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

The cold pressor test is used in the clinical testing of the autonomic nervous system. However, little is known about changes in the autonomic control of the cardiovascular system during repeated challenge with cold. Heart rate (HR), respiratory sinus arrhythmia (RSA), T-wave amplitude of ECG (TWA), blood pressure, body temperature and perceived pain were recorded in 18 male subjects during three CPTs which consisted of four minutes immersion of the left hand into cold water at 1 degree C. Breathing during CPT was either spontaneous or paced at 0.23 Hz or 0.1 Hz. Pain intensity and HR decreased and TWA increased during the cold immersion and in the resting period preceding cold in the second and third trials. Systolic and pulse blood pressure increased in resting periods in the third trial. RSA increased in the second and third cold challenge during paced breathing at 0.1 Hz only. A decrease in body temperature (0.48 degree C) at the end of the experiment correlated marginally with HR changes. Our study shows that sustained cardiovascular changes are induced by the first challenge with cold, and persist or increase with repeated cold pressor tests.
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PMID:Cardiovascular adjustments and pain during repeated cold pressor test. 872 92

The present study examined the spinal antinociceptive effects of adenosine analogs and inhibitors of adenosine kinase and adenosine deaminase in the carrageenan-induced thermal hyperalgesia model in the rat. The possible enhancement of the antinociceptive effects of adenosine kinase inhibitors by an adenosine deaminase inhibitor also was investigated. Unilateral hindpaw inflammation was induced by an intraplantar injection of lambda carrageenan (2 mg/100 microl), which consistently produced significant paw swelling and thermal hyperalgesia. Drugs were administered intrathecally, either by acute percutaneous lumbar puncture (individual agents and combinations) or via an intrathecal catheter surgically implanted 7-10 days prior to drug testing (antagonist experiments). N6-cyclohexyladenosine (CHA; adenosine A1 receptor agonist; 0.01-1 nmol), 2-[p-(2-carboxyethyl)phenylethylamino]-5'-N-ethylcarboxamidoadenos ine (CGS21680; adenosine A2A receptor agonist; 0.1-10 nmol), 5'-amino-5'-deoxyadenosine (NH2dAdo; adenosine kinase inhibitor: 10-300 nmol), and 5-iodotubercidin (ITU; adenosine kinase inhibitor; 0.1-100 nmol) produced, to varying extents, dose-dependent antinociception. No analgesia was seen following injection of 2'-deoxycoformycin (dCF; an adenosine deaminase inhibitor; 100-300 nmol). Reversal of drug effects by caffeine (non-selective adenosine A1/A2 receptor antagonist; 515 nmol) confirmed the involvement of the adenosine receptor, while antagonism by 8-cyclopentyl-1,3-dimethylxanthine (CPT; adenosine A1 receptor antagonist; 242 nmol), but not 3,7-dimethyl-1-propargylxanthine (DMPX; adenosine A2A receptor antagonist; 242 nmol), evidenced an adenosine A1 receptor mediated spinal antinociception by NH2dAdo. dCF (100 nmol), which was inactive by itself, enhanced the effects of 10 nmol and 30 nmol NH2dAdo. Enhancement of the antinociceptive effect of ITU by dCF was less pronounced. None of the antinociceptive drug regimens had any effect on paw swelling. These results demonstrate that both directly and indirectly acting adenosine agents, when administered spinally, produce antinociception through activation of spinal adenosine A1 receptors in an inflammatory model of thermal hyperalgesia. The spinal antinociceptive effects of selected adenosine kinase inhibitors can be significantly augmented when administered simultaneously with an adenosine deaminase inhibitor.
Pain 1998 Feb
PMID:Antinociception by adenosine analogs and inhibitors of adenosine metabolism in an inflammatory thermal hyperalgesia model in the rat. 952 Feb 38

Carnitine palmitoyltransferase II (CPT II) deficiency is the most common lipid myopathy in adults and is characterized by exercise-induced pain, stiffness, and myoglobinuria. Retrospective analysis of patients with CPT II deficiency has made it possible to correlate the presence of disease-causing mutations in the CPT2 gene with residual CPT activity in muscle. We present evidence that the ratio of CPT II activity to citrate synthase activity in the skeletal muscle of patients presumed to have CPT II deficiency is important for predicting whether the patient has one, two, or no mutations in the CPT2 gene. This finding will assist in the future correlation of the phenotype with the genotype and in identifying manifesting heterozygotes.
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PMID:Biochemical and molecular correlations in carnitine palmitoyltransferase II deficiency. 1039 18

The aim of this study was to evaluate the results of complex hip revision using a cemented, collarless and polished femoral stem design (CPT, Zimmer, Warsaw, In.) within a tightly impacted morselized allograft. We have now been using the impaction grafting technique in combination with the CPT stem (Zimmer) for 10 years in complex cases of severe bone loss. In this study we have elected to report only those patients who have been revised at least once before revision using the impaction grafting technique. All the patients in the study group have a minimum follow-up of 5 years after the impaction grafting revision. In total, 43 consecutive hips in 40 patients, 22 men and 18 women, with a follow-up time of between 5 and 7 years are included in the study. The complications related to the revised hip consist of three early dislocations managed by closed reduction. Two patients suffered from periprosthetic fracture, both managed with plate osteosynthesis. Two cementless sockets were revised due to aseptic socket loosening. The Endoklinik rating of preoperative bone loss for the revised hips was 2 in 13 hips, 3 in 23 hips, and 4 in 7 hips. During the first year 29 stems subsided 2-4 mm within the cement mantle. In 8 cases, a subsidence of 5-9 mm was measured. The subsidence was nonprogressive, and no subsidence occurred after the 1st year. The Charnley, D'Aubigne, Postel scoring (maximum 6 points) for pain improved from 2.2 points preoperatively to 4.4 postoperatively, function from 2.3 to 4.3, and movement from 2.3 to 4.1. In conclusion, the concept of impaction grafting in THR revision in our study has so far proven to be successful with good clinical results at 5 years despite the relatively high early subsidence of the femoral component.
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PMID:Complex cemented revision using polished stem and morselized allograft. Minimum 5-years' follow-up. 1044 25

We report a case of a patient with carnitine palmityl deficiency in active labour. We discuss the metabolic and energetic implications of obstetrical labour in regard with the mitochondrial myopathy and we propose an optimal management. Neuroaxial analgesia and glucose infusion are indicated in early labour because it is necessary to alleviate stress and pain in order to avoid rhabdomyolysis associated with CPT deficiency. Combined spinal epidural analgesia using intrathecal opioid alone then epidural naropein should be a relevant choice because of a minimal motor blockage. Monitoring of myolysis using serum creatinine phosphokinase levels must take in account CK and MB fractions releases to the circulation during obstetrical labour.
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PMID:[Anesthetic management of obstetrical labor in a parturient with muscular carnitine palmitoyl transferase deficiency]. 1109 24

Capsaicin, the pungent ingredient in hot pepper, activates nociceptors to produce pain and inflammation. However, repeated exposures of capsaicin will cause desensitization to nociceptive stimuli. In cultured trigeminal ganglion (TG) neurons, we investigated mechanisms underlying capsaicin-mediated inhibition of action potentials (APs) and modulation of voltage-gated sodium channels (VGSCs). Capsaicin (1 microM) inhibited APs and VGSCs only in capsaicin-sensitive neurons. Repeated applications of capsaicin produced depolarizing potentials but failed to evoke APs. The capsaicin-induced inhibition of VGSCs was prevented by preexposing the capsaicin receptor antagonist, capsazepine (CPZ). The magnitude of the capsaicin-induced inhibition of VGSCs was dose dependent, having a K(1/2) = 0.45 microM. The magnitude of the inhibition of VGSCs was proportional to the capsaicin induced current (for -I(CAP) < 0.2 nA). Capsaicin inhibited activation of VGSCs without changing the voltage dependence of activation or markedly changing channel inactivation and use-dependent block. To explore the changes leading to this inhibition, it was found that capsaicin increased cAMP with a K(1/2) = 0.18 microM. At 1 microM capsaicin, this cAMP generation was inhibited 64% by10 microM CPZ, suggesting that activation of capsaicin receptors increased cAMP. The addition of 100 microM CPT-cAMP increased the capsaicin-activated currents but inhibited the VGSCs in both capsaicin-sensitive and -insensitive neurons. In summary, the inhibitory effects of capsaicin on VGSCs and the generation of APs are mediated by activation of capsaicin receptors. The capsaicin-induced activation of second messengers, such as cAMP, play a part in this modulation. These data distinguish two pathways by which neuronal sensitivity can be diminished by capsaicin: by modulation of the capsaicin receptor sensitivity, since the block of VGSCs is proportional to the magnitude of the capsaicin-evoked currents, and by modulation of VGSCs through second messengers elevated by capsaicin receptor activation. These mechanisms are likely to be important in understanding the analgesic effects of capsaicin.
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PMID:Capsaicin inhibits activation of voltage-gated sodium currents in capsaicin-sensitive trigeminal ganglion neurons. 1116 May 9

Research has demonstrated that exposure to acute stress may attenuate pain perception. Mechanisms of this effect in humans have not been determined. This study was conducted to determine the extent to which psychophysiological and adrenocortical responses to acute stress predict subsequent pain perception. One hundred and fifty-two healthy participants (80 women) were assigned to one of two conditions: rest followed by the cold pressor test (CPT; N=76) or stress followed by CPT (N=76). The stress protocol consisted of a public-speaking challenge. Participants rated their pain every 15 s during a 90-s hand CPT (0-4 degrees C), and they completed the short form of the McGill Pain Questionnaire. Salivary cortisol, mood, blood pressure (BP), and impedance cardiography measures were collected in both conditions. Women had lower BP and reported greater pain than men in both conditions (ps<0.01). Participants in the stress condition reported less pain during CPT than those in the rest condition (p=0.02). Regression analyses demonstrated that the stress effect on pain ratings was mediated by systolic BP level during stress; however, cortisol responses did not affect this relationship. Mood changes were independent predictors of pain. The study demonstrates that BP changes in response to stress mediate the stress-induced attenuation of pain perception.
Pain 2003 Dec
PMID:Blood pressure but not cortisol mediates stress effects on subsequent pain perception in healthy men and women. 1465 11

Glutamate (which facilitates peripheral nociception) releases adenosine (which inhibits peripheral nociception via adenosine A(1) receptors) when injected locally into the rat hindpaw. The present study determined whether this locally released adenosine could modulate spontaneous pain behaviors produced by a local injection of 1.5% formalin, by determining the effect of 8-cyclopentyl-theophylline (CPT; selective adenosine A(1) receptor antagonist) on flinching produced by formalin/glutamate combinations. Experiments were performed following a prior conditioning injection of 2.5% formalin into the contralateral hindpaw 3-4 days earlier. CPT augmented flinching behaviors produced by 1.5% formalin/1 micromol glutamate, but had no effect on behaviors produced by formalin or glutamate alone. CPT also augmented flinches generated by formalin/alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) and formalin/kainic acid, but not by formalin/N-methyl-D-aspartate (NMDA) combinations. The conditioning leads to a clearer expression of the peripheral inhibitory effect of adenosine (inhibitory effect of an inhibitor of adenosine kinase on flinching also was observed), rather than an increased release of adenosine (no enhanced release observed by microdialysis). Microglia appear to be involved in the conditioning, as microglia are activated in the dorsal spinal cord 3 days following injection of 2.5% formalin, and augmentation of formalin/glutamate-induced flinching by CPT is inhibited by the glial metabolic inhibitor fluorocitrate. The augmentation of flinching by CPT is also eliminated following a spinal pretreatment with MK-801 (NMDA receptor antagonist), cyclohexyladenosine (adenosine A(1) receptor agonist), N(G)-nitro-L-arginine methyl ester HCl (nitric oxide synthetase inhibitor), and chelerythrine (protein kinase C inhibitor). The conditioning pretreatment with 2.5% formalin does not lead to a generalized chemical or thermal hypersensitivity in the contralateral hindpaw. This study demonstrates that prior exposure to 2.5% formalin in the contralateral hindpaw reveals an inhibitory effect of adenosine on peripheral nociception in the presence of glutamate; this conditioning involves microglia and other mechanisms involved in central sensitization.
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PMID:Glutamate-evoked release of adenosine and regulation of peripheral nociception. 1521 63

Interventional pain management has been growing by leaps and bounds with the introduction of an array of new CPT codes, the expansion of interventional techniques, and utilization. Interventional pain management dates back to the origin of neural blockade and regional analgesia, in 1884. Over the years, pain medicine and interventional pain management have taken many approaches, including biological, biopsychosocial, and psychosocial. In the late 1990s and early 2000s, a new philosophy of precision diagnosis and high-tech management has evolved. An interventional pain physician may be either a reductionist, a monotherapist or a combination of the two. Interventionalists have been criticized for excessive undisciplined application of needle procedures. Interventional techniques are performed by many primary specialists (anesthesiology, physiatry, neurology, etc.) and physicians designated by CMS in interventional pain management (-09) and pain management or pain medicine (-72) which went into effect in 2003 and 2002. Overall, the frequency of utilization of interventional procedures has increased substantially since 1998. It is estimated that among Medicare recipients, the frequency of interventional procedures, which includes epidural, spinal neurolysis, and adhesiolysis procedures; facet joint interventions and sacroiliac joint blocks; and other types of nerve blocks, excluding continuous epidurals, implantables, disc procedures, intraarticular injections, trigger point and ligament injections, had increased by 95% from 1998 to 2003. In the Medicare population, facet joint interventions and sacroiliac joint blocks have increased by 222% from 1998 to 2003. Overall, the utilization of various nerve blocks (excluding epidurals, disc injections, and facet joint blocks) in Medicare recipients from 1998 to 2003 were performed approximately 50% of the time by non-pain physicians. Interventional pain management is growing rapidly, under the watchful eye of the government, and third party payors. Establishing an algorithmic approach and following guidelines may improve compliance and quality of care without implications of abuse.
Pain Physician 2004 Oct
PMID:The growth of interventional pain management in the new millennium: a critical analysis of utilization in the medicare population. 1685 89

The new millennium has seen the introduction of an array of new Current Procedural Terminology(R) (CPT) codes and the expansion of interventional techniques. Among the many issues of interest to physicians practicing interventional pain management in 2003 are CPT coding, correct coding issues, and utilization. The CPT developed and updated by the American Medical Association, is the most important and commonly used coding system for interventional pain physicians in the United States. A recent development in the CPT system has been to include Category I, Category II, and Category III CPT codes. Inclusion of a code in Category I is generally based on the procedure being consistent with contemporary medical practice and being performed by many physicians in clinical practice in multiple locations. In contrast, CPT Category III, also known as emerging technology codes, is a set of temporary codes for emerging technology, services, and procedures. There have been many new codes since 2000, along with changes in the definitions of the codes and vignettes. In order for the correct coding initiative to be effective, it is essential that the coding describes what actually transpires at each patient encounter. When multiple procedures are performed at the same session, the procedure and post-procedure work do not have to be repeated for each procedure, and, therefore, a comprehensive code describing the multiple services commonly performed together can be used. Thus, many activities which are integral to a procedure are considered as generic activities and are assumed to be included as acceptable medical/surgical practice and, while they couldn't be performed separately, they should not be considered as such when a code narrative is defined. Under this initiative, almost all interventional techniques are affected. The utilization of interventional techniques in the modern era is the final issue. Utilization has been increasing gradually. Thus, it is important for interventional pain physicians to understand the utilization patterns across the nation and for various techniques. This review will discuss the issues of CPT coding, correct coding, and utilization as they pertain to interventional techniques.
Pain Physician 2003 Jan
PMID:Interventional pain management: evolving issues for 2003. 1687 68


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