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

Chest wall pain after coronary artery bypass surgery is often attributed to incisional pain or anxiety. Although this assumption is often correct, a small number of patients have an unrecognized chest wall complication of the median sternotomy. In this paper we identify these delayed postoperative midsternotomy complications and discuss their appropriate management.
 ...
PMID:Delayed chest wall complications of median sternotomy. 352 Aug 44

Severe breast pain or mastalgia is a common symptom, affecting up to 70% of the female population at some time in their lives. It accounts for approximately 50% of referrals to a specialised breast clinic, two-thirds of patients having cyclical and one-third experiencing noncyclical mastalgia, or pain arising from the chest wall deep to the breast. After exclusion of breast cancer and proper reassurance, 85% of patients can be discharged from the clinic without specific treatment. In only 15% of patients is the pain severe enough to affect their lifestyle and warrant drug therapy. Using EF-12 (gammalinolenic acid; gamolenic acid) as first-line therapy, with danazol and bromocriptine usually as second-line agents, a clinically useful improvement in pain can be anticipated in 92% of patients with cyclical and 64% with noncyclical mastalgia. Patients with severe recurrent or refractory mastalgia may require treatment with tamoxifen, goserelin or testosterone, but the short and long term adverse effects of these drugs preclude their use as first-line agents. Chest wall pain is usually self-limiting, but symptomatic relief can often be obtained using steroidal and local anaesthetic injections or nonsteroidal anti-inflammatory drugs.
 ...
PMID:Drug therapy of mastalgia. What are the options? 753 Jun 28

Inadequate pain relief from systemic medications is common in patients with advanced malignancy. Chest wall pain secondary to tumor involvement of chest wall structures can be challenging to manage with systemic medications, and occasionally patients benefit from interventional procedures such as intercostal nerve blocks and neurolysis. In this report, the authors describe the case of a 58-year-old woman with advanced non-small cell lung cancer with tumor invasion into the third thoracic rib. After reaching maximum tolerated doses of transdermal fentanyl, oral hydromorphone, and oral ketamine, the patient elected for intercostal nerve blockade and neurolysis. Prognostic nerve blockade was performed using liposomal bupivacaine administered via intercostal approach. This formulation of bupivacaine provided an excellent prognostic blockade, which lasted for approximately 96 hours. This extended period of time allowed the patient to fully evaluate the prognostic blockade, prior to proceeding with neurolysis with phenol. This case suggests that liposomal bupivacaine may be a valuable adjunctive agent for prognostic blockade prior to neurolysis for cancer pain.
J Pain Palliat Care Pharmacother 2014 Mar
PMID:Intercostal administration of liposomal bupivacaine as a prognostic nerve block prior to phenol neurolysis for intractable chest wall pain. 2447 69

Stereotactic body radiotherapy is the preferred treatment modality for patients with inoperable early stage lung cancer. Chest wall toxicity is a potentially dose limiting side effect and may include fractures or pain secondary to treatment. The pathophysiology of these symptoms is unclear although it is presumed that radiation may alter the bone's normal tissue environment, affecting maintenance and remodeling. Chest wall pain is likely neuropathic secondary to injury to the intercostal nerves. Identifying patients with chest wall toxicity can be difficult due to the varying definitions of toxicity as well as heterogeneous contouring guidelines. Multiple studies have demonstrated a correlation between treatment factors and the incidence of chest wall toxicity. An increase in dose and treatment volume appear to be the most consistent radiation factors associated with toxicity. Patient factors such as body mass index, female gender, tumor location, and age have also been correlated with an increased likelihood of developing side effects. Management of chest wall toxicity is typically conservative using analgesic medications although surgical intervention may be required for displaced fractures. In this review, we examine the treatment, patient, and tumor factors predictive for chest wall toxicity and the implications for the treating physician.
...
PMID:Predictors and management of chest wall toxicity after lung stereotactic body radiotherapy. 2526 88