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

To examine the pathophysiological mechanisms of vascular disturbances and to assess the role of the sympathetic nervous system, 12 patients with reflex sympathetic dystrophy (RSD) of the hand were studied using laser Doppler flowmetry. Cutaneous blood flow, skin resistance and skin temperature were measured at the affected and contralateral hands. Sympathetic vasoconstrictor reflexes were induced bilaterally by deep inspiration. Four patients were treated with unilateral surgical sympathectomy and pain and vascular changes were documented in follow-up investigations. (1) After acclimatization in cold environment (< or = 18 degrees C) blood flow and skin temperature were considerably lower on the affected side in 10 patients. No additional vasoconstrictor reflexes could be elicited. (2) After acclimatization in warm environment (22-24 degrees C) blood flow and skin temperature demonstrated no side differences in all cases. Vasoconstrictor responses were the same on both sides. (3) After sympathectomy vasoconstrictor reflexes were absent. Skin resistance was considerably higher on the affected side. In the first 4 weeks the affected hand was warmer and blood flow was higher compared with the healthy side. Thereafter, skin temperature and perfusion slowly decreased and the affected hand turned from warm to cold. Very regular high amplitude vasomotion waves occurred unilaterally. There were no signs of reinnervation. Two patients had long-term pain relief. We conclude as follows. (1) Side differences in skin temperature and blood flow are no static descriptors in RSD. They are dynamic values depending critically on environmental temperature. Therefore, they have to be interpreted with care when defining reliable diagnostic criteria. (2) Vascular disturbances in RSD are not due to constant overactivity of sympathetic vasoconstrictor neurons. Changes in vascular sensitivity to cold temperature and circulating catecholamines may be responsible for vascular abnormalities. Alternatively, RSD may be associated with an abnormal (side different) reflex pattern of sympathetic vasoconstrictor neurons due to thermoregulatory and emotional stimuli generated in the central nervous system. (3) After sympathectomy, denervation supersensitivity of blood vessels and intense vasomotion may be associated with recurrence of pain in some patients.
Pain 1996 Oct
PMID:Reflex sympathetic dystrophy: skin blood flow, sympathetic vasoconstrictor reflexes and pain before and after surgical sympathectomy. 895 25

Bosentan, a specific mixed antagonist of endothelin receptors with no vasoconstrictor activity, inhibits neurogenic plasma extravasation (NPE) within rat dura mater. This would predict efficacy in aborting migraine attacks, without causing cardiovascular side-effects. We investigated the efficacy of 250 mg i.v. bosentan in a randomized, double-blind, placebo-controlled, clinical trial. Improvement from moderate/severe to mild/no headache at 2 h (primary efficacy measure) occurred in 5/23 (22%) of bosentan-treated and in 9/25 (36%) of placebo-treated patients (effect difference -14%; 95% CI -52%, 24%). Thus, inhibition of NPE may not predict clinical efficacy of experimental antimigraine drugs. Vasoconstrictor action may be needed.
Pain 1996 Oct
PMID:Endothelin antagonist bosentan blocks neurogenic inflammation, but is not effective in aborting migraine attacks. 895 32

Lidocaine (lignocaine) 1% with epinephrine (adrenaline) 1:200,000 (maximum dose 40mL) is the agent of choice in skin surgery. It can be used at all sites except the fingers, toes and penis, where epinephrine should be avoided. Epinephrine-induced vasoconstriction delays local anaesthetic clearance, thus prolonging its effect and, by reducing peak blood lidocaine concentrations, enables a higher maximum dose to be used. Adding epinephrine, however, introduces the possibility of a drug interaction with tricyclic antidepressants and nonselective beta-blockers. Also, injection pain is greater because of the acidic sodium metabisulphite that has to be added to prevent epinephrine oxidation. Injection pain can be reduced by buffering the solution using sodium bicarbonate. There are no drug interactions that prevent the use of plain lidocaine: injection pain is least with 0.5% solutions. Injection of large volumes of very dilute lidocaine solutions (tumescent anaesthesia) enables higher maximum doses of lidocaine to be tolerated and large areas to be anaesthetised by infiltration. Amethocaine gel is a faster acting and more effective topical anaesthetic compared with eutectic lidocaine-prilocaine cream, but is a topical sensitiser. In high risk patients, prophylactic antibiotics should be given to prevent bacterial endocarditis when operating on infected lesions and on potentially colonised crusted lesions in high-risk patients (i.e. those with prosthetic heart valves). Wound infections following surgery on infected skin lesions can be prevented by the prophylactic use of mupirocin ointment. Aspirin-induced inhibition of platelet adhesion results in bleeding complications in approximately 15% of skin surgery patients receiving aspirin. Patients whose bleeding time is > 8 minutes are particularly at risk, and aspirin should be stopped at least 7 days prior to surgery in these patients. Aspirin can be continued in other patients without serious bleeding complications.
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PMID:Drug management in skin surgery. 895 52

The formalin test for nociception, predominantly used with rodents, is characterized by continuous pain due to tissue injury induced by formalin. In addition to the pain generated by formalin itself, the classical formalin test for nociception comprises a number of additional strong stressful events such as restraint and injury caused by needle insertion. These events have hampered its use as a model of stress employing continuous pain as a stress stimulus. We describe here a new, simple method of a subcutaneous application of formalin in conscious rats without restraint and needle insertion. Formalin or physiological saline (controls) was injected subcutaneously through a chronically implanted catheter in the region of the lower leg. In most animals, the cardiovascular and behavioural responses to subcutaneously injected formalin were biphasic. The early phase was quantitatively characterized. Formalin (2.5%, 50 microL) induced a marked increase in mean arterial pressure and heart rate. Maximal increases occurred during the first 3 min after formalin injection and were followed by a gradual decline of both cardiovascular parameters to levels higher than the preinjection baseline. Subcutaneous saline injection did not induce any changes in mean arterial pressure and heart rate. The behavioural response to formalin featured intensive licking and biting of the injection site. The behavioural response to subcutaneous saline did not differ from the spontaneous behavioural activity recorded in noninjected rats. Subcutaneously injected formalin induced an immediate increase in plasma corticotrophin (ACTH), corticosterone, noradrenaline, and adrenaline levels, and all hormones remained increased during the whole observation period (60 min). Adrenaline and noradrenaline levels in plasma were slightly, but significantly, elevated during the initial 5 min after subcutaneous saline application but returned to basal values after 15 min. The magnitude of the hormonal responses characterizes the described formalin test as a moderate stress stimulus. The complex response pattern to formalin injected through the subcutaneous catheter is brought about exclusively by pain generated by formalin-induced tissue injury. The described technique of subcutaneous formalin injection represents a new tool to study mechanisms activating brain neuronal circuits that generate the cardiovascular, endocrine, and behavioural responses of the reaction to pain.
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PMID:A new formalin test allowing simultaneous evaluation of cardiovascular and nociceptive responses. 943 44

Previous work in our laboratory has demonstrated that adrenal medullary transplants into the spinal subarachnoid space can alleviate neuropathic pain behaviors. The purpose of this study was to test the possibility that motor, as well as, sensory dysfunction is reduced by adrenal medullary transplants. Peripheral neuropathy was induced by a chronic constriction injury (CCI) of the sciatic nerve of rats. In addition to exaggerated responses to noxious and innocuous stimuli characteristic of peripheral nerve injury, severe impairment of hindpaw placing and grasping reflexes following CCI was observed. Two weeks following CCI, either adrenal medullary or control striated muscle tissue was implanted into the spinal subarachnoid space. Adrenal medullary, but not control transplants, produced significant restoration of hindlimb reflex function in animals with peripheral nerve injury. This was reversed by pretreatment with the alpha-adrenergic antagonist phentolamine, but not the opiate antagonist naloxone, suggesting a role for catecholamines secreted by the implanted cells in reflex recovery. Adrenal medullary transplants also attenuated hyperalgesia and allodynia resulting from nerve injury. These results indicate that adrenal medullary transplants can alleviate sensorimotor dysfunction consequent to peripheral nerve injury.
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PMID:Adrenal medullary transplants attenuate sensorimotor dysfunction in rats with peripheral neuropathy. 944 42

We describe the loss of function in the sciatic nerve after an uneventful sciatic nerve block using 25 ml of lignocaine 1% with adrenaline 1 in 200,000 in a patient receiving beta blocker drugs. Lack of pain on injection and complete regeneration of the nerve after 12 months in a patient with severe peripheral vascular disease led us to postulate ischaemic nerve damage as a mechanism of injury. Adrenaline-induced unopposed alpha-mediated vasoconstriction in a beta-blocked patient is suggested as a possible mechanism of peripheral nerve injury worthy of further investigation.
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PMID:Sciatic nerve palsy following uneventful sciatic nerve block. 948 77

Adrenal chromaffin cells produce analgesic substances, such as catecholamines and enkephalins, and intrathecal (i.t.) implantation of either allografted adrenal tissue or xenogenic chromaffin cells produce antinociception in animals. We evaluated the analgesic effect of bovine chromaffin cells in a model of central pain in which rats exhibit chronic allodynia-like behavior after photochemically induced ischemic spinal cord injury. Bovine chromaffin cells or endothelial cells were injected i.t. onto the lumbar spinal cord and their effects on mechanical and cold allodynia-like behaviors were studied for up to 8 weeks. The chronic allodynia-like behavior was stable for months without signs of remission and i.t. implantation of human endothelial cells did not alleviate the chronic allodynia-like behavior for the entire observation period. In contrast, 2 weeks after i.t. implantation of bovine chromaffin cells, the mechanical allodynia was abolished in the spinally injured rats, and the enhanced response to cold stimuli was significantly reduced. The overall effects were significant up to 8 weeks after i.t. implantation, although the anti-allodynic effect decreased towards the end of the observation period. No signs of side-effects were noted after i.t. implantation. The allodynia-like state was temporarily restored by naloxone (0.5 mg/kg) or phentolamine (0.3 mg/kg) injected intraperitoneally. Immunohistochemical examination revealed that tyrosine hydroxylase (TH)-positive chromaffin cells could be identified adjacent to the spinal cord up to 4 weeks after i.t. implantation, whereas at 8 weeks the TH-positive cells were sparse. It is concluded that bovine chromaffin cells stay viable in rat spinal cord for a considerable period of time after i.t. administration and alleviate chronic allodynia-like behavior in spinally injured rats, possibly through activation of opioid and alpha-adrenoceptors. The present results further document a new therapeutic approach for the treatment of chronic neuropathic pain.
Pain 1998 Feb
PMID:Long-term alleviation of allodynia-like behaviors by intrathecal implantation of bovine chromaffin cells in rats with spinal cord injury. 952 Feb 25

Peripheral neuropathy is often found in ischemic limbs with nondiabetic atherosclerotic peripheral vascular disease (PVD). Sensory symptoms such as burning pain are common in severely ischemic limbs, and sympathectomy has been undertaken for ischemic rest pain. The authors assessed noninvasive quantitative skin vasomotor reflexes in toes and standard systemic cardiovascular autonomic tests in 44 PVD subjects with varying severity of limb ischemia, 30 age-matched control subjects, and nine PVD subjects associated with diabetes. Skin vasoconstrictor reflexes to inspiratory gasp, Valsalva maneuver, and postural change, and the postischemic reactive hyperemic response, were evaluated by the measurement of skin blood flow on toe pads by use of a laser Doppler flowmeter. Vasoconstrictor responses were not significantly different between PVD toes, even in severely ischemic limb, and age-matched controls. Reactive hyperemia was significantly less in PVD than in controls. Cardiovagal and systemic vasoconstrictor reflexes were also evaluated. All PVD subjects showed normal systemic cardiovascular reflexes. In contrast, these reflexes were severely impaired in diabetic PVD. The authors demonstrated that skin vasoconstrictive sympathetic reflex is preserved in chronically ischemic limbs with PVD, suggesting that sympathetic nerve fibers are relatively resistant to chronic ischemia.
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PMID:Preservation of skin vasoconstrictor responses in chronic atherosclerotic peripheral vascular disease. 952 40

Adult male rats showed very high levels of crouching when exposed to a cat, with suppression of the nondefensive behaviors (e.g., lying, locomotion, rearing) that were shown by toy cat-exposed controls. The crouching of cat-exposed rats declined slightly but reliably with increasing time within daily 60-min exposure sessions. However, the lack of a reliable cat-exposure x days interaction for crouching over the 20 days of testing indicated minimal habituation of the rats' defensive response to the cat over this exposure schedule, although rat and cat were separated by a wire mesh screen, precluding contact and pain. Following the 20th day of exposure, cat-exposed rats showed reliably higher basal plasma corticosterone levels, suggesting a lack of habituation of this stress-linked response as well. Adrenal weights were also higher and thymus weights lower in these animals compared with controls, while spleen and testes weights and testosterone levels were not reliably different. Of the 13 cat-exposed subjects, 6 (and a single control) failed to show a 10 microg/mL corticosterone (CORT) increase in response to an acute restraint stressor. In 3 of these 6 cat-exposed rats, the failure to meet this criterion was attributable to a low level of CORT following restraint, suggesting failure of the normal CORT surge to the acute restraint stressor. These findings of organ weight changes, enhanced basal CORT, and reduced CORT response to stress in a subgroup of animals are similar to many of the phenomena obtained with other intense, chronic stressors such as subordination, and suggest that repeated predator exposure produces a pattern of intense behavioral and endocrine response that is very slow to habituate. Because it is a natural stressor for both male and female subjects, and one for which pain and even handling of the subject is unnecessary, cat exposure may provide a particularly relevant and adaptable paradigm for research involving analysis of gender effects on the stress response.
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PMID:Behavioral and endocrine change following chronic predatory stress. 952 99

The role of peripheral epinephrine in the influence of anxiety on pain was investigated by intravenously infusing epinephrine and placebo in three increasing doses. The effect of epinephrine was measured within subjects on several subjective and autonomic measures: subjective pain, skin conductance response, heart rate response due to electrical stimulation, threshold for heat pain and threshold for pressure pain. Heat pain threshold was measured both on normal skin and on skin sensitized with capsaicin, since there is evidence that effects of sympathetic stimulation are only to be found in damaged or sensitized skin. Epinephrine caused a slight increase in subjective pain due to electrical stimulation and a decrease in heat pain threshold, which was larger on capsaicin-treated than on normal skin. However, heart rate response due to electrical stimulation and pressure pain threshold were not significantly influenced, while skin conductance response was even inhibited by epinephrine. Attentional focus, which was manipulated within electrical stimulation, seemed to have a much stronger influence on pain responses than pharmacological manipulation, independent of epinephrine. It may be speculated that, although evidence was found for effects of epinephrine on pain, they may be overruled by effects of attention.
Pain 1998 Jun
PMID:Anxiety and pain: epinephrine-induced hyperalgesia and attentional influences. 971 49


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