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)

We report a 67-year-old man who presented with a 3-month history of progressively increasing pain in the lumbar spine. His past medical history was unremarkable, and physical examination disclosed local tenderness over the lower spine. No neurologic dysfunction was identified. Routine laboratory evaluation including alkaline phosphatase activity was normal. An X-ray film of the lumbar spine showed enlargement and increased density of L-5 vertebra. A whole-body bone scan revealed markedly increased uptake at the L-5 level. To further evaluate the nature of the disorder and the cause of his pain, a computed tomography (CT) scan was obtained. It disclosed multiple lucent areas with some sclerotic changes mainly affecting the vertebral body of L-5. No spinal stenosis was found. Subsequently, a bone biopsy of L-5 was performed that showed typical findings consistent with Paget's disease. The patient was treated with etidronate (200 mg b.i.d. for 6 months) followed by salmon calcitonin (50 IU 3 times/week s.c. for 6 months). The pain declined gradually in severity and the patient became symptom free after 12 months of treatment. A repeat X-ray film, obtained at that time, showed no significant change. However, a bone scan showed almost complete normalization. The present case illustrates that a high index of suspicion is required when only a single vertebra is affected by Paget's disease, especially, when alkaline phosphatase activity is normal. It may present with severe pain without evidence of neurologic dysfunction. CT scan may be a useful adjunct in establishing the diagnosis and elucidating the cause of pain.
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PMID:Paget's disease of bone affecting a single vertebra: clinical, radiologic, and histopathologic correlations. 157 28

The efficacy of intranasal salmon calcitonin was examined in a double-blind randomized study in reflex sympathetic dystrophy. Sixty-six patients were randomly divided in two groups receiving physiotherapy. In addition group I also received 3 x 100 U/day of salmon calcitonin by intranasal spray whereas group II received 3 sprays of placebo. The pain and the range of motion were improved by calcitonin administration. Similarly the patients' ability to work was also improved. The results confirmed that salmon calcitonin has an effect but that this effect was not equally observed on all parameters analyzed. It was most marked on pain (at rest and on movement) and on the ability to work.
Pain 1992 Feb
PMID:The effect of adding calcitonin to physical treatment on reflex sympathetic dystrophy. 158 34

We studied the effects of intracerebroventricularly (ICV) administered salmon calcitonin (sCT) on the self-mutilation behavior (autotomy) of rats after dorsal rhizotomy. sCT was given 2 micrograms/rat ICV, on alternate days) from day 15 to day 40 after surgery and autotomy was scored until day 60. Autotomy scores were significantly reduced during treatment but once the ICV sCT was stopped mean values for the treated group gradually returned to control levels. These data support the concept that autotomy is a useful model of chronic pain, sensitive to centrally acting antinociceptive agents. In addition, these findings extend the knowledge of the antinociceptive profile of sCT and are in agreement with recent clinical observations.
Pain 1992 Feb
PMID:Intracerebroventricular salmon calcitonin reduces autotomy behavior in rats after dorsal rhizotomy. 158 47

Based on the important relationship of calcitonin and serotonin with narcotic drugs at the level of the central nervous system and with the modulating mechanisms of pain sensation, we have studied whether central baseline levels of these modulators possess a predictive value for the assessment of the intensity and duration of narcotic spinal analgesia. Therefore, intradural levels of calcitonin an serotonin were measured in 18 patients who underwent and infraumbilical laparotomy with intradural anesthesia with bupivacaine associated with 0.5 mg of morphine. There was no statistically significant correlation between the levels of calcitonin and serotonin with the age, weight, height, sex, values of analogic visual scale 2, 4, 6, 12 and 24 hours after lumbar punction, and duration of the analgesia. Even though a correlation exists in experimental models, our results indicate that baseline values of modulators calcitonin and serotonin lack of predictive value for the assessment of the degree and duration of narcotic spinal analgesia.
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PMID:[Lack of predictive power of cerebrospinal fluid calcitonin and serotonin concentrations for the intensity of postoperative pain and the duration of analgesia after subarachnoid morphine administration]. 159 86

Esophageal pain is transmitted via the sympathetic nervous system to the spinal cord, in which pain from visceral and somatic sources ascends to higher centers in the brain. Primary afferent neurons are bipolar, with the peripheral end specialized to be a sensory receptor. Nociceptors of somatosensory afferents are free nerve endings that can be activated by mechanical, thermal, or chemical stimuli. Esophageal nociceptive neurons have not been specifically identified but probably are also free nerve endings. Most esophageal spinal mechanoreceptors have been shown to be nociceptive. Some esophageal mechanonociceptors have a wide dynamic range and respond to physiologic and painful stimuli, while others have a high threshold of stimulation and are solely nociceptive. Esophageal spinal afferents have their cell bodies in the dorsal root ganglia and contain substance P and calcitonin gene-related peptide. These putative neurotransmitters are transported in both the peripheral and central directions of bipolar afferent neurons. Primary afferent neurons are likely to also contain an excitatory amino acid neurotransmitter such as glutamate. Centrally, nociceptive primary afferents terminate on neurons in specific layers of the dorsal horn of the spinal cord. Convergence of multiple visceral afferents with somatic afferents onto the same dorsal horn neurons may explain referred pain. A patient's inability to distinguish esophageal from cardiac pain may be due to convergence of pain pathways. Second-order neurons in the dorsal horn project in the anterolateral system to the brain. Within the anterolateral system, nociception ascends in the spinothalamic, spinoreticular, and spinomesencephalic tracts. The thalamus relays fast pain to the postcentral areas of the parietal lobe of the cortex. Pathways to the reticular formation are slow and may mediate the increased arousal that occurs in response to pain. The spinomesencephalic tract projects to midbrain sites including the periaqueductal gray. Organ-specific pathways in the brain have yet to be defined, but neuroanatomic tracing techniques employing neurotropic viruses are being developed. The perception of pain can be influenced at multiple levels, such as the receptor in the esophagus, the synapses in the dorsal horn of the spinal cord or thalamus, or the cortex. A fundamental mechanism of modulating nociception is descending inhibition.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Mechanisms of esophageal pain. 159 55

A randomized, placebo-controlled, double-blind, crossover study in 40 lumbar spinal stenosis patients with a 1-year follow-up showed that calcitonin had beneficial effects on the patients' symptoms without producing any notable side effects. Calcitonin had a clear analgesic effect. The mean of walking distance increased, but the crossover trend was not as good as the analgesic effect. Side effects such as erythema and nausea were usually mild and transient. Calcitonin therapy can be used as a conservative treatment in selected cases of lumbar spinal stenosis. When rest pain was mild or the walking distance was under 200-300 m because of neurogenic claudication, the effect of calcitonin seemed to be poor.
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PMID:Calcitonin treatment in lumbar spinal stenosis: a randomized, placebo-controlled, double-blind, cross-over study with one-year follow-up. 159 76

The effect of intranasal salmon calcitonin on pain, erosion progression, and bone loss in 40 women with rheumatoid arthritis was investigated. The study design was double blind, placebo controlled for the first four months and open for the next 36 months, allowing for cross over to active drug treatment or to the control group. Morning stiffness was reduced in the group treated with salmon calcitonin after two and four months. After an average follow up of 28 months no significant effect on erosion progression was observed using the Larsen score. The mean (SD) monthly progressions in the Larsen score in the calcitonin and control groups were 0.21 (0.22) and 0.23 (0.28) respectively. The bone mineral density was evaluated in the forearm and spine. During the 12 months of follow up the control group lost bone at a rate of 2%/year at the spine and 4.8%/year at the radius distal third. In contrast, the group receiving nasal calcitonin gained 1% in bone mineral density at the lumbar spine and no loss at the radius distal third. The increase in bone density at the spine in the calcitonin group was not sustained and a loss of 1.8%/year was observed in the second year. The difference with the placebo group remained significant.
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PMID:Intranasal calcitonin for the prevention of bone erosion and bone loss in rheumatoid arthritis. 161 60

Osteoporosis, associated with a high turnover of bone and acute bone loss, occurs in a number of clinical models, such as following prolonged steroid therapy, extremity and spinal immobilisation, and often is associated with fracture. Confinement to bed and subsequent hypodynamism relating to the pain following a vertebral fracture may activate the process of high bone turnover and acute bone loss. In postmenopausal women, the acute bone loss resulting from such clinical pictures may be superimposed on to the natural course of bone loss occurring in many postmenopausal women. Salmon calcitonin, a potent inhibitor of osteoclast activity, has been shown to prevent bone loss in all clinical models of acute bone loss due to increased bone turnover and osteoclastic resorption. In addition, salmon calcitonin has a potent analgesic effect, thereby causing a reduction in bone pain and improvement in functional capacity. For these reasons, calcitonin remains a first-line therapy in bone loss related to a hyper-resorptive state.
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PMID:Management of high turnover osteoporosis with calcitonin. 162 13

It has been shown that human calcitonin (hCT) is absorbed through the nasal mucosa when administered together with promoters like sodium glycocholate (SGC) or dihydrofusinate. The aim of this study was to compare the clinical and metabolic effect of intranasal (in) and intramuscular (im) hCT in patients with osteoporosis or with Paget's disease of bones. Fifteen women with postmenopausal or with senile osteoporosis entered a randomized six months trial with in hCT (plus SGC) or with im hCT 100 U on alternate days. Six women in each group were treated for 2 months, and only four women in each group continued treatment for an additional 4 months period. In hCT, but not im hCT, reduced subjective pain, while urinary cAMP increased to a similar extent in the 2 groups. Other metabolic indexes and bone mineral content (BMC) were unchanged, no new fractures took place, and side effects were fewer with in than with im hCT. To confirm the analgesic effect of in hCT, twelve patients with Paget's disease of bone were randomly treated for 20 days with in or im hCT 100 U/day: during the short period of treatment, pain was reduced by in, not by im hCT, and urinary cAMP excretion similarly increased in the two groups of patients.
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PMID:Intranasal and intramuscular human calcitonin in female osteoporosis and in Paget's disease of bones: a pilot study. 164 50

Increasing pain in the region of the lumbar vertebrae occurred in a 23-year-old woman known for the past 6 1/2 years to have Crohn's disease affecting the ileocolon. Radiology revealed marked osteopenia with collapse and deformation of the vertebral bodies. The only pointer to a bone disease was a markedly lowered serum level of 25-OH-vitamin D (less than 10 ng/ml). Biopsy from the ileal crest revealed pure osteoporosis without osteomalacia. Decisive pathogenetic factors were, in the main, glucocorticoid medication, malnutrition and the long duration of Crohn's disease. During treatment with monofluorophosphate, 152 g daily, in fixed combination with 600 mg calcium as well as calcitonin (initially 100 I.U. daily subcutaneously for two weeks, then 100 I.U. every other day s.c.) and vitamin D (3 x 1,000 I.U. daily by mouth) she became free of symptoms, and she has remained so for 9 months.
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PMID:[Severe osteoporosis in a young female patient with Crohn's disease]. 164 71


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