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

A consecutive series of 38 eyes of 35 glaucoma patients treated with transillumination guided cyclocryotherapy (CCT) either to obtain pain relief or to achieve IOP control was studied at Helsinki University Eye Hospital. Transillumination was used to guide the applications to the correct site. The follow-up range was 1-43 months (mean 9 months). Pretreatment IOP was 39 +/- 13 mm Hg and postoperative 26 +/- 16 mm Hg (mean +/- SD). Twenty-three eyes underwent one and 15 eyes 2-5 procedures. IOP control (IOP 9-23 mm Hg) was achieved in 50%. The response was more favorable in eyes without iris neovascularisation (59% achieved IOP control) than in eyes with neovascular glaucoma (38% achieved IOP control). The best response was achieved in eyes with chronic uveitis (5/7 eyes achieved IOP control). Repeated procedures improved the IOP control rate. Hypotony (IOP < 9 mm Hg) without clinical signs of phthisis occurred in three eyes (8%). Thirteen eyes needed primarily pain relief and 92% achieved it. Postoperatively vision was better in 8%, unchanged in 37% and worse in 55%. Visual acuity was 0.05 or better in nine eyes pretreatment and in eight eyes after treatment.
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PMID:Transillumination guided cyclocryotherapy in the treatment of secondary glaucoma. 128 52

Experience with Doppler sonographic pulse curve analysis is given from 40 glaucoma patients (examination of the temporal posterior ciliary artery), and from premature babies (blood flow in the anterior cerebral artery). In the latter group the reaction to pain and stress connected with blood sampling was studied. In the glaucoma patients focus was on the influence of IOP level on vascular autoregulation, and the possible response to therapy with beta-blockers. Describing an averaging technique, methodological problems are discussed as relevant for the detection of changes in flow and velocity in small blood vessels.
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PMID:Doppler sonographic pulse curve analysis for estimation of the haemodynamic function. 135 27

Treatment of intractable pain with parenteral, subarachnoid, or epidural narcotics is often unsatisfactory due to tolerance and other systemic complications that accompany increasing dosages of these drugs. Other disadvantages include the potential infections with implantable pumps and the inconvenience of repeated narcotic administration. During the past several years, studies at the author's laboratory indicated that transplantation of adrenal medullary tissue or isolated chromaffin cells into the spinal subarachnoid space can significantly reduce pain in several rodent models without resulting in development of tolerance. Adrenal medullary chromaffin cells were selected because they produce high levels of both opioid peptides and catecholamines, agents that independently, and possibly synergistically, reduce pain when injected locally into the spinal subarachnoid space. The adrenal medullary transplants survive for prolonged periods, and continue to produce high levels of both catecholamines and met-enkephalin. These transplants reduce pain in two rodent chronic pain models, an arthritis model and a peripheral neuropathy model, both of which closely resemble human chronic pain syndromes. The success of the animal studies has led to initiation of human clinical trials in patients with chronic cancer pain; results are promising.
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PMID:Chromaffin cell transplants for alleviation of chronic pain. 137 36

The place of laparoscopic surgery continues to increase in the field of surgery in our specialty. Although the advantages would seem to be obvious, it seemed to us interesting to quantify, if possible, the parameters of operative stress and compare laparoscopic surgery with conventional surgery. Markers studied are Prolactin, Cortisol, Adrenaline, Nor-Adrenaline, Dopamine and the Beta-Endorphins. The only marker that shows any difference in the two procedures in our study is Beta-Endorphin which is significantly less raised in laparoscopic surgery directly after the operation (p less than 0.01). This was very specific for pain, which is one of the benefits of this technique and shown in this parameter which confirms the clinical impression. The curves of the changes in the different markers have been analysed and discussed.
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PMID:[Laparoscopic surgery versus laparotomy. Comparative analysis of stress markers]. 140 65

The effects of vasoconstrictor-containing local anesthetics on the carotid and cerebral circulation were investigated using an ultrasonic quantitative blood flow measurement system. Nineteen healthy adult volunteers were divided into two groups according to age. The local anesthetics used were 2% lidocaine containing 1:80,000 epinephrine and 2% lidocaine containing 1:25,000 norepinephrine. One (1.8 mL) or two (3.6 mL) cartridges of each anesthetic were injected into unilateral or bilateral maxillary gingivae. Epinephrine-containing lidocaine had little effect on carotid and cerebral hemodynamics. Norepinephrine-containing lidocaine increased arterial blood pressure, decreased heart rate, and decreased carotid arterial blood flow and velocity, which caused increased cerebrovascular resistance and decreased cerebrovascular capacitance. The results suggest that norepinephrine may induce vasoconstriction of the cerebral blood vessels in both young and old adults in a dose-dependent manner. These changes appear to be greater in older people.
Anesth Pain Control Dent 1992
PMID:Effects of epinephrine and norepinephrine contained in 2% lidocaine on hemodynamics of the carotid and cerebral circulation in older and younger adults. 142 88

In a recent survey that the author conducted among podiatrists, the typical therapeutic injection for inflammatory lesions consisted of 2.25 or 2.5 mL of 1% lidocaine or plain bupivicaine (or, rarely, with epinephrine 1:200,000), 0.5 mL of hexadrol, and 0.25 mL of an insoluble cortisone such as triamcinolone acetonide (Kenalog). It is clear that variation exists and that each doctor has his or her own "cocktail" for therapeusis. The author finds that 1% lidocaine with epinephrine 1:200,000 therapeutic injections alone have a profound clinical effect when used in concert with biomechanic control. These injections are given as a series once a week and then the interphase is stretched out as needed. Because no steroids are used, there is no limit to the number of injections, and so, for chronic entities such as metatarsophalangeal (MTP) joint osteoarthritis, the author has been giving certain patients 6 to 10 therapeutic injections a year for 15 to 18 years, while controlling pain. Because all "cocktails" usually contain some amount of local anesthetic, maybe the podiatric community is using added medications such as steroids unnecessarily. Steroids mask poor diagnostic and technical skills and also infections. Clinicians also should spend time controlling the pedal sympathetics through "chemical sympathectomy." This posterior tibial nerve and artery therapeutic block was developed by Dr. Marvin Steinberg in the 1940s. Treatments are given in 1-week intervals with the first treatment giving 3 to 5 days' relief, the second 5 to 7 days, the third 7 to 10 days, and then 2- and 4-week intervals. Eventually, a comfortable interphase is selected, if necessary. In order for the blocks to work in summation, a vasoconstrictor such as epinephrine is mandatory. Lidocaine is the active ingredient of chemical sympathectomy; it blocks the artery and nerve, including the posterior tibial sympathetics. The posterior tibial sympathetics control 85% of the sympathetics to the foot, including all four muscle layers and the vital structures of the sole of the foot. Epinephrine works at the vasovasorum, nervonervorum, vasonervorum, and nervovasorum to maintain the active medication longer and make the block more effective. This chemical sympathectomy works even better than a lumbar paravertebral sympathectomy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Preoperative and therapeutic local anesthetics and steroids. 158 7

In animal neuroma models the application of alpha-adrenergic agonists causes a burst of spontaneous afferent activity. The increased activity has been hypothesized to generate nociceptive input. Corroborative work in humans, however, has not been done. Nine subjects with chronic nerve end neuromas received perineuromal injections of normal saline, epinephrine (5 micrograms), and lidocaine in a blinded manner. Qualitative and quantitative pain assessments were performed with each injection. Epinephrine, but not saline, caused an intense increase in reported pain with subjects often commenting that the appendage was "on fire". Lidocaine significantly reduced but did not completely abolish the reported pain. The chemosensitivity of the neuroma to epinephrine may explain some of the clinical responses noted after sympathetic system manipulation. It is likely that alpha-adrenergic sensitivity is only one of many components sustaining or exacerbating pain after nerve injury.
Pain 1992 Apr
PMID:Pain response to perineuromal injection of normal saline, epinephrine, and lidocaine in humans. 159 85

Neuropeptides, including substance P (SP), calcitonin gene-related peptide (CGRP) and somatostatin (SS) in dorsal root ganglia (DRG) may play a role in neurogenic inflammation and pain transmission. Adrenal corticosteroids regulate neuropeptide synthesis in some areas of the CNS and may modulate neurogenic inflammation and sensory perception. We have investigated the effects of adrenalectomy and dexamethasone (0.2 mg/kg/day) treatment on neuropeptide content of rat cervical DRG using specific and sensitive radioimmunoassays. In control animals, a differential distribution of neuropeptide was found; SP and CGRP content increased from C4 to C7 in contrast to SS content, which decreased from C4 to C7. Ten days following adrenalectomy, the mean SS content of cervical DRG decreased significantly to 79.6 +/- 4.5% of sham-operated controls. In contrast, SP and CGRP content increased significantly 10 days after adrenalectomy to 134.6 +/- 6.9% and 132.0 +/- 11.6% of sham-operated controls, respectively. The effects of adrenalectomy on CGRP and SS were reversed by administration of dexamethasone. These results suggest that glucocorticoids affect the neuropeptide content of DRG in the adult rat.
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PMID:Effect of adrenalectomy and dexamethasone on neuropeptide content of dorsal root ganglia in the rat. 172 40

Photocoagulation of the iris surface in the course of rubeosis iridis was performed in 11 patients (12 eyes) with secondary absolute glaucoma. The intraocular pressure was lowered down to 30-35 mm Hg in 8 eyes, in the remaining 4 eyes it oscillated between 45 and 50 mm Hg. The pain receded in all the cases. One considers the possibility that in the disappearance of pain--besides the lowering of the IOP--a substantial factor was the lesion of the innervation of the iris.
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PMID:[Laser coagulation of the iris surface with neovascularization in glaucoma]. 172 96

We compared the analgesia, side effects, and plasma concentrations of buprenorphine and fentanyl in a double-blind study of 78 parturients receiving one of these drugs by patient-controlled epidural infusion after elective cesarean section with epidural anesthesia. Patients were randomized to three epidural infusion groups: group 1 (n = 26), 3 micrograms/mL buprenorphine with 0.015% bupivacaine and 1 microgram/mL epinephrine; group 2 (n = 26), 3 micrograms/mL fentanyl with 0.015% bupivacaine and 1 microgram/mL epinephrine; and group 3 (n = 26), 3 micrograms/mL fentanyl with 0.015% bupivacaine. Plasma for determination of opioid concentrations was obtained in some subjects in each group at intervals up to 48 h during the infusion and in some subjects from each group at intervals after the infusion was stopped. Pain relief was similar and satisfactory in all three groups. The median overall satisfaction scores were high for all three groups. Pruritus was more common in the fentanyl groups (P less than 0.05). However, vomiting was more disturbing to the patients and seen only with buprenorphine. No patient had a respiratory rate less than 12 breaths/min. Epinephrine use was associated with a slower infusion rate (P less than 0.05, group 2 vs 3). All patients were able to ambulate without difficulty. Mean opioid plasma concentrations did not exceed 1.5 ng/mL. Thus, epidural patient-controlled analgesia in all three groups provided excellent analgesia, permitted ambulation, and was without serious side effects. Epidural buprenorphine offered no advantages over epidural fentanyl.
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PMID:Epidural patient-controlled analgesia after cesarean section: buprenorphine-0.015% bupivacaine with epinephrine versus fentanyl-0.015% bupivacaine with and without epinephrine. 850 57


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