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

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

The effects of 33% nitrous oxide on the two components of the blink reflex were studied on seven healthy volunteers. The blink responses were elicited by a supraorbital nerve stimulation and recorded from the ipsilateral orbicularis oculi muscle. The intensity of stimulation was chosen at two to three times the reflex threshold in order to obtain stable suprathreshold reflex responses as well as a tolerable pain sensation reported by the volunteers. Nitrous oxide administration resulted in a potent depression of the two components of the blink reflex. This depressive effect was more marked upon the late (R2) nociceptive component (83%) than upon the early (R1) component (41%). Simultaneously, subjects reported either a decrease in pain sensation or an indifference toward the painful stimulus. None of these effects were reversed by a double-blind intravenous naloxone (1.4 mg) injection. The analgesic effect of nitrous oxide is a nonspecific depressant action on the transmission of the nociceptive messages in central nervous structures, independent of pain-suppressive endogenous morphine-like systems.
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PMID:Failure of naloxone to reverse the nitrous oxide-induced depression of a brain stem reflex: an electrophysiologic and double-blind study in humans. 405 Dec 11

Discrepancies between athletes' ratings of the seriousness and disruptive impact of an athletic injury and ratings by one experienced Sports Medicine Trainer were examined for 30 male and 13 female athletes undergoing treatment at a Sports Medicine Clinic. Overestimation of the seriousness or disruptive impact of the injury was significantly correlated with reports of more pain, higher state anxiety, and greater feelings of anger, apathy, loneliness, and inadequacy, and was more common among athletes competing at lower levels. These findings indicate need for psychological support for those athletes who overreact to injury.
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PMID:Differences in perceptions of seriousness and disrupting effects of athletic injury as viewed by athletes and their trainer. 409 54

The muscolo-cutaneous nerve, and skin biopsies from 3rd and 5th finger-tips and the back were studied in a 8-year-old girl with congenital indifference to pain, and in a control child of the same age. The tips of the fingers, and the toes were the most damaged areas. The diameters of myelinated and unmyelinated fibers of the nerve in the sick child and the control child were compared. A loss of 54% of myelinated fibers and 33% of unmyelinated fibers was observed. In the skin, the loss of myelinated fibers was 82% in the 3rd finger-tip, 78% in the 5th, and 35% in the back, and of unmyelinated fibers, 97%, 87%, and 8%, respectively. Eighty four per cent of free endings were absent in the 3rd finger-tip and they were completely absent in the 5th. As for Meissner's corpuscles, 97% were absent in the 3rd finger, and 75% in the 5th. The absence of degenerating fibers and the unimodal distribution of unmyelinated fibers raise the problem of the nosological position of this case of congenital indifference to pain, as compared to the sensory neuropathies.
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PMID:[Structural and ultrastructural quantitative study of skin and nerve biopsies in the diagnosis of congenital indifference to pain]. 615 33

The congenital insensitivity-to-pain syndrome is a sensory syndrome in which pain is impaired. It has been variably classified under a variety of terms, on occasion leading to some confusion. The condition is present at birth. The patient is usually, but not always, normal with respect to intelligence, development, and psychological adjustments. Other sensory perceptions are normal. Traumatic lesions as a result of self-mutilative acts are not uncommon, especially at an early age. The condition may not be apparent clinically until the time of initial tooth eruption. As the primary teeth erupt, the patient acquires the necessary apparatus for self-infliction of wounds to oral structures, skin, and fingernails. A case of congenital indifference to pain is presented, with clinical documentation of tooth-related problems occurring over a 2-year period and of the steps taken to correct or minimize the traumatic effects of chewing.
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PMID:Oral manifestations of the congenital insensitivity-to-pain syndrome. 615 25

The case of a 12 years old boy with a congenital anaesthesia covering all cutaneous and visceral districts is reported. There were no other neurological abnormalities apart a light mental retardation and loss of axon reflex after intradermal injection of hystamine. Notwithstanding this last finding a diagnosis of congenital indifference to pain was made. The differential diagnosis between indifference and insensitivity to pain is discussed.
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PMID:[Congenital analgesia]. 616 89

A 16-year-old boy had congenital absence of pain sensitivity and no impairment of other sensory modalities. Routine electrophysiologic investigation showed no abnormalities. The threshold and latency of electrically elicited corneal reflex and cortical potentials evoked by tooth pulp stimulation were normal, but suprathreshold electric stimulation of corneal mucosa and dental pulp, as well as electric stimulation of dorsal roots, did not elicit pain. The total CSF opioid activity was raised. However, naloxone hydrochloride administration failed to reverse the analgesia. The axon reflex to intradermal injection of histamine dihydrochloride was absent. Cutaneous nerve branches showed unspecific changes affecting part of unmyelinated axons. most of the unmyelinated as well as the myelinated axons were normal. We consider the case an example of congenital indifference to pain.
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PMID:Congenital absence of pain. 616 87

This paper reports the case of a boy aged 10 months who suffers from congenital analgesia in its pure form. All clinical, biochemical, neuro=physiological and histological data considered to be significant in the differential diagnosis are presented. The findings in all diseases in which impairment of pain sensation occurs are tabulated. 38 patients meet the diagnostic criteria for pure congenital analgesia. The diagnostic criteria are generalized indifference to pain dating from birth; no impairment of other sensory modalities; normal intelligence; normal deep tendon reflexes; no visceral pain perception; normal skin biopsy; no diminution of myelinated or un-myelinated nerve fibres in sural nerve biopsy; normal motor and sensory nerve conduction velocities and normal karyotype. The mode of inheritance remains unclear, but it is assumed, that congenital analgesia might be an autosomal-recessively inherited disease.
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PMID:The differential diagnosis of congenital analgesia and other diseases with diminished pain perception in childhood. Case report and review. 616 92

A unique programme of rehabilitation and pain control has been created within the Istituto Nazionale per lo Studio e la Cura dei Tumori in Milan. Rehabilitation of mastectomy, amputee and ostomy patients has been very active and, particularly in this last group, a good rehabilitative outcome may be observed. Pain evaluation was one of the main problems. The treatment modalities have been refined in order to obtain the maximum pain relief with the minimum trauma possible. These treatments are based on a closely monitored analgesic drug administration and on percutaneous thermocontrolled lesions. The growing needs of the Cancer Institution have brought to about 30 000 the number of treatments performed by the Service during the last year. Nevertheless, enormous efforts are necessary to break the barrier of indifference to this problem that still persists in the oncologic field.
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PMID:Organizing pain control and rehabilitation service in a cancer centre. 617 74

Three children, from different kinships, with generalized insensitivity to pain, showed unusual manifestations of congenital, presumably inherited, sensory and autonomic neuropathy. The first child appeared to have a syndrome resembling those previously described as congenital indifference to pain, congenital universal loss of pain sensation from infancy without other apparent neurological deficit. Unlike most types of hereditary sensory and autonomic neuropathies (types I, II, III), but like type IV, she had normal sensory nerve action potentials. Abnormalities of sudomotor function and of somatosensory evoked potentials were demonstrated. A severe decrease in the number of sural nerve A delta fibres and a small reduction in C fibres were demonstrated morphometrically. An abnormality of C fibres was confirmed by a marked reduction in nerve dopamine-beta-hydroxylase activity. The plasma and CSF concentrations of beta endorphins, substance P and several other neuropeptides and hormones were normal. Unequivocal evidence of a neuropathic lesion is provided by this patient; her disorder may be identified as the fifth type of hereditary sensory and autonomic neuropathy. The second patient had a congenital pansensory neuropathy and progressive retinitis pigmentosa. Whether the disorder is inherited and, if so, whether the retinitis pigmentosa results from the same or from a second genetic abnormality, is unclear. The third case has, in addition to what is usually seen in hereditary sensory and autonomic neuropathy, type II, an unusually severe kinaesthetic difficulty in oral food handling. The sural nerves of the second and third patients had fibre composition characteristic of hereditary sensory and autonomic neuropathy, type II, few or no myelinated fibres and reduced numbers of unmyelinated fibres.
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PMID:Not 'indifference to pain' but varieties of hereditary sensory and autonomic neuropathy. 618 47


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