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)

Fibromyalgia-like symptoms such as muscle pain and tenderness, exhaustion, reduced exercise capacity, and cold intolerance, resemble symptoms associated with endocrine dysfunction like hypothyroidism, and adrenal or growth hormone insufficiency. To investigate the potential of management of endocrine abnormalities for relieve of symptoms of patients with fibromyalgia, we reviewed experimental and clinical studies of endocrine functioning and endocrine treatment. Serum GH, androgen, and 24-hour urinary cortisol levels of patients with fibromyalgia tend to be in the lower part of the normal range, while serum levels of thyroid hormone, female sex hormones, prolactin, and melatonin are normal. With exception of GH, these conclusions are based on studies in small samples. With respect to dynamic responsiveness of the hypothalamic-pituitary-adrenal (HPA) axis, the dexamethasone suppression test and stimulation with ACTH show normal results, while patients show marked ACTH hypersecretion in response to severe acute stressors, perhaps indicative of chronic CRH hyposecretion. This finding and slightly altered responsiveness of growth hormone, thyroid hormone, and prolactin in pharmacologic stimulation tests suggest a central rather than peripheral origin of endocrine deviations. Because hormone level deviations were not severe, occurred in subgroups of patients only, and few controlled clinical trials were performed, there is--unless future research shows otherwise--little support for hormone supplementation as a general therapy in the common patient with fibromyalgia. In patients with clinically overt hormone deficiency, hormonal supplementation is an option. In patients with hormone levels that are in the lower part of the normal range, interventions aimed at pain, fatigue, sleep or mood disturbance, and physical deconditioning may indirectly improve endocrine functioning.
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PMID:Evaluation and management of endocrine dysfunction in fibromyalgia. 1212 26

HIV-associated lipodystrophy often includes excess accumulation of visceral fat. Recombinant human growth hormone (rhGH) is a potential treatment for the excess visceral fat. Prospective, open-label trials of 24 weeks of rhGH 6 mg/d and 24 weeks of 4 mg every other day were conducted with an intervening washout period of 12 weeks. Thirty HIV-positive participants (26 men and 4 women) with visceral adiposity were enrolled. The main outcome measure was change in visceral adipose tissue (VAT) on whole-body magnetic resonance imaging scan. Changes in whole-body subcutaneous adipose tissue and skeletal muscle, glucose metabolism, serum lipids, and quality of life were also assessed. Despite stable body weight, VAT decreased in evaluable subjects an average of 42% with rhGH 6 mg/d (n = 24; p <.001) and 15% with 4 mg every other day (n = 10; p <.01) after 12 weeks, with trends toward further decreases after an additional 12 weeks at each dose. Subcutaneous adipose tissue also decreased, but proportionately less and not significantly on the lower dose. Skeletal muscle increased. Body composition rebounded to or near baseline after the washout period. Effects on lipids were inconsistent. Total cholesterol levels fell on the higher dose only, whereas high-density lipoprotein cholesterol levels increased on the lower dose only, and there was no effect on triglyceride levels. Joint pain was the most common adverse event, and was reflected in subjective quality of life measurements as an increase in bodily pain. Insulin sensitivity fell, and 4 participants developed diabetes. Other adverse events included cancer of unknown relationship to treatment in 3 participants. Levels of distress decreased after 24 weeks on the higher dose. In conclusion, rhGH effectively reduces the excess visceral adipose tissue often associated with HIV fat redistribution/lipodystrophy. However, frequent adverse effects warrant controlled studies and careful patient monitoring, especially regarding glucose tolerance.
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PMID:Effect of recombinant human growth hormone in the treatment of visceral fat accumulation in HIV infection. 1213 44

Detecting and quantifying pain in infants and young children is a complex task because young children cannot communicate this subjective phenomenon. In the 1950s, it was postulated that there might be "wound hormones" produced in injured tissues that activated the pituitary-adrenal axis. Research in adults demonstrated that plasma levels of different hormones, including corticosteroids, cathecholamines, growth hormone, and insulin, changed in response to emotionally and physically stressful stimuli. Stress response is the term given to those hormonal and metabolic changes that follow injury or trauma, but the debate as to whether increased stress response is a sign of pain or whether decreased stress response is a sign of diminished pain has not been resolved yet. Following the study of systemic response to surgery, the ability of anesthetic agents to substantially attenuate intraoperative and postoperative stress response has been reported. In newborns, a strong correlation between preoperative stress and postoperative complication rate was found. The full extent of the vulnerable infant's pain is still poorly understood, but further research of known biologic markers and newly discovered ones could promote our understanding of the pain response and increase our ability to prevent undesirable outcome.
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PMID:Biologic markers of pain in the vulnerable infant. 1238 Apr 66

The purpose of this communications is to 1) demonstrate the potential of percutaneous drug-delivery on the example of female reproductive steroids, 2) point out the differences between transdermal and conventional drug dosing, and 3) outline new technologies and innovations that are looming on the horizon, specifically in the area of pain control. Transdermal delivery systems are of two basic types. The first ones employ principles of passive diffusion, and they are used for hormonal replacement therapy (HRT) and contraception. Patches for HRT, designed to release estradiol (E2) only, require a simultaneous dosing with oral progestogens. Patches employing both E2 and a progestogen release the combination either continuously or sequentially. In the latter method, estrogen-only patches are applied for 14 days, followed by a 14-day application of patches releasing both hormones. Both methods successfully cope with symptoms and signs of menopause, including bone loss. Contraceptive transdermal patches deliver ethinylestradiol in combination with the progestogen norelgestromin. This system provides high contraceptive protection with predictable withdrawal bleeding and without major adverse events and weight changes. Hormones delivered by the skin avoid first-pass liver metabolism. Other advantages include rapid onset and termination of action, self-administration, and attainment of therapeutic hormone levels with low daily doses. A disadvantage is the variable intra- and inter-individual percutaneous absorption. In some patients, patches can cause skin irritation. Active systems deliver therapeutics across intact skin non-invasively by means of an electric potential (electrotransport). A system consisting of tooth-like titanium microprojections that penetrate only the keratinized epidermis facilitates painless and needle-free transport of complex molecules to the capillaries of the dermis. Other devices use low frequency ultrasound. These systems enable precise dosage, delivery of large molecules, such as growth hormone and vaccines, and dosing of analgesics "on demand". Novel transdermal technologies are profoundly changing the current methods of pain management. (Fig. 6, Ref. 47.).
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PMID:Optimizing delivery of therapeutics: percutaneous technologies. 1241 1

Neuropeptide FF, one of the mammalian PQRFamides, has been reported to affect the latency of the tail-flick response in rat. We intended to examine the nociceptive effect by the peptide PQRFamides from the comparative aspect. Using the dot immunoblot method with antiserum to FMRFamide as an assay system, a peptide (frog's nociception-related peptide, fNRP) which has the C-terminal sequence PQRFamide was isolated from the brain of the frog, Rana catesbeiana. The determined sequence, SIPNLPQRF-NH(2), is the same as that named first (frog growth hormone-releasing peptide-gene-related peptide-1: fGRP-RP-1, which is encoded in the cDNA of the fGRP precursor. Since the peptide was isolated from the frog brain, we tested another amphibian, the newt, which has a tail, by the hot beam tail-flick test. Intraperitoneal injection of fNRP significantly increased the latency of the pain response (tail-flick) 90 min after administration. The effect was blocked by simultaneous administration of 5 mM naloxone. The result provides evidence for the interaction of fNRP and opioid steps in the analgesia pathways in the newt.
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PMID:Identification of a novel frog RFamide and its effect on the latency of the tail-flick response of the newt. 1260 Jun 86

The clinical safety, use and pharmacokinetics of a new needle-free device for delivery of growth hormone (GH) were compared with those of conventional needle injection devices. In an open-label, randomized, 4-period crossover study, 18 healthy adults received single subcutaneous injections of Genotropin administered by the Genotropin ZipTip needle-free device and by conventional injection. Bioequivalence was established between the devices. In a separate open-label, randomized, multicenter, 2-period crossover study, pediatric patients underwent 2-weeks Genotropin treatment administered by the Genotropin ZipTip and by a fine-gauge needle device (>95% used the Genotropin Pen). In total, 128/133 patients who were treated completed the study. Genotropin ZipTip was well tolerated and >50% of patients found no difference between the devices for all parameters assessed. After study completion, >20% patients preferred to continue using Genotropin ZipTip. Although statistical analyses demonstrated superiority of the Genotropin Pen versus Genotropin ZipTip for bleeding, pain, soreness, and bruising, Genotropin ZipTip was considered to provide a safe and bioequivalent alternative to needle injection.
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PMID:Are needle-free injections a useful alternative for growth hormone therapy in children? Safety and pharmacokinetics of growth hormone delivered by a new needle-free injection device compared to a fine gauge needle. 1270 63

The placebo and nocebo effect is believed to be mediated by both cognitive and conditioning mechanisms, although little is known about their role in different circumstances. In this study, we first analyzed the effects of opposing verbal suggestions on experimental ischemic arm pain in healthy volunteers and on motor performance in Parkinsonian patients and found that verbally induced expectations of analgesia/hyperalgesia and motor improvement/worsening antagonized completely the effects of a conditioning procedure. We also measured the effects of opposing verbal suggestions on hormonal secretion and found that verbally induced expectations of increase/decrease of growth hormone (GH) and cortisol did not have any effect on the secretion of these hormones. However, if a preconditioning was performed with sumatriptan, a 5-HT(1B/1D) agonist that stimulates GH and inhibits cortisol secretion, a significant increase of GH and decrease of cortisol plasma concentrations were found after placebo administration, although opposite verbal suggestions were given. These findings indicate that verbally induced expectations have no effect on hormonal secretion, whereas they affect pain and motor performance. This suggests that placebo responses are mediated by conditioning when unconscious physiological functions such as hormonal secretion are involved, whereas they are mediated by expectation when conscious physiological processes such as pain and motor performance come into play, even though a conditioning procedure is performed.
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PMID:Conscious expectation and unconscious conditioning in analgesic, motor, and hormonal placebo/nocebo responses. 1276 20

We present the case of a boy with Costello syndrome who developed osteofibrous dysplasia during a phase of growth hormone therapy. The lesion and the accompanying pain disappeared after discontinuation of the therapy. Growth hormone is a known mitogen for some neoplasms and osteofibrous dysplasia has been reported to become aggressive. Thus, although osteofibrous dysplasia in Costello syndrome has not been reported before, growth hormone therapy should be used under close supervision in children with this syndrome.
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PMID:Osteofibrous dysplasia in a Japanese boy with Costello syndrome. 1456 66

Fibromyalgia (FM) is a disease entity consisting of a heterogeneous cluster of symptoms that has thus far eluded identification of a causative etiology. The disease onset appears to follow physiological and/or psychological stressors and involves a subset of symptoms that are consistent with varied disorders found in multiple medical specialties to include rheumatology, immunology, endocrinology, neurology, and psychiatry. Owing to the heterogeneity of the symptom complex and the heretofore absence of serum markers that might serve as concrete diagnostic criteria, this disease has baffled clinicians and basic scientists alike. Recent findings regarding sleep architecture, immunology, and endocrinology have provided clues that may help in the understanding and resultant treatment of this entity. Women with fibromyalgia tend to present with an alpha-delta sleep anomaly, which when treated with a growth hormone secretagogue (GHS), reduces the rheumatological pain and restores slow-wave sleep architecture. These findings suggest the somatotrophic axis may be involved in the etiology and the treatment of this disorder. Those diagnosed with FM respond to various stressors with increased disruption of their physiological homeostasis. When compared to healthy age-matched cohorts, there are quantitative differences in various neuroactive steroid levels, immunological markers, and feedback mechanisms. The varied physiological alterations in patients diagnosed with fibromyalgia when compared to controls will be discussed along with the potential treatment options for this population.
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PMID:Fibromyalgia: symptom constellation and potential therapeutic options. 1461 Mar

Prader-Willi syndrome (PWS) is a complex condition with many medical and psychological features. In individuals with this syndrome, causes of death were studied. Data of 27 case reports were collected. Ages at death ranged from neonatal to 68 years. None of the individuals were treated with growth hormone (GH). Most cases were not completely documented and autopsy was performed in a minority of cases only. In five cases, death was considered not to be causally related to PWS. Hypotonia with hypoventilation was noted in the babies, and acute respiratory illness with unexpected sudden death was experienced in young children with PWS. Two young children died after a short period of fever and gastroenteritis. Obesity and its complications leading to death were pronounced in the adult group. One (possibly two) adult(s) died from gastric dilatation and shock. Based on these data, some cautious conclusions can be drawn. In babies with PWS hypoventilation is a risk factor; upper airway infection may be more serious than anticipated and any other clinical features pointing to an infection should be taken very seriously. Therefore, young infants with PWS hospitalized with an upper airway infection and/or hypoventilation or gastroenteritis symptoms, should be closely monitored. Early diagnosis and prevention of overweight is a major factor in preventing early causes of death in individuals with PWS. In the adult group, weight reduction is important but difficult to manage. Sleep apnea should be recognized and treated. Pain in the upper stomach and/or vomiting should be taken as a possible sign of acute intestinal dilatation; intravenous support may be life saving.
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PMID:Prader-Willi syndrome: causes of death in an international series of 27 cases. 1473 79


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