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

Pain in the cervical spine in the course of degenerative changes is a frequent complaint reported by patients seeking the help of various specialists. Depending on the location of pathologic changes, the pain in the spine may be accompanied by a whole array of signs and symptoms, which are sometimes more troublesome for the patient than the back pain itself. The symptoms are sometimes so persistent and difficult to treat that they lead the patient to apathy and depression, even to the point of suicidal attempts. Should serious aggravation of symptoms develop despite all efforts at successful conservative therapy, surgical treatment is employed to remove the osteophytes protruding into the lumen of the vertebral canal and compressing the spinal roots. An analysis from 1969 to 1988 of treatment in 237 patients with neurologic disorders and concomitant or dominant disturbances of blood flow in vertebral arteries showed that there are specific indications for surgical decompression of the arteries, i.e., when lumen is constricted by the osteophytes at the level of uncovertebral joints. In a series of 47 patients, 42 cases were found to be pain free.
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PMID:Anterior operations in cervicarthrosis and vertebral artery compression. 193 58

The Urbach-Wiethe disease is a rare condition, where a hyaline substance of an unknown biochemical nature is accumulated in both teguments and mucous membranes. It has an autosomic and recessive genetic transmission. Cutaneous and mucous lesions (especially on the upper digestive tract) are described, insisting about the laryngeal location and the neurological troubles (with their main symptom: intracranial calcifications). The association of the disease with congenital indifference to pain is to be noted. Two particular cases are reported.
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PMID:[Urbach-Wiethe disease. Apropos of 2 cases]. 242 29

A case of a variant of congenital indifference to pain, in which the patient initially developed lower extremity neurogenic arthropathy ultimately requiring bilateral above-the-knee amputations, is presented. After he began using his upper extremities for weight bearing and load bearing, the patient developed bilateral severe neurogenic arthropathy of his hands and wrists.
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PMID:Neurogenic arthropathy of the hand and wrist. 242 61

The authors report a new case of indifference to pain secondary to hereditary sensory neuropathy in a 3 year 9 month-old boy. This child presented with isolated diffuse deficiency of pain and heat sensitiveness with preserved touch without any other neurologic involvement or anhidrosis. Nerve biopsy showed the complete lack of amyelinic fibers. P substance, which might act as a mediator or modulator of the nociception, was absent from the cutaneous nerve endings.
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PMID:[Indifference to pain secondary to congenital sensory neuropathy. Apropos of a new case]. 244 80

The imaging of peripheral nerve lesions remains limited to the radiographic demonstration of secondary skeletal lesions in birth trauma, reflex sympathetic dystrophy, neuropathic arthropathy, leprosy, and congenital indifference to pain. Nerve root avulsions can be imaged directly and the newer imaging modalities now allow delineation of lesions that previously could not be studied using conventional radiography. The ability of ultrasound, CT, and MRI to differentiate soft tissue structures makes it possible, in many instances, to study the primary abnormality in trauma, nerve entrapment syndromes, and tumors. With fractures, the possibility of trauma to adjacent nerves can only be inferred on the radiographs, while the role that peripheral nerve injury plays remains controversial in other entities, such as amputation with replantation. Imaging of peripheral nerve lesions remains in its infancy. With further refinement in the signal-to-noise ratio made possible by advances in MRI technology, we may be optimistic about future imaging of peripheral nerve pathology.
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PMID:Imaging of peripheral nerve lesions. 244 45

Based on a review of numerous studies conducted on normal, neurosurgical and brain-injured individuals, the right cerebral hemisphere appears to be dominant in the perception and identification of environmental and nonverbal sounds; the analysis of geometric and visual space (e.g., depth perception, visual closure); somesthesis, stereognosis, the maintenance of the body image; the production of dreams during REM sleep; the perception of most aspects of musical stimuli; and the comprehension and expression of prosodic, melodic, visual, facial, and verbal emotion. When the right hemisphere is damaged a variety of cognitive abnormalities may result, including hemi-inattention and neglect, prosopagnosia, constructional apraxia, visual-perceptual disturbances, and agnosia for environmental, musical, and emotional sounds. Similarly, a myriad of affective abnormalities may occur, including indifference, depression, hysteria, gross social-emotional disinhibition, florid manic excitement, childishness, euphoria, impulsivity, and abnormal sexual behavior. Patients may become delusional, engage in the production of bizzare confabulations and experience a host of somatic disturbances such as pain and body-perceptual distortions. Based on studies of normal and "split-brain" functioning, it also appears that the right hemisphere maintains a highly developed social-emotional mental system and can independently perceive, recall and act on certain memories and experiences without the aid or active reflective participation of the left. This leads to situations in which the right and left halves of the brain sometime act in an uncooperative fashion, which gives rise to inter-manual and intra-psychic conflicts.
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PMID:The right cerebral hemisphere: emotion, music, visual-spatial skills, body-image, dreams, and awareness. 246 90

Dr Albert Schweitzer is reported to have stated, "We must all die. But that I can save ... [someone] from days of torture, that is what I feel is my great and ever new privilege". If, in spite of their anecdotal texture, the reflections in this article challenge my clinical colleagues to further hard reflection, comparison, or contrast with their own professional experience, they will have been worthwhile. If our collective experiences view pain management as a clinical-ethical issue, then no patient should ever have to bear pain due to the ignorance or apathy of well-intentioned but misinformed caregivers. I conclude with the words of Judith Spross, an oncology nurse: Pain is an emergency for the person who experiences it regardless of the urgency of the underlying pathology. I believe we must apply the science and art of pain relief as though life depended upon it. Certainly the quality of life does.
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PMID:Ethical issues in pain management. 247 Dec 39

Inborn analgesia (IA) is described in 3 members of a family: a 14 month-old girl, hel father and grandfather on the paternal line. Generalized indifference to pain and visceral analgesia with other senses intact was noted in all patients since birth. Profound reflexes, intellectual development, karyotype, motor and sensory nervous excitation propagation velocities, somatosensory evoked potentials were all normal. Notedly, the IA inheritance was found to be autosome-dominant in this family.
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PMID:[A case of familial congenital analgesia with autosome-dominant type of inheritance]. 247 79

Psychiatrists have tended to be reluctant followers rather than leaders in the proliferation of concern for child abuse that has developed over the past 25 years. By discounting the relevance of child sexual trauma, psychiatric clinicians and theoreticians overlook not only the therapeutic needs of many survivors but the opportunity to reconceptualize the role of trauma in the etiology and treatment of conditions presumed to be incurable. Present controversies over child sexual abuse are mirrors of past misadventures with uncovering. Since 1860, child abuse has been discovered and then discredited every 35 years by the most visionary clinicians of the day, each faced with the alternative of denouncing the discovery or succumbing to scorn and disgrace. The history of child sexual abuse, whether viewed by parent via child, therapist via patient, or adult survivor via the child within, is one of unimaginable pain and betrayal masked by adult distancing, disavowal, victim blame, and identification with the aggressor. The lurid emotional imperatives of the trauma itself have no place in a just and fair society, and they resist translation into the rational, objective language and concepts of behavioral science. The subject of child sexual abuse is itself so passionate and so paradoxical that it provokes polarized dichotomies at every level, leaving indifference and avoidance as the only hope for serenity. The active nesciance, the determined insistence on not knowing, that pervades every aspect of child sexual abuse encourages the most authoritative scholars to be the most repressive of radical discovery, especially if authority has been achieved as a reaction against youthful vulnerability. Every clinician facing a survivor of childhood sexual trauma faces an assault on personal comfort and authority, just as each patient in that encounter risks intimidation and disgrace. The connections between childhood assault and adult adjustment will be missed unless the therapist can find an unprejudiced path toward mutual acceptance. The promise of genuine understanding and radical resolution of the effects of child sexual abuse is dimmed on both sides by a history of abandonment in the face of scornful, punishing authority. Freud's concept of the unconscious as the arena for successful psychotherapy, his sense of the patient as a normal, healthy individual incapacitated by the effects of buried trauma and his initial optimism for radical recovery from post-traumatic handicaps were soundly derived from his clinical confrontations with child sexual abuse, as were Ferenczi's parallel contributions 35 years later.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The centrality of victimization. Regaining the focal point of recovery for survivors of child sexual abuse. 266 33

One hundred adults with a chief complaint of chronic fatigue were evaluated in an outpatient setting to determine a possible association with somatization disorder. Somatization disorder was diagnosed in 15 patients. Eight functional somatic symptoms were reported more frequently by these patients: pain in extremities, joint paint, chest pain, other pain, shortness of breath, blurred vision, muscle weakness, and sexual indifference (p less than 0.001). Current mood disorders, anxiety disorders, and psychoactive substance use disorders were less common in patients with somatization disorders than in patients without this diagnosis (p less than 0.01).
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PMID:Somatization disorder in patients with chronic fatigue. 279 31


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