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

The controversy about acupuncture is familiar to us since its recent reintroduction into this country. Much of its philosophical concepts were taken at their face values as the bases for condemnation. Since I last reviewed these antiquated concepts in the light of modern medicine, much has developed. It seems that if the effects of acupuncture were transmitted along the peripheral nerves to the central nervous system, it would be more effective if applied segmentally to the site of noxious stimulation. Disruption of extralamniscal pathways would abolish its analgesic effect. The distant and nonsegmentally located acupuncture points exert their influences through the integrative efforts of the reticular formation and the thalamus. The demonstration of transmissibility of acupuncture analgesia through blood and cerebrospinal fluid in animals implicates the involvement of humoral factors. Since such an effect can be suppressed by naloxone or by hypophysectomy, endorphins are thought to be involved. Such laboratory evidences indeed begin to shed some light on a possible neurohumoral mechanism of acupuncture. The differences between acupuncture and hypnosis are discussed. Acupuncture points were compared with referred pain, trigger points and motor points of the skeletal muscles. Its possible uses for other than pain, such as drug addiction, alcoholism, etc. are also reviewed.
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PMID:Recent advances in the understanding of acupuncture. 20 30

In its early stages necrotizing fasciitis may mimic an uncomplicated cellulitis, with erythema and only mild swelling and minimal pain. The combination of physical findings in a patient with a current history of drug addiction should arouse suspicion of an underlying fasciitis. An aggressive diagnostic approach including incisional biopsy, visual inspection of the underlying subcutaneous tissue, fasica and muscle, along with a Gram stain is suggested. Extensive and frequent debridement, appropriate antibiotics and physical therapy remain the essentials of treatment. A patient is discussed in whom a delay in diagnosis lead to near-fatal sepsis.
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PMID:Necrotizing fasciitis in narcotic addicts. 77 30

The analgesic effects of butorphanol tartrate and morphine sulfate were compared in 127 patients judged to have moderate to severe pain following major operations. The study was double-blind, and the drugs were given IM at several dosage levels. Scores for pain intensity and relief, as well as pain-intensity difference, were determined at 30, 60 and 120 minutes after medication, then were analyzed by a parallel-line assay method in a modified computer program. The analysis indicated butorphanol tartrate to be 7 times as potent as morphine sulfate. Peak analgesic effects were obtained at 60 minutes with both drugs. Side effects were minimal in degree and incidence. Neither butorphanol nor morphine induced any changes in blood pressure, pulse rate, or respiratory rate. These data, along with those from studies elsewhere, suggest that butorphanol is a safe, potent, and effective analgesic agents, with probably a low potential for inducing drug dependence.
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PMID:Butorphanol and morphine: a double-blind comparison of their parenteral analgesic activity. 77 40

On the basis of a 9-year experience with 231 patients with post-laminectomy and post-spinal fusion stenosis of the lumbar spinal canal, we emphasize the importance of recognizing and adequately decompressing such lesions. In the majority of such patients pain relief has been achieved, but some of the failures can be attributed to technical reasons. Most failures are due to associated lesions and to functional factors. A special surgical techniy be advisable. The indications for fusion however were few and require further investigation and evaluation. The significant failure rate points to the need for continuing research into the causes of low back pain and adequate management programs for the patient with the "multiple operated back" who still has disabling pain and drug dependence.
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PMID:Post-laminectomy and post-fusion stenosis of the lumbar spine. 125 76

A 30-year old primigravida with a history of drug addiction came to the Rigshospitalet in Copenhagen, Denmark for prenatal care at 15 weeks gestation. Physicians did an amniocentesis because of family history of trisomy 21. Ultrasound examinations in the 17th and 18th weeks of gestation indicated a living fetus with the placenta on the right lateral wall of the uterus, but there was an insufficient amount of amniotic fluid. Maternal alpha fetoprotein serum levels were extremely high (298 kIU/L). Physicians predicted a poor fetal prognosis and advised the woman to undergo an abortion. On the first day, they inserted 4 vaginal pessaries of 1 mg gemeprost and administered 25-30 mg bupivacain through an epidural catheter to control abdominal pain. 8 hours after first insertion, they began intravenous (IV) administration of oxytocin. Her cervix remain closed and uterine tension did not increase. 2 hours after beginning the oxytocin IV, she suffered from an abrupt severe abdominal pain which was transferred to the right shoulder. Heart rate and blood pressure remained normal. 4 hours later, her body temperature rose, so she received 500 m pivampicillin 3 times/day. She experienced no vaginal bleeding and no uterine contractions. Her cervix had still no opened. On the third day, health workers inserted 5 more pessaries. On the fourth day, they administered 75 ml isotonic saline/hour transcervically, but she still did not abort. Her temperature vacillated even though she received antibiotics and the pain continued despite epidural analgesics. On day 5, health workers administered 3.75 mcg prostaglandin F2 alpha/minute transcervically. After 6 hours of no progress, they performed a laparotomy and observed a macerated, malodorous fetus in the peritoneal cavity which continued 1200 ml of blood. The medial part of the left fallopian tube an the left uterine corner had ruptured. They removed the fetus via wedge resection; it had no malformations. Physicians should consider ectopic pregnancy when attempts at induced abortion do not succeed.
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PMID:Misdiagnosis of interstitial pregnancy followed by uterine cornual rupture during induced midtrimester abortion. 132 30

Twenty patients with complications of drug addiction were admitted to the Department of Vascular Surgery of the Santa Catarina University Hospital, from January 1986 to September 1990. Most of these patients were male, aged between 20 and 35 years. The most common drug used was propoxiphene, followed by cocaine. Swelling, ulcers and pain in the inferior extremities were the most common signs and symptoms. Six patients presented deep venous thrombosis, four had acute lymphangitis, all of them in the lower limbs. Five patients had acute arterial occlusions, one presented common femoral artery mycotic aneurysm and another had a false aneurysm of the superficial femoral artery. Venous and lymphatic complications were clinically treated with antibiotics, heparin and local care. Six patients were submitted to surgical procedures. One was treated by aneurysmectomy and vascular reconstruction, another with aneurysmectomy and arterial ligation. On one patient forearm fasciotomy was performed. Two amputations and one drainage of abscess were carried out.
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PMID:[Vascular complications in intravenous drug addicts]. 134 Mar 77

Although there is increasing awareness of the short-term psychological and social adaptations to childhood sexual abuse, little is known about the long-term effects of such abuse, particularly its effect on subsequent medical utilization and the experience and reporting of physical symptoms. We re-analyzed data from a previous study of 100 women scheduled for diagnostic laparoscopy (50 for chronic pain, 50 for tubal ligation or infertility evaluation) who received structured, physician-administered psychiatric and sexual abuse interviews. Women were regrouped by severity of childhood sexual abuse, and we compared the groups with respect to lifetime psychiatric diagnoses and medically unexplained symptom patterns. Unadjusted odds ratios showed that risk for lifetime diagnoses of major depression, panic disorder, phobia, somatization disorder and drug abuse, and current diagnoses of major depression and somatoform pain disorder were significantly higher in the severely abused group compared with women with no abuse or less severe abuse. Logistic regression analysis demonstrated that number of somatization symptoms, lifetime panic disorder and drug dependence were predictive of a prior history of severe childhood sexual abuse. Psychiatric disorders and medical symptoms, particularly chronic pelvic pain, are common in women with histories of severe childhood sexual abuse. Clinicians should inquire about childhood sexual and physical abuse experiences in patients with multiple medical and psychiatric symptoms, particularly patients with chronic pelvic pain.
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PMID:Medical and psychiatric symptoms in women with childhood sexual abuse. 145 59

Narcotic analgesic pethidine is widely applied in clinical practice to relieve pain caused by cancer or severe surgical conditions. Iatrogenic addiction following long term medication of narcotic analgesics have been noticed but rarely documented. In this presentation, the authors studied the clinical feature of pethidine dependency as well as experiences of residential detoxification in analysing 34 cases collected in the National Drug Dependence Treatment Center in previous two years. Manifestation of pethidine addiction are much alike to heroin and all abstinent syndromes can be relieved either by methadone or clonidine within 3 weeks except psychological craving throughout the detoxification period. In conclusion, the authors hold that iatrogenic narcotic addiction of this kind is curable as long as the addicts are highly and conscientiously motivated together with rehabilitation measures after detoxification.
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PMID:[Iatrogenic addiction of pethidine: clinical feature and experience of detoxification]. 149 13

It is claimed that a significant percentage of chronic pain patients suffer from drug/alcohol abuse/dependency/addiction. To address this question, 24 articles alluding to chronic pain patient drug/alcohol dependence/addiction were reviewed according to the following criteria: method for drug misuse diagnosis, which drug misuse diagnosis used (abuse, dependence, or addiction), and percentage of patients within each diagnostic category of drug misuse. The result of the review indicated that only seven studies utilized acceptable diagnostic criteria and/or definitions for the drug misuse diagnoses and gave percentages of drug misuse. Within these seven studies, the prevalence percentages for the diagnoses for drug abuse, drug dependence, and drug addiction were in the range of 3.2-18.9%. It is concluded that these diagnoses occur in a significant percentage of chronic pain patients. However, there is little evidence in these studies that addictive behaviors are common within the chronic pain population.
Clin J Pain 1992 Jun
PMID:Drug abuse, dependence, and addiction in chronic pain patients. 163 86

A randomized investigation compared the efficacy and safety of nalbuphine administered by two methods, a patient-controlled infuser system and intramuscular (IM) injections, after major gynecologic surgery. Forty-seven patients were randomly assigned to receive nalbuphine by either method. The 22 patients using the infuser were given a 2.0-mg, incremental dose with a 10-minute lock-out interval between doses. A similar group receiving 10-15 mg IM every three hours served as the control. Misprogramming, overdosage, depressed respiration and drug dependence were not encountered. Self-administration provided equally satisfactory sedation and more immediate pain relief without painful injections. Although patients with the infuser had the ability to self-administer more medication, they did not use higher doses of nalbuphine than did the IM group. The additional cost of the infuser system was offset by the satisfaction expressed by the patients and by the improved nursing efficiency. Nalbuphine administered with a patient-controlled infuser provided an effective balance between analgesia and sedation and offered advantages over IM injections.
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PMID:Nalbuphine after major gynecologic surgery. Comparison of patient-controlled analgesia and intramuscular injections. 177 27


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