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

In a consecutive series of 227 psychiatric hospital admissions, data were recorded in respect of the complaint of pain. Eighty-six (38%) had pain. Fourty-four (19%) mentioned it spontaneously and 49 (22%) had no relevant physical cause. Women were affected more often than men (P less than 0.01) and tended to complain more often of severe pain (P less than 0.01). Severe pain was more often reported spontaneously (P less than 0.02). Also, the longer pain lasted the more likely the patient was to report it spontaneously (P less than 0.02). Men more often had a relevant physical diagnosis (P less than 0.05) and the low back was the commonest site of pain in them. Pain was relatively often associated with diagnoses of anxiety and personality disorder and relatively infrequently with schizophrenia, organic brain syndromes and transient situational disturbances. It is concluded that whilst there is a strong association between pain and psychiatric illness, this is less prominent, paradoxically, in some of the more severe psychiatric disturbances.
Pain 1978 Apr
PMID:Significance of pain in psychiatric hospital patients. 64

A comparative study of 259 patients operated on for ruptured lumbar discs, with and without spinal fusion, has been carried out. Simple removal of the herniated nucleus pulposus was performed in 119 patients while 68 were subjected to combined removal of the herniated disc material and lumbo-sacral fusion. During the first postoperative months the results were similar in the two groups, with a satisfactory result in 89 and 88 per cent of the cases respectively. During the following years a significant difference occurred between the groups. Severe pain recurred in 27% of the patients with simple removal of the herniated disc material and in 15% of those with the combined operation (P less than 0.01). The cause of the recurrence in the patients without fusion was disc herniation in 10% (at the same level in 7% and at a different level in 3%), and adhesions, or osteochondrosis with or without instability in 17%. In the patients with the combined operation the recurrences were caused by pseudoarthrosis in 9%, by disc herniation in 3%, and by other causes in 3%. At the final examination 6--7 years after the first operation, the results were still better in the fused patients, but the difference was no longer significant. Eighty-five per cent of the patients with the combined operation has a satisfactory result with regard to pain as compared with 76% in the other group. Thus, the results show that the combined operation gives better protection against recurrence of pain. However, it is a more extensive procedure and has complications of its own, and it should therefore mainly be used in young patients.
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PMID:Comparison of the results in patients operated upon for ruptured lumbar discs with and without spinal fusion. 66 23

A Psion microcomputer controlled infusion system for alfentanil was assessed for the provision of post-operative analgesia in 14 patients who had undergone aortic bifurcation graft surgery. The system employed a pharmacokinetic model working in real time to deliver any selected target plasma concentration of alfentanil. The alfentanil infusion system was used for a mean time of 39 hours and for 96% of this time, patients were scored as having no pain or only mild pain. Severe pain was recorded for only 0.05% of the study time. The use of a pharmacokinetic delivery system may offer a convenient and simple method of providing postoperative analgesia with alfentanil.
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PMID:Postoperative analgesia using a computerised infusion of alfentanil following aortic bifurcation graft surgery. 148 71

The pain during the balloon dilatation of angioplasty was evaluated prospectively to assess its clinical significance. In 54 angioplasties, no pain was observed in 54%, mild pain in 20%, moderate pain in 11% and severe pain in 15%. Moderate or severe pain was observed in 39% of 28 iliac angioplasties and in 7% of 14 femoral angioplasties. There was a significant difference between the two groups. We did not find any significant correlation between the severity of pain and stenotic ratio before angioplasty. Severe pain may be a warning of severe dissection; in our study, all severe dissections were accompanied by severe pain without arterial rupture.
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PMID:Percutaneous transluminal angioplasty: pain during balloon inflation. 153 78

The pathophysiology, assessment, and pharmacologic management of acute pain in infants and children are reviewed, and the mechanism of action, pharmacokinetics, clinical efficacy, adverse effects, and dosages of opioid analgesics, nonopioid analgesics, and local anesthetics used for regional blocks are discussed. The pathophysiology of pain and the physiologic rationale for treatment of pain are similar in children and adults. Severe pain can be controlled by i.v. or epidural administration of opioid analgesics. Neonates are more susceptible to the depressant effects of opioids, and opioid analgesia must be administered with caution in infants who are not receiving mechanical ventilation because of the associated risk of respiratory depression. Patient-controlled analgesia is a useful technique in older children. Acetaminophen and NSAIDs are useful for relieving milder pain of noninflammatory and inflammatory origin, respectively. Epidural or intrathecal administration of local anesthetics provides regional analgesia with minimal physiologic alterations. Topical application of local anesthetics is effective for many minor procedures. A variety of pain management techniques are available for the management of acute pain in pediatric patients. The development of drugs having fewer adverse effects and noninvasive administration techniques will be important research priorities in the coming years.
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PMID:Management of acute pain in children. 168 May 98

Cancer of the pancreas is rising in incidence and will strike 27,000 Americans this year. There is no curative therapy for most patients, so palliation of symptoms should be the prime concern. Severe pain is very common, and often difficult to treat. Neurolytic celiac plexus block (NCPB) is claimed by some to be the most effective way to treat pancreatic cancer pain (PCP), yet only a minority of patients undergo this procedure. We have reviewed the literature on NCPB to determine if it has been adequately evaluated in the management of PCP. There have been 15 published series since 1964 on NCPB for PCP. A total of 480 patients with cancer of the pancreas were reported; at least a satisfactory response to NCPB was reported in 418 (87%). We found major deficiencies in these reports. None described the pre-NCPB analgesic history. Post-NCPB data were also limited. No information was given concerning post-NCPB analgesic dosages, and only 4 series stated that most patients did not require opiates. Information on whether NCPB was effective until death was lacking or incomplete in 12 series. Many claimed additional benefits of NCPB such as decreased nausea, decreased constipation, and increased appetite, but none provided any data to support these claims. We conclude that the data available on NCPB for PCP are insufficient to judge for efficacy, long-term morbidity, or cost effectiveness, and rigorous evaluation of the technique is required.
Pain 1990 Jun
PMID:Has the analgesic efficacy of neurolytic celiac plexus block been demonstrated in pancreatic cancer pain? 169 55

Severe pain at rest is a major symptom of advanced peripheral arterial occlusive disease (PAOD). Preliminary studies of treatment with iloprost, a prostacyclin analogue, showed encouraging results in patients with ischaemic rest pain. Therefore a randomized, placebo-controlled multicentre study was undertaken in 113 patients admitted to hospital with rest pain of at least 2 weeks duration caused by severe PAOD. The patients were randomly assigned to receive 2-week placebo or iloprost infusions for 6 hours per day at a dose of 0.5-0.2 ng/kg/min in addition to conventional care. Demographic data and arteriographic findings were similar in the two groups. Eleven patients withdrew from the study before completion and 102 patients could be included in the final analysis. Significantly more patients in the iloprost group (62.5% of 48) than in the placebo group (42.6% of 54) had complete relief of pain without analgesic therapy during at least five consecutive days at the end of the treatment period (p less than 0.05, chi 2-test). Facial flush, headache and nausea were the most common side effects during iloprost infusion. Serious adverse reactions did not occur. Thus, a 2-week iloprost infusion was shown to be safe and effective as a treatment for ischaemic rest pain caused by PAOD.
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PMID:Reduction of ischaemic rest pain in advanced peripheral arterial occlusive disease. A double blind placebo controlled trial with iloprost. 172 69

Severe pain which cannot be controlled medically is the major factor for which patients seek surgical treatment for trigeminal neuralgia. Patients should be neurologically screened and have an enhanced CT scan prior to surgery in order to exclude a secondary cause for the disease. Peripheral techniques such as cryotherapy and alcohol injections give short-term pain relief but have few complications. The most popular operation, radiofrequency thermocoagulation in the Gasserian ganglion, has a mean recurrence of 3 years, but leaves patients with extensive sensory loss. Microvascular decompression and partial rhizotomy are major neurosurgical procedures that have a low recurrence rate but carry a risk of death and serious morbidity. Patients should be more involved in the choice of surgery.
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PMID:Surgical management of trigeminal neuralgia. 202 91

Severe pain is a prominent characteristic of many rheumatic conditions occurring in patients with human immunodeficiency virus (HIV) infection. These conditions may affect joints or soft tissues. Some painful syndromes, such as acquired immune deficiency syndrome-associated arthritis, may be unique to HIV-infected individuals, whereas others, such as Reiter's syndrome, may also occur in patients without HIV infection but appear more severe in infected patients. Joint and soft tissue pain is usually most intense in the lower extremities. The pathogenesis of the pain is not completely understood but may involve subclinical neuropathic disease.
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PMID:Painful rheumatic syndromes associated with human immunodeficiency virus infection. 204 90

Synovectomy of the elbow was performed on 54 patients (70 elbows) with rheumatoid arthritis. The mean follow-up time was 7.5 years (range 1.5-22 years). Clinical evaluation showed marked relief of pain in 28 elbows (40%). In 27 cases (38.5%) the pain was moderate but still less than preoperatively. Severe pain was recorded in 15 cases (21.5%) at the time of check up. As to postoperative range of movement, the mean flexion are was 114.5 degrees and the mean rotation are 134.5 degrees. Latitudinal instability was recorded up to 5 degrees in 33 (47%) elbows, up to 10 degrees in 20 (28.5%), up to 15 degrees in 6 (8.5%), and more than 15 degrees in 11 (16%). The mean carrying angle was 10 degrees in valgus. Measurement of strength in flexion and extension showed a reduction of approximately 50% compared to age-matched healthy controls. Reoperations were performed in 10 elbows (14%); the interval between the primary synovectomy and second operation in these cases averaged 8 years.
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PMID:Results of elbow synovectomy in rheumatoid arthritis. 205 39


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