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

Dorsal root entry zone (DREZ) lesions were used to treat intractable pain due to deafferentation in 78 patients managed between 1981 and 1988. Etiology of pain included avulsion of brachial or lumbosacral plexuses (27 cases), spinal cord injury (20 cases), amputation (nine cases), post-herpetic neuralgia (16 cases), and cauda equina injury (six cases). Three different lesioning techniques were employed: a radiofrequency (rf) method using a 0.5 X 2-mm stainless steel electrode with control of electric current and duration (Group 1: 21 cases); the CO2 laser (Group 2: 20 cases); and an rf method, using a 0.25 X 2-mm stainless steel electrode with control of electrode temperature and duration (Group 3: 37 cases). Overall, 48 (61.5%) of 78 patients received satisfactory pain relief, defined as a 50% or greater reduction in pain intensity, cessation of narcotic analgesic usage, and improvement in functional capacity. Fourteen (67%) of the 21 Group 1 patients obtained effective pain relief, compared to nine (45%) of the 20 Group 2 patients and 25 (68%) of the 37 Group 3 patients. Neurological complications including mainly ipsilateral leg weakness or loss of proprioception occurred in 52.3% of the patients in Group 1, 15% of the Group 2 patients, and 8.1% of the Group 3 patients. These results support the view that DREZ lesions may be made most effectively and safely with the rf lesioning technique associated with control of electrode temperature and duration.
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PMID:Clinical experience with radiofrequency and laser DREZ lesions. 169 Dec 82

This is the first report of estimating conduction velocity (CV) of the slowly conducting somatosensory spinal tracts or the spino-thalamic tract (STT) in man. The CV of the STT was measured by recording somatosensory evoked potentials (SEPs) following CO2 laser stimulation of the hand and foot, which was previously shown to cause pain or heat sensation by activating cutaneous nociceptors and by its ascending signals through A delta fibers and probably STT. When the CV of A delta fibers was assumed to be 10-15 m/sec, the CV of STT was found to be approximately 8-10 m/sec in normal young subjects. It was slightly slower in subjects over 60 years of age. In contrast, the CV of the posterior column, which was calculated based on SEPs following electrical stimulation of the median and posterior tibial nerves, was approximately 50-60 m/sec.
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PMID:Estimation of conduction velocity of the spino-thalamic tract in man. 170 48

Brief heat stimuli, elicited by a CO2 laser (10.6 microns wave length), activate the most superficial cutaneous nerve terminals of the thin myelinated A delta and unmyelinated C fibres which mediate heat and pain sensations. This paper investigates late cerebral potentials (SEPs) in response to laser pulses in comparison with those to conventional electrical stimulation in 18 patients with a dissociated sensory deficit (intact mechano-sensibility and disturbed temperature and pain sensation). Patients were stimulated in the most disturbed limb (affected area) and in a corresponding control area. In all 18 patients the SEPs elicited by laser stimuli were able to identify the body site with heaviest disturbances in pain and thermo-sensibility: the SEPs from the affected area were reduced or delayed, compared to the control area. In contrast, no alterations in SEPs could be observed after conventional electrical nerve stimulation, in agreement with the normal mechano-sensibility. However, the degree of SEP modulation in response to cutaneous heat stimuli did not correspond to the severity of the subjectively reported sensory deficit. Highest correlations between sensory deficits and abnormal SEPs were found in all those patients in whom computer tomography or MR imaging documented a localized destructive process in the CNS. All patients with the smallest SEP modulations despite a considerable sensory deficit had an inflammatory aetiology. Preliminary criteria to define a laser-evoked SEP as pathological are discussed.
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PMID:Laser-evoked brain potentials in patients with dissociated loss of pain and temperature sensibility. 171 38

Since the first demonstration of a laser in 1960, numerous applications of this unique form of energy have been developed for the manufacturing, electronic, consumer and medical industries. Recent technological innovations have permitted development of lasers appropriate for use in the dental operatory. The carbon dioxide laser has been used for soft tissue surgery; the Nd:YAG laser has both soft and hard tissue applications. Advantages of laser treatment over conventional methods include minimal cellular destruction and tissue swelling, hemostasis, increased visualization of surgical sites and reduced post-operative pain. Additionally, it is possible to perform many procedures without needing anesthesia. Soft tissue clinical applications of the Nd:YAG laser include gingivectomies, gingivoplasties, operculectomies, biopsies, incising and draining procedures, frenectomies and treatment of aphthous ulcers; hard tissue clinical applications include vaporizing decay, etching enamel and dentin, desensitizing exposed root structure and creating temporary analgesia. As both clinical experiences and scientific investigations expand, possible future applications of the dental laser may well include development of new dental adhesives and composite systems, new methods for managing caries and new endodontic treatments. With its numerous benefits, the laser is having a positive impact on patients and the dental team.
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PMID:The pulsed Nd:YAG dental laser: review of clinical applications. 172 87

During a period of 18 months with a history of chronic pelvic pain symptomatology (severe dysmenorrhea, severe dyspareunia, extramenstrual pain) retroverted or retroflexed uterus, and infertility were subjected to laparoscopy for diagnostic and therapeutic purposes as well. These women were able to follow up this protocol. After informed consent had been presented patient decided, in a case of endometriosis being verified by the tissue pathology intraoperatively, which one mode of therapy (Group I or Group II) would be administered in her case. All women failed to respond to non-steroidal, antiinflammatory medication, as well as to oral contraceptive treatment. Proposed intraoperative staging of pelvic endometriosis that has not yet been published, was utilized by the author. Group I twenty women were subjected to a translaparoscopic CO2 laser excision and (or vaporization of endometriosis implants, CO2 laser uterine nerve ablation, uterine suspension with Falope Rings and intraperitoneally 32% Dextran was installed. Group II twenty women were subjected only to a translaparoscopic CO2 laser endometriosis excision and/or vaporization and intraperitoneally 32% Dextran-70 was installed. In Group I extramenstrually pain was 90%, severe dysmenorrhea 85%, and infertility 90% were cured. Ten per cent of extramenstrual pain, 5% of severe dysmenorrhea, and 15% of severe dyspareunia were improved. Infertility in this group was unchanged in 10%. Patients' symptoms were not worsened during the 18 months of observation. In Group II only 60% infertility was curred. In 60% extramenstrual pain, in 35% severe dysmenorrhea, in 5% severe dyspareunia were improved. Symptoms were noted to worsen in 5% extramenstrual pain, in 5% severe dysmenorrhea, in 10% severe dyspareunia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A new translaparoscopic approach in endometriosis treatment: a. CO2 laser endometriosis excision and/or vaporization. b. CO2 laser uterine nerve ablation. c. Uterine suspension with Falope Rings. d. Intraperitoneally 32% Dextran-70 installation. 172 45

Chondrodermatitis nodularis chronica helicis is a painful, persistent, or recurrent inflammatory lesion involving the cartilage and skin of the external ear. These lesions are resistant to many therapeutic modalities and often recur even after surgical excision. The CO2 laser was used to vaporize the cutaneous nodules and involved cartilage. The wounds were allowed to heal with only minimal care using hydrogen peroxide cleansing and applications of topical antibiotic ointment. Twelve lesions have been treated with no recurrences after 2 to 15 months. There have been no complications or infections following laser surgery. The pain from these lesions is gone immediately following laser surgery. Healing with excellent cosmetic results is complete usually within 3 to 4 weeks.
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PMID:Chondrodermatitis nodularis chronica helicis. Successful treatment with the carbon dioxide laser. 128 23

The present study was undertaken to examine possible changes in subjective appraisal and central nervous system processing, indexed by pain-related cerebral evoked potentials (N290, P400), of incoming noxious information in 20 pain-free control volunteers and 18 subjects suffering from right-side cervico-brachial pain (CBS). Detection threshold and cerebral evoked potentials were recorded in response to noxious CO2 laser stimulation of the right and left hands. The results indicate that when compared to controls, CBS subjects exhibit an elevation in detection threshold intensity and a reduction in the amplitude of the P400 peak following laser stimulation of the pain affected side. There were also differences in the choice of qualitative descriptor for laser stimuli although not in the subjective rating of stimulus intensity. These changes were not apparent for responses on the unaffected limb. The severity of clinical pain was found to be related to the magnitude of reduction in P400 amplitude only on the pain affected side. Conversely, feelings of anxiety were associated with higher amplitude responses on both the right and left sides, suggesting a more generalized relationship between these factors. We interpret these findings to indicate an alteration in central nervous system processing and subjective appraisal of acute experimental pain in subjects with chronic CBS. Moreover, these alterations appear to be restricted to pain affected pathways and are more related to the severity of clinical pain than to general mood state.
Pain 1991 Nov
PMID:Cerebral event-related responses induced by CO2 laser stimulation in subjects suffering from cervico-brachial syndrome. 176 12

Infrahuman studies employing behavioral indices of pain reactivity have supported a central antinociceptive action of nicotine which appears to be selective and dependent on the class of pain elicited. Human investigations employing subjectively based ratings and judgments of pain intensity have been less conclusive regarding the painfulness of stimuli following nicotine/smoking administration. As the more objective brain-evoked potential (EP) measure has been shown to reflect pain intensity and to be sensitive to a variety of analgesics, this study attempted to examine, together with subjective responses, the effects of cigarette smoking on EPs to pain stimuli administered under varying warning conditions. Twelve male and twelve female smokers served as experimental subjects. In smoking and nonsmoking sessions, subjective intensity ratings (SR) and vertex EPs were assessed in response to electrical skin stimuli presented at a level 20% above pain threshold. Stimulation was either nonwarned or warned with warning conditions involving single or repeated presentations of electrical current at constant or increasing intensities 12 seconds prior to pain stimulation. SRs and peak-to-peak N1-P2 EP amplitudes were measured for each smoking session and warning condition. A significant condition effect was observed for SRs with increasing prepain warning stimulation resulting in the greatest pain ratings. Although smoking did not directly alter SRs or EPs to pain, smoking exposure, as measured by carbon monoxide, was found to be differentially correlated with EP alterations in male and female smokers depending on the warning condition.
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PMID:Subjective and brain-evoked responses to electrical pain stimulation: effects of cigarette smoking and warning condition. 176 8

Heat stimuli, applied to the skin by non-contact radiation pulses emitted by a CO2-laser, activate simultaneously both A-delta (mean conduction velocity 14 m/s) and C-fibres (0.8 m/s), which terminate in the most superficial skin layers. Correspondingly, brief heat stimuli elicit two pain sensations with mean reaction times of about 500 ms and 1400 ms. Similarly, two evoked potential waveforms were observed in the electroencephalogram: the late components N240/P370 and the ultralate components N1050/P1250. The shape of the two components was reproducible in independent samples of healthy volunteers. In patients with dissociated sensory loss, the laser evoked cerebral potentials are affected, depending on the kind of disturbed nerve and tracts. This is shown in patients with syringomyelia, encephalomyelitis disseminata, myelitis, Brown-Sequard syndrome, Wallenberg syndrome. In cases with hereditary motor and sensory neuropathy type I or with neurosyphilis, ultralate potentials are observed as correlates of delayed pain perception in the affected body areas. The laser evoked cerebral potentials reflected the clinical disorder of pain sensitivity in most cases, whereas somatosensory evoked potentials in response to conventional nerve stimuli failed in objectifying the diagnosis. As such, evoked cerebral potentials in response to laser heat stimuli applied to the hairy skin can be used for an overall examination of the functional integrity of peripheral small fibres, anterolateral tracts and thalamocortical projections.
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PMID:Laser-evoked cerebral potentials in the assessment of cutaneous pain sensitivity in normal subjects and patients. 176 52

Conduction velocity of A delta fibers of the human peripheral nerves was measured by using pain-related somatosensory evoked potentials following CO2 laser stimulation. It was found to be approximately 9 m/s in the forearm as well as in the lower leg. Because conventional conduction study using electric stimulation reflects only functions of large myelinated fibers related to deep proprioceptive and tactile sensations, the present noninvasive and simple, novel method is the only laboratory examination currently available to investigate physiological functions of the small diameter fibers mediating pain-temperature sensations.
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PMID:Estimation of conduction velocity of A delta fibers in humans. 176 50


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