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

A retrospective review over 6 yr of patients presenting to the hand clinic was performed to identify cases of postoperative brachial plexopathy (PBP) and to assess both prognosis and early indices of prognosis. Over this period (1989-1995), 22 patients were referred by the hospital's surgical departments to the hand clinic because of PBP. Eight cases followed open heart surgery (OHS) and 14 followed non-cardiac surgery (NCS). Median full recovery took 10 (range 4-16) weeks and 20 (8-50) weeks, respectively. Long-term follow-up revealed one OHS patient with residual tingling and three NCS patients with residual weakness. Brachial plexopathy after median sternotomy was characterized by a predominance of sensory complaint in the lower roots of the plexus. Injury after non-cardiac surgery was reflected by a predominance of motor deficit in the upper and middle roots. Brachial plexus injury after cardiac surgery carries an excellent prognosis for full functional recovery. Although the limited number of cases precludes statistical substantiation, the data suggest that the prognosis of PBP after non-cardiac surgery may be worse in males, diabetics, those with injury to all roots of the plexus and, when in addition to the motor deficit there is sensory loss and pain or dysaesthesia. At a 1 week "prognostic milestone", 79% of NCS patients with significant symptomatology enjoyed complete recovery although this took as long as 5 months to 1 yr in 50% of patients. At a 6-8 week "prognostic milestone", 50% of those who had not yet had improvement in the motor deficit suffered residual neurological deficit. All patients recovered to a significant extent even when recovery was not complete and none suffered from late deterioration or chronic pain.
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PMID:Prognosis of intraoperative brachial plexus injury: a review of 22 cases. 938 59

Carpal tunnel decompression gives relief of symptoms of tingling and numbness in the fingers in around 90% of carpal tunnel syndrome cases. The most common complaint after operation is pain and tenderness about the operation scar. The normal median nerve slides back and forth during wrist movement. Loss of this movement due to scar adhesion is suggested as a cause of wound pain and residual symptoms. We performed a controlled, blinded study of bilateral primary carpal tunnel releases comparing standard closure with a hypothenar fat pad flap modified closure. No significant differences in pain or other symptoms were found.
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PMID:Open carpal tunnel release. Does a vascularized hypothenar fat pad reduce wound tenderness? 945 82

We report a 67-year-old hypertensive right-handed woman who developed severe pain and dystonia in her left upper and lower extremity after a thalamic infarction. She was well until 9 months prior to the present admission to our hospital, when she had an acute onset of left hemiparesis which turned out to have been caused by a thalamic infarct. Her hemiparesis showed nearly complete recovery during the next four months. She noted an onset of severe spontaneous pain and difficulty in using her left hand four months prior to the present admission. Neurologic examination on admission revealed an alert and well oriented Japanese woman. Cranial nerves were intact. Although she did not have weakness, her left hand showed thalamic posture, and upon standing, she showed a dystonic posture in which her left forearm took pronation and flexion at the elbow joint and her left lower extremity took extension in the knee joint and planter flexion in the ankle joint. Her dystonic posture increased during walking and disappeared in the supine position. She complained of severe spontaneous pain and tingling sensation in her left extremities. Position sense was diminished in her left leg. However other sensations were intact. She had slight ataxia on the left side. Deep tendon reflexes were symmetric, but the planter response was extensor on the left side. MRI revealed a small lacunar infarct involving the right posterolateral thalamic region. EMG with surface electrodes revealed non-reciprocal tonic discharges in the left biceps brachii and forearm flexor and extensor muscles. She responded poorly to various medications. Only trihexyphenidyl showed partial alleviation of her pain and dystonic posture. We thought her pain might be caused by dystonic contraction of the skeletal muscles, at least in part. We injected 25 IU of botulinus toxin as a total dose into her biceps brachii, triceps brachii, and wrist flexor muscles. A few days after the injection, her dystonic posture began to show marked improvement; as her dystonia improved, her pain also showed marked improvement. This patient appeared to represent a case of post-hemiplegic dystonia. Her pain was initially thought to be the thalamic pain. However, as her pain disappeared with improvement of her dystonia, her pain is most likely to have been caused by the dystonic muscle contraction. Botulinus toxin treatment appears to be useful for post-hemiplegic painful dystonia.
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PMID:[A case of post-hemiplegic painful dystonia following thalamic infarction with good response to botulinus toxin]. 949 Aug 97

The objective was to determine whether symptomatic workers with an abnormal sensory nerve conduction study consistent with carpal tunnel syndrome differed, in terms of electrophysiologic measures, psychosocial, demographic, anthropometric, or ergonomic variables, from workers with an asymptomatic median mononeuropathy. This was a cross-sectional study of active workers at six different work sites. Cases were defined as workers with electrodiagnostic findings of a median mononeuropathy in either hand, based on a 0.5-msec prolongation of the median sensory evoked peak latency compared to the ulnar latency. This group was stratified on the basis of symptoms of numbness, tingling, burning or pain in the hand. The two groups were compared in terms of demographic, anthropomorphic, psychosocial, electrophysiologic, and ergonomic risk factors. Active workers from six different sites were tested; five sites involved manufacturing workers, and one site represented clerical workers. One hundred eighty-four active workers with a median mononeuropathy were documented on nerve conduction studies. These workers represented a subset of more than 700 workers screened at six different locations. The main outcome measure was the patient's report of symptoms of pain, numbness, tingling or burning in the hand or fingers that lasted more than 1 week or occurred three or more times at the initial screening. Workers with a median mononeuropathy who complained of hand symptoms were more likely to be female, to have jobs with higher hand repetition levels, to have higher ratings of job security, not to have a history of diabetes, to use more force in their job with more abnormal postures of their wrist and fingers, and to have a trend toward a more prolonged median sensory distal latency. Most logistic regression models explained less than 15% of the variance (pseudo R2). Women with jobs that have higher ergonomic risks and no history of diabetes were more likely to have reported symptoms associated with carpal tunnel syndrome compared to other workers with a documented median mononeuropathy. Psychosocial variables were not particularly discriminatory. None of the models allows enough precision to predict on an individual basis.
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PMID:Median mononeuropathy among active workers: are there differences between symptomatic and asymptomatic workers? 951 44

Photodynamic therapy (PDT) with topically applied delta-aminolevulinic acid (ALA) is increasingly employed to treat patients with multiple solar keratoses and superficial skin tumors. For these indications, ALA-PDT has been shown to be highly efficient. Treatment of multiple or extended lesions, however, is substantially hampered by the fact that ALA-PDT is associated with burning pain during the irradiation procedure. The standard irradiation devices commonly used for ALA-PDT emit red light around 630 nm. In the present half-side comparison study we have observed that ALA-PDT employing a green light irradiation device (543-548 nm) is equally effective, as compared with standard red light ALA-PDT. In contrast to red light ALA-PDT, however, green light ALA-PDT caused only little tingling and burning but no pain. These observations indicate that green light ALA-PDT is superior to standard ALA-PDT, because it is associated with less unwanted side effects.
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PMID:Green light is effective and less painful than red light in photodynamic therapy of facial solar keratoses. 954 54

Oltipraz has been used clinically in many regions of the world as an antischistosomal agent and is an effective inhibitor of aflatoxin hepatocarcinogenesis in rats. This chemopreventive action of oltipraz results primarily from an altered balance in aflatoxin metabolic activation and detoxication. In 1995, a randomized, placebo-controlled, double-blind intervention was conducted in residents of Qidong, People's Republic of China, who are at high risk for exposure to aflatoxin and development of hepatocellular carcinoma. The major study objectives were to define a dose and schedule for oltipraz that would reduce levels of aflatoxin biomarkers in biofluids of the participants, and to further characterize dose-limiting side effects. Two hundred thirty-four healthy eligible individuals, including those infected with HBV, were randomized to receive either 125 mg oltipraz daily, 500 mg oltipraz weekly, or placebo. Blood and urine specimens were collected to monitor potential toxicities and evaluate biomarkers over the 8-week intervention and subsequent 8-week follow-up periods. Overall, compliance in the intervention was excellent; approximately 85% of the participants completed the study. Objective evaluation of adverse events was greatly facilitated by inclusion of a placebo arm in the study design. A syndrome involving numbness, tingling, and pain in the fingertips was the only event that occurred more frequently among the active groups (18 and 14% of the daily 125 mg and weekly 500 mg arms, respectively) compared to placebo (3%). These symptoms were reversible and could be relieved with non-steroidal antiinflammatory agents. A more complete understanding of the chemopreventive utility of oltipraz awaits completion of an assessment of the efficacy of oltipraz in modulating levels of aflatoxin biomarkers.
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PMID:Oltipraz chemoprevention trial in Qidong, Jiangsu Province, People's Republic of China. 958 63

A retrospective chart review identified patients who had surgery through Henry's standard anterior and anterolateral approaches to the humerus. Of the patients contacted, 62% had problems with the skin incision with reports of pain, numbness, and tingling around the scar. The frequency of cutaneous problems including neuroma prompted an anatomic study; the lower lateral cutaneous nerve branches to the arm were dissected in seven cadaver arms to determine their course. Henry's incision was then compared with a midline anterior incision. The cutaneous nerves were noticeably less numerous and smaller in diameter in the midline incision, probably related to the internervous, or watershed zone of cutaneous nerves in the anterior midline of the arm. Henry's standard intermuscular humeral exposure was no more difficult with the anterior midline incision. This study supports the notion that an anterior midline incision to approach the shaft of the humerus would minimize scar discomfort from cutaneous nerve injury.
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PMID:A modification of Henry's anterior approach to the humerus. 965 43

One of the explanations for the negative effects of underpredicted aversive experiences is that they have more impact than correctly predicted aversive experiences. In a laboratory experiment 40 normal female subjects executed an auditory discrimination task. Subjects were randomly assigned to a correct information condition and an underprediction information condition. After ten trials (baseline) subjects were informed that they would receive some painful (correct prediction) or non-painful tingling (underprediction) stimuli during the discrimination task. Starting just before five of the following 20 discrimination trials, 2 s of painful electrical stimulation was given. Subjects rated sensations and painfulness of the electrical stimulation, subjective anxiety, and degree of distraction from the task, after each pain stimulus. Reaction times of the discrimination task and heart rate were measured. Underprediction information resulted in lower pain ratings, but stronger heart rate responses and higher disruption on the discrimination task, compared to correct information. This suggests that while underpredictions of pain do not hurt more, disruption on primary tasks and physiological impact are higher. Underpredicted pain has more impact than correctly predicted pain, not because it hurts more, but because it conveys inherent danger information.
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PMID:Underpredicted pain disrupts more than correctly predicted pain, but does not hurt more. 974 97

Two cases are described in which patients presented 16 and 17 years, respectively, after complete or incomplete amputation/replantation of the arm. In case 1, the patient complained of coldness, pain, and tingling in the replanted arm in the previous 24 hours and noticed that his fingers had gone white. Arteriography and subsequent surgery revealed obliteration of the vein graft (inserted in the distal brachial artery) by neointimal thickening and atherosclerotic plaque, which was confirmed in a subsequent morphologic examination. In case 2, the patient presented with discomfort and a pulsatile swelling on the inner aspect of his upper arm. Arteriography and surgery revealed an aneurysm in the previously inserted vein graft in the brachial artery, with some atherosclerotic degeneration. Both vein grafts were successfully replaced with a fresh autologous vein graft and the patients remain well several years later. The 2 cases suggest that as part of replantation surgery of a limb, it is essential to maintain postoperative clinical monitoring for signs of graft degeneration in all patients with long-term vein graft insertion.
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PMID:Late occlusion of microvascular vein grafts in replantation. 984 67

The authors report a case of vibration white finger syndrome in a 51-year old male, pneumatic drill worker. The patient complained of severe pain in the I, II, III and IV right fingers related to acral ischemic lesions. Dried skin with desquamation, tingling, paraesthesia and loss of sensation were present in both hands. Several arterial obstructions on forearm, hand and fingers were evident bilaterally at the angiography. Medical treatment, including administration of calcium-channel blockers, pentoxifylline and intravenous prostaglandin therapy, was unsuccessful. Under local anaesthesia an epidural spinal cord cervical electrode was implanted to control pain and ameliorate local microcirculatory conditions. The clinical result was excellent with the disappearance of symptoms and healing of acral lesions in a few weeks. Epidural spinal cord electrical stimulation represents an excellent technique for treatment in secondary Raynaud phenomenon related to vibration white finger syndrome.
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PMID:Spinal cord stimulation in vibration white finger. 985 48


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