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

Dorsal column stimulators (DCS) have been implanted in 130 patients with various chronic pain syndromes at the University of California, San Francisco, between 1969 and 1973. Preoperative psychiatric evaluation and percutaneous dorsal column stimulation testing were of value in rejecting those patients most likely to have unsatisfactory long-term results with DCS. Best results occurred in patients with phantom limb or peripheral nerve pain and worst results in patients with paraplegic pain, documented arachnoiditis, pancreatitis and arthritis. The need is stressed for careful preoperative selection and for close, prolonged postoperative care in a situation permitting access to multidisciplinary facilities for patient care.
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PMID:Experience with dorsal column stimulation for relief of chronic intractable pain: 1968-1973. 108 Aug 99

For a patient suffering with his legs, the pain is usually associated with the presence of one or more varices that can be seen. The physician must not fall into this trap. Questioning is vital. Establishing the kind of pain and the conditions under which it occurs may elok for (1) a rheumatological etioloty: sciatic or crural nerve pain, calcaneal pain: (2) a surgical etiology: an inguinal or particularly a crural hernia, a popliteal cyst; (3) a medical etiology: exogenous polyneuritis, hypokalaemia resulting from the abuse of laxatives or of diuretics, etc.
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PMID:[Pitfalls during phlebology consultation]. 108 1

Exposure to sauna heat during sauna bathing raises the skin temperature of the bather near the hot pain perception threshold and enhances sympathetic activity. Self-reports provided by regular bathers of changes in intensity of their ongoing pain might, therefore, add novel information on the effect of intense heat on various pain conditions. We interviewed consecutive patients attending our pain clinic over a period of 1 year about their pain-related responses to sauna bathing and controlled the results by quantitated somatosensory tests. There were 61 patients with chronic neuropathic pain of peripheral origin, 13 patients with central pain and 59 patients with rheumatoid pain. Allodynia and hyperalgesia to heat were relatively infrequent in all groups (10%, 15% and 8%, respectively). Three out of 17 patients with postinjury nerve pain reported similar exacerbation. By contrast, mechanical allodynia was present in 48% of patients with peripheral neuropathic pain and in 54% of patients with central pain. The results speak against an important role for C-afferent or sympathetic postganglionic fibres in most subclasses of neuropathic pain. Animal models of neuropathic pain should be critically viewed against this finding.
Pain 1992 Apr
PMID:Effect of exposure to sauna heat on neuropathic and rheumatoid pain. 137 27

Morton's neuroma is one of the most common causes of nerve pain in the foot. This article describes the treatment of this condition with carbon dioxide laser surgery, presenting the disadvantages and advantages of this method. This method has proven to be effective; postoperative pain and healing time are decreased and patients are able to resume normal ambulation faster than with conventional scalpel surgery.
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PMID:Treatment of Morton's neuroma with the carbon dioxide laser. 139 87

In a series of 25 patients with head and neck cancer who had severe pain, the type and cause of the pain were analyzed. There were two types of pain: nociceptive and non-nociceptive. Nineteen (76%) patients had nociceptive pain that could be subdivided into actual nociceptive pain (9 patients), nociceptive nerve pain (8 patients), or referred pain (2 patients). The cause of nociceptive pain was secondary to tumor recurrence in 16 patients and secondary to benign inflammation in 3 patients. Of the six (23%) cases of non-nociceptive pain, all were diagnosed as neuropathic pain secondary to the sequels of neck dissection. World Health Organization guidelines were applied for the treatment of symptomatic pain of nociceptive pain; if necessary, nerve blocks were used after this treatment. Non-nociceptive pain was usually treated with amitriptyline or carbamazepine. If tumor recurrence was the cause of the pain, antitumor-directed therapy was applied, when possible. Relief was achieved in 52% of the patients after two attempts to treat pain, in 64% after three attempts, and in up to 72% after four attempts. Pain could not be controlled in 28% of the patients. Patients with tumor recurrence had a short median survival time of 3 months, regardless of pain control. Patients with neuropathic pain had a survival time of 16 months or more (median not reached). The authors conclude that the type and cause of the pain in cancer of the head and neck can be determined; this can lead to the administration of proper symptomatic therapy or treatment directed at the underlying cause. In most cases, several successive attempts to treat pain were made before relief was achieved.
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PMID:Types and causes of pain in cancer of the head and neck. 160 40

Our experience in treating 10 patients with intractable pain with paraplegia employing percutaneous epidural or dorsal column stimulation is presented. Initial and long-term results in this group are contrasted with those of 9 patients with intractable post-amputation or post-traumatic neuroma pain. The successful results of neurostimulation treatment of peripheral nerve pain contasts with the disappointing results in the treatment of paraplegic pain.
Pain 1980 Feb
PMID:Neurostimulation in the modulation of intractable paraplegic and traumatic neuroma pains. 696 47

This paper presents epidemiological data on silent nerve function impairment in leprosy based on a retrospective study of 536 patients registered at Green Pastures Hospital, Pokhara, West Nepal. Because of the multiple possible aetiologies it is proposed that the clinical phenomenon should be named 'Silent Neuropathy' (SN). We defined this as sensory or motor impairment without skin signs of reversal reaction or erythema nodosum leprosum (ENL), without evident nerve tenderness and without spontaneous complaints of nerve pain (burning or shooting pain), paraesthesia or numbness. The functioning of the main peripheral nerve trunks known to be affected in leprosy was assessed using a nylon filament to test touch thresholds and a manual voluntary muscle test to quantify muscle strength. Almost 7% of new patients had SN at first examination. The incidence rate of SN among the 336 new patients who were available for follow-up was 4.1 per 100 person years at risk. In total, 75% of all SN episodes diagnosed after the start of chemotherapy occurred during the first year of treatment. During steroid treatment the sensory and motor function in nerves affected by SN improved significantly (p = 0.012, Wilcoxon matched-pairs signed ranks test) over a period of 3 months. The patients with more extensive clinical disease (3/9 or more body areas involved, more than 3 enlarged nerves or a positive skin smear) were found to be at increased risk of developing SN. We discuss 4 different possible aetiologies of SN: 1, Schwann cell pathology; 2, nerve fibrosis; 3, cell-mediated immune reaction; and 4, intra-neural ENL. Some epidemiological evidence is presented that suggests that SN cannot be equated with a 'reversal reaction expressing itself in the nerves'. It is recommended that all patients should have a nerve function assessment at every visit to the clinic at least during their first year of treatment. Regular nerve function assessment is essential to detect SN at an early stage and to prevent permanent impairment of nerve function.
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PMID:Silent neuropathy in leprosy: an epidemiological description. 888 21

Chronic somatic peripheral nerve pain was treated prospectively in 24 nonrandomized patients by a program of direct electrical nerve stimulation. Patients qualified for the program if anesthetic (lidocaine) nerve block of the involved cutaneous zone of the peripheral nerve relieved symptoms and transcutaneous electrical nerve stimulation transiently improved and did not exacerbate somatic pain. Results were judged according to a pain score. Patients noted improved sleep and complete absence of the need for narcotic pain medication. On the basis of subjective and objective criteria, 18 patients had good or excellent results and 6 had implant failures. Of the six patients with failures, three failed the trial period and did not have implantation, and three had no significant pain relief and were judged as treatment failures. Three patients had late equipment failure after initial good results. Most patients had some relief of pain, which increased their quality of life and eliminated the need for narcotic analgesia. Direct electrical nerve stimulation should be considered for somatic peripheral nerve pain that has not been ameliorated with other methods. It will reduce, although not necessarily eliminate, pain and pain behavior in most patients.
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PMID:Chronic peripheral nerve pain treated with direct electrical nerve stimulation. 787 91

It is uncertain whether there exists a nociceptive component in malignant nerve pain responsive to NSAIDs and opioids. 20 patients with malignant nerve pain were randomly assigned to treatment with naproxen 1500 mg versus slow-release morphine 60 mg daily during 1 week, followed by cross-over medication during the second week in a double-blind, double-dummy protocol. In the 16 evaluable patients, a significant (P < 0.05) reduction of 26% (S.E. +/- 7.9) in pain intensity was reached at day 7, compared to baseline pain. At day 7, significant pain relief of 32% (P < 0.05) was observed in the naproxen group, but not in the morphine group (21%, P = 0.14). Patients using morphine needed approximately twice as much paracetamol rescue than patients using naproxen. Additional pain relief could be observed in 4/9 patients with cross-over medication. These data support the concept of a nociceptive component in malignant nerve pain responding to NSAIDs and opioids, and favour the combination of both an anti-inflammatory drug and an opioid for symptomatic pain relief.
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PMID:Medical therapy of malignant nerve pain. A randomised double-blind explanatory trial with naproxen versus slow-release morphine. 799 6

This study aimed to identify areas of disagreement in the management of neurogenic pain. A short questionnaire was mailed to 179 consultants with an interest in chronic pain (response rate 89%). The questionnaire listed 11 specific conditions involving nerve pain (e.g., post-herpetic neuralgia, causalgia) together with 11 treatments (e.g., antidepressants, neurectomy). Consultants were asked to rate the use of each treatment for each condition as 'appropriate', 'no value or positively harmful' or 'no opinion'. Much disagreement emerged about the value of each therapy for each condition: in almost every instance at least some consultants disagreed with the majority view. The dissenting minority was greater than 20% of those who gave an opinion for 48 of the 121 applications of therapy asked about. The appropriateness of treatments for trigeminal neuralgia, amputation stump pain and phantom pain was most often in dispute and there was little consensus on the value of nerve blocks. There were a few areas of near agreement. Antidepressants and anticonvulsants were mostly identified as appropriate for all the conditions listed and there was some agreement that strong opioids and the neuroablative techniques were appropriate for cancer pressure or infiltration of nerves but, with a few exceptions, of no value for all other neurogenic pain conditions. Divergence of views about treatments may indicate a lack of credible evidence on the value of therapies or a lack of professional knowledge. Where published evidence is clear, the consequences for patients may be under-use of useful therapies or potential iatrogenic harm.
Pain 1993 Sep
PMID:Polarised views on treating neurogenic pain. 823 50


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