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

The results of treating trigeminal neuralgia with percutaneous retroganglionic glycerol rhizotomy in 319 patients from an overall series of 394 patients with 459 operations carried out over a period of 5 1/2 years are reported. Idiopathic trigeminal neuralgia was the diagnosis in 252 patients. 34 patients had trigeminal neuralgia associated with multiple sclerosis. The remaining 33 patients suffered from symptomatic trigeminal neuralgia or atypical facial pain. 230 patients (91.3%) with idiopathic trigeminal neuralgia and 30 patients (88.2%) with multiple sclerosis reported complete freedom from pain. In 12 patients (4.8%) of those with tic douloureux and in 1 patient (2.9%) with multiple sclerosis, pain was alleviated, and the patients required a reduced pharmacotherapy. 10 patients (3.9%) and 3 patients (8.8%) were considered to be treatment failures. The rate of recurrences within the first 2 years was 10.9 and 40.0%, respectively. In the long-term, the rate of recurrences in patients with tic douloureux was 36.9%. 144 patients (45.1%) noticed a hypesthesia. 132 patients (41.4%) had hypalgesia following the procedure, and there was a decrease of symptoms in the long-term observation in 20.0% of the patients. 59 patients (18.5%) developed dysesthesia postoperatively which regressed only to an inappreciable extent in the long-term course. In 16 patients (5.0%) exclusively with a preexisting organic lesion or who had received surgical pretreatment, there was a loss of corneal sensation. The investigation showed on the one hand the effectiveness of the method, but on the other hand also the possibility of marked sensory disorder in selected cases.
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PMID:Five-and-a-half years' experience with percutaneous retrogasserian glycerol rhizotomy in treatment of trigeminal neuralgia. 350 39

In an attempt to validate recent assertions that the strongest indicators of hysteria are the "positive" findings in the neurological examination, seven of the most accepted features (history of hypochondriasis, secondary gain, la belle indifference, nonanatomical sensory loss, split of midline by pain or vibratory stimulation, changing boundaries of hypalgesia, giveaway weakness) were sought in 30 consecutive neurology service admissions with acute structural nervous system damage. All subjects showed at least one of these findings; most presented three or four. The presence of these "positive" findings of hysteria in patients with acute structural brain disease invalidates their use as pathognomonic evidence of hysteria. A second, retrospective study on the misdiagnosis of hysteria demonstrated that women, homosexual men, the psychiatrically ill, and patients presenting plausible psychogenic explanations for their illness are most liable to be misdiagnosed. Certain disorders, particularly movement disorders and paralysis, are most often mislabeled as hysteria. A diagnosis of hysteria must be made with great caution as it so often proves incorrect.
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PMID:The validity of hysterical signs and symptoms. 376 Aug 49

Ten patients with intractable pain of central origin were operated on for pain relief by implanting the chronic stimulating electrode (Medtronic Co.) in the posterior limb of the internal capsule, thalamic sensory nuclei or mesencephalic lemniscus medialis, and the results were briefly described. Localization of the lesion demonstrated by CT was projected on the Schaltenbrand & Bailey's atlas in each of these patients and the deep brain structure involved was identified. The lesions were located mainly in the posterolateral thalamus including posteromedial part of the internal capsule (thalamic pain), however, they were located outside of the thalamus in some cases (suprathalamic pain). Two particular patients were described in detail because clinical courses, especially operative results were esteemed to be suggestive of an important role of lemniscal system in pain modulation. A 48-year-old man (Case 7) developed severe spontaneous burning pain on the right half of the body after extensive putaminal hemorrhage. Stimulation of the posterior limb of the internal capsule or of the thalamic sensory relay nuclei elicited no pain relief. Consequently a lesion was stereotaxically made in the most medial portion of the lemniscus medialis of the rostral mesencephalon. This operative procedure provoked previously unrecognized significant dysesthesia and hyperpathia predominantly of the extremities as well as aggravation of hypesthesia and hypalgesia. The second patient (Case 8) was a 44-year-old man who developed dysesthesia, hyperpathia and spontaneous pain of the left hand and face after hemorrhage in the right sensory cortex. Stimulation of the mesencephalic lemniscus medialis of the right side elicited comfortable warm sensation in contralateral upper half of the body including hand, fingers and face with simultaneous diminution of pain. These two cases were suggestive of the role of lemniscus medialis in pain modulation. Blockade of the lemniscus medialis elicited, and its facilitation inhibited the pain. Lemniscal and extralemniscal (spinothalamic) system have been proven to be intermingled in the thalamic and suprathalamic levels. Though both of the systems might be involved in the manifestation of central pain including our present ten cases, it was discussed and postulated that the facilitation of the lemniscal system might inhibit the activity of spinothalamic system, thus resulting in pain relief.
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PMID:[Role of the lemniscal system in pain modulation--a consideration based on clinical experience]. 387 48

Twenty-one patients who had undergone total hip replacement were randomly assigned to one of three groups in order to compare a single dose of 1 mg/kg of pethidine im (I) and 20 mg (II) or 60 mg of extradural pethidine (III) in a double-blind design. The degree of analgesia, the adverse effects, and the kinetics were studied for 18 h. Pain was monitored using a visual analogue scale (VAS). Supplementary doses of oxycodone if required were given no earlier than 0.75 h after pethidine. Plasma concentrations of pethidine were measured with gas chromatography mass spectrometry (GCMS). Hypoalgesia to pin prick test was evaluated. Low pain scores were observed in the extradural groups between 0.25 and 1.5 h after the dose. A significant difference in pain score compared with the im group was found after the higher extradural dose only between 0.5 and 1 h (p less than 0.05). The area under the curve (AUC) of pain score versus time (0-18 h) was not significantly different between groups. The recorded adverse effects were minor in all three groups. The terminal half-lives and plasma clearances of pethidine, and the time to peak concentration were not different between the groups. Single patients in the extradural groups showed hypoalgesia to pin prick in parallel to the effect. The present study shows that extradural pethidine produces shortlived analgesia, in contrast to the long-lasting effect of morphine found in other studies.
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PMID:Extradural and parenteral pethidine as analgesia after total hip replacement: effects and kinetics. A controlled clinical study. 395 58

Twenty nine patients with trigeminal neuralgia were treated by retrogasserian glycerol injection method. Two of 29 were postherpetic and 27 were idiopathic trigeminal neuralgia. The mean age of these 27 was 65.2 years old ranging from 35 to 83 and the mean duration of symptoms was 7.6 years ranging from 6 months to 25 years. As previous surgical treatment there were 9 alcohol block, 5 thermorhizotomy of the Gasserian ganglion and one microvascular decompression. Twenty-two gauge needle was introduced into the trigeminal cistern via foramen ovale under the fluoroscopic control. Before injection of glycerol trigeminal cisternography using metrizamide of 300 mgI/dl was done to ascertain whether or not the needle tip was properly placed in the cistern. Patients' neck being flexed anteriorly, pure glycerol, amounting from 0.15 to 0.6 ml, was injected into the cistern with small increments through the needle. If the needle was inserted too deeply in the cistern, it is more probable that glycerol should escape from the cistern into the posterior fossa. So it was advisable that needle tip should be placed in the bottom of the cistern. When there was no pain relief, second injection was performed usually 7 days after the first injection. Complications were as follows; dysesthesia (81%), hypertension (70%), hypalgesia and hypesthesia (48%) headache (22%), ocular dysesthesia (11%), masseter weakness (7%), hyperalgesia (7%), attack of paroxysmal pain (7%). Most of these complications subsided within 8 weeks. Dysesthesia and hypalgesia that had persisted over 8 weeks were recognized in 30% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Glycerol injection method for trigeminal neuralgia]. 401 Aug 77

Characteristics of primary (within the area of injury) and secondary (outside the area of injury) hyperalgesia were determined after a heat injury applied to the glabrous skin of the hand in 8 human volunteers. The heat injury consisted of two burns (53 degrees C, 30 s) applied over an area 7.5 mm in diameter separated (centre to centre) by a 2 cm interval. Following the injury, a zone of hyperalgesia to mechanical stimuli measuring 20.1 +/- 3.6 cm2 (mean +/- SEM) developed in an area surrounding and including the burns. Within this zone, the pain threshold for mechanical stimuli decreased significantly by a similar amount for all areas tested (12.0 +/- 1.1 bars to 5.2 +/- 0.5 bars). Hyperalgesia to heat occurred only within the area of the burns. The heat pain threshold decreased and total ratings of heat pain increased significantly. In contrast, there was decreased pain to heat stimuli between the two burn sites, and no change in painfulness of the heat stimuli at other areas within the zone of hyperalgesia to mechanical stimuli. Particularly notable was the coexistence of hypalgesia to heat stimuli and hyperalgesia to mechanical stimuli in the uninjured region between the two burn sites. These results indicate that the characteristics of primary and secondary hyperalgesia differ and also suggest that the mechanism for hyperalgesia to mechanical and thermal stimuli differ.
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PMID:Evidence for different mechanisms of primary and secondary hyperalgesia following heat injury to the glabrous skin. 650 13

A 5-year retrospective study shows that stimulation of the neuraxis by biocompatible on-demand electrical energy systems is an effective alternative in the management of chronic organic regional pain syndromes. The clinical criteria of improved sense of well-being - reduction of drug intake and increase in activities of daily living - were employed to show that 50% of selected patients reported improvement in 60% of the cases in which stimulation-induced hypalgesia (SIH) was present. There is no apparent significant difference between mono- and bipolar electrical systems. There was no surgical mortality in the series. Complications of electrode migration (6%), rejection syndrome (14%), infection (6%) and unknown causes (8%) did present technical problems that are being resolved. Granulation tissue, apparently stimulated by electrical energy, suggests application in the healing processes. The existence of a variable response neuronal adaptation system is suggested in some patients by the drop in stimulation efficacy after long-term stimulation of fully implanted systems. Challenge of SIH by antagonist naloxone produced variable responses in cooperative patients. The soporific effect seen with transcutaneous electrical nerve stimulation reported in 40% of cases is not seen with the fully implanted epidural systems, despite the use of similar on-demand pulse generators. Biocompatible electrical stimulation of the spinal neuroaxis holds promise as a management modality for highly selected human patients with chronic pain syndromes.
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PMID:Stimulation of the spinal neuraxis by biocompatible electrical current in the human. 697 77

A patient is reported in whom deep musculoskeletal pain apparently blocked transmission from nociceptive cutaneous fibers in an adjacent region. When the deep musculoskeletal pain was abolished with local anesthesia, the cutaneous hypalgesia disappeared. Naloxone did not influence the hypalgesia. Possible mechanisms are discussed.
Pain 1982 Aug
PMID:Inhibition of cutaneous nociception by deep musculoskeletal pain. A clinical observation. 698 49

Twenty five healthy pregnant women received an epidural injection (at levels varying from T11-T12 to L3-L4) of morphine (2 or 3 mg in 10 ml of saline solution 9 p. thousand) in order to achieve pain relief for delivery. The degree of dilation never exceeded 5 cm at time of injection. Pain level decreased in 22 cases (88 p. cent) but only 16 women (64 p. cent) were fully satisfied. Hypoalgesia begun after 25 minutes and disappeared after 19 hours. No respiratory or haemodynamic changes were noted. On the other hand, the duration of the first stage of labour decreased. The best results are seen when injection is achieved at highest levels, facing spinal cord segments supplying the cervix and the perineum. No newborn showed any sign of respiratory or neurologic depression.
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PMID:[Epidural morphine for obstetrical pain relief (author's transl)]. 724 51

"Postoperative hypalgesia" following electroacupuncture or electrostimulation anesthesia is considered to be a notable advantage of these techniques, which supports the thesis, that endorphines may be involved in the mechanism of pain relief by these methods. After establishing definitive criteria postoperative hypalgesia was observed in 50% of patients undergoing operations on the lumbar vertebral column with electroacupuncture. A comparative investigation using psychological tests showed, that these patients are more pain tolerant than those, in whom postoperative hypalgesia was not observed. Observation alone of the patients during the postoperative period is unreliable to assess real postoperative pain relief objectively. Exact documentation and critical proof of the phenomenon of "postoperative hypalgesia" must be emphasized. These may be possible essentials to establish optimal methods of electrostimulation -- anesthesia.
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PMID:[Postoperative hypalgesia following electrostimulation -- anaesthesia by stimulation of typical acupuncture points (author's transl)]. 746 83


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