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

In protriptyline (25 mg/kg) pretreated rats stereotactic 5,7-dihydroxytryptamine (5,7-DHT) lesions of the medial plus laternal 5-hydroxytryptamine (5-HE) bundles in the mesencephalon increased the 5-HT fluorescence in these bundles, and reduced the in vitro uptake of [3H] 5-HT in the hypothalamus to 16% of control values after 2 mug 5,7-DHT/4mul and 12% after 4 mug 5,7-DHT/4mul, and in the cortex cerebri to 35 and 34% of control values, respectively. Selective lesion of the medial 5-HT bundle reduced [3H] 5-HT uptake both in hypothalamus and in cortex cerebri to 45-48% of control values, while selective lesion of the lateral 5-HT bundles significantly reduced [3H] 5-HT uptake only in cortex (to 73-75%). No significant change was observed in [3H] noradreanaline uptake after any injection, or in [3H] 5-HT uptake after vehicle injections. Locomotor activity in an open field 3-10 days postoperatively was significantly reduced by lesions of the medial plus lateral 5-HT bundles. 5-Hdroxytryptophan (50 mg/kg) and a peripheral decarboxylase inhibitor (MK 486, 75 mg/kg) 17 days postoperatively induced a pronounced behavioral "5-HT syndrome" in these rats with medial plus lateral lesions but not in controls. Pain sensitivity, as measured by the hot plate test, was not changed by any lesion, even when tryptophan hydroxylase was partly inhibited with alpha-propyldopacetamide (100 mg/kg). Morphine analgesia and acquisition of a one-way avoidance response also were unchanged. Apomorphine (2 mg/kg)-induced locomotor activity and stereotyped behavior, as measured in an Animex activity meter, were not significantly different from control values in the 5,7-DHT groups. It was concluded that the medial 5-JT BUNDLE INNERVATES BOTH THE HYPOTHALAMUS AND THE CORTEX CEREBRI AND THE LATERAL 5-HT bundle mainly the cortex. These ascending 5-HT neurons are involved in maintaining open field ambulation. No wupport was obtained for the view that they are involved in pain mechanisms, in morphine-induced analgesia, in apomorphine-induced motor behavior, or in one-way avoidance learning.
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PMID:Behavioral effects of 5, 7-dihydroxytryptamine lesions of ascending 5-hydroxytryptamine pathways. 94 13

Pain in the feet is an important diagnostic feature and a major management problem of rheumatoid arthritis. Of 50 hospitalized patients, 28% recalled painful feet as the sole presenting symptom of their disease.RHEUMATOID DISEASE COMMONLY AFFECTS THE FEET: 90% of the patients studied complained of foot pain at some time during the course of their disease, 86% had clinical involvement and 92% had radiological changes in their feet.The forefoot is most frequently involved. Midfoot involvement was noted in 68% but was symptomatic in only 22%. Changes in the ankle were least common but always symptomatic.
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PMID:Painful feet in rheumatoid arthritis. 474 32

Pulmonary angiographic studies were performed on 100 patients with suspected pulmonary embolic disease.In the majority, the contrast medium was injected through a catheter located in the outflow tract of the right ventricle or the pulmonary trunk.PULMONARY EMBOLIC DISEASE SHOULD BE SUSPECTED IN THE PRESENCE OF THE FOLLOWING UNEXPLAINED SYMPTOMS OR SIGNS: (1) dyspnea, (2) thoracic pain, (3) hemoptysis, (4) left ventricular failure, (5) global ventricular failure, and (6) pulmonary function deterioration.Pulmonary angiography is a simple, specific and objective method by which to diagnose thromboembolic disease of the lung. Acute myocardial infarction and terminal illness were the only contraindications to the procedure.
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PMID:[Angiographic studies of pulmonary embolic disease: indications and contraindications]. 592 68

Review of the literature indicates that most routine orofacial dysfunctions are characterized by deep pain. Various disorders of the masticatory systems, particularly musculoskeletal conditions, are thought to be triggered by occlusal disharmonies. The pain component develops following a pattern of bruxism, muscle hyperactivity, fatigue and spasm. Treatment for most disorders has been to modify the occlusion, although the rational for doing so appears questionable.CRITICAL ISSUES IN THE FIELD OF OCCLUSION RELATED TO OROFACIAL PAIN ARE REVIEWED: occlusal disharmonies, coincidence of retruded-intercuspal contact positions, non-working side interferences, maximum intercuspation of teeth, occlusal adjustment, and occlusal appliances.The studies reviewed fail to support the clinical objective of obtaining equal contact at retruded and intercuspal positions and that the lateral pterygoid muscles stabilize the temporomandibular joint. The relationship between non-working side interferences and pain dysfunction is also not readily supported by controlled studies. Occlusal adjustment appears to be unsatisfactory as a modality for management of pain: not all patients improved following treatment, some relapse occurs even with the most stable contacts, and other treatments such as intra-articular injections of corticosteroids reduced symptoms more readily. Occlusal splints seem to reduce most clinical signs and symptoms on both a short-term and long-term basis. Placement of mandibular orthopedic repositioning appliances results in reduction of pain in some patients, but usually this treatment is followed by extensive rehabilitation.Six major areas are suggested for clinical studies that attempt to relate occlusion to management of orofacial pain. These include: establishment of an ideal jaw position, sequencing of symptoms in the pain history, relationship of pain to other symptoms, development of physiological methods to assess how occlusal modification affects pain perception and pain tolerance, and determination of which treatment modalities produce the most effective relief of pain.
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PMID:Occlusal therapy in the management of chronic orofacial pain. 637 67

Approximately 50% of patients with cancer develop bone metastases and these have an important influence on the quality of life. PURPOSE OF THE STUDY. To evaluate a lower dose than the one already proven to be effective (8 Gy) in the palliation of painful bone metastases. METHODS AND MATERIALS. In a prospective study we analyzed the pain relief, after a single dose of 6 Gy, in 170 patients with painful bone metastases. This was assessed by a questionnaire. RESULTS. A degree of pain relief, was achieved in 88% of the treatments and there was complete relief in 39%. When the treatment was given to the vertebrae, infield spinal cord compression developed in 9%, and when given to the pelvis or femur, infield fractures developed in 8%. CONCLUSION. We concluded that a single dose of 6 Gy was very effective in the palliation of painful bone metastases.
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PMID:Single-dose radiotherapy (6 Gy): palliation in painful bone metastases. 853 6

AIM OF REPORT. This report reviews the evidence about the effectiveness of treatments for chronic pain. While treatment of chronic pain is usually seen as an integrated service, this report concentrates on the individual interventions that constitute the service. HOW THE RESEARCH WAS CONDUCTED. Searches of databases and journals identified over 15,000 randomised studies with pain as an outcome, and many more which were not randomised. Over 150 systematic reviews relevant to chronic pain treatment were identified and their quality assessed using a simple scoring system. Systematic reviews conducted for this report were based mainly on randomised trials. The number needed to treat (NNT) was chosen as the output for the report. NNTs of 2-4 indicate effective treatments. Because NNT is treatment-specific it overcomes problems associated with highly variable placebo or control event rates in pain trials. Such variability is predominantly due to the limited numbers of patients in the clinical trials. Dichotomous outcome measures are important in synthesising information from many studies, and in deriving NNTs. Methods have been developed which allow mean information on pain relief and intensity to be converted reliably into the simple dichotomous outcome of at least 50% pain relief. RESEARCH FINDINGS. PHYSICAL INTERVENTIONS. Transcutaneous electrical nerve stimulation (TENS) has been shown not to be effective in postoperative and labour pain. In chronic pain, there is evidence that TENS effectiveness increases slowly, and that large doses need to be used. There is lack of evidence for the effectiveness of TENS in chronic pain. There is a lack of evidence for the effectiveness of relaxation. Intravenous systemic regional blockade with guanethidine has been shown to be without effect. Epidural corticosteroids are effective in the short term for back pain and sciatica. Injections of corticosteroids in or around shoulder joints for shoulder pain have been shown not to be effective. There is a lack of evidence supporting spinal cord stimulators. Case series are of poor quality and do not provide evidence of effectiveness, although at least 50% pain relief at 5 years is reported in over 50% of patients. PHARMACOLOGICAL INTERVENTIONS. Minor analgesics are important in chronic pain. NNTs were calculated for analgesics given orally for moderate or severe acute postoperative pain. The NNTs found ranged from 17 (poor) for codeine, 60 mg, to 2.5 (good) for ibuprofen, 400 mg. Anticonvulsant and antidepressant drugs are prescribed for neuropathic pains like diabetic neuropathy. NNTs are of the order of 2.5, showing them to be effective treatments. However, there are too few studies with too few patients to determine which is the best drug. Minor adverse events are common, and major adverse events occur in about 1 in 20 patients. There are no studies comparing antidepressants and anticonvulsants directly. Systemic local anaesthetic-type drugs have been shown to be effective in nerve injury pain but there is little or no evidence to support their use in migraine or cancer-related pain. Topical NSAIDs (for example, gels, creams) are effective in rheumatological conditions with an overall NNT of 3. There are too few studies to determine which is the best agent. Topical NSAIDs have few adverse events; most importantly they are without the major gastrointestinal adverse events found with oral NSAIDs, which might make them an important choice for some patients with peripheral arthritis. (ABSTRACT TRUNCATED)
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PMID:Systematic review of outpatient services for chronic pain control. 948 61

CHONDROPROTECTIVE DRUGS: Long-acting chondroprotective drugs have a symptomatic effect. They are only effective in subjects with osteoarthritis and have no pure pain relieving effect. They act within several weeks, improve functional manifestations and have a remnant effect. CHONDROITIN SULFATES 4&6: CS 4&6 are glycosaminoglycans which participate in the matrix structure of cartilage. They are well absorbed after oral intake. They have a dose-dependent inhibitor effect in vitro on proteoglycan and collagen catabolism and have been shown to stimulate matrix synthesis. Several clinical studies have demonstrated the chondroprotective efficacy of CS 4&6 in osteoarthritis involving the hip, knee and finger joints. OSTEOARTHRITIS OF THE KNEE: A controlled randomized double-blind study versus placebo was conducted in 104 patients with femorotibial osteoarthritis. The objective was to demonstrate that CS 4&6 given orally in a sequential regimen at the dose of 800 mg/d has a beneficial effect both in terms of clinical manifestations and in terms of the anatomic progression in patients with osteoarthritis of the knee. The main efficacy criteria was the Lequesne functional score. After 1 year of treatment with CS 4&6, the functional impairment was reduced by approximately 50%, a significant improvement over placebo for all clinical criteria. Tolerance was excellent or good in more than 90% of the cases. A STRUCTURE MODULATOR: This study suggests that chondroitin sulfates act as structure modulators as shown by the improvement in the interarticular space visualized on the x-rays of patients treated with CS 4&6.
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PMID:[Anti-arthrosis treatments: efficacy and tolerance of chondroitin sulfates (CS 4&6)]. 985 36

The same healthcare system that excels at defining best practices and coordinating care for cardiac surgery and other acute illness has paid little attention to defining and implementing care models for the terminally ill. This issue of THE QUALITY LETTER looks at the care of the dying as a quality improvement priority. Experts say that many patients' dying days are spent in pain, isolated from loved ones and subject to extraordinary lifesaving measures unwanted by the patients--often because their caregivers lack adequate training in meeting their needs. The objective, say the experts, is a compassionate and patient/family-centered model of care. Use the self-assessment tool provided to determine whether your system shows the danger signs that care of the dying is inadequate and review six ways that your community can start improving service to the dying.
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PMID:Care of the dying: can we do better? 1016 86

DIFFICULT DIAGNOSIS: Depression in the elderly can take on many often misleading aspects. Sadness may be considered legitimate or "normal" for an elderly person. Depression may masquerade as an organic disorder where somatic complaints, pain and anxiety predominate. All these different clinical forms may mislead the clinician. THE MASK OF HYPOCHONDRIA: A tendency to hypochondria, found in more than one-half of all depressed elderly subjects, may be reinforced by bouts of complementary examinations. The patient is convinced of having an unrecognized organic disease. The mask of hypochondria must be considered with special care because it is a major risk factor for attempted and successful suicide. THE MASK OF DELUSIONS: Elderly patients often develop a state of melancolia-like depression with delusions. Delusions may be congruent with the predominant depressed mood, for example a guilt feeling for an act never committed, or inversely, non-congruent with the thymic state (persecution, negation delusin), for example Cotard syndrome where the patient is persuaded that his/her organs are malfunctioning or have disappeared. Despite these impressive mood disorders that often incite prescription of a neuroleptic, these elderly patients respond favorably to antidepressor treatment.
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PMID:[Depression in the elderly. Clinical aspects]. 1126 11

THE ROLE OF IONIC CHANNEL DYSFUNCTION: During various neurological diseases has been evoked for many years on electro-physiological data. Molecular biology has led to great progress in neurology, and can be considered "functional" since it is surpasses the classical anatomo-clinical methods. IONIC CHANNEL DYSFUNCTION: Can be determined genetically, resulting from the mutation of a gene code of a channel sub-unit. CHANNELOPATHIES ARE RESPONSIBLE: For muscular diseases (myotonia, familial periodic paralysis, malignant hyperthermia and congenital myasthenia), but also for central nervous system disorders such as familial hemiplegic migraine, hereditary paroxystic ataxia and certain forms of Mendel's law hereditary epilepsy. ACQUIRED IONIC CHANNEL DYSFUNCTION: Resulting from auto-immune aggression is implied in diseases such as Lambert-Eaton's myasthenic syndrome and Isaac's neuromyotonia syndrome. It probably plays a part in the clinical, and particularly the sensitive expression (paresthesia and pain) of some peripheral neuropathies and certain central nervous system affections, such as multiple sclerosis.
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PMID:[Ion channel abnormalities ("channelopathies") in neurologic diseases]. 1188 65


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