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)

Immunocyte-derived beta-endorphin can activate peripheral opioid receptors on sensory neurons to inhibit pain within inflamed tissue. This study examined mu-opioid receptors (MOR) on sensory nerves and beta-endorphin (END) in activated/memory CD4(+) cells (the predominant population homing to inflamed tissue). We found an upregulation of MOR in dorsal root ganglia, an increased axonal transport of MOR in the sciatic nerve and an accumulation of MOR in peripheral nerve terminals in Freund's adjuvant-induced hindpaw inflammation. A large number of CD4(+) cells containing beta-endorphin, but very few naive cells (CD45RC(+)), were observed in inflamed tissue, suggesting that this opioid is mainly present in activated/memory cells (CD4(+)/CD45RC(-)). Taken together, our results indicate an enhanced transport of both MOR and of the endogenous ligand beta-endorphin to injured tissue. This unique simultaneous upregulation of both receptors and ligands may serve to prevent excessive and/or chronic inflammatory pain.
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PMID:beta-Endorphin-containing memory-cells and mu-opioid receptors undergo transport to peripheral inflamed tissue. 1128 56

HIV cholangiopathy is a disease of advanced-stage AIDS that presents with biliary symptoms and anicteric cholestasis. An abnormal ultrasound examination in a patient with low CD4 count is evaluated by endoscopic retrograde cholangiopancreatography, which demonstrates the characteristic cholangiographic abnormalities. Besides being the gold standard for diagnosis, it offers therapeutic intervention and possible pain relief in the presence of papillary stenosis. An infectious pathogen is identifiable in a majority of patients, suggesting infection-related damage to the biliary tree. Anti-infective therapy, however, usually is ineffective, and prognosis is related to the underlying stage of AIDS.
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PMID:Cholangiopathy in HIV-infected patients. 1129 Dec 44

An axonal sensory neuropathy is a frequent complication in the course of HIV infection; more than 30% of all HIV-infected individuals will develop a polyneuropathy. Low CD4 cell counts and high HIV RNA loads increase the risk. This neuropathy causes pain, paresthesias and burning sensations and/or numbness in the feet, which sometimes occurs in the hands as well. Neurological examination reveals sensory deficits in a stocking and glove distribution and depressed or absent ankle reflexes, without severe paresis. The cause of the sensory neuropathy is unknown. Either the HIV infection or certain other infections, for example cytomegalovirus, may play a role in the pathogenesis; vasculitis may be a process associated with this. Some antiretroviral drugs within the nucleoside analogue group cause a neuropathy but the pathogenesis of this remains unclear. Amitriptyline, tramadol and carbamazepine can be used for symptomatic treatment. The efficacy of lamotrigine and gabapentin has yet to be confirmed.
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PMID:[Sensory neuropathy in HIV infection: pathogenesis and therapy]. 1133 55

This study investigates factors associated with the self-reported use of complementary therapies, types of therapies used, and sources of complementary therapy information among HIV-positive patients attending a public, HIV outpatient clinic in New Orleans. A convenience sample of 287 clients (220 men and 67 women) was given a self-administered anonymous questionnaire. Overall, complementary therapy use was 31%. Patients who used complementary therapy were more likely to be white (O.R., 2.5), female (O.R. 3.3), a high school graduate (O.R. 2.9), and to know another complementary therapy user (O.R. 7.8). Age, sexual orientation, CD4 cell count, injection drug use, living with another HIV-infected person, having pain, and HIV support group membership were not associated. Men were more likely than women, and whites were more likely than nonwhites, to use vitamins/minerals, imagery/meditation, and dietary regimens. Nonwhites were more likely than whites, and women more likely than men, to use spiritual healing. Of those using complementary therapy, men were more likely than women, and whites more likely than nonwhites, to get information about complementary therapy from HIV organizations, friends, and homosexual-oriented media. Doctors and nurses were the most frequently cited source of complementary therapy information for women. Frequency, type of therapies used, and source of information about complementary therapy among HIV-infected persons vary by race and gender. Clinicians should be educated about complementary therapies so that they can provide information to their patients and be aware of self-treatment behavior.
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PMID:Complementary therapy use among HIV-infected patients. 1136 56

Esophageal conditions due to fungal, ulcerative, and neoplastic causes often signal the onset of symptomatic HIV infection. Most cases are fungal and due to Candida albicans, which is characterized by esophageal inflammation causing pain on swallowing (dysphagia and odynophagia). Ulcerative esophageal disease is commonly associated with cytomegalovirus (CMV), idiopathic causes, and herpes simplex virus (HSV). CMV, characterized by odynophagia resulting from ulcerations in the distal third of the esophagus, is clinically indistinguishable from idiopathic ulceration. HSV is more widespread and abrupt than other ulcerative processes, and its erosive injury can cause painful swallowing, ulceration and oral cavity lesions. Patients with esophageal distress, low CD4 counts, and little possibility of other GI conditions most likely suffer from Candida infection and should immediately begin an empiric trial of antifungal therapy. If an individual's first bout of odynophagia does not respond to empiric oral azole therapy, the diagnosis of fungal esophagitis is probably incorrect and an upper endoscopic evaluation should be performed. Patients generally respond quickly and completely to treatment of a first episode of fungal esophagitis; therefore, neither primary prophylaxis nor long-term suppressive therapy are recommended due to the risk of infection with a resistant strain. Failure of patients on suppressive therapy to respond to antifungal medication usually indicates resistant fungal infection that may require treatment with intravenous amphotericin. If CMV-isolated esophagitis is diagnosed, the patient should begin intravenous ganciclovir, followed by IV foscarnet if the healing after three weeks is minimal.
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PMID:Management of HIV-associated esophageal disease. 1136 91

A case is presented of a 34-year-old man with a 10-year history of HIV infection (CD4 counts 750-1100/mm3) who initially presented with upper right quadrant pain that was crampy, achy and periumbilical, not affected by food, and was indicative of early-stage acalculous cholecystitis. Over a three month period, tests failed to identify the cause of his pain. It was first labeled gastroenteritis and then irritable bowel syndrome. By the third month, his pain was mostly in the right upper quadrant. This area was sore when touched and worse after ingestion of fatty foods. A test detected elevated transaminases. It appeared that he had acalculous cholecystitis, which is one of several hepatobiliary complications of HIV. In HIV-infected individuals, acalculous cholecystitis is often an infectious disease of the biliary tract. Patients present with right upper quadrant and/or epigastric pain that is worse after fatty meals. Eventually, sonographs can detect a thickening of the gall bladder wall and dilation of the hepatic ducts, but early in the disease it is unlikely that the test result will be abnormal. The condition is often caused by CMV and cryptosporidium, but other pathogens may also cause acalculous cholecystitis. Perforation of the gall bladder and development of potentially irreversible abnormalities which complicate infection may result if the condition is left untreated. Although frequently connected with infectious diseases, cholecystitis may also occur in patients with high CD4 counts and no other HIV-related conditions.
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PMID:Abdominal pain in an HIV-infected man. 1136 36

CD4 cells with low levels of glutathione, a biochemical that protects cells from oxidative stress, have been found to be predictive of poor survival. A randomized study of N-acetyl-cysteine, a drug that helps replenish glutathione, began with in-depth analysis of glutathione levels in different lymphocyte subsets, and correlated these levels with survival. Patients with high glutathione levels had a 3-year 60-80 percent survival rate, compared with as low as 20 percent for those with low glutathione. The second part of the study involved randomizing patients to N-acetyl-cysteine or placebo; patients receiving N-acetyl-cysteine had a statistically significant survival advantage over those receiving placebo. Adverse effects thought to be attributed to N-acetyl-cysteine were also observed in the placebo group. There is controversy as to whether further studies of N-acetyl-cysteine should be conducted for several reasons: N-acetyl-cysteine is readily available and is inexpensive, and studies could compromise patients from being able to obtain it on their own; other drug study results could be subject to interference; and there are no validated surrogate markers for continued study of N-acetyl-cysteine. HIV-infected patients are, however, advised to avoid substances, such as acetaminophen and other pain relievers, that inherently lower glutathione levels.
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PMID:Stanford NAC study: glutathione level predicts survival. 1136 46

A retrospective study of cases of paronychia associated with anti-retroviral therapy diagnosed in two general hospitals is here reported. Lesions appeared from 3 and 48 months after institution of therapy. At diagnosis, 84.6% of patients were on indinavir therapy. CD4 values ranged from 120 and 1,332 cells/mm3 and viral load was lower than 200 copies/ml in 92.3 of cases. Conservative therapy was applied in 7 patients and surgery in 6. In all patients indinavir therapy was discontinued, and cure was achieved 16 weeks later. The "retinoid" effect of indinavir is discussed as likely pathogenic explanation for this complications. We advocate for topic therapy and change of anti-retroviral therapy, reserving surgery for patients not responding to therapy. Pain and functional limitation caused by this non uncommon complication (1.6% of our patients treated with anti-retroviral agents) makes its knowledge necessary and an active search by clinicians in patients receiving indinavir therapy.
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PMID:[Paronychia in patients infected with HIV treated with indinavir]. 1159 57

Because effects of cigarette smoking on health-related quality of life (HRQL) have not been well described, we carried out a cross-sectional assessment of HRQL using the Medical Outcomes Survey Scale adapted for patients with human immunodeficiency virus (MOS-HIV questionnaire) in 585 HIV-infected homosexual/bisexual men, injection drug users, and female partners enrolled in a multicenter, prospective study of the pulmonary complications of HIV infection. Mean scores for the following dimensions of HRQL were calculated: general health perception, quality of life, physical functioning, bodily pain, social functioning, role functioning, energy, cognitive functioning, and depression. A multivariate model was used to determine the impact on HRQL of the following factors: smoking, CD4 loss, acquired immune deficiency syndrome (AIDS) diagnoses, number of symptoms, study site, education, injection drug use, gender, and age. Current smoking was independently associated with lower scores for general health perception, physical functioning, bodily pain, energy, role functioning, and cognitive functioning (all with p < 0.05). We conclude that patients with HIV infection who smoke have poorer HRQL than nonsmokers. These results support the use of smoking cessation strategies for HIV-infected persons who smoke cigarettes.
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PMID:Adverse impact of cigarette smoking on dimensions of health-related quality of life in persons with HIV infection. 1178 76

The present study was designed to determine the role of central expression of immunoregulatory molecules in the development and maintenance of allodynia following a peripheral inflammatory insult or nerve transection. Differential spinal expression of major histocompatibility complex (MHC) class II, platelet-endothelial cellular adhesion molecule (PECAM), intercellular adhesion molecule (ICAM) and CD4 was observed in the two injury models. Intraplantar zymosan produced transient allodynia and only PECAM and ICAM immunoreactivity. In contrast, persistent mechanical allodynia and enhanced spinal PECAM, ICAM, MHC class II and CD4 immunoreactivity was observed following peripheral nerve transection. MHC class II knockout mice exhibited attenuated allodynia following spinal nerve transection as compared to wild-type control mice. These findings suggest that central neuroimmune activation may contribute to the maintenance of neuropathic pain following peripheral L5 spinal nerve transection but not following a peripheral inflammatory insult.
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PMID:The differential role of spinal MHC class II and cellular adhesion molecules in peripheral inflammatory versus neuropathic pain in rodents. 1196 Jun 44


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