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

It is difficult to summarize an article of this type, in which the author is certain that his case has been presented fairly, but is aware that other views that are contrary could be stated and endorsed by pertinent clinical cases. Bearing this fact in mind, I wish to reiterate the following: Lateral canals are demonstrated in endodontic cases with much less frequency than they exist. This variance rarely, if ever, causes an endodontic failure. Some demonstrated lateral canals may really be other conditions. Preoperative evaluation should include examination of radiographs for lateral, as well as periapical, lesions. Lateral canals may be demonstrated by a variety of filling techniques. Careful canal preparation may enhance the frequency of such demonstration. Cases with necrotic pulps probably yield more frequent demonstration than do cases with vital pulps. Lateral canals harboring inflamed and/or infected material may cause pain during endodontic treatment. They may simulate periodontal disease and may cause problems with treatment if present when a tooth is left open for drainage. Periodontal disease may cause pulp exposure via lateral canals located coronally. Improper use of post room may lead to lateral failure from breakdown of tissue in a lateral canal. The enigma of the lateral canal has been the object of description and discussion in many articles, but no one is truly certain of their exact significance in endodontic therapy for the long haul.
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PMID:The enigma of the lateral canal. 659 81

The speculative efforts of the scientists who research the atavistic enigma of the "spontaneous" aches which affect the head, nuc and neck of a great number of people, seem to be driven by the conviction that they are faced with a systemic autonomic illness rather than a local one. Pain is an obligatory phenomenon which dominates this ailment, and is more or less patently paralleled by a constellation of autonomic functions such as nausea, vomiting, vaso-constrictor dilation and arterial hypotension. An analogous vegetative constellation emerges at "cascades", that is, a stereotypical succession, following upon intense physiological (induced) pain. In a migraine attack, the autonomic hyperfunctions are the same in quality but their chronology is completely disrupted: the usual vegetative "cascade" being deeply perverted. In spite of concentric assaults by clinicians, biologists, rhythmologists and psychologists this species of medical sphynx has remained throughout the centuries. The core of the dilemma is in essence the following: are we dealing with a physiological or a pathological pain? The former (physiological pain) should be symptomatic of vascular (migraine) or psychic (muscle contraction headache) disorder; the latter (pathological) should be symptomatic of a malfunctioning of the nociceptor system.
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PMID:Concluding remarks on the Capri symposium: myths, facts and new trends in migraine. 661 7

Pain intensity and the importance of pain for the cancer patient depend on a variety of individual factors and show considerable divergence (Bonica and Ventafridda 1979). They are greatly influenced by the enigma of the cancer disease as well as the consequential psychiatric problems (Frey 1980). An effective neurological analysis of the cancer pain, although demanding for the physician, is important for further specific diagnostic procedures and for the indication of appropriate therapy. Sometimes thorough neurological examination can lead to the first diagnosis of the carcinoma; when there is already evidence of metastases, the unfavorable prognosis can be made at the same time.
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PMID:Analysis of cancer pain by the neurologist. 669 6

Chronic pain remains an enigma which mystifies the most experienced clinicians. The traditional approaches to malignant pain employ narcotic analgesics, radiotherapy, surgical intervention, and chemotherapy. Within the context of a "therapeutic community" oriented pain unit, we attack this major public health problem differently. The use of non-narcotic analgesics, mood altering medications, various forms of psychotherapy (individual, group, family, gestalt, psychomotor) and peer pressure when used in conjunction with various physical modalities of treatment (including biofeedback, transcutaneous electrical nerve stimulator, physical therapy, whirlpool, massage, ice, heat, etc.) appear most efficacious. Frequently, the powerful tools of psychological medicine are taken for granted; yet, depression in the United States is widespread and so significantly complicates medical illness that any treatment program designed for pain patients must be holistic in its orientation if it is to be effective.
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PMID:The use of non-narcotic drugs and other alternatives for analgesia as part of a comprehensive pain management program. 698 52

The displacing temporomandibular joint disc presents an enigma. Modern imaging techniques of arthrography, CT, and MRI, as well as arthroscopy show that a displaced or even totally dislocated disc is not necessarily associated with disease, and such a joint can function quite without symptoms. Conversely these techniques, and notably arthroscopy, show that in some cases trauma initiates a cascade of events affecting not only the disc but also synovium, capsule, ligaments, and cartilage. Changes in synovial fluid, alterations in collagen, and associated release of pain-producing substances, cause alteration in joint dynamics. Reversible at early stages, these processes can produce adhesions which alter joint movement, including disc displacement. There is no single cause of disc displacement, but rather the effect of trauma on the interplay between structural, behavioural, and orthopaedic factors. Clinical diagnosis, excluding imaging, is briefly discussed emphasizing the concept of the barrier, and the use of diagnostic manipulation.
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PMID:Aetiology and management of the anterior dislocated disc. The anterior dislocated disc: some considerations of aetiology and clinical diagnosis. 799 47

Hypnotic analgesia remains an enigma. Recent neuroscience studies demonstrate that widespread distributed processing occurs in the brains of individuals experiencing pain. Emerging research and theory on the mechanisms of consciousness, along with this evidence, suggest that a constructivist framework may facilitate both pain research and the study of hypnosis. The authors propose that the brain constructs elements of pain experience (pain schemata) and embeds them in ongoing consciousness. The contents of immediate consciousness feed back to nonconscious, parallel distributed processes to help shape the character of future moments of consciousness. Hypnotic suggestion may interact with such processing through feedback mechanisms that prime associations and memories and thus shape the formation of future experience.
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PMID:Hypnotic analgesia: a constructivist framework. 943

Fibromyalgia is a challenge to the modern day physician. Today's practice of medicine is evidence-based, but fibromyalgia shifts this paradigm. There is even still debate as to whether this diffuse musculoskeletal pain syndrome, with a reduced pain threshold, and tender points on examination constitutes a definitive entity or disease process. We do not have the luxury of measurable abnormal findings on clinical examination or laboratory testing. The diagnosis of this condition is not aided by the use of any modern-day technology, and is simply a clinical syndrome. No treatment which we prescribe for fibromyalgia is universally successful in managing symptoms. Our skills as physicians are constantly challenged by treatment options offered to patients by non-conventional medicine. Even so, as physicians, our role should be to support our patients and continue to pursue scientific study in order to better understand this enigma.
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PMID:Is fibromyalgia a distinct clinical entity? The approving rheumatologist's evidence. 1056 74

Although the neurobiological causative factors are now beginning to be understood, to a large extent the complex mechanisms involved in migraine remain an enigma, with the appearance of a transient unilateral cephalic pain, possibly preceded by a protean aura and associated with several other symptoms. The factors involved include three clinical signs or symptoms, i.e., pain, the aura (focalized neurological and neurosensory signs), and accompanying symptoms (e.g., sensory, psychological, or digestive); and three anatomical sites, i.e., the brain, the meningeal or intracranial vessel and a peripheral cranial nerve, the trigeminus (V). Familial hemiplegic migraine (FHM) has led to a consideration of the genetic origin of ionic channel-dependent pathologies (channelopathies), while certain other arguments which are for the most part indirect favor the hypothesis of abnormalities, again possibly of genetic origin, in the central neurotransmitters (including serotonin), which are involved in the transmission of pain messages and in vasomotor control. However, the main point is that each of the sites involved has its specific pharmacopoeia, which can contribute towards the treatment of migraine.
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PMID:[The physiopathology of migraine]. 1107 39

The treatment of lateral epicondylalgia, a widely-used model of musculoskeletal pain in the evaluation of many physical therapy treatments, remains somewhat of an enigma. The protagonists of a new treatment technique for lateral epicondylalgia report that it produces substantial and rapid pain relief, despite a lack of experimental evidence. A randomized, double blind, placebo-controlled repeated-measures study evaluated the initial effect of this new treatment in 24 patients with unilateral, chronic lateral epicondylalgia. Pain-free grip strength was assessed as an outcome measure before, during and after the application of the treatment, placebo and control conditions. Pressure-pain thresholds were also measured before and after the application of treatment, placebo and control conditions. The results demonstrated a significant and substantial increase in pain-free grip strength of 58% (of the order of 60 N) during treatment but not during placebo and control. In contrast, the 10% change in pressure-pain threshold after treatment, although significantly greater than placebo and control, was substantially smaller than the change demonstrated for pain-free grip strength. This effect was only present in the affected limb. The selective and specific effect of this treatment technique provides a valuable insight into the physical modulation of musculoskeletal pain and requires further investigation.
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PMID:Specific manipulative therapy treatment for chronic lateral epicondylalgia produces uniquely characteristic hypoalgesia. 1167 30

Fibromyalgia still represents an enigma to modern medicine and the aetiopathogenesis is far from explored. The management of patients with fibromyalgia is thus mostly based on empirical research, and only a few controlled studies have been performed. Basic drug therapy rests on the administration of amitriptyline and conventional analgesics. Such therapy should be initiated only after careful patient information and delineation of therapeutic goals are provided. Any drug therapy should be administered in combination with physical treatment and cognitive behavioural therapy. Because of the appearing contours of pathogenic mechanisms, hopefully a number of new drugs will be available to the patients with this complex pain syndrome in the near future.
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PMID:Management of fibromyalgia: what are the best treatment choices? 1189 27


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