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

The Louisiana State University (LSU) Affiliated Hospitals foot clinic has had good success in the treatment of metatarsal and heel pain using the following five modalities. Muscle strengthening and muscle stretching of the intrinsic muscles and the muscles about the ankle joint, especially the gastrocnemius-soleus complex. Contrast baths in the acute condition to decrease the edema and inflammatory process. Nonsteroidal agents with the acute condition to decrease the inflammatory response. Shoe modifications. Orthotic devices. Orthotic devices seem to be the most useful in the treatment of both conditions. It has been found necessary to prescribe orthotics in almost all cases of chronic problems to institute permanent relief. Opposition remains to multiple steroid injections into either area, although there is no great objection to one or possibly two injections into a particular area to decrease the inflammatory process. It has been observed that a general worsening of the condition occurs from multiple injections. After repeated steroid injections one sets the stage for increased atrophy of the fat pad, which results in a more prominent bony surface and increased pain. Cases have been documented on many occasions showing indented areas over the heel or metatarsals or complete loss of the metatarsal fat pad of patients who have received multiple injections of steroids.
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PMID:Conservative management of metatarsal and heel pain in the adult foot. 380 11

Fifty-two cases of trapeziometacarpal joint osteoarthritis were treated with arthrodesis using small staple fixation. Eighty-five per cent of the patients were free of pain, with normal thumb. Opposition to the fourth finger tip was always possible and opposition to the little finger tip was observed in 94% of cases. Four patients (7.6%) developed a non-union but only two complained of pain. Arthrodesis with power staple fixation minimizes bone resection and postoperative immobilization (mean 28 days) because of the good stability following this procedure.
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PMID:Trapeziometacarpal joint arthrodesis for osteoarthritis. Results of power staple fixation. 975 6

Epidural block remains the most effective, safe approach to pain relief for labor, and demand for its use continues to grow. Opposition to epidural block in labor, based on a widely acclaimed 1993 study, has led to the widespread discouragement of its use for laboring women and the denial of payment to some anesthesiologists who use it. Within the past year, strong evidence has emerged showing that the association of epidural block with dystocia and cesarean section is casual and not causal.
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PMID:Epidural anesthesia and the progress of labor. 1701 29

Spinal proinflammatory cytokines are powerful pain-enhancing signals that contribute to pain following peripheral nerve injury (neuropathic pain). Recently, one proinflammatory cytokine, interleukin-1, was also implicated in the loss of analgesia upon repeated morphine exposure (tolerance). In contrast to prior literature, we demonstrate that the action of several spinal proinflammatory cytokines oppose systemic and intrathecal opioid analgesia, causing reduced pain suppression. In vitro morphine exposure of lumbar dorsal spinal cord caused significant increases in proinflammatory cytokine and chemokine release. Opposition of analgesia by proinflammatory cytokines is rapid, occurring < or =5 min after intrathecal (perispinal) opioid administration. We document that opposition of analgesia by proinflammatory cytokines cannot be accounted for by an alteration in spinal morphine concentrations. The acute anti-analgesic effects of proinflammatory cytokines occur in a p38 mitogen-activated protein kinase and nitric oxide dependent fashion. Chronic intrathecal morphine or methadone significantly increased spinal glial activation (toll-like receptor 4 mRNA and protein) and the expression of multiple chemokines and cytokines, combined with development of analgesic tolerance and pain enhancement (hyperalgesia, allodynia). Statistical analysis demonstrated that a cluster of cytokines and chemokines was linked with pain-related behavioral changes. Moreover, blockade of spinal proinflammatory cytokines during a stringent morphine regimen previously associated with altered neuronal function also attenuated enhanced pain, supportive that proinflammatory cytokines are importantly involved in tolerance induced by such regimens. These data implicate multiple opioid-induced spinal proinflammatory cytokines in opposing both acute and chronic opioid analgesia, and provide a novel mechanism for the opposition of acute opioid analgesia.
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PMID:Proinflammatory cytokines oppose opioid-induced acute and chronic analgesia. 1859 65