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

In female patient, aged 41, 3 years ago appeared skin changes of urticarial type, and occasional pain in the joints of shoulders and hands, followed by complete weakness and exhaustion, as well as the occurrence of face and eyelid edema. Laboratory findings confirmed the presence of hypocomplentemia with proteinuria, microhematuria and cylindruria. Histopathologic (HP) finding of skin biopsy was leukocytoclastic vasculitis, and HP finding of the kidneys was mesangioproliferative glomerulonephritis. The regression of skin changes was observed during hospitalization after Dapsone was administered. The therapy started with corticosteroids (Prednisone 40 mg/day with weekly dose from 5 mg to 30 mg). In spite of the therapy, hypocomplementemia and proteinuria up to 335 mg/24 h have maintained for a year in the later controls in an outpatient department. The patient is without discomfort, and renal function is stable.
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PMID:[Urticarial vasculitis--a syndrome with low complement levels and secondary glomerulopathy]. 1064 62

Low back pain patients (n=142) on sick leave for at least 8 weeks were given a multi-modal cognitive behavioural treatment program (MMCBT) that lasted for 4 weeks. Before treatment, all patients were tested with a comprehensive test battery. The outcome at 12-month follow-up was predictable from the pretest, but only when combining medical and psychological data. Patients who returned to work (Returners, 50%) in the MMCBT group were characterised by less pain, more psychological strength, were evaluated by the physiotherapist as having a good prognosis for return to work, and were less educated. Patients who did not return to work (Non-returners) in the MMCBT group felt tense and unfit, felt hopelessness concerning the future, were less physically active, thought their complaints would worsen if they continued working, and reported fewer difficulties driving a car. Returners to work (58%) in the randomised control group (n=81), who received ordinary physical therapy, were characterised by high levels of energy, less subjective health complaints, less exhaustion for a condition test, and did not work in positions giving a constant load on the back. There was no significant differences between number of patients who had returned to work in the MMCBT and the control group. Non-returners in the control group lacked energy, trained less regularly, worked in occupations that gave an almost constant load on the back, and did not expect to be back to work in the course of a couple of weeks. It seems to be important to develop further diagnostic tools to identify those who might benefit from extensive or specific treatments. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.
Eur J Pain 1998
PMID:Predictors for outcome of a multi-modal cognitive behavioural treatment program for low back pain patients-a 12-month follow-up study. 1070 Mar 25

One hundred and ninety (190) patients presenting with "functional cardiovascular disorders" (ICD 10, F 45.3) received purely herbal combination therapy comprising crataegus and camphor (Korodin Herz-Kreislauf-Tropfen) or a placebo, identical in colour and taste to the active treatment, over a period of four weeks within the scope of a multi-centre, placebo-controlled, double-blind study. The principal criterion was the fall in the overall score obtained for a heart-related symptom complex (HSK) during administration of the herbal combination or randomly allocated placebo. The overall score fell significantly by 5.5 or 4.5 points, respectively, from a baseline value of 10.0 points each (p = 0.0165). The sub-score for exhaustion, joint pain, heart disorders, pain on pressure and the total score on the Giessen discomfort chart (GBB) indicated better efficacy with the crataegus-camphor combination than with the placebo. On completion of treatment, the investigators assessed the efficacy of the active drug as "very good to good" in 70.5% of their patients compared with a similar evaluation in just 49.5% of the placebo patients. The degree of satisfaction with the drug therapy according to physician and patient reflected the objective results obtained. 71.6% of subjects in the active drug group were satisfied with their treatment compared with just 52.7% in the placebo group. Adverse events (undesirable side effects) were recorded in 8.3% and 8.5% of patients, respectively. A correlation with the active drug therapy was established in only two cases. Tolerance was therefore positively assessed.
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PMID:[Effects of an herbal crataegus-camphor combination on the symptoms of cardiovascular diseases]. 1096 17

Encephalitis has been reported to be a rare cause of severe dystonia. We describe five patients with markedly severe dystonia from Japanese encephalitis. These patients with markedly severe dystonia were seen during the past 8 years as a subgroup of 50 patients with Japanese encephalitis. The diagnosis of markedly severe dystonia was based on increasingly frequent episodes of generalized dystonia with bulbar, respiratory, or metabolic derangement or leading to exhaustion or pain. The diagnosis of JE was based on clinicoradiologic features and a fourfold increase of hemagglutination-inhibiting antibody titers in paired serum. The outcome of the patients was defined as a good, partial, or poor recovery on the basis of 1-year clinical status. All the patients were males, and their ages ranged from 6 to 19 years. Movement disorders appeared 1 to 3 weeks after the illness as the level of consciousness started improving. During the next 1 to 4 weeks, patients began to experience markedly severe dystonia. It was associated with marked axial dystonia resulting in opisthotonus and retrocollis in five patients, jaw-opening dystonia in two patients, teeth clenching in one patient, and oculogyric crisis and neck deviation in another patient. The attacks of markedly severe dystonia lasted for 2 to 30 minutes and occurred as many as 20 to 30 times daily. Other developments included fixed limb dystonia in one patient, severe spasticity and rigidity in five patients, and focal muscle wasting in one patient. These patients had only a modest improvement after treatment. Markedly severe dystonia abated by 2 to 6 months in all the patients who were followed up. Cranial magnetic resonance imaging showed bilateral thalamic involvement in all patients, brainstem involvement in three patients, and basal ganglia involvement in two patients. At the 3-month follow-up, all patients had a poor outcome. At 1 year, one patient had a complete recovery; one had a partial recovery; and two were bedridden. It can be concluded that markedly severe dystonia is an important and serious sequela of Japanese encephalitis and may occur as the result of thalamus, midbrain, or basal ganglia involvement in various combinations.
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PMID:Markedly severe dystonia in Japanese encephalitis. 1110 1

As oncologists have become more effective in alleviating pain, nausea and depression, fatigue has emerged as the most important symptom suffered by cancer patients. Indeed, the current literature suggests that fatigue is currently the most important untreated symptom in cancer medicine. In recent surveys of patients and their caregivers, fatigue is more important for the quality of life than pain, nausea or depression. Yet these same surveys confirm that oncologists underestimate the importance of cancer related fatigue. This may be partly because patients often do not fully share the full nature of their concerns. When patients do raise the issue of fatigue, the physicians' recommendations are often non specific. However, recent research has shown that fatigue is not inevitable and untreatable, but a symptom amenable to differential diagnosis and specific intervention. Like pain, fatigue is intrinsically a subjective problem where the doctor relies on the patient's reporting. Weakness, exhaustion, lethargy and asthenia are all used as functional descriptions of fatigue. While these are descriptive terms, clinical research in the measurement and alleviation of fatigue requires reproducible measurement tools. Several studies already exist and have begun to explore this important area of symptom management.
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PMID:[Fatigue syndrome caused by malignant tumor. An increasing priority in patient care]. 1143 22

Complex method of surgical treatment of epifascial phlegmon is elaborated. The flaps tailoring and dividing in accordance to anatomic site and its blood supply permits to do radical cleansing and sanitation of focus with mixture of hydrogen peroxide and spirituous solution of iodine preserving the viable skin maximally. In contrast to conventional "stripe" incisions, application of the proposed method permits to preserve the wound from significant lympho--and plasma losses, causing the wound exhaustion, secures the possibility of visual control of the necrotic process course. The wound coverage with cutaneo-subcutaneous flap of the full value assists reducing of the pain intensity. The flap fixation prevents its shortening, that's why good cosmetic effect is noted after the wound healing concludes. Complex program of the necrotic fascitis treatment proposed had permitted to reduce the hospitalization duration of patients twice and to lower the mortality rate more than in 3 times.
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PMID:[Non-clostridial epi-fascia phlegmon]. 1147 7

The present study was designed to explore the extent to which advanced cancer pain is explicable in terms of both physical pain intensity and affect. Most notably, it expanded on previous findings by more clearly elucidating the relationship between several discrete emotional states and the total experience of cancer pain. One hundred and eleven patients with cancer pain attending a Pain and Symptom Control Clinic were studied. Visual Analogue Scales (VASs) were used to quantify overall pain intensity and the accompanying affect. Then, correlations were calculated to evaluate the relationships both between and within these two variables. Overall, the participants rated both the pain intensity and the negative affect associated with that pain as high. Of the examined affective components of pain, frustration and exhaustion were found to be the most significant. In addition, some gender differences were identified in terms of frustration, anger, fear, exhaustion, helplessness, and hopelessness.
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PMID:Sensory and affective dimensions of advanced cancer pain. 1183 90

The purpose of this presentation is to discuss the possibility that sensitization is a psychobiological mechanism underlying not only multiple chemical sensitivity (MCS), but a much more general cluster of illness, referred to as "subjective health complaints". Sustained arousal, or sustained "stress" responses, may be an important factor for the development of these conditions. Patients with subjective complaints without objective changes are sometimes referred to as having "fashionable diagnoses" or "unexplained symptoms". They may be given diagnoses like MCS, epidemic fatigue, chronic fatigue syndrome, burnout, stress, a variety of intoxications, environmental illness, radiation, multiple chemical hypersensitivity, food intolerance, functional dyspepsia, irritable bowel, myalgic encephalitis, postviral syndrome, yuppie flu, fibromyalgia, or vital exhaustion. One issue is whether this is one general condition or separate entities. Another issue is whether sensitization may be the psychobiological mechanism for most or all of these conditions. Finally, is it likely that sustained arousal may facilitate the development of sensitization in some or many neural circuits? In this review, the main emphasis will be on musculoskeletal pain. This is the most frequent and most expensive condition for sickness compensation and disability. The comorbidity of other complaints, however, will also be taken into account.
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PMID:Sensitization, subjective health complaints, and sustained arousal. 1200 15

Self-reported sleep quality, strain and health in relation to perceived working conditions in females The aims of this study were to examine self-reported sleep quality, perceived strain and health in relation to working conditions; the prevalence and severity of sleep disturbances and daytime distress arising from poor sleep in women on different work shifts. Furthermore, to see whether females with gastrointestinal symptoms, joint-, back- or muscle-pain and who are dissatisfied with working hours differ with regard to the above aspects. Finally, degree of strain-related symptoms and sleep difficulties were tested as predictors of sleep quality and general health outcome. Important research questions are whether registered nurses and those on rotating work shifts have greater sleep problems than others. A total of 156 females, aged 20-59 years, working at three different casualty departments, answered structured questionnaires. The results showed a persistently high rate of psycho-physiological long-term effects of stress related to working conditions. Thirty-four per cent were dissatisfied with their working hours, and exhibited significantly more mental strain, fatigue/excessive tiredness and inability to relax after work because of involuntary thoughts, in relation to working conditions than others did. Sixty-two females (39.7%) complained of insufficient sleep. The sleep quality outcome was significantly predicted by difficulty falling asleep (odds ratio 8.4), difficulty in falling asleep after nocturnal awakening (odds ratio 3.4) and perceived exhaustion (odds ratio 2.6). Females suffering from gastrointestinal symptoms and joint-, back- and muscle symptoms for several days in a week or even everyday were especially sensitive to worse sleep quality. Independent of work shifts, registered nurses exhibited a higher degree of mental strain and prolonged recovery in comparison with others. In conclusions, sleep initiation difficulties, troubled sleep and exhaustion significantly predicted reduced sleep quality outcome with decreased resilience to stress and vulnerability to psycho-physiological disorders in females working within the health care system.
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PMID:Self-reported sleep quality, strain and health in relation to perceived working conditions in females. 1200 Jun 72

Fibromyalgia-like symptoms such as muscle pain and tenderness, exhaustion, reduced exercise capacity, and cold intolerance, resemble symptoms associated with endocrine dysfunction like hypothyroidism, and adrenal or growth hormone insufficiency. To investigate the potential of management of endocrine abnormalities for relieve of symptoms of patients with fibromyalgia, we reviewed experimental and clinical studies of endocrine functioning and endocrine treatment. Serum GH, androgen, and 24-hour urinary cortisol levels of patients with fibromyalgia tend to be in the lower part of the normal range, while serum levels of thyroid hormone, female sex hormones, prolactin, and melatonin are normal. With exception of GH, these conclusions are based on studies in small samples. With respect to dynamic responsiveness of the hypothalamic-pituitary-adrenal (HPA) axis, the dexamethasone suppression test and stimulation with ACTH show normal results, while patients show marked ACTH hypersecretion in response to severe acute stressors, perhaps indicative of chronic CRH hyposecretion. This finding and slightly altered responsiveness of growth hormone, thyroid hormone, and prolactin in pharmacologic stimulation tests suggest a central rather than peripheral origin of endocrine deviations. Because hormone level deviations were not severe, occurred in subgroups of patients only, and few controlled clinical trials were performed, there is--unless future research shows otherwise--little support for hormone supplementation as a general therapy in the common patient with fibromyalgia. In patients with clinically overt hormone deficiency, hormonal supplementation is an option. In patients with hormone levels that are in the lower part of the normal range, interventions aimed at pain, fatigue, sleep or mood disturbance, and physical deconditioning may indirectly improve endocrine functioning.
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PMID:Evaluation and management of endocrine dysfunction in fibromyalgia. 1212 26


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