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

Recovery of cold, warmth and heat-pain sensations in skin grafts was studied psychophysically in 22 patients who had had split skin grafts transplanted over muscle fascia 1 to 4 years earlier. A thermal stimulator based on the Peltier principle and controlled by a microprocessor was used to measure the thermal sensitivity of the grafts. Control measurements were obtained from the corresponding opposite side of the body. Cold sensitivity was present in 14 grafts (from 1-4 years old). However, with one exception, the threshold for cold sensation remained higher than normal in all patients. Warmth sensitivity was present in 6 grafts (from 1-4 years) which were all also sensitive to cold. Heat-pain sensitivity was present in 8 grafts. If the warmth and heat-pain sensibility had recovered, the sensation threshold was closer to the normal value than that for cold. In 7 grafts (from 1-3 years) no recovery was obtained.
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PMID:Regeneration of cold, warmth and heat-pain sensibility in human skin grafts. 280 27

Cross-finger flaps have been performed by our group in more than 200 patients. Subjective questioning and objective testing in a random group of 23 of these patients confirms the value of this procedure for reconstruction of the injured finger. It is reliable and flexible in its application. The patients usually report their flaps to be functional, durable, and free of pain. Cold intolerance, as with other methods of reconstruction, remains a problem. Sensibility in the flaps proved to be functional in the majority of patients. The preservation of length and range of motion is reflected in the fact that disability settlement was a rare occurrence. This flap has been applied in patients of widely varying ages with minimal morbidity. Overall patient satisfaction has been quite rewarding. In the properly selected patient, the carefully performed procedure provides a superior means of reconstruction for the injured finger with loss of significant soft tissue. of reconstruction for the injured finger with loss of significant soft tissue. Overall patient satisfaction has been quite rewarding. widely varying ages with minimal morbidity. Overall patient satisfaction has been quite rewarding. This flap has been applied in patients of
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PMID:The cross-finger flap. An established reconstructive procedure. 383 Oct 54

Cutaneous sensory and vascular function was examined following application of capsaicin to the sciatic nerve and systemic injection of guanethidine. Together the two drugs produced a reduction in sensitivity to heat-pain, inflammatory pain (formalin test), tactile stimulation and skin temperature of the foot that exceeded the effects of either drug alone. The inflammation produced by an injection of formalin to the plantar surface of the hind paw was reduced equally by capsaicin or capsaicin + guanethidine. Cold sensitivity and inflammation produced by yeast injection were unaffected by all treatments. The data imply a peripheral interaction between peptidergic and noradrenergic systems with significant functional implications that may be important in the pathology of familial dysautonomia.
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PMID:Behavioral evidence in rats for a peptidergic-noradrenergic interaction in cutaneous sensory and vascular function. 646 34

After upper extremity injury, pain on exposure to cold (cold sensitivity) is a significant problem. This cross-sectional observational study (1) assesses the incidence and prevalence of cold intolerance, (2) evaluates the relationship between functional status and degree of cold intolerance, and (3) correlates health-related quality of life (HRQL) with symptoms of cold intolerance. Patients in a tertiary care center completed questionnaires to document (1) cold sensitivity, (2) upper extremity pain, symptoms, and function, and (3) HRQL. Cold sensitivity was found to be associated with more functional limitations, greater pain, and reduced HRQL. As the severity of cold intolerance increased, functional limitations and pain increased and HRQL decreased. Cold intolerance has a profound effect on HRQL.
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PMID:Significance of cold intolerance in upper extremity disorders. 978 95

1. Experiments were performed on anaesthetized cats to investigate the receptive properties of regenerated cutaneous tibial nerve nociceptors, and to obtain evidence for coupling between them and other afferent fibres as being possible peripheral mechanisms involved in neuropathic pain. These properties were studied 6-7 months after nerve section and repair. 2. Recordings were made from 25 regenerated nociceptors; 14 were A fibres and the remainder were C fibres. Their receptive field sizes and conduction velocities were similar to controls. There was no significant difference between their mechanical thresholds and those of a control population of nociceptors. 3. Regenerated nociceptors were significantly more responsive to suprathreshold mechanical stimuli than were uninjured control fibres. This increase in mechanical sensitivity occurred in both A and C fibres, although A fibres showed a greater increase in mechano-sensitivity than C fibres. Over half of the regenerated nociceptors (13/25) showed after-discharge to mechanical stimuli which was never seen in controls; the mean firing rate during this period of after-discharge was significantly related to both stimulus intensity and stimulus area. 4. There was no significant difference between the heat encoding properties of regenerated nociceptors and control nociceptors. Cold sensitivity was similarly unchanged. Thus, abnormal peripheral sprouting was unlikely to account for the increased mechanical sensitivity of the regenerated fibres. None of the regenerated nociceptors were found to be coupled to other fibres. 5. These results suggest that the clinical observation of mechanical hyperalgesia in patients after nerve injury may have a peripheral basis. Based on this model, other signs of neuropathic pain (i.e. tactile or thermal allodynia) are more likely to be due to altered central processing.
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PMID:Modality-specific hyper-responsivity of regenerated cat cutaneous nociceptors. 1020 Apr 35

We have tested for anti-nociceptive effects of the anticonvulsant KCNQ channel opener, N-(2-amino-4-(4-fluorobenzylamino)-phenyl)carbamic acid ethyl ester (retigabine), in rat models of experimental pain. In the chronic constriction injury and spared nerve models of neuropathic pain, injection of retigabine (5 and 20 mg/kg, p.o.) significantly attenuated (P<0.05) mechanical hypersensitivity in response to pin prick stimulation of the injured hindpaw. In contrast, retigabine had no effect on mechanical hypersensitivity to von Frey stimulation of the injured hindpaw in either model. Cold sensitivity in response to ethyl chloride was only attenuated (P<0.05) in the chronic constriction injury model. In the formalin test, retigabine (20 mg/kg, p.o.) attenuated flinching behaviour in the second phase compared with vehicle (P<0.05), and this effect was completely reversed by the KCNQ channel blocker 10,10-bis(4-pyridinylmethyl)-9(10H)-anthracenone (XE-991; 3 mg/kg, i.p.). Neither retigabine nor XE-991 administration affected the latency to respond to noxious thermal stimulation of the tail in control animals. These results suggest that retigabine may prove to be effective in the treatment of neuropathic pain.
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PMID:The anticonvulsant retigabine attenuates nociceptive behaviours in rat models of persistent and neuropathic pain. 1255 70

Cold intolerance frequently occurs after successful digital revascularization and replantation. A series of 11 patients with cold intolerance 6 to 24 months after digital revascularization/replantation were treated daily for 2 weeks with beraprost, a stable prostacyclin analogue. That pain was reduced in 9 of 11 cases after treatment and digital thermography showed significantly increased surface temperature after the 2-week course of beraprost. These findings support the use of beraprost to relieve symptoms of cold intolerance under these clinical conditions.
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PMID:Prostacyclin analogue (beraprost) relief of cold intolerance after digital replantation and revascularization. 1523 11

The World Health Organization's model of health suggests that tendon and nerve injury outcomes can be assessed in terms of impairment, activity limitations, and participation restrictions. A tendon injury results in impairment of motion and strength of affected digits. Literature on outcome of tendon surgery has focused on active motion. Recently developed devices can be used to measure strength impairments associated with individual digits after tendon injury, although the importance of either grip or digital strength measures as indicators of post-tendon recovery has not been fully delineated. Published impairment rating scales have expressed outcome based on regained total active motion of relevant joints. These scales also tend to classify outcomes on a subjective four-point scale ranging from poor to excellent. Subjective ratings have not been validated, vary across scales, and inhibit meaningful comparisons by diluting information. Nerve injuries result in an impairment of motion, strength, sensibility, and sympathetic nerve function. Development of quantitative measures of sensibility continues to evolve, although all current methods have some limitations. Two-point discrimination was once a mainstay of assessment, but current evidence suggests it is less valid and responsive than other quantitative sensory testing. Cold sensitivity is common and can be measured through rewarming responses or by self-report. A comprehensive impairment rating scale for nerve injury with subscales addressing sensory, motor, and pain/discomfort domains has been developed. Use of this validated instrument will facilitate more meaningful comparisons across centers and studies. Recent literature on treatment outcomes has focused on impairment measures with minimal attention to activity limitations and participation restrictions. Validation of appropriate scales and inclusion of both impairment and disability measures in future clinical studies is required to fully understand health outcomes after tendon and nerve injury.
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PMID:Measurement of health outcomes following tendon and nerve repair. 1589 87

As relevant literature is scarce, this study was undertaken to assess the donor site morbidity of cross-finger flaps. It included 23 patients who had undergone reconstruction of a finger defect with a cross-finger flap. Any additional trauma to the donor finger was an exclusion criterion. Split thickness skin grafts were employed for donor site closure in 13 cases, full thickness skin grafts were used in 10 cases. Follow-up time averaged 83 months. Active and passive total range of motion of the donor finger and maximal pinch grip strength in kilopascals were measured. Both parameters were compared to the corresponding finger of the other hand. The donor site scar was evaluated for instability and pain in the donor finger was determined subjectively with a visual analogue scale. Cold intolerance and the cosmetic appearance of the donor site were also assessed. Active total range of motion of the donor fingers averaged 156 degrees . Average active total range of motion of the contralateral control fingers was 173.6 degrees . There was a significant difference between the donor fingers and the control fingers (p = 0.03) but not between split thickness and full thickness grafted donor sites (p = 0.91). Grip strength was significantly impaired in the donor fingers (p = 0.03), but there was no significant difference between split thickness and full thickness grafted donor sites. Subjective cosmetic evaluation by the patients revealed significantly better results for full thickness grafted donor sites. Donor finger pain averaged 2.4 with a range of 0-8. Five of the 13 patients with split thickness grafted donor sites and two of the 10 patients with full thickness grafted donor sites mentioned cold intolerance. In conclusion, the cross-finger flap is a secure and valuable option. There is, however, significant donor site morbidity. Our results suggest that alternative solutions should also be considered and if a cross-finger flap is employed, donor sites should be closed with full thickness grafts.
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PMID:Donor site morbidity in cross-finger flaps. 1603 23

Pain in the paretic upper limb is a common complaint in the post-stroke patients. It usually affects shoulder joint and, less frequently, wrist and hand. Pain is usually accompanied by limited mobility of the shoulder and sometimes by swelling of the hand and wrist. The aetiology of these complaints remains unclear. The objective of the study was to evaluate the incidence of pain, limited mobility, swelling and other signs that appear in the paretic limb within the first year after stroke. Forty-five stroke patients treated in the Department of Neurology in 2000 who answered the questionnaire concerning type, localization and intensity of the complaints from paretic upper limb were included. Twenty-six patients (58%) had a painful shoulder, wrist or hand. These complaints concerned women more frequently than men (71% vs. 46%, consecutively), younger patients aged below 55, and those who initially had more severe paresis. Symptoms and signs appeared within first month after stroke in majority of patients, and 70% of patients considered these symptoms very disturbing, significantly deteriorating the dexterity of the paretic limb. Thirty five percent of patients complained of limited mobility in the shoulder joint, 18% had incomplete mobility of fingers in the paretic limb. Twenty two percent of patients had swollen wrist and hand, and 24% had a discoloration and trophic changes of the skin in the paretic hand. Cold intolerance by means of freezing sensation in the affected limb was experienced by 58% of patients. Three patients had complaints both in shoulder and hand, with accompanied swelling, trophic changes and vasomotor disturbances in the hand, what fulfilled criteria for the diagnosis of shoulder-hand syndrome. The results of the study show that upper limb pain and limited mobility are common complications of the stroke. Usually underestimated by family doctors these symptoms and signs cause a significant discomfort for the patients and delay the recovery of the paretic limb.
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PMID:[Upper limb pain and limited mobility in the patients after stroke]. 1681 69


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