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

In 387 pat., we observed the interdependence of abnormal vertebral column and failures in epidural anaesthesia by medial tap with the "los of resistance" method. We could show that in contradistinction to other opinions scoliosis induces no higher rate of failure of epidural anaesthesia than the normal vertebral column. In patients with kyphoscoliosis and ossified ligaments the epidural space was identified less frequently than in the normal group, perforations of the dura were encountered more frequently. These results are statistically significant. In patients who had or have pain in the back (p.e. lumbago) and those with ossified ligaments we found significantly more pain during operation although analgesia was tested before. In these three abnormalities of the vertebral column we recommend to judicously balance advantages against disadvantages of epidural anaesthesia and alternative anaesthetic procedures.
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PMID:[The influence of abnormal vertebral column on failure in epidural anaesthesia (author's transl)]. 14 69

A case of traumatic spinal subarachnoid hematoma causing compression of the cauda equina is reported here. The patient, a 76 year-old woman, who had fallen down by accident 1 month before, was admitted to our hospital presenting lumbar pain radiating into her right thigh, monoplegia of the right leg and urinary incontinence. Myelography and metrizamide CT demonstrated a filling defect mimicking intradural extramedullary tumor at the level of L1 and L2. Magnetic resonance imagings (MRI) revealed a subacute or chronic hematoma compressing the conus medullaris and the cauda equina. Operation was performed and an old hematoma, which occupied most of the spinal subarachnoid space and compressed the conus and cauda equina from right to left, was removed. No definite bleeding point was detected and no traumatic change was seen on the cord. Neither tumor nor abnormal vessel was detected. After surgery, the symptoms improved partially. On a review of the literature, we found only 4 cases of traumatic spinal subarachnoid hematoma, all of which occupied the cervical or thoracic portion of the spine. Our case is the first report, except for the cases following lumbar spinal tap, of traumatic spinal subarachnoid hematoma causing compression of the cauda equina. Though usually blood in CSF diffuses immediately, a clot may be formed when a large amount of bleeding obstructs the spinal canal. In our case, furthermore, deformity and narrowing of the spinal canal had preceded for many years, following lumbar vertebral compressed fracture related with osteoporosis. This might have promoted the process of canal obstruction and clot formation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of traumatic spinal subarachnoid hematoma causing compression of the cauda equina]. 140 50

Nine patients with DeBakey type III aortic dissection (type III a; 6, type III b; 3) that underwent acute surgical therapy were studied with particular emphasis on the preoperative CT images and operative indication. It took 6 approximately 192 hours (mean 40.6 +/- 56.0) from onset of the disease to the operation. The reasons why operations were required in acute phase were prolonged pain; 2, fluid retensionin in thoracic cavity; 3, increasing fluid retension; 3, shock state; 1, anuria; 1.6 (75%) of 8 thoracic aortic dissection cases showed intra-thoracic fluid retension in chest roentogenogram or CT image. We performed prosthetic interposition of descending thoracic aorta in 8 patients and Y-graft interposition of abdominal aorta in a patient. During the operations, we found fluid retension in the thoracic and pericardial cavity in 83% (5 cases) of 6 non-ruptured cases. To diagnose ruptured aneurysm, CT image played very important role. But we could not discriminate between ruptured aneurysm and intrapleural serous fluid retension on the CT image. Puncture of intra-thoracic fluid is effective procedure to diagnose rupture of the aneurysms but it is impossible in some cases and traumatic tap may lead misdiagnosis. Therefore we think moderate or increasing fluid retension in the thoracic cavity should be added to the operative indication of acute DeBakey type III aortic dissection and that the early operation will make mortality rate lower.
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PMID:[Studies on acute surgical therapy for DeBakey III aortic dissection: especially on the CT images and the operative indication]. 147 88

Observation of overt pain behaviours was carried out by physicians during routine clinical examination of 120 patients with chronic low back pain. Reliable ratings were achieved but only after very careful standardization in an additional 60 pilot patients. Overt pain behaviour was found to be related to other clinical measures of illness behaviour--pain drawing, behavioural symptoms, behavioural signs, use of walking aides and downtime--but did tap an additional dimension. It is concluded that clinical observation of overt pain behaviour can provide useful additional information about illness behaviour in low back pain. Reliable observations can be achieved in a carefully standardized research situation but in routine clinical practice are vulnerable to considerable observer error and bias.
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PMID:Observation of overt pain behaviour by physicians during routine clinical examination of patients with low back pain. 153 80

Assessment of physical and psychosocial dysfunction is recognized as essential in chronic pain patient evaluation. One instrument, the Sickness Impact Profile (SIP), has demonstrated good reliability and validity as a measure of dysfunction among chronic pain patients. An alternate measure, the Chronic Illness Problem Inventory (CIPI), is shorter and more easily scored than the SIP, but as yet has not been applied widely to chronic pain problems. In the present study, 95 chronic low back pain patients completed the SIP, the CIPI, activity diaries, the McGill Pain Questionnaire (MPQ), and the Center for Epidemiologic Studies-Depression scale (CES-D), before participating in a chronic pain treatment study. Overt pain behaviors were also coded from videotapes of a standardized assessment protocol. Seventy-five subjects completed the measures post-treatment. The results indicate that although the SIP and the CIPI are significantly correlated and appear to be measuring similar constructs, there is also substantial unshared variance between them, suggesting that they may tap somewhat different aspects of dysfunction in chronic pain. The CIPI shows promise as a useful alternative measure of dysfunction in chronic low back pain patients, but requires further validation for this purpose.
Pain 1992 Apr
PMID:The Chronic Illness Problem Inventory as a measure of dysfunction in chronic pain patients. 153 1

Calcium pyrophosphate dihydrate (Ca2P2O7.2H2O) crystal-associated arthropathy (pseudogout) was diagnosed in a dog. Clinical signs included non-weightbearing lameness, signs of pain on joint manipulation, and high rectal temperature. Arthrocentesis of carpal joints revealed extra- and intracellular crystals containing calcium. The suspected cause was polyarthritis secondary to chronic Ehrlichia infection. Results of joint tap performed after resolution of the clinical signs were negative for calcium pyrophosphate dihydrate crystals.
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PMID:Calcium crystal-associated arthropathy (pseudogout) in a dog. 157 46

Forty-one patients with rheumatoid arthritis were treated for 2 weeks at a Tiberias spa hotel. Randomized into 2 groups, Group 1 received a combination of mineral baths and mud packs, and Group 2 had tap water baths only. Both groups had a significant but temporary improvement in Ritchie index. Group 1 showed a significant improvement in grip strength. No improvement was noticed in morning stiffness, 15 meter walk time and laboratory variables of disease activity in either group. Twelve patients with osteoarthritis (OA) received 2 weeks of treatment with mineral baths and mud packs. Statistically significant improvement for a period of 6 months was noticed in night pain, pain on passive motion, tenderness on palpation and in the index of severity of OA of the knee.
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PMID:Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis. 179 9

Few validated instruments are available to assess beliefs and attitudes that patients have regarding pain, or ability to function despite discomfort. The Pain and Impairment Relationship Scale (PAIRS) was developed to tap these important beliefs and attitudes in chronic pain patients. Preliminary data indicate that the PAIRS is internally consistent and significantly related to impairment in a highly selected pain clinic sample of patients, including some chronic low back pain patients. The present study was designed to extend the validation of the PAIRS to a more general sample of chronic benign low back pain patients. Furthermore, additional tests supported the discriminant, convergent and divergent validity, as well as the reliability and relative independence from favorable self-report response bias of the PAIRS, by respectively demonstrating that: (1) the impairment beliefs assessed with the PAIRS were more prominent in chronic low back pain (CLBP) patients than in matched non-pain, healthy controls; (2) scores on the PAIRS were significantly related to measures of physical impairment, but not to physicians ratings of disease severity; (3) the impairment beliefs assessed with the PAIRS are readily distinguishable from cognitive distortions and emotional distress; (4) PAIRS scores for chronic low back pain patients are relatively consistent over time; and (5) PAIRS scores are not significantly associated with measures of favorable self-report response bias. We conclude that the PAIRS has demonstrated at least preliminary utility for applications by researchers and clinicians interested in chronic pain.
Pain 1991 Jan
PMID:Pain and impairment beliefs in chronic low back pain: validation of the Pain and Impairment Relationship Scale (PAIRS). 182 11

Response and receptive field properties were evaluated for 62 spinomesencephalic tract cells in the upper cervical spinal cord (C1-C3) of cats anesthetized with sodium pentobarbital and alpha-chloralose. Recordings were made from cells in laminae I-VIII and X contralateral to antidromic stimulating electrodes positioned in the rostral, caudal and intercollicular region of the midbrain. The mean antidromic threshold for all cells was 185 +/- 132 microA, and conduction velocities ranged from 2.3 to 38.6 m/sec. Twelve cells were backfired from both midbrain and diencephalic stimulation sites. Receptive fields ranged from simple, i.e., ipsilateral forelimb or face, to complex, i.e., excitatory and/or inhibitory responses from large portions of the body. Peripheral receptive fields included muscles, joints, cornea, dura, forelimbs, hind limbs, tail, and/or testicles. Five functional classes of cells were observed: (a) wide dynamic range (14 cells); (b) high threshold (2 cells): (c) low threshold (4 cells); (d) deep/tap (11 cells); and (e) non-responsive (31 cells). Eight cells were evaluated for responses to different doses (5-150 micrograms) of intravenous (i.v.) serotonin. Two of the 8 cells exhibited excitatory effects, whereas 2 cells classified as deep/tap and 4 cells classified as non-responsive were not affected. The results of this study have shown the upper cervical component of the spinomesencephalic tract is made up of a heterogenous population of cells involved in the integration of varied inputs from large portions of the body. It is proposed that the large population of SMT cells in the upper cervical spinal cord may be involved in pain mechanisms, especially those related to the affective consequences of acute and chronic pain.
Pain 1991 May
PMID:Functional properties of spinomesencephalic tract (SMT) cells in the upper cervical spinal cord of the cat. 187 27

Diffuse, chronic, and dysesthetic pain following spinal cord injury (SCI) has been described by several authors under different terms. As illustrated by the two patients described here, central dysesthetic syndrome (CDS) can be mistaken for musculoskeletal, peripheral neuropathic or visceral disease in SCI patients. In these patients, an added clue to the central neuropathic nature of their symptoms was allesthesia and allodynia to light touch or tapping over areas rostral to the level of injury; this may be called the proximal tap or "central Tinel" sign.
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PMID:The proximal tap or "central Tinel" sign in central dysesthetic syndrome after spinal cord injury. 188 51


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