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

Pain is a feared but universal experience. Early pain theories focused on locating neurological pain fibers. However, when surgical interventions failed to control the pain, other explanations were sought. The interplay between practice and research has advanced our understanding and management of pain. Current pain theories explain pain as a physical, psychological and social experience. Nursing interventions that are multidimensional will have a better chance at ameliorating a patient's pain.
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PMID:Pain theories and their relevance to nursing practices. 322 38

The analgesic effect of conventional transcutaneous nerve stimulation has been studied in 29 patients, all having a chronic pain caused by peripheral neurological disease. As already reported in the literature half of patients were improved on a short-term basis. Long-term improvement was observed mainly in patients with traumatic nerve lesions; such cases, thus appear to be the best indication for this method. It should be emphasized that whatever the etiology, the delay between the onset of pain and the beginning of transcutaneous stimulations was a critical factor. Nine out of ten patients suffering for less than one year were satisfactorily improved. This suggests that transcutaneous stimulations should be used as early as possible after the onset of neurological pain.
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PMID:[The use of electrical transcutaneous nerve stimulations in chronic pain. Method and preliminary results in 28 cases (author's transl)]. 627 37

Neurogenic pain is by definition linked to a lesion of the pain pathways at any level. There are many causes for the neurological pain which can be present in sympathetic disorders, in peripheral neuropathies and central nervous disorders too. In despite of these multiple aetiologies, the neurological pain is characterised by: demyelinisation at the anatomic lesion; a spontaneous firing described by the authors as related to three mechanisms, sensitivation, deafferentation and lost of inhibition; a common and specific clinical semiology very different indeed from the peripheral pain described as a surafferentation.
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PMID:[Neurological pain]. 780 47

Pain is a common complain in patients with spinal cord injury. Deafferentation, nociceptive stimuli and psychological component may both contribute in pain generating. Main importance of clinical evaluation may be pointed out since level of injury and complete or incomplete lesion may affect the expression of symptomatic pain and projection of neurological pain. Closed to symptomatic approach, pain treatment in spinal cord injured people consist in medical and rehabilitation. Chronic neurological pain remains still difficult and may take in account psychological factors.
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PMID:[Pain in paraplegic and tetraplegic patients]. 857 15

Neuropathic pain is part of the neurological disease spectrum and may be an expression of severe medical pathology. Painful neuropathies have multiple disguises and may to a certain extent be mimicked by non-neurological pain conditions. Painful neuropathic conditions express themselves with spontaneous and/or abnormal stimulus-evoked pain. The diagnosis of peripheral or central neuropathic pain should be made only when the history and signs are indicative of neuropathy in conjunction with neuroanatomically correlated pain distribution and sensory abnormalities within the area of pain. A future mechanism-based classification of pain has recently been suggested to facilitate the development of mechanism-tailored treatment strategies. This is a sound approach and should be pursued. It is mandatory, however, to retain the traditional organ-based diagnostic workup, which should precede further in-depth characterization of specific pain mechanisms. Extensive preparatory work is needed on how to link certain symptoms and signs to specific mechanisms, as elucidated from animal studies, before we can introduce mechanism-coupled treatment strategies.
Eur J Pain 2002
PMID:Neuropathic pain: clinical characteristics and diagnostic workup. 1188 41

The author describes the histories of three patients with panic-like episodes that turned out to be related to underlying, previously unsuspected tick-borne diseases. Each woman experienced symptoms that are not usual in panic disorder but are typical of neurological Lyme disease, including exquisite sensitivity to light, touch, and sounds, joint pain often in combination with cognitive changes including mental fogginess and loss of recent memory, and some degree of bizarre, shifting, and often excruciating neurological pain. Because these symptoms are atypical of primary panic disorder, they were very helpful in alerting the clinician to suspect an underlying physical illness. In each case, the results of testing revealed positive hallmarks of disseminated Lyme and other tick-borne diseases, including Lyme borreliosis caused by the spirochete, Borrelia burgdorferi, babesiosis, and ehrlichiosis. Since beginning treatment with intensive doses of appropriate antimicrobial medications for their tick-borne infections, all three patients have become free of panic attacks. Treatment of their infections by a specialist in Lyme disease allowed one of the women to discontinue anti-anxiety medication completely and another to reduce the dose of medication to occasional use only. The third patient is no longer anxious but her depression is resolving more slowly despite the ongoing use of an antidepressant. Two of the patients have also needed ongoing medication for pain and other symptoms of late-stage, neurological Lyme disease.
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PMID:Panic attacks may reveal previously unsuspected chronic disseminated lyme disease. 1599 Apr 95

Zaldiar is a complex medication containing 37,5 mg of tramadol and 325 mg of paracetamol. It has been used in the treatment of 30 patients with diabetes mellitus type II with neurological pain caused by diabetic polyneuropathy. The treatment duration was 10 days with tailored dosages from 1 to 4 tablets. The examination of patients was carried out before the treatment, during it daily and 10 days after. Pain intensity was assessed mainly by the Visual Analogue Scale (VAS). The analgesic effect of zaldiar by VAS was noticed from the 2nd day with the corresponding subjective feeling on the 4th day when the intensity of pain was reduced by 30%. In total, the pain was reduced by 50% in 23 patients and at least by 30% in the others. The drug was well-tolerated.
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PMID:[Pharmacotherapy with zaldiar of the pain syndrome in diabetic polyneuropathy]. 1837 59

In order to analyze aspects of pain patient care in neurology, we conducted a survey among German neurology departments that aimed to determine different structural aspects of neurological pain medicine. A 5-page questionnaire was sent to 391 neurological departments, and a return rate of 59.8% was achieved. Some 70% of university-based neurology departments have established their own outpatient clinic, and some 80% of these departments actively take part in interdisciplinary pain services. University hospitals operate an interdisciplinary pain clinic in 94.7%. Almost all neurological departments admit pain patients, especially for further diagnosis and neurological treatment. These fields are accepted as important neurological tasks. The quality of care is reported to be excellent. Routine questioning for pain of all admitted patients is carried out by 85% of all hospitals, and an extensive pain history is taken by almost 90% of departments. Our survey data confirm that the documentation of medical, psychological and psychosocial pain histories and the process of pain patient care are partly fulfilled, yet need improvement. Routine application of validated instruments and regular inquiry of the presence/course of pain may improve the process of care and--as the basis of outcome--pain management in neurology.
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PMID:Pain therapy in german neurology. Structures and standards of evaluation. 1867 32

Chronic pain is a frequent component of many neurological disorders, affecting 20-40% of patients for many primary neurological diseases. These diseases result from a wide range of pathophysiologies including traumatic injury to the central nervous system, neurodegeneration and neuroinflammation, and exploring the aetiology of pain in these disorders is an opportunity to achieve new insight into pain processing. Whether pain originates in the central or peripheral nervous system, it frequently becomes centralized through maladaptive responses within the central nervous system that can profoundly alter brain systems and thereby behaviour (e.g. depression). Chronic pain should thus be considered a brain disease in which alterations in neural networks affect multiple aspects of brain function, structure and chemistry. The study and treatment of this disease is greatly complicated by the lack of objective measures for either the symptoms or the underlying mechanisms of chronic pain. In pain associated with neurological disease, it is sometimes difficult to obtain even a subjective evaluation of pain, as is the case for patients in a vegetative state or end-stage Alzheimer's disease. It is critical that neurologists become more involved in chronic pain treatment and research (already significant in the fields of migraine and peripheral neuropathies). To achieve this goal, greater efforts are needed to enhance training for neurologists in pain treatment and promote greater interest in the field. This review describes examples of pain in different neurological diseases including primary neurological pain conditions, discusses the therapeutic potential of brain-targeted therapies and highlights the need for objective measures of pain.
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PMID:Neurological diseases and pain. 2206 41

Matrix metalloproteinases (MMPs) constitute a family of zinc-dependent endopeptidases that mediate extracellular matrix turnover and associated processes, such as cell survival, growth, and differentiation. This paper discusses important functions of MMP in the normal and injured nervous system, focusing on the role played by these proteases in neurological pain syndromes, most prominently in neuropathic pain and migraine headaches. In the past decade, metalloproteinases emerged as key modulators of neuropathic pain, with MMP-9 acting as an initiator of the neuropathic cascade. Increased MMP activity was detected in migraine patients, independent of aura, in tight association with metabolic derangements. The therapeutic implications of MMP inhibition are considered in the context of neurogenic pain regulation.
Pain Res Treat 2012
PMID:Matrix metalloproteinases in neuropathic pain and migraine: friends, enemies, and therapeutic targets. 2297 Mar 61


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