Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Baseline concentrations of beta-endorphin (beta-EP) and monoamine metabolites (MHPG: 3-methoxy-4-hydroxy-phenylglycol, HVA: homovanillic acid, 5-HIAA: 5-hydroxyindoleacetic acid) in lumbar CSF (LCSF) and ventricular CSF (VCSF) were measured in 18 patients with intractable pain; 10 with deafferented pain and 8 with peripheral pain. Control values were obtained from 37 individuals of various ages. Changes in the concentrations of these substances were determined before and after giving stimulations (2-5 V, 0.2-0.5 msec, 40-50 Hz, 20-sec duration) to 6 patients through electrodes implanted in deep brain structures (DBS; posterior limb of the internal capsule in 5 patients and rostral mesencephalic lemniscus medialis in one patient), and to 2 other patients through electrodes implanted in the spinal dorsal column (DCS). The control value of beta-EP in LCSF was 57.6 +/- 24.7 pg/ml, which was not significantly different from that of VCSF. Great variation in the individual control LCSF beta-EP concentrations was found, but it was not related to differences in age. The mean baseline LCSF beta-EP concentration was significantly higher (p less than 0.05) than the control in the patients with deaffernted pain before stimulation. One of the monoamine-metabolites, MHPG, showed higher level in the patients with peripheral pain (p less than 0.01). The LCSF beta-EP concentration was not affected by deep brain stimulation, but was increased by dorsal column stimulation. In one patient with excellent pain relief by stimulation of the posterior limb of the internal capsule, the LCSF HVA and 5-HIAA concentrations were conspicuously increased.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[beta-Endorphin and monoamine metabolite concentrations in patients with intractable pain--changes before and after deep brain or spinal dorsal column stimulation]. 241 30

Intrathecal neurolytic blocks are performed with either 95% alcohol or with 6-8% phenol in glycerin. Alcohol is hypobaric and phenol hyperbaric compared with the cerebrospinal fluid; positioning of the patient must therefore be done accordingly. This is a report about 67 consecutive neurolytic alcohol blocks of the lower sacral roots. Although lumbar puncture is done at the lowest possible level at L5-S1, the block only affects the roots from S3 or S4 downwards. The detailed anatomy of the caudal dural sack reveals why S1 and S2 are not affected. S1 and S2 contribute to the lumbosacral plexus and are important for the innervation of the lower extremities. However in patients with very low CSF pressure, S2 and S1 might become damaged. This is the most important result of this series. To avoid an unexpected extension of the block in patients with very low CSF pressure, we now recommend that synthetic CSF be instilled prior to alcohol. The results were unsatisfactory in patients with perineal pain and pain in the lower extremities as well. In these cases S2 or S2 + S1 are already affected by the tumor. One should employ other therapeutic procedures (e.g., epidural morphine) for these patients. After careful selection of patients, alcohol neurolysis of the lower sacral roots is a useful procedure.
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PMID:[Intrathecal alcohol neurolysis of the lower sacral roots in inoperable rectal cancer]. 241 8

A seventeen year old boy presented with destructive arthropathy of the lower limbs and discovertebral spaces. Past history yielded recurrent episodes of indolent fractures and progressive knee and ankle deterioration. The patient denied any pain sensation in the past and at examination. Other neurological tests were normal. Beta-endorphin level was elevated in the CSF. Response to the cold pressor test was modified after injection of Naloxone. The nosology and physiopathology of congenital insensitivity to pain are discussed.
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PMID:[A case of congenital insensitivity to pain with destructive arthropathies of the limbs and spine. Discussion on nosology and physiopathology of the disease]. 242 25

Improved knowledge about biochemical mechanisms underlying pain suppression by CNS electric stimulation is one condition for the further advancement of this form of treatment. In 6 patients treated with PVG stimulation and in 14 with spinal cord stimulation the concentration of substance P-like immunoreactivity in lumbar CSF increased significantly following stimulation. However, these changes may be unspecific and not directly related to the suppression of pain. Measurements of somatostatin, cholecystokinin, vasoactive intestinal polypeptide, neurotensin and monoamine metabolites in CSF showed no changes related to stimulation and the ensuing pain relief. Possible reasons for these negative findings are discussed.
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PMID:Possible neurohumoral mechanisms in CNS stimulation for pain suppression. 242 25

Spontaneously elevated nociceptive threshold levels were markedly diminished after Naloxone injections in 4 patients with congenital insensitivity to pain. This finding suggested the hypothesis of a relation between congenital insensitivity to pain and permanent hyperfunction of an endomorphinic system. Radio-immunoassay of CSF beta-endorphin was performed in all 4 cases. The normal or only slightly elevated levels cannot explain electrophysiologic findings, but as a function of the multiplicity of endogenous opioid systems, hyperactivity of another endomorphinic system cannot be excluded. Other hypotheses may also be proposed.
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PMID:[Cerebrospinal fluid beta-endorphin in congenital insensitivity to pain]. 243 47

The aim of the present study was to investigate the discriminative power of a series of variables (including determination of depressive symptomatology by means of a visual analogue scale, determination of personality traits by means of the Karolinska Scales of Personality, determination of monoamine metabolites in CSF, platelet MAO activities, serum cortisol before and after dexamethasone suppression and urinary melatonin) in differentiating chronic pain patients from healthy subjects, and patients with idiopathic pain syndromes from patients with neurogenic pain syndromes. Separately each of the measures gave a significant but often low contribution to the discrimination, while a combination of several measures gave a complete discrimination both between healthy subjects and patients with chronic pain syndromes and between patients with idiopathic and neurogenic pain syndromes, respectively.
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PMID:Discrimination of idiopathic pain syndromes from neurogenic pain syndromes and healthy volunteers by means of clinical rating, personality traits, monoamine metabolites in CSF, serum cortisol, platelet MAO and urinary melatonin. 243 35

Seven patients suffering intractable pain from head and neck cancer (age 48-73, mean 57.5 years) underwent acute stimulation of dorsal periaqueductal gray matter (PAG) with immediate cessation of pain. Two patients received chronic PAG stimulation with relief of pain during stimulation. The effect was not reversed by naloxone and there were no changes in CSF peptides.
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PMID:Dorsal periaqueductal gray-matter stimulation in humans. 243 81

In 35 patients a subcutaneously implanted injection port/reservoir was used to provide intrathecal morphine to relieve pain due to cancer. The reservoir offers an alternative to rather expensive devices. It can be used for repeated injections or for infusion. It is easy to locate and facilitates ambulatory treatment. The injections were carried out by members of the patient's family after they had been taught how to do it. Initially, doses of 0.25-0.5 mg of morphine resulted in pain relief for 14 to 24 hours. After 5 weeks of treatment morphine requirements increased to 0.75-2 mg. Side-effects were minimal, and three delayed CSF fistula, two of them confirmed by isotope tracking with Tc99m, closed spontaneously.
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PMID:Intrathecal therapy: rationale, technique, clinical results. 244 59

Metabolites of selected neurotransmitters (5-HIAA, HVA and DOPAC) and beta-endorphin were measured in the CSF of 39 chronic pain patients and compared to controls. Twelve of the pain patients also fulfilled criteria for major depression. The concentration of 5-HIAA was increased in female but not male pain patients; there was no significant difference in the CSF concentrations of HVA and DOPAC. The presence of depression did not influence the concentrations of neurotransmitters. No correlation was found between the concentrations of monoamine metabolites and beta-endorphin. However, there was a positive correlation between 5-HIAA and HVA in controls and chronic pain patients without depression but not in depressed patients. It is concluded: chronic pain states are associated with elevation of CSF 5-HIAA in female patients; depression abolishes a positive correlation between 5-HIAA and HVA.
Pain 1987 Nov
PMID:CSF monoamine metabolites in chronic pain. 244 27

In 30 patients with diagnosed fibromyalgia, the CSF level of immunoreactive substance P (SP) was investigated. Compared to normal values (9.6 +/- 3.2 fmol/ml), all the patients had elevated CSF levels of SP (36.1 +/- 2.7 fmol/ml, range 16.5-79.1 fmol/ml). Anamnestic information from the patients revealed that 53.3% had Raynaud/Raynaud-like phenomenon localized in the fingers, the toes or both. Although SP levels did not differ significantly in patients with or without the Raynaud phenomenon, elevated activity may be present in the peripheral branches of SP neurons which could be responsible for the last (rubor) phase of the triphasic Raynaud's phenomenon. SP levels were significantly higher in patients who were smokers (40.1 +/- 2.7 fmol/ml, range 25.3-64.1 fmol/ml), compared to patients who were non-smokers (29.2 +/- 5.0 fmol/ml, range 16.5-79.1 fmol/ml). We propose elevated CSF levels of SP and the Raynaud phenomenon as characteristic features for fibromyalgia with potential as diagnostic markers of the disease and further that smoking might be an aggravating factor for its pathogenesis or development.
Pain 1988 Jan
PMID:Elevated CSF levels of substance P and high incidence of Raynaud phenomenon in patients with fibromyalgia: new features for diagnosis. 244 29


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