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

Spinal cord stimulation (SCS) has routinely been used since the beginning of the 1970s. The initial indications for stimulation were the so-called deafferentation or neurogenic pain. Further work has confirmed that neurostimulation is useful in severe peripheral vascular disease in relieving pain and increasing capillary blood flow and oxygen tension. The effects are similar to those of sympathectomy. In 1964 Apthorp et al. discovered that sympathectomy relieved angina in about 75% of patients. The use of SCS to treat angina follows logically from its use in peripheral vascular disease. METHODS. The pain-relieving effect of SCS was investigated in two patients, 54 and 69 years old, who were hospitalised for 8 and 28 days. Both patients had severe angina pectoris (duration 2 and 15 years, New York Heart Association class III and II), related to three-vessel disease, and one of them had previously undergone his third bypass operation. The other patient was not considered suitable for surgery. The antianginal treatment (long-acting nitrates, beta-blockers, calcium antagonists) was regarded as optimal and was not changed during the observation period (Table 1). SURGICAL TECHNIQUE AND STIMULATION EQUIPMENT. We used the commercially available Medtronic SCS system. The operation was performed under local anaesthesia to allow the patient to answer questions during the intraoperative stimulation. The epidural space was punctured at the level of T7-T8 in one case and T11-T12 in the other. The electrode tip was positioned in the midline or a few millimetres to the left at the T1-T2 level (Figs. 1, 2), so that the patient felt a prickling sensation in the precordial area and into the arms. The distal end of the electrode was sutured to the fascia and connected via a tunnelled extension lead to the external pulse generator. The pulse width was 200 microseconds, frequency 80 Hz. An appropriate amplitude (usually 8-10 V) was used for comfortable paraesthesia. The study consisted of two parts: a run-in period (1 week) to standardise the stimulation when mobilisation was performed. A treatment period (18 months) to determine the patient's working capacity after continuous stimulation (Table 2). After a successful run-in period a Medtronic receiver was implanted, connected to the electrode and stimulated by external pulse generator. Different variables were used to assess the effect: pulse rate, blood pressure, the product of pulse rate and systolic blood pressure, estimated anginal pain, and ST changes in the electrocardiogram (ECG) before, during and after mobilisation. RESULTS. The stimulation was carried out for 30 min 10-12 times a day during the run-in period and five to six times a day during the treatment period. Altogether there was slight lowering of heart rate and systolic blood pressure. Consequently the product of heart rate and systolic blood pressure was diminished. In one case (NYHA II) the distinct disorder of repolarisation reverted to the normal condition as shown on ECG. In the other case (NYHA III) the ECG remained unchanged because of a severe aneurysm of the cardiac wall. Both patients experienced nearly complete pain relief after a few days for 6 and 12 months respectively. However, an increasing effort tolerance could be demonstrated in both patients by reducing the extent of the heart failure (NYHA II/III to NYHA I/II) (Table 2). DISCUSSION. Our two hospitalised patients had clinically intractable angina pectoris and severe manifestations of heart disease corresponding to at least NYHA functional class II-III. Both were unsuitable for operation and showed no improvement on individually titrated maximal oral antianginal drug treatment. During SCS treatment significant improvement was obvious: chest pain, ST-segment depression, and the extent of heart failure could be reduced. Both patients reached a better NYHA functional class, exhibited increased working capacity and reported reductions in anginal attacks and pain. Th
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PMID:[Epidural spinal cord stimulation in therapy-resistant angina pectoris]. 836 77

Scoliosis with progressive deformity can develop late in life. The authors studied 200 patients older than age 50 years with back pain and recent onset of scoliosis. Seventy-one percent of patients were women, and no patient had undergone spinal surgery. The curves involved the area from T12 to L5 with the apex at L2 or L3 and did not exceed 60 degrees. Degenerative facet joint and disc disease always were present, and the curves were associated with a loss of lumbar lordosis. Forty-five patients with severe pain and neurologic deficits were studied using myelography. Indention of the column of contrast medium was seen at several levels but was most severe at the apex of the curve. It was least severe at the lumbosacral joint. The curves progressed an average of 3 degrees per year over a 5-year period in 73% of patients. Grade 3 apical rotation, a Cobb angle of 30 or more, lateral vertebral translation of 6 mm or more, and the prominence of L5 in relation to the intercrest line were important factors in predicting curve progression.
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PMID:Degenerative symptomatic lumbar scoliosis. 851 97

A porous-coated humeral head replacement with biologic resurfacing of the glenoid was performed in 14 patients between 1989 and 1992. Six of the 14 patients had greater than 2 years of follow-up and form the basis of this report. The patients ranged in age from 33 to 54 years. Diagnoses were osteoarthritis in one, postreconstruction arthritis in four, and posttraumatic arthritis in one. The biologic resurfacing was done with either autogenous fascia lata or anterior shoulder capsule. All patients were relieved of pain. Average postoperative positions were elevation 138 degrees, external rotation 50 degrees, and internal rotation to the T12 spinous process. These results represent average increases of 57 degrees, 45 degrees, and six spinal segments, respectively. No donor site complications occurred. With Neer's rating scale there were five excellent results and one satisfactory result. We conclude that biologic resurfacing of the glenoid appears to improve the results of hemiarthroplasty and may well be the procedure of choice for young patients with end-stage glenohumeral arthritis.
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PMID:Biologic resurfacing of the glenoid with hemiarthroplasty of the shoulder. 854 69

A 16 year old girl did a handstand for fun, returned to her feet, experienced a sudden pain in her back, and became progressively paraplegic within 30 hours. MRI showed lumbar cord swelling, multiple Schmorl's nodes, a collapsed T11-T12 disc space, and intraspongious disc prolapse into the T12 vertebral body. These findings, related to the initial manoeuvre, suggested that an acute vertical disc herniation could have occurred as the first step in a process leading to spinal cord infarction due to fibrocartilaginous emboli from the nucleus pulposus of the intervertebral disc. The medical literature so far reports 32 cases of fibrocartilaginous embolism (FCE) of the spinal cord, all at necropsy, with the exception of one histologically demonstrated in a living patient. A clinical diagnosis of FCE would be desirable for many important reasons, but was never made. This causes severe limitations in the knowledge of the disease and precludes any therapeutic possibility. On the basis of the clinical features and findings in the present case, compared with data from the reported cases, a first attempt is made to identify the clinical context within which new information obtainable through MRI examination can lead to a reliable clinical diagnosis of FCE. The vexed question of the pathogenesis has been reviewed. An increased intraosseous pressure within the vertebral body, due to acute vertical disc herniation, seems to offer a consistent pathogenetic explanation and some therapeutic prospects.
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PMID:Fibrocartilaginous embolism of the spinal cord: a clinical and pathogenetic reconsideration. 855 52

Retrocrural splanchnic nerve alcohol neurolysis with a CT-guided anterior transortic approach, a new method for splanchnic block alleviation of chronic abdominal pain, is described. Ten patients with chronic abdominal pain requiring narcotic treatment, six with pancreatic carcinoma, one with gastric carcinoma, two with chronic pancreatitis, and one with pain of unknown etiology, were referred for splanchnic nerve neurolysis. With CT guidance, a 20 gauge needle was placed through the aorta into the retrocrural space at T11-T12, and 5-15 ml 96% alcohol was injected into the retrocrural space. Following the procedure, 6 of 10 patients were pain free, 2 patients had temporary pain relief, and 2 patients were without response. There were no significant complications. CT-guided anterior transaortic retrocrural splanchnic nerve alcohol neurolysis is technically feasible, easier to perform than the classic posterolateral approach, and may have less risk of complications. The success rate in this initial trial was reasonable and, therefore, this technique provides an additional method for the treatment of abdominal pain.
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PMID:Retrocrural splanchnic nerve alcohol neurolysis with a CT-guided anterior transaortic approach. 857 69

Young women with right iliac fossa pain are commonly referred to general surgeons as possible acute appendicitis. The differential diagnosis that includes pelvic visceral disease may be very difficult to determine clinically, especially when the history and physical signs are equivocal. We believe that diagnostic accuracy may be improved by eliciting precisely the site of abdominal pain. Right-sided low inguinal pain may be referred from the female pelvic viscera in the same way as testicular pain may be referred to the groin, as these viscera derive their autonomic nerve supply from the T10-L2, mainly T12-L1, spinal segments in both sexes. There are no previous reports of the value of the symptom of right-sided low inguinal pain in differentiating pelvic visceral disease from acute appendicitis in young women. This paper reports a prospective study of the discriminant value of this symptom in such patients.
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PMID:Right-sided low inguinal pain in young women. 919 21

Experiments were performed on male rats. The responses of dorsal horn convergent neurons in spinal cord (T12-L1) to noxious stimulation of hind paw were recorded extracellularly with glass microelectrode. When low intensity (2 V) electroacupuncture (EA) was used, the nociceptive responses of convergent neurons were inhibited by EA at "Zusanli" near noxious stimulation area, but not at "Xiaguan" far from the area. When intensity (18 V) high than the threshold of C fibers EA was applied at the far acupoint "Xiaguan", obvious analgesic effects on convergent neurons were also produced, showing an extensive analgesic effect of strong EA at acupoint. This extensive analgesic effect was abdicated by lesion of nucleus raphe magnus (NRM), but still persisted to some extent by EA at the same segment acupoint "Zusanli" with 18 V or 2 V intensity. The results suggest that, the extensive analgesia of strong EA at far segment acupoint may be mainly mediated by noxious stimulation through NRM, a negative feedback mechanism modulating pain of supraspinal cord. The analgesia due to 2 V EA at the same segment acupoint may be mainly produced by gate control in spinal cord, but also to some extend by supraspinal cord mechanism.
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PMID:[Central mechanism of an extensive analgesic effect due to strong electroacupuncture of acupoint on spinal dorsal horn neurons]. 876 53

Activation of the protooncogene c-fos at spinal cord segments T12-L2 and L5-S1 was used to study the effects of topical administration of capsaicin on bladder primary afferents coursing in the hypogastric (HGN) or pelvic (PN) nerves of adult rats. Two hours after capsaicin instillation in the bladder numerous Fos cells occurred in lamina I at T12-L2 and in lamina I, intermediolateral gray matter (ILG) and dorsal commissure (DCM) at L5-S1. Twenty-four hours later, the Fos immunoreaction had disappeared from the spinal cord. At this time, instillation of 1% acetic acid into the bladder of capsaicin-treated rats induced considerably fewer Fos cells than in animals that had been instilled only with the vehicle solution for capsaicin. The difference in the average number of Fos cells was statistically significant in lamina I, ILG and DCM at L5-S1 but not in lamina I at T12-L2. Thus, intravesical capsaicin at the doses used excites bladder primary afferents coursing in the HGN and PN, but only desensitizes those coursing in the PN. It is suggested that this may depend on the differential occurrence of capsaicin receptors in the two nerves.
Pain 1996 Mar
PMID:Desensitization follows excitation of bladder primary afferents by intravesical capsaicin, as shown by c-fos activation in the rat spinal cord. 878 21

Following resection of an adenocarcinoma of the cecum, a 59-yr-old patient developed pelvic pain. Imaging of the pelvis was unrevealing, but magnetic resonance imaging of the spine demonstrated a T12 epidural lesion. Pelvic pain may be due to an upper lumbar or lower thoracic radiculopathy. This referral pattern must be recognized when evaluating cancer patients with occult pelvic pain.
J Pain Symptom Manage 1996 Jan
PMID:Palliative care rounds: T12 epidural metastasis mimicks pelvic recurrence of cecal adenocarcinoma. 881 52

The aim was to prospectively study the relationship between pelvic pain of otherwise unknown origin and laxity in the posterior vaginal fornix. Twenty-eight patients with negative laparoscopy findings, lower abdominal pain and laxity in the posterior ligamentous supports of the uterus underwent surgical approximation of their uterosacral ligaments. At 3-month review, 85% of patients were cured, and at 12 months, 70%. Nonorganic pelvic pain has frequently been attributed to psychological factors. However, the results suggest that this may be a T12-L1 parasympathetic pain referred to the lower abdomen, perhaps due to the force of gravity stimulating pain nerves unable to be supported by the lax uterosacral ligaments in which they are contained. It was concluded that laxity in the posterior ligaments of the vagina should first be excluded before referring patients with pelvic floor discomfort or pain for psychiatric care.
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PMID:Severe chronic pelvic pain in women may be caused by ligamentous laxity in the posterior fornix of the vagina. 888 67


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