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

The purpose of this study was to evaluate the differential perceived exertion measured using a new set of Visual Analogue Scales (VAS) during pedaling and running. The subjects were eleven healthy males. They performed an incremental maximal test and then three 4-min stages of exercise, for both pedaling and running. During the tests, VO2, V(CO2), V(E), f, and HR were monitored continuously. Bla and perceptual variables including VAS consisting of four scales (VAS 1-VAS 4) and Borg's RPE were measured at the end of each stage. Although the VO2 (%VO2max)) and HR for both pedaling and running were not significantly different, Bla in pedaling was significantly higher than that in running. A significant interaction (mode, stage) was also obtained. The VAS 1 of pedaling was significantly higher than that of running. A significant interaction in VAS 1 (mode, stage) was obtained. The VAS 2 of pedaling was significantly higher than that of running. The subjects indicated that local pain became stronger than central pain in pedaling, but they were almost equal in running. In both pedaling and running, leg pain became stronger than arm pain (VAS 3). VAS 4 showed that during running, breathing difficulty and heart pain were almost equal in perceived intensity. However, during pedaling, breathing difficulty became greater than heart pain. Thus, a new four-part visual analogue scale was found to be useful for monitoring exercise intensity. In addition, the new VAS gave us more information in relation to the differential perceived exertion reflected in the different physiological responses obtained by different exercise modes.
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PMID:Differential perceived exertion measured using a new visual analogue scale during pedaling and running. 1667 14

We present a 40-year-old man referred with complaints of neck pain, left arm pain, headaches, paresthesias in the index and middle fingers, with numbness in the C7 nerve root distribution. Conventional recumbent magnetic resonance imaging (MRI) was read by the radiologist as a small protrusion at C5-C6 that did not correlate with his symptoms. The patient had exhausted his treatment options. He underwent MRI in a weight-bearing, upright position with extension that revealed a positional cervical disc protrusion on the left at C6-C7. The protrusion was causing a proximal left C6-C7 neural foraminal stenosis and impingement that correlated with his symptoms. With this information, we were able to offer a targeted epidural block. Imaging the spine in the weight-bearing position with extension or placing the spine in the position of pain may increase the diagnostic accuracy for the neuroradiologist and neuroimagist, who then can provide the spine surgeon or neurosurgeon potentially with additional information to further improve patient care.
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PMID:Open stand-up MRI: a new instrument for positional neuroimaging. 1676 Jul 93

Steroid injections are often employed as an alternative treatment for radicular pain in patients with degenerative spinal disorders. Prospective randomised studies of the lumbar spine reveal contradictory results and non-randomised and most often retrospective studies of the cervical spine indicate pain reduction from steroid injections. No prospective randomised study on transforaminal steroid injections for the treatment of radicular pain in the cervical spine focusing on short-term results has been performed. Forty consecutive patients were employed for the study. The inclusion criteria were one-sided cervical radiculopathy with radicular distribution of arm pain distal to the elbow and corresponding significant degenerative pathology of the cervical spine at one or two levels on the same side as the radicular pain and visualised by MRI. A transforaminal technique was used for all injections. A positive response to a diagnostic selective nerve root block at one or two nerve roots was mandatory for all patients. The patients were randomised for treatment with steroids/local anaesthetics or saline/local anaesthetic. Only the neuroradiologist performing the blocks was aware of the content of the injection; all other persons involved in the study were blinded. Follow up was made 3 weeks after the randomised treatment by a clinical investigation and with a questionnaire focusing on the subjective effects from the injections. At follow up, there were no differences in treatment results in the two patient groups. Statistical analysis of the results confirmed the lack of difference in treatment effect. Further studies have to be performed before excluding steroids in such treatment and for evaluating the influence of local anaesthetics on radiculopathy in transforaminal injections.
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PMID:Transforaminal steroid injections for the treatment of cervical radiculopathy: a prospective and randomised study. 1683 37

Since the description of electrical stimulation of nerve trunks as a means of providing pain relief, innovative peripheral nerve and nerve root stimulations have been developed. An extra-foraminal technique of electrical stimulation of cervical nerve roots resulting in reduction of upper extremity radicular pain is demonstrated here. Electrical stimulation of the C6 and C7 nerve roots was accomplished using a four-electrode spinal cord stimulator lead that was placed percutaneously within the exit zone of the neuroforamina using an extra-foraminal approach. Subsequent C6 and C7 nerve root stimulation provided a reduction in arm pain within the distribution of the stimulation.
Pain Physician 2004 Jan
PMID:Cervical nerve root stimulation: demonstration of an extra-foraminal technique. 1686 19

Chronic neck pain, headache, and arm pain are some of the most common patient complaints confronting today's health care provider. Chronic neck pain is reported to be a frequency symptom in 34% of the general population with 14% of the general population reporting neck pain that lasted for more than 6 months. The magnitude of the problem is demonstrated by increase of cervical spine surgery by 45% and cervical fusion by 70% over a ten year period from 1979 through 1988. Therapeutic effectiveness of a large variety of interventions in managing chronic neck pain is inconclusive. Pain and dysfunction have been attributed to a number of structure in the neck which have a potential for producing a pain pattern in the neck, head, and upper extremity which include intervertebral disc, nerve roots, facet joints, and ligamentous and muscular structures. Neural blockade in the cervical spine, though introduced in 1912, lagged behind that of the lumbar spine. At the present time, neural blockade is an extremely popular tool for diagnostic purposes in evaluation of neck pain, even though it has not developed a definitive role in the management of chronic neck pain and associated syndromes. The object of this review is to focus on various aspects of neural blockade in the management of chronic neck pain and associated syndromes including its rationale, clinical effectiveness, indications, and complications.
Pain Physician 1999 Oct
PMID:Neural blockade in cervical pain syndromes. 1690 18

Among 61 patients underwent disc replacement with the Bryan prosthesis, 47 patients were followed more than 3 months and their clinical and radiologic data were retrospectively analyzed to clarify very early clinical and radiologic outcomes and complications of disc arthroplasty with the Bryan Cervical Disc prosthesis during the learning period. Mean follow-up period was 6 months. Mean age was 45.6 years. Single-level procedure was done in 39 patients and 2-level in 8; a total of 55 levels replaced. Neck disability index improved from 59.8% to 22.9%. Visual analog pain score (VAS) of the neck improved from 8.4 to 1.6. VAS of shoulder/arm pain improved from 8.8 to 2.4. Mean patients' subjective improvement rate of symptoms was 71.1%. According to improvement in the neck disability index and VAS (over 50% improvement rate in each parameter), patients' subjective improvement rate (over 50%), and patients' satisfaction, the surgical success was achieved in 39 patients (83%). Eight patients (17%) showed failure. Mean segmental angle became more kyphotic after surgery from -0.7 degree of kyphosis (-11 to 7.7 degrees) to -1.3 degrees (-32 to 20.9 degrees) without statistical significance (P=0.55). Among 24 segments that showed preoperative kyphosis, 13 (54.2%) showed aggravated kyphosis, 7 (29.1%) showed decreased kyphosis and 4 (16.7%) recovered to lordosis. Among 31 segments that showed preoperative lordosis, 19 (61.3%) showed loss of lordosis and 12 (38.7%) showed increased lordosis. Mean range of motion increased significantly after surgery (6.7 to 8.5 degrees, P=0.04). Preoperative and postoperative segmental kyphosis was not related to clinical success. Cervical arthroplasty with the Bryan Cervical Disc prosthesis failed to restore segmental lordotic angle. A concern arises because it is well known that the fusion in kyphotic curvature causes more frequent problems on adjacent levels in anterior cervical discectomy and fusion. For the present, it seems preferable to exclude the patient who already has significant segmental kyphosis from disc arthroplasty with Bryan Cervical Disc prosthesis.
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PMID:Early clinical and radiologic outcomes of cervical arthroplasty with Bryan Cervical Disc prosthesis. 1702 8

We investigated the relationship between musculoskeletal disorders and sleep problems among 98 employees (79 women) at three nursing homes. Self-reported data were collected regarding pain in the neck, shoulders, arms, legs, and low back, sleep disturbances, daytime sleepiness (Epworth Sleepiness Scale), and the level of workload on the hands, legs, and low back by type of care. Pain in the arms was significantly associated with less difficulty initiating sleep, fewer symptoms of insomnia, and a higher level of daytime sleepiness. After adjusting for age and gender, only the association between arm pain and daytime sleepiness remained significant (Odds Ratio 6.70, 95% Confidence Interval 1.40-31.97). Participants with both arm pain and daytime sleepiness showed significantly greater levels of workload in some kinds of care in a systemic manner than counterparts without either complaint. These findings suggest that arm pain is associated with elevated sleep propensity/fatigue in nursing home work.
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PMID:Arm pain and daytime sleepiness among nursing home employees. 1708 31

Despite the increasing research on placebos in recent times, little is known about the nocebo effect, a phenomenon that is opposite to the placebo effect and whereby expectations of symptom worsening play a crucial role. By studying experimental ischemic arm pain in healthy volunteers and by using a neuropharmacological approach, we found that verbally induced nocebo hyperalgesia was associated to hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, as assessed by means of adrenocorticotropic hormone and cortisol plasma concentrations. Both nocebo hyperalgesia and HPA hyperactivity were antagonized by the benzodiazepine diazepam, suggesting that anxiety played a major role in these effects. The administration of the mixed cholecystokinin (CCK) type-A/B receptor antagonist proglumide blocked nocebo hyperalgesia completely but had no effect on HPA hyperactivity, which suggests a specific involvement of CCK in the hyperalgesic but not in the anxiety component of the nocebo effect. Importantly, both diazepam and proglumide did not show analgesic properties on basal pain, because they acted only on the nocebo-induced pain increase. These data indicate a close relationship between anxiety and nocebo hyperalgesia, in which the CCKergic systems play a key role in anxiety-induced hyperalgesia. These results, together with previous findings showing that placebo analgesia is mediated by endogenous opioids, suggest that the analgesic placebo/hyperalgesic nocebo phenomenon may involve the opposite activation of endogenous opioidergic and CCKergic systems.
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PMID:The biochemical and neuroendocrine bases of the hyperalgesic nocebo effect. 1710 75

The objectives of the prospective randomized study are to investigate the clinically relevant change after anterior cervical decompression and fusion (ACDF) using measures of pain intensity (visual analog scale, VAS) and neck disability index (NDI). And to determine the number of subjects showing persistent pain and disability at 6-year follow-up. To investigate the possibility of differences in outcome between ACDF with the cervical intervertebral fusion cage (CIFC) and the Cloward procedure (CP). Clinically relevant change and residual, postoperative pain intensity and disability after ACDF have been investigated a little. Ninety-five patients with neck and radicular arm pain lasting for at least 6 months were randomly selected to receive ACDF with the CP or the CIFC. Questionnaires concerning pain and NDI were obtained from 83 patients (87%) at a mean follow-up time of 76 months (range 56-94 months). When evaluating clinical benefits regarding pain intensity 6 years after ACDF, according to different cut-off points and relative percentages, symptoms improved in 46-78% of patients. Improvement in NDI was seen in 18-20% of patients. Approximately 70% of the patients had persistent pain and disability at 6-year follow-up. There was no clinically important difference following CP versus CIFC. Thirty millimeter and 20% in pain intensity and NDI, respectively, are reasonable criteria to suggest a clinically relevant change after ACDF. Before patients undergo ACDF, they should be informed that they have an approximate 50% probability of achieving pain relief and little probability of functional improvement. The findings demonstrate that there is poor evidence for difference between CIFC and CP.
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PMID:Investigation of clinically important benefit of anterior cervical decompression and fusion. 1714 33

Forearm pain occurring during high +Gz exposure has been linked with vascular distension from elevated transmural pressure of hydrostatic origin and is exacerbated by positive pressure breathing (PBG). We postulated that at high vascular transmural pressure vascular autoregulation might be overcome and be associated with worsened pain. Six volunteers were studied at +4, +5, +6, and +7 Gz on a human centrifuge. Forearm vascular resistance (FVR) was assessed by Doppler ultrasound resistive index (RI), and superficial forearm venous pressure (FVP) was measured via an indwelling catheter. Pain rating was assessed by numerical scale. The left arm was located at heart level (control position), or on the throttle (test position). Runs were completed with and without positive pressure breathing for G protection (PBG); subjects wore full coverage anti-G trousers and chest counter-pressure. In the test position, pain increased with increasing acceleration (P < 0.0001), and was more severe with PBG at +5 Gz and +7 Gz (P < 0.05). FVP rose substantially more in the test than control position (238 +/- 17 mmHg vs. 61 +/- 8 mmHg at +7 Gz, P < 0.0001) but the presence or absence of PBG had no effect on the FVP increase during acceleration in either position. In the test position, RI fell with increasing acceleration above +5 Gz (P < 0.0001), and the fall was greater with PBG (P < 0.05). Forearm pain was thus associated with a decrease in FVR and an increase in vascular transmural pressure. PBG exacerbated forearm pain and prompted a greater fall in RI, but had no effect on FVP response. These findings support FVR but not forearm venous distension in the aetiology of +Gz arm pain.
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PMID:Failure of vascular autoregulation in the upper limb with increased +Gz acceleration. 1747 80


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