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

Between April 1981 and July 1984, 51 patients received intraoperative radiation therapy (IORT) as a component of therapy for the management of primary or recurrent pelvic malignancies which were initially unresectable for cure. For these patients, curative surgical alternatives did not exist, or would have involved extensive procedures such as pelvic exenteration, distal sacrectomy, hemipelvectomy, or hemicorporectomy. The primary disease was colorectal in 38 patients. Treatment consisted of external beam radiation (range 3000 to 6890 cGy, median 5040 cGy), surgical debulking when feasible, and an intraoperative electron beam boost to the gross or microscopic residual disease (dose range 1000 to 2500 cGy, median 1750 cGy) utilizing 9-18 MeV electrons. The most common IORT associated toxicities were peripheral neuropathy and ureteral obstruction. None were life-threatening or fatal in severity. Of the 50 patients evaluable for neurotoxicity analysis, 16 (32%) developed peripheral neuropathy consisting of pain in 16 patients, numbness and tingling in 11, and weakness in 8. The pain, numbness and tingling resolved in about 40% of patients, while weakness resolved in only 1 of 8. Sixteen ureters were initially unobstructed by tumor at the time of IORT. Of these, 10 (63%) subsequently showed evidence of obstruction and hydronephrosis. The development of neurotoxicity was more common at IORT doses of 1500 cGy or more versus 1000 cGy. Ureteral obstruction with hydronephrosis occurred more frequently at IORT doses of 1250 cGy or more compared to 1000 cGy. There was no relationship between the likelihood of developing complications and the total external beam dose. The observed dependence of human nerve toxicity primarily on the IORT dose is consistent with data generated from animal experiments.
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PMID:Peripheral nerve and ureteral tolerance to intraoperative radiation therapy: clinical and dose-response analysis. 217 Oct 42

The purpose of this article is to define as a distinct clinical entity, the syndrome of cervical spinal cord neurapraxia with transient quadriplegia. Sensory changes include burning pain, numbness, tingling, or loss of sensation, whereas motor changes consist of weakness or complete paralysis. The phenomenon of cervical spinal cord neurapraxia occurs in individuals with (1) developmental cervical spinal stenosis, (2) congenital fusions, (3) cervical instability, or (4) intervertebral disc protrusions when associated with a decrease in the anteroposterior diameter of the spinal canal. There is no evidence that the occurrence of cervical spinal cord neurapraxia predisposes an individual to permanent neurologic injury. However, patients with this syndrome and associated with cervical spine instability or acute or chronic degenerative changes should be precluded from further participation in contact sports. Those with developmental spinal stenosis or spinal stenosis associated with congenital abnormalities should be treated on an individual basis.
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PMID:Cervical spinal stenosis with cord neurapraxia and transient quadriplegia. 218 46

Herpetic whitlow is a herpes infection of the digits of the hand, first described in 1909, caused by either herpes simplex virus type 1 or type 2. It was not until 1959 that herpetic whitlow was reported to occur in health care professionals. Nurse anesthetists are among the many health care professionals considered to be at high risk for acquiring herpetic whitlow, making it an occupational, but preventable, disease. After an initial infection, the virus invades the nerve tissue supplying the affected area, thus creating a reservoir for the virus to remain latent until reactivated. The recurrence of herpetic whitlow suggests that the infection persists for life. Pain, tingling and burning of the distal phalanx are the initial symptoms. Swelling and vesicles on an erythematous base follow. The infection is self-limiting, usually resolving in about three weeks. Primary infections are very inflammatory and persistent. Diagnosis can be made clinically and confirmed by many laboratory tests. Early recognition is most important, and treatment is symptomatic. The drug acyclovir has proven to be an effective chemotherapeutic agent for suppressive therapy.
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PMID:Herpetic whitlow: an occupational hazard. 231 23

A case of permanent injury to the nerves of the lumbosacral plexus as a result of regional paracervical block anesthesia before dilatation and curettage for abortion at 8 weeks' gestation is presented. The woman, aged 35, para 2, was given xylocaine. During injection she complained of pain in the gluteal muscle and left leg. The pain intensified and numbness, tingling and paraesthesia developed over 24 hours. The pain radiated to the L5-S1 distribution on the left when she raised her lower limb. She had difficulty moving her lower leg, and by 9 days later had hypotonia and foot drop, with absent ankle reflexes. While she gradually improved over 2 months, her condition stabilized with hypoesthesia of the left foot, foot drop and absent left ankle jerk reflex. The cause of this neuropathy is unknown, but thought to be either hematoma, direct trauma, infection. Thorough knowledge of nerve structure in the area is essential when giving paracervical block.
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PMID:Lumbosacral plexopathy following regional paracervical block anaesthesia. 239 35

Twelve patients who developed radiation-induced brachial plexopathy (RIBP) after receiving radiation therapy for breast carcinoma (7 patients) or Hodgkin's lymphoma (5 patients) were followed for 12 or more years, with a mean follow-up time of 20 years. Tingling and numbness of the fingers as well as weakness of the hand or arm were the most prominent presenting symptoms of RIBP. Whereas pain in most patients evolved only later in the course, it became a predominant feature in only 2. In 8 of the 12 patients, the plexopathy was surgically treated, either by neurolysis only or by neurolysis plus omental grafting in order to stop progression or paresis and/or pain. In 8 patients, including 6 of the operated group, there was slow and steady progression of RIBP over time, with the final outcome being almost complete paralysis of the arm (2 patients) or severe sensorimotor paresis rendering the hand useless (6 patients). In only 4 patients, including 2 of the non-operated group, was there absence of progression and stabilization of the paresis with only slight functional loss of the affected arm in 3 patients and severe palsy in 1. None of the 12 patients had any clear long-lasting improvement of their sensorimotor impairment. It is concluded from this study that RIBP, irrespective of surgery (neurolysis and/or omentum transplant), left two-thirds of the patients with severe or total paresis of the arm. However, the almost complete relief of severe pain (6 of 8 patients), both immediately and in follow-up patients treated with neurolysis and/or omental transplant, indicates that surgical treatment has a beneficial effect on pain relief.
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PMID:Natural history of radiation-induced brachial plexopathy compared with surgically treated patients. 239 47

There continues a significant debate over the best contemporary method for treating trigeminal neuralgia. Glycerol injection into the trigeminal cistern has been used in a consecutive series of 200 patients. A total of 80% of the patients have had good or excellent pain relief. Side effects have been a mild and usually transient numbness and tingling or mild objective sensory deficit to pin and touch in approximately 1/2 of the patients. Complications have been extremely infrequent and have resolved in time. A recurrence rate of 24% has been the single largest disadvantage of the procedure. Reinjection is usually successful in treatment of recurrence. The combination of efficacy, minimal and temporary neurologic dysfunction, and low complication rate make this procedure, in our opinion, the procedure of choice for the first step, when surgical treatment is required.
Clin J Pain 1989 Jun
PMID:Percutaneous injection of glycerol for the treatment of trigeminal neuralgia. 252 Apr 3

The novel 5-HT 1-like receptor agonist GR43175 has been evaluated as a treatment for acute migraine in a series of open, dose-ranging and controlled clinical trials. Patients with severe attacks of migraine have attended special pain or headache clinics for treatment and assessment. Given intravenously as a bolus, GR43175 is capable of aborting all migraine symptoms within 10-30 min in over 90% of cases at a dose of 64 micrograms/kg. Characteristic transient and reversible side effects with such a regimen include feelings of heaviness, pressure and occasionally warmth or tingling which can be diminished by extending the duration of drug administration to a short infusion. Initial dose-ranging studies with a dispersible tablet formulation of GR43175 have revealed an efficacy of 70-85% within 2 h with doses of 70-280 mg. Furthermore, tolerability is excellent. These encouraging early results warrant larger-scale controlled studies of GR43175 in acute migraine.
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PMID:Overview of initial clinical studies with intravenous and oral GR43175 in acute migraine. 254 86

In three women with multiple sclerosis, paroxysmal itching occurred. We were able to detect the spinal segment lesions corresponding to the dermatome of paroxysmal itching by magnetic resonance imaging (MRI) in them. Case 1. A 38-year-old woman was admitted with chief complaints of tingling sensation in the left side of the body, left hemiparesis and paroxysmal itching in the neck and left upper extremity. Examination on admission revealed left hemiparesis, mildly exaggerated deep tendon reflexes in the left upper and lower extremities, positive Lhermitte's sign. Superficial sensation was decreased and dysesthetic below the left C3 segment. Vibration and joint sense were moderately decreased in the left upper limb. Painful tonic seizure-like attack occurred in the neck bilaterally. Paroxysmal itching occurred in the neck and left upper extremity corresponding to the cervical spinal segments bilateral C3, left C4 to C6. MRI revealed multiple high signal intensities in the white matter of the cerebral hemispheres, the medullo-cervical junction and the cervical segment C3 to C4 in T2-weighted spin-echo images. The C3 to C4 lesion was found in the left dorsal area of spinal cord in axial image. High signal areas of cervical cords on T2-weighted spin-echo images were reduced in response to adrenocorticosteroid therapy, and paroxysmal itching disappeared. Case 2. A 24-year-old woman complained chiefly of mild tetraparesis and left hand clumsiness. On admission, she had right central facial palsy, mild weakness of all limbs, painful tonic seizure of left upper limb, positive Lhermitte's sign and bilateral Babinski sign. Superficial sense was mildly decreased and dysesthetic in left upper extremity.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Paroxysmal itching and magnetic resonance imaging of the spinal cord in multiple sclerosis]. 262 19

Recent literature suggests that phantom pain and stump pain have closely related physiologic mechanisms and that treatments frequently overlap. Decreased blood flow in the residual limb is related to burning and tingling phantom and stump pain, whereas spasms in major muscles of the residual limb precede cramping phantom and stump pain. There is little support for psychological mechanisms underlying the vast majority of chronic phantom and stump pain problems, but these mechanisms can exacerbate both acute and chronic pain. It is critically important to educate patients about the process of amputation and the physiologic mechanisms of phantom sensation and pain in order to minimize magnification of pain due to stress. Acute stump pain usually responds well to traditional interventions based on identifying and correcting specific problems in the residual limb. Most traditional treatments for phantom pain and chronic stump pain are not effective for more than a few months. Recommended treatments are related to underlying mechanisms. For chronic phantom and stump pain, burning sensations are treated with interventions designed to increase blood flow to the residual limb, whereas cramping sensations are treated with interventions that reduce muscle spasms.
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PMID:Stump and phantom limb pain. 265 77

"Effort" thrombosis, also called the Paget-Schroetter syndrome or primary thrombosis of the upper extremity, has been well documented in the literature. However, in our review of the United States, Canadian, and British literature, we found only 52 cases in which it was related to sports participation. We report a case of axillary and subclavian vein "effort" thrombosis in a young woman athlete, who was predisposed to thrombosis by all three postulates of the Virchow triad: namely, (1) stasis caused by constriction from a cervical rib, (2) increased coagulability as a result of oral contraceptive use, and (3) vessel wall injury because of competitive softball participation. Of the available therapeutic plans, we believe that athletes with "effort" thrombosis should have aggressive treatment that is initiated as early as possible to prevent swelling, tingling numbness, easy fatigue of the arm, and pain on prolonged use of the affected extremity.
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PMID:"Effort" thrombosis of the axillary and subclavian vein associated with cervical rib and oral contraceptives in a young woman athlete. 275 May 60


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