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

Among neural lesions of the arms, the most common one is the medianus lesion in the carpal tunnel, followed by the ulnar nerve lesion in the elbow, while the ulnar nerve compression in the Guyon tunnel is found rarely. Besides the history and the clinical picture, the electromyoneurographic analyses make an early and accurate diagnosis possible. The characteristics of the evoked muscle potential and distal latencies in the diagnosis of the carpal tunnel syndrome are of utmost importance. In diagnosing the cubital syndrome, the multisegmental determination of the motor conduction velocity of the ulnar nerve and the features of the M-potential obtained by means of stimulation above the compression are very important. Generally speaking, the slowing down of the motor conduction velocity remains localised to the entrapped segments. The neural potential over the compression in the elbow cannot be evoked, and it is hardly evoked in the wrist. Within the period of the last five years, the author examined 154 patients clinically and electrophysiologically. 132 had the carpal tunnel syndrome, 20 the ulnar groove syndrome, and 2 Guyon's canal syndrome. The patients were treated conservatively and operatively. The success in the conservative treatment of the carpal tunnel syndrome was evident in the first three months by the absence of sensory symptoms in more than 50% of cases. The constant effect was achieved after six months. In that period the EMG findings were not essentially changed, and motor symptoms were also stationary. With the operative treatment the unpleasant symptoms, pain and shudder, disappeared after a relatively short period. Definitive results were achieved after six months. Motor symptoms were less improved and the EMG findings were showing a tendency to improvement. The ulnar groove syndromes were not remarkably influenced by the conservative therapy. Half the operated patients lost their sensory symptoms. Within six months the other half remained with the same or even more trouble.
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PMID:[Nerve compression syndromes of the arm]. 262 73

Tarsal tunnel syndrome (TTS) is defined as the entrapment of the posterior tibial nerve in the tarsal tunnel of the ankle. The etiologies of tarsal tunnel syndrome are mainly the presence of a ganglion, osseous prominence with tarsal bone coalition, trauma, varicose veins, neurinoma, hypertrophy of the flexor retinaculum, or systemic disease (rheumatoid arthritis, ankylosing spondylitis). However, no specific cause can be identified in some cases. Patients with chronic renal failure tend to develop peripheral nerve entrapment and carpal tunnel syndrome is the best-known peripheral entrapment neuropathy among them. Contrary to carpal tunnel syndrome, tarsal tunnel syndrome is observed less frequently in chronic renal failure patients. The common presenting symptoms of TTS are paresthesias and/or pain in the plantar side of the foot. Motor symptoms are rarely detected. Diagnosis is made primarily by electroneuromyographic studies and physical examination. Surgery is the treatment of choice and the outcome is generally favourable. In this report, we present a patient with tarsal tunnel syndrome complicating peritoneal dialysis.
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PMID:Tarsal tunnel syndrome in a patient on long-term peritoneal dialysis: case report. 1805 74

Multiple sclerosis (MS) is associated with a large reduction in physical activity behavior, and emerging evidence indicates that this reduction might be correlated with symptoms and self-efficacy. The present study examined the nature of the associations among MS-related symptoms, exercise self-efficacy, and physical activity behavior in 80 individuals with a definite diagnosis of MS. Participants completed a measure of MS-related symptoms and self-efficacy and then wore an accelerometer for seven days. Both the frequency of overall symptoms and the frequency of motor symptoms had significant moderate inverse relationships with physical activity behavior (r=-0.47, P<0.0001 and r=-0.49, P<0.0001, respectively). Additionally, exercise self-efficacy was significantly and moderately correlated with physical activity (r=0.39, P<0.0001) and had significant and moderate inverse relationships with overall symptom frequency (r=-0.40, P<0.0001) and motor symptom frequency (r=-0.30, P=0.008). Path analysis demonstrated that both overall symptoms and motor symptoms had direct effects on physical activity as well as indirect effects on physical activity by way of self-efficacy. Such results suggest that the management and monitoring of MS-related symptoms may play an important role in encouraging physical activity adoption and maintenance in individuals with MS.
J Pain Symptom Manage 2008 Jul
PMID:Physical activity behaviors in individuals with multiple sclerosis: roles of overall and specific symptoms, and self-efficacy. 1836 58

Pain, spasticity, tremor, spasms, poor sleep quality, and bladder and bowel dysfunction, among other symptoms, contribute significantly to the disability and impaired quality of life of many patients with multiple sclerosis (MS). Motor symptoms referable to the basal ganglia, especially paroxysmal dystonia, occur rarely and contribute to the experience of distress. A substantial percentage of patients with MS report subjective benefit from what is often illicit abuse of extracts of the Cannabis sativa plant; the main cannabinoids include delta-9-tetrahydrocannabinol (delta9-THC) and cannabidiol. Clinical trials of cannabis plant extracts and synthetic delta9-THC provide support for therapeutic benefit on at least some patient self-report measures. An illustrative case is presented of a 52-year-old woman with MS, paroxysmal dystonia, complex vocal tics, and marijuana dependence. The patient was started on an empirical trial of dronabinol, an encapsulated form of synthetic delta9-THC that is usually prescribed as an adjunctive medication for patients undergoing cancer chemotherapy. The patient reported a dramatic reduction of craving and illicit use; she did not experience the "high" on the prescribed medication. She also reported an improvement in the quality of her sleep with diminished awakenings during the night, decreased vocalizations, and the tension associated with their emission, decreased anxiety and a decreased frequency of paroxysmal dystonia.
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PMID:Current status of cannabis treatment of multiple sclerosis with an illustrative case presentation of a patient with MS, complex vocal tics, paroxysmal dystonia, and marijuana dependence treated with dronabinol. 1849 77

Levodopa has been the mainstay of symptomatic therapy for Parkinson Disease (PD) for 40 years providing benefit to virtually all patients. Levodopa therapy results in improved activities of daily living, enhanced quality of life, and improved mortality. However, the long-term use of levodopa is associated with the development of motor fluctuations and dyskinesia. In addition, levodopa therapy has further limitations. It has little or no effect on certain motor features (e.g. gait and balance dysfunction) and a non-motor symptom complex (autonomic dysfunction, pain syndromes, sleep disorders, mood disturbances, dementia). Further, multiple case reports illustrate the potential of levodopa and other dopaminergic agents to cause or reveal a series of impulse control disorders. This review highlights the levodopa unresponsive symptoms in PD.
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PMID:Levodopa unresponsive symptoms in Parkinson disease. 1878 79

The mechanisms underlying pain in Parkinson's disease (PD) are unclear. Although a few studies have reported that PD patients may have low pain threshold and tolerance, none could accurately assess whether there was a correlation between sensory thresholds and demographic/clinical features of PD patients. Thus, tactile threshold, pain threshold, and pain tolerance to electrical stimuli in the hands and feet were assessed in 106 parkinsonian patients (of whom 66 reported chronic pain) and 51 age- and sex-matched healthy subjects. Linear regression models determined relationships between psychophysical parameters and demographic/clinical features. Female gender, severity of disease, medical disease associated with painful symptoms, and dyskinesia were more frequently observed in PD patients experiencing pain, even though dyskinesia did not reach significance. Pain threshold and pain tolerance were significantly lower in PD patients than in control subjects, whereas the tactile threshold yielded comparable values in both groups. Multivariable linear regression analyses yielded significant inverse correlations of pain threshold and pain tolerance with motor symptom severity and Beck depression inventory. Pain threshold and pain tolerance did not differ between PD patients with and without pain. In the former group, there was no relationship between pain threshold and the intensity/type of pain, and number of painful body parts. These findings suggest that pain threshold and pain tolerance tend to decrease as PD progresses, which can predispose to pain development. Female gender, dyskinesia, medical conditions associated with painful symptoms, and postural abnormalities secondary to rigidity/bradikinesia may contribute to the appearance of spontaneous pain in predisposed subjects.
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PMID:Spontaneous pain, pain threshold, and pain tolerance in Parkinson's disease. 2108 24

The aim of this study is to review the clinical outcome of patients treated for spinal dural arteriovenous malformations and investigate the presence of pretreatment indicators of outcome after short- and midterm follow-up. The authors retrospectively reviewed the records of 65 consecutive patients treated either surgically or endovascularly in 3 neurosurgery departments between 1989 and 2009. After treatment, 80% of patients reported improvement of at least 1 symptom. Motor symptoms improved more than sensory disorders, pain, or sphincter impairment. Spinal dural arteriovenous fistulas at the thoracic level, and in particular at the lower level, responded better than those in other spinal areas. Spinal dural arteriovenous fistula is a rare pathology with a malignant course that should be treated aggressively. This study appears to confirm that neurological status before treatment, anatomical location of the fistula, and symptoms at presentation are all factors that can predict outcome. Early diagnosis of spinal dural arteriovenous malformations in the lower thoracic area in patients with an Aminoff scale score < 3 was associated with the most favorable outcome.
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PMID:Spinal dural arteriovenous fistulas: outcome and prognostic factors. 2253 20

Spinal dural arteriovenous fistulas (AVFs), the most common type of spinal cord vascular malformation, can be a challenge to diagnose and treat promptly. The disorder is rare, and the presenting clinical symptoms and signs are nonspecific and insidious at onset. Spinal dural AVFs preferentially affect middle-aged men, and patients most commonly present with gait abnormality or lower-extremity weakness and sensory disturbances. Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances. Patients with severe neurological deficits at presentation tend to have worse posttreatment functional outcomes than those with mild or moderate pretreatment disability. However, improvement or stabilization of symptoms is seen in the vast majority of treated patients, and thus treatment is justified even in patients with substantial neurological deficits. The extent of intramedullary spinal cord T2 signal abnormality does not correlate with outcomes and should not be used as a prognostic factor.
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PMID:Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas: an overview. 2253 26

Pain occurring in Parkinson's disease (PD) may affect a large proportion of patients. Based on the results of the methodologically more robust case-control studies that detected a significantly greater frequency of pain in PD patients than in control subjects, pain should now be considered as a non-motor symptom of PD. The heterogeneous quality of pain, the variable relationship of pain with parkinsonian motor signs, and the mixed response of pain to dopaminergic drugs suggest complex mechanisms for pain in PD. Some evidence raises the possibility of common mechanisms shared by pain patients, regardless of the clinical heterogeneity of pain and its variable relationship with motor signs.
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PMID:The epidemiology of pain in Parkinson's disease. 2320 97

Pain is a frequently observed non-motor symptom of patients with Parkinson's disease. In some patients, Parkinson's-related pain responds to dopaminergic treatment. In the present study, we aimed to elucidate whether subthalamic deep brain stimulation has a similar beneficial effect on pain in Parkinson's disease, and whether this effect can be predicted by a pre-operative l-dopa challenge test assessing pain severity. We prospectively analyzed 14 consecutive Parkinson's patients with severe pain who underwent subthalamic deep brain stimulation. In 8 of these patients, pain severity decreased markedly with high doses of l-dopa, irrespective of the type and localization of the pain symptoms. In these patients, subthalamic deep brain stimulation provided an even higher reduction of pain severity than did dopaminergic treatment, and the majority of this group was pain-free after surgery. This effect lasted for up to 41 months. In the remaining 6 patients, pain was not improved by dopaminergic treatment nor by deep brain stimulation. Thus, we conclude that pain relief following subthalamic deep brain stimulation is superior to that following dopaminergic treatment, and that the response of pain symptoms to deep brain stimulation can be predicted by l-dopa challenge tests assessing pain severity. This diagnostic procedure could contribute to the decision on whether or not a Parkinson's patient with severe pain should undergo deep brain stimulation for potential pain relief.
Pain 2013 Aug
PMID:Subthalamic deep brain stimulation versus best medical therapy for L-dopa responsive pain in Parkinson's disease. 2363 30


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