilation has suppressive effects on single-unit activity of WDR cell and the mechanisms of those suppressive effects are related to pain modulating system by endogenous opiates.
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PMID:[The effects of hyperventilation upon the spinal pain modulating system (second report)]. 818 71

Nine patients were examined in the chronic stage of spinal cord injury (12 to 56 months postinjury). Surface lumbosacral spinal cord evoked potentials (LSEPs) were obtained using electrodes placed over the S1, L2, L4, and T12 vertebral levels, referenced to a T6 surface electrode. Epidural LSEPs were obtained using a multielectrode lead placed percutaneously into the epidural space for evaluation of the efficacy of spinal cord stimulation for modification of pain and spasticity. The LSEPs resulting from supramaximal stimulation of the tibial nerve at the popliteal fossa were composed of propagating and stationary action potential components. Based on the surface LSEP amplitudes and latencies established in healthy subjects, the data was divided into normal (less than 2 SD), marginal (between 2 and 2.5 SD), and abnormal (greater than 2.5 SD) categories. Comparison of surface and epidural LSEPs at the T12 vertebral level for the normal group (n = 6, 4 incomplete and 2 complete) revealed a mean epidural/surface amplitude ratio of 9.44 and a latency for the major negative component of 15.2 +/- 0.6 ms for the epidural versus 14.8 +/- 0.6 ms for the surface LSEP. In cases where the lead was progressively removed and LSEPs recorded (n = 4) the propagating components rapidly attenuated and increased in duration while the stationary components attenuated but did not change in duration. The LSEPs for the marginal group (n = 2, 1 incomplete and 1 complete) showed similar epidural/surface amplitude ratios. In the abnormal case (n = 1, complete) surface LSEPs were absent but epidural LSEPs were present but with stationary and propagating components of low amplitude. This study demonstrates the ability of the epidural LSEP to provide more information than the surface LSEP of the functional condition of the lumbosacral spinal cord, particularly regarding the character of the propagating action potentials and in cases when the surface LSEPs appear to be of very low amplitude or absent.
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PMID:Surface and epidural lumbosacral spinal cord evoked potentials in chronic spinal cord injury. 825 44

Extra-adrenal paragangliomas associated with vertebral pain and clinical neurological abnormalities as a result of metastasis to the vertebral column were diagnosed in four dogs of different breeds by light microscopy. All were males (two intact and two neutered) aged 8 years. Metastatic neoplasms occurred as extradural masses with associated bone lysis at vertebrae C4 (2 cases), T12-L1 (1 case) and L4 (1 case). The neoplastic cells exhibited similar morphology with little variation between cases. All neoplasms showed cytoplasmic granules after staining with the Churukian-Schenk modification of the Pascual argyrophil stain for neurosecretory granules or for membrane bound electron-dense granules (dense-core granules). On immunohistochemical examination the neoplastic cells gave positive results for neuron-specific enolase and negative results for chromogranin and epithelial membrane antigen. Multiple organ metastasis and metastasis to bone have been reported previously, but these cases were unusual due to the involvement of the spine as an apparent predilection site for metastasis, and the sex (male) and age of the animals affected.
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PMID:Metastasizing extra-adrenal paraganglioma with neurological signs in four dogs. 831 56


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