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)

The loin pain-hematuria syndrome is a poorly understood constellation of symptoms consisting of persistent hematuria and intractable loin pain with negative comprehensive urological evaluation. The patients are severely debilitated by the pain and are usually dependent on narcotics. Various medical and surgical treatments have been tried unsuccessfully, ultimately leading to nephrectomy in many instances. The symptoms may subsequently occur contralaterally. Renal autotransplantation as a form of nephron-sparing denervation therapy for relief of pain was performed on 12 kidneys in 10 patients (2 bilaterally). Excluding 3 patients with followup of less than 1 year (all 3 are pain-free), 8 of the 9 autotransplantations have resulted in dramatic relief of pain, curtailment of narcotic use and return of the patient to normal daily function. Median followup was 43 months (range 15 to 53 months). The remaining patient had pain in the graft area necessitating transplant nephrectomy 4 months later. For patients severely affected by pain and narcotic dependence with this syndrome, renal autotransplantation may provide a nephron-sparing surgical solution.
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PMID:Loin pain-hematuria syndrome: role for renal autotransplantation. 153 28

Sixteen cases in which celiac plexus block with depot steroid was used to treat chronic pancreatitis pain were reviewed. Only 4 of 16 patients reported pain relief with the procedure. Of the 12 patients who did not obtain relief, narcotic dependence was present in 11 of 12. No patients in the "relief" group were narcotic dependent. Prior pancreatic surgery was present in 9 of the 12 patients without relief and in 1 of 4 patients with relief. It is postulated that refractory chronic pancreatitis pain may be an extreme form of what has been termed "abnormal illness behavior." Furthermore, these results underscore the poor results experienced using neural blockade for the relief of chronic pain when narcotic dependence is present.
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PMID:Steroid celiac plexus block for chronic pancreatitis: results in 16 cases. 262 51

Rats were injected with progressively increasing doses of morphine or meperidine during a period of 3 to 40 days. From this colony of animals individual rats were used at 3- to 4-day intervals for electrophysiologic experiments to analyze the activity of nociceptive neurons in the somesthetic thalamus. After an i.p. injection of chloralose-urethane and the appropriate preparation for a stereotaxic microelectrode penetration of the thalamus, a nociceptive neuron was identified in the nucleus ventralis posterolateralis by its unique spacing of spike potentials emitted in response to pricking the foot with a pin. In addition to the short-latency response that formed a high activity peak on poststimulus time histograms, spikes following the stimulus up to 500 ms also formed activity peaks. Single-pulse stimulation of the sciatic nerve evoked the same response as pinpricks, but innocuous stimuli (pin shielded with a piece of cork) evoked a response without the late activity peaks. Only neurons that exhibited this differential response were regarded as nociceptive. Their response and spontaneous activity were accumulated separately on a digital computer. Following this, naloxone was infused i.v. and the computer accumulations were repeated. It was found that during naloxone-precipitated narcotic withdrawal, innocuous stimuli evoked responses indicative of pain; the nociceptive system was sensitized. Furthermore, a small dose or morphine or meperidine heightened the sensitization. This action of the narcotic agents was reversed by 5-hydroxytryptophan, which assisted the narcotics in suppressing pain in morphine- or meperidine-dependent rats but had no demonstrable effect in control animals. The spontaneous tonic activity of the nociceptive neurons of the somesthetic thalamus was high in rats exhibiting narcotic dependence. Naloxone decreased the count, but not to the value of the control animals. The sensitization of nociception can be explained by a decreased action of a neural pathway that descends from the periaqueductal gray matter via the nucleus raphe magnus to the spinal cord and there blocks the excitation of the spinothalamic tract cells by A-delta and C fibers. The mechanisms that increase the spontaneous activity of the thalamic nociceptive neurons remain unclear.
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PMID:Changes in thalamic nociception resulting from morphine- and meperidine-dependence in rats. 653 10

The purpose of this study was to evaluate prospectively the efficacy of bilateral thoracoscopic splanchnicectomy (TS) for pain due to chronic pancreatitis. Pain is invariably a major debilitating factor in the course of chronic pancreatitis. This study was performed to evaluate the effect of bilateral TS on pain intensity, hospital admissions, and daily functions in patients with debilitating pain due to chronic pancreatitis. Twenty bilateral TS were performed in 20 patients. Follow-up was obtained in all patients and averaged 15 months (6 months to 3 years). To evaluate efficacy of the procedure, all 20 patients were personally interviewed after TS regarding impact of pain and change in lifestyle. Using the 0-10 numeric rating scale, patients ranked pre- and postoperative pain level and overall mood. A KASPER report was obtained for 17 of 20 patients from the Kentucky Drug Control and Professional Practices to obtain accurate information on all narcotic prescriptions filled for 1 year prior to surgery until today. Information from the KASPER report provided very objective information on pain medication use before and after TS. Thirteen patients (65%) had a decreased pain level, and 12 patients (55%) also developed an improved overall mood. The number of hospital admissions for chronic pancreatitis pain decreased in 19 patients (95%), and the days spent in the hospital decreased for 15 patients (75%). Overall, 12 patients (60%) indicated pain symptom relief during a mean duration of 14.8 months after the procedure. KASPER reports indicated a decrease in pain medication prescriptions filled for 9 patients (53%), 3 of which were able to discontinue completely use of opioids for pain associated with chronic pancreatitis. TS is a minimally invasive procedure that appears to offer pain relief, improve quality of life, and reduce narcotic dependence in patients with pain from chronic pancreatitis. The decrease in hospital admissions represents further quality of life improvement in this difficult to treat group of patients.
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PMID:Bilateral thoracoscopic splanchnicectomy for pain control in chronic pancreatitis. 1521 13

Pain from chronic pancreatitis leads to disability, malnutrition, and narcotic dependence. This study demonstrates the efficacy of bilateral thoracoscopic splanchnicectomy in reducing pain associated with chronic pancreatitis. This study reviews results from this procedure between 1998 and 2006. Data included pain levels, hospital admissions, nutritional status, and the duration between splanchnicectomy and pancreatic resection. Narcotic use was determined from the Kentucky All Schedule Prescription Electronic Reporting system. Fifty-four patients underwent splanchnicectomy with technical success in 98 per cent and immediate symptom relief in 43 per cent. Additional surgery occurred in 44 per cent (average time to surgery was 26 months). Failure of pain relief occurred in 17 per cent, early recurrence (6-12 months) occurred in 15 per cent, and 68 per cent had over a year of relief. Admissions decreased from 5.8 to 2.9 post surgery. Average pain levels decreased from 8.7 to 6.1 post surgery (P < 0.001). Kentucky All Schedule Prescription Electronic Reporting demonstrated decreased or stable narcotic use in half of the patients. Over half (55%) maintained or gained weight, whereas 39 per cent experienced weight loss. Discharge occurred 24-hours after surgery. Bilateral thoracoscopic splanchnicectomy demonstrates a positive impact on pain control, hospital admissions, nutritional status, and narcotic use. Thoracoscopic splanchnicectomy is an effective and safe option in the treatment of pain from chronic pancreatitis.
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PMID:An objective study of pain relief in chronic pancreatitis from bilateral thoracoscopic splanchnicectomy. 1855 93

Since the mu opioid receptor (MOR) is known to be involved in the therapeutically relevant pathways leading to the manifestation of pain and addiction, we are currently studying the specific structural characteristics that promote antagonism at the MOR. The opiates 6beta-naltrexol and 6beta-naltrexamide function as neutral antagonists in in vitro and in vivo systems previously exposed to morphine, and are under investigation as improved treatments for narcotic dependence. In this research, we synthesized and characterized carbamate and sulfonate ester derivates of 6beta-naltrexol that do not contain a protic group at C(6), and evaluated these compounds for opioid receptor affinity. In vitro receptor subtype (mu, kappa, and delta opioid receptors) binding data of the carbamate and sulfonate derivatives is reported. All four compounds synthesized exhibited affinity for the MOR better than the standard 6beta-naltrexol HCl. Based on K(i) data, the order of MOR affinity is as follows: 9>13>14>10>6beta-naltrexol HCl. Carbamate 9 and tosylate 13 displayed subnanomolar affinity for the MOR, while 10 was the most mu-selective compound synthesized. In conclusion, our data indicate that the absence of a hydrogen-bond donor on the C(6) oxygen enhances rather than impedes the in vitro affinity of naltrexol derivatives for the MOR. Additionally, data also suggest that increasing the bulk around C(6) may allow control of subtype selectivity within these compound series.
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PMID:Design, synthesis, and characterization of 6beta-naltrexol analogs, and their selectivity for in vitro opioid receptor subtypes. 1936 45