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

A specific regional pain syndrome, the iliac crest pain syndrome (ICPS), defined by typical local tenderness over the medial part of the iliac crest, was recently found in hospital referred patients with chronic low back pain (LBP). To validate the prevalence of ICPS in different patient settings and to present quantitative data about associated clinical features, we prospectively studied 204 consecutive patients with LBP from a general practice (n = 40), an occupational health service (n = 124) and a rheumatology clinic (n = 40). ICPS was found in 53, 33 and 58%, respectively (41% of the total group). Associated clinical features were localized pain (in 73% of patients with ICPS) and typical pain reproduction by movements of the lumbar spine (64%) or hips (53%), leg raising (37%) and the heel-fall test (24%), in contrast to 2-12%/sign in patients with LBP without ICPS. These observations demonstrate that ICPS is present in a considerable percentage of all patients with LBP and is easy to differentiate clinically from patients with other forms of LBP.
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PMID:Iliac crest pain syndrome in low back pain: frequency and features. 183 44

The greater trochanteric pain syndrome (GTPS) or trochanteric bursitis is a regional pain syndrome characterized by typical local tenderness over the trochanteric region. Recently this syndrome was found in hospital-referred, chronic low back pain (LBP) patients. To confirm the correlation between GTPS and LBP in different patient settings and to present quantitative data about associated clinical features, we prospectively evaluated consecutive LBP patients from a general practice (n = 40), an occupational health service (n = 124) and a rheumatology outpatient clinic (n = 40). GTPS was found in 25, 18 and 45% of patients, respectively and was associated with female sex and duration of LBP. Associated clinical features were radiating pain and paraesthesiae in the legs, tenderness of the ilio-tibial tract and aggravation of pain during standing for a short time, descending stairs, lying on the affected side and crossing legs. These observations demonstrate that GTPS is common in LBP and is easy to recognize on clinical grounds.
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PMID:Greater trochanteric pain syndrome (trochanteric bursitis) in low back pain. 183 15

Myofascial pain is a regional pain syndrome characterized in part by a trigger point in a taut band of skeletal muscle and its associated referred pain. We examined a series of 172 patients presenting to a university primary care general internal medicine practice. Of 54 patients whose reason for a visit included pain, 16 (30%) satisfied criteria for a clinical diagnosis of myofascial pain. These patients were similar in age and sex to other patients with pain, and the frequency of pain as a primary complaint was similar for myofascial pain as compared with other reasons for pain. The usual intensity of myofascial pain as assessed by a visual analog scale was high, comparable to or possibly greater than pain due to other causes. Patients with upper body pain were more likely to have myofascial pain than patients with pain located elsewhere. Physicians rarely recognized the myofascial pain syndrome. Commonly applied therapies for myofascial pain provided substantial abrupt reduction in pain intensity. The prevalence and severity of myofascial pain in this university internal medicine setting suggest that regional myofascial pain may be an important cause of pain complaints in the practice of general internal medicine.
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PMID:Prevalence of myofascial pain in general internal medicine practice. 278 62

Pain in the chest may be the presenting feature of a diverse number of musculoskeletal chest wall conditions. The more common causes are costochondritis, trauma to the chest wall, benign overuse myalgia, fibrositis, referred pain, and psychogenic regional pain syndrome. These disorders are often mistaken for angina pectoris and other serious disorders. Information about onset, location, character, duration and modulating factors of the pain and other symptoms, a meticulous examination of the ribs, spine, sternum and their articulations, and a few judiciously selected diagnostic studies will establish the diagnosis in most patients. Knowledge and understanding of the underlying pathogenic mechanisms of these musculoskeletal disorders is important for optimal management.
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PMID:Approach to musculoskeletal chest wall pain. 306 94

Chronic rheumatic pain syndromes such as the fibrositis syndrome, 'whiplash' syndrome, low back pain syndrome and regional pain syndrome are common clinical disorders of unknown cause. The presence of tender points in predictable anatomical locations is essential to their diagnosis. Exaggerated dermatographia or flare response to mechanical stimulation is also a commonly observed physical finding. Dermatographia is thought to be a local axon reflex mediated phenomenon, and, as such, is a component of the neurogenic inflammatory response. Because neurogenic inflammation may be mediated by polymodal nociceptors we examined the flare response to topical capsaicin, a chemical method of stimulating local axon reflexes, in 12 patients with chronic rheumatic pain syndromes and in 10 controls. There was a significant correlation (rs = 0.61; p less than 0.01) between the area of flare induced by mechanical stimulation and the area of flare induced by chemical stimulation for all subjects. Patients with chronic rheumatic pain syndromes had a lower threshold for capsaicin-induced flare responses compared with controls. They also had larger flares at capsaicin concentrations of 0.02 and 0.033 mg/mL (p less than 0.05) applied as 20 microL aliquots over 30 minutes. It is concluded that neurogenic flare responses are increased in patients with chronic rheumatic pain syndromes.
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PMID:Neurogenic flare responses in chronic rheumatic pain syndromes. 349 68

The musculoskeletal structures of the thoracic wall and the neck are a relatively common source of chest pain. Pain arising from these structures is often mistaken for angina pectoris, pleurisy or other serious disorders. In this article the clinical features, pathogenesis and management of the various musculoskeletal chest wall disorders are discussed. The more common causes are costochondritis, traumatic muscle pain, trauma to the chest wall, "fibrositis" syndrome, referred pain, psychogenic regional pain syndrome, and arthritis involving articulations of the sternum, ribs and thoracic spine. Careful analysis of the history, physical findings and results of investigation is essential for precise diagnosis and effective treatment.
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PMID:Musculoskeletal chest wall pain. 402 4

Reflex sympathetic dystrophy, or as it is now known, complex regional pain syndrome, Type 1, is an unusual complication of a variety of injuries whose development should be suspected in the presence of disproportionate pain coupled with autonomic disturbance. Early recognition and treatment with multimodality therapy offer a high probability of recovery.
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PMID:A review of reflex sympathetic dystrophy. 748 50

We present a revised taxonomic system for disorders previously called reflex sympathetic dystrophy (RSD) and causalgia. The system resulted from a special consensus conference that was convened on this topic and is based upon the patient's history, presenting symptoms, and findings at the time of diagnosis. The disorders are grouped under the umbrella term CRPS: complex regional pain syndrome. This overall term, CRPS, requires the presence of regional pain and sensory changes following a noxious event. Further, the pain is associated with findings such as abnormal skin color, temperature change, abnormal sudomotor activity, or edema. The combination of these findings exceeds their expected magnitude in response to known physical damage during and following the inciting event. Two types of CRPS have been recognized: type I, corresponds to RSD and occurs without a definable nerve lesion, and type II, formerly called causalgia refers to cases where a definable nerve lesion is present. The term sympathetically maintained pain (SMP) was also evaluated and considered to be a variable phenomenon associated with a variety of disorders, including CRPS types I and II. These revised categories have been included in the 2nd edition of the IASP Classification of Chronic Pain Syndromes.
Pain 1995 Oct
PMID:Reflex sympathetic dystrophy: changing concepts and taxonomy. 927 20

This prospective, consecutive series describes peripheral nerve stimulation (PNS) for treatment of severe reflex sympathetic dystrophy (RSD) or complex regional pain syndrome, in patients with symptoms entirely or mainly in the distribution of one major peripheral nerve. Plate-type electrodes were placed surgically on affected nerves and tested for 2 to 4 days. Programmable generators were implanted if 50% or more pain reduction and objective improvement in physical changes were achieved. Patients were followed for 2 to 4 years and a disinterested third-party interviewer performed final patient evaluations. Of 32 patients tested, 30 (94%) underwent permanent PNS placement. Long-term good or fair relief was experienced in 19 (63%) of 30 patients. In successfully treated patients, allodynic and spontaneous pain was reduced on a scale of 10 from 8.3 +/- 0.3 preimplantation to 3.5 +/- 0.4 (mean +/- standard error of the mean) at latest follow up (p<0.001). Changes in vasomotor tone and patient activity levels were markedly improved but motor weakness and trophic changes showed less improvement. Six (20%) of the 30 patients undergoing PNS placement returned to part-time or full-time work after being unemployed prestimulator implantation. Initial involvement of more than one major peripheral nerve correlated with a poor or no relief rating (p<0.01). Operative modifications that minimize technical complications are described. This study indicates that PNS can provide good relief for RSD that is limited to the distribution of one major nerve.
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PMID:Long-term results of peripheral nerve stimulation for reflex sympathetic dystrophy. 860 52

Trochanteric bursitis, a common regional pain syndrome, is characterized by chronic, intermittent aching pain over the lateral aspect of the hip. The incidence of trochanteric bursitis peaks between the fourth and sixth decades of life, but cases have been reported in all age-groups. The diagnosis may be elusive, especially if symptoms are atypical. This condition can be associated with pain and limitation of function. Treatment includes physical therapy measures, analgesics, and local glucocorticoid injection. In this article, we review the pathogenesis, common initial symptoms, diagnostic approach, and treatment options for trochanteric bursitis.
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PMID:Trochanteric bursitis (greater trochanter pain syndrome). 864 85


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