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

We have investigated the effect of chronic lithium (Li+) treatment on stress-induced hypoalgesia, a phenomenon known to be dependent on the activation and sensitization of the central opioid system. Adult female Wistar rats received either 20 mM LiCl in the drinking water (serum level of 0.5 mEq/l, N = 110) or tap water (controls, N = 113) for 28 days. The rats were divided into three subgroups and were trained either by receiving 60 inescapable 1-mA footshocks (IS) while yoked to an escapable (ES) group, or by confinement (NS) to the shock box. As a control for the activation of the opioid system, we included rats injected with 0.9% saline (N = 24) or morphine (4 mg/kg, sc, N = 20) before confinement. Twenty-four hours later, the rats (N = 187) were either submitted to five inescapable (1 s, 0.6 mA) footshocks (shock reexposure) or received no shocks over the same period (N = 80). The pain threshold was estimated using a tail-flick apparatus after the training session and immediately after the shock reexposure. ANOVA followed by Duncan's test indicated that hypoalgesia was produced soon after the training session in the morphine and shocked groups and persisted in the Li(+)-IS group for up to three days. Hypoalgesia was reinstated in the control IS and morphine groups by reexposure to the shocks, but was not modified in the Li(+)-IS groups. We conclude that Li+ treatment prolongs the hypoalgesia induced by inescapable shocks.
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PMID:Lithium treatment prolongs shock-induced hypoalgesia. 858 Aug 72

The most common crystal-related arthropathies-gout, calcium pyrophosphate dihydrate disease or "pseudogout," and calcific periarthritis/tendinitis-may be appropriately diagnosed and managed by the primary care physician. Definitive diagnosis via synovial tap is recommended, as the clinical picture may not identify some cases. The acute pain and swelling of attacks, regardless of etiology, generally respond to treatment with nonsteroidal anti-inflammatory drugs and local or occasionally systemic corticosteroids. Once a causative crystal has been identified and a diagnosis established, a plan for long-term management and prevention of recurrences may be devised. Thus, uric-acid-lowering therapy may be indicated in a patient who has experienced recurrent attacks of gout, whereas control of serum phosphate levels might be effective in some individuals with hyperphosphatemia and hydroxyapatite-associated periarthritis or arthritis. Crystal deposits in joints can be destructive as well as painful. Treatment, therefore, has two objectives: To relieve the pain of the acute attack, thus restoring normal function, and to prevent the accumulation of crystals that can lead to degenerative disease. Identification and subsequent treatment of preventable or correctable underlying disorders may be one of the most gratifying aspects of managing crystal-induced arthropathies.
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PMID:Crystal-induced arthritis: an overview. 860 27

The efficacy of epidural corticosteroids in the treatment of sciatica was investigated by meta-analysis of all randomized controlled trials. Eleven suitable trials of good quality were identified involving a total of 907 patients. The use of epidural (caudal or lumbar) steroid in the short-term (up to 60 days) increased the odds ratio (OR) of pain relief ( > 75% improvement) to 2.61 (95% CI 1.90-3.77) when compared with placebo. Despite some variations in trial characteristics there was little evidence of significant heterogeneity (P = 0.07). When the trials were analysed for near or total relief of pain in the short-term the OR is 2.79 (95% CI 1.92-4.06), for heterogeneity (P = 0.07). For longterm relief of pain (up to 12 months) the OR is 1.87 (95% CI 1.31-2.68). Efficacy is independent of the route of injection; for caudal epidural steroid the OR is 3.80 (95% CI 1.36-10.6) and for the lumbar epidural steroid 2.43 (95% CI 1.77-3.74). Adverse events included dural tap (2.5%), transient headache (2.3%) and a transient increase in pain (1.9%). There were no reported longterm adverse events. In conclusion we present quantitative evidence from meta-analysis of pooled data from randomized trials that epidural administration of corticosteroids is effective in the management of lumbosacral radicular pain.
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PMID:A meta-analysis on the efficacy of epidural corticosteroids in the treatment of sciatica. 913 12

Reflexes evoked by applying non-painful taps to an incisor tooth were recorded from the jaw closing masseter and temporal muscles of 21 human subjects. A series of inhibitory, excitatory, inhibitory and excitatory waves (the 'Q, R, S and T' waves of the post-stimulus electromyographic complex (PSEC)) occurred in full-wave rectified and averaged electromyograms. Conditioning by remote noxious stimulation (RNS; application of 3 degrees C water to a hand) usually produced increases in activity at the Q-R and S-T transitions of the PSEC (at mean latencies of 24 and 54 ms respectively), which resulted principally from a shortening of the inhibitory Q and S waves. Changes in the amplitudes of the excitatory R and T waves were also found. The effects of RNS were quantified by integrating records of the difference between conditioned and control PSECs. The RNS-induced effect on the entire PSEC was significantly (P < 0.01) greater when the reflexes were evoked by applying hard (7.4 mN.s) as opposed to soft (3.4 mN.s) taps to the tooth. However the ratio between the effects on the ST and QR segments did not differ significantly between these two intensities of tap stimuli. RNS-induced sensations of pain and increases in systemic arterial blood pressure were not correlated with the RNS-induced effects on the different segments of the PSEC. The results suggest that RNS may affect particularly those elements of the PSEC evoked by higher threshold afferents and that the effects are mediated by mechanisms acting directly at the brainstem level and are not secondary to pain or autonomic responses.
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PMID:Effects of remote noxious stimulation on exteroceptive reflexes in human jaw-closing muscles. 883 60

Various authors have indicated that imbalance of the vastus medialis/vastus lateralis muscles might lead to patellofemoral pain syndrome. However, few reports have been published to substantiate such a hypothesis. The purpose of this study was to attempt to set a scale for the normal reflex response times of the vastus medialis oblique and vastus lateralis muscles after a patellar tendon tap and to determine if patellofemoral pain syndrome patients have an alteration in this firing sequence. A control group of 80 healthy adults was compared with a group of 19 patellofemoral pain syndrome patients. Results indicated that the reflex response time of the vastus medialis oblique was significantly shorter than the reflex response time of the vastus lateralis in the normal subjects (p < or = .01). When comparing these data in the patellofemoral pain syndrome group, a significant earlier firing was obtained from the vastus lateralis in comparison with the vastus medialis oblique (p < or = .01). These findings suggest that a reversal has occurred in the firing pattern of the vastus medialis oblique and vastus lateralis muscles in patellofemoral pain syndrome patients. The results indicate an alteration in the neuromuscular answer of the vastus medialis oblique and vastus lateralis muscles during a patellar tendon tap.
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PMID:Reflex response times of vastus medialis oblique and vastus lateralis in normal subjects and in subjects with patellofemoral pain syndrome. 924 11

Palatable sweet ingestion produces a morphine-like analgesia in both rats and human infants (2-5). To determine whether palatable sweet ingesta induces antinociception in human adults, 60 university students (30 men, 30 women) were exposed to a pressure algometer both before and after consuming either a sweet soft drink, filtered tap water, or nothing (Experiment 1). Pain responsivity was assessed with four pain measures: threshold, tolerance, and visual analogue scale (VAS) ratings of intensity and unpleasantness. Results showed that women who consumed either soft drink or water reported increased pain tolerance and VAS ratings at posttreatment compared with those receiving nothing. However, differences between groups were not found for men. Moreover, compared to men, women reported lower pain thresholds and tolerances and rated the pain as more intense. In Experiment 2, 40 women consumed either nothing or foods that they rated previously as palatable (chocolate-chip cookies), unpalatable (black olives), or neutral (rice cakes). Women who consumed the palatable sweet food showed increased pain tolerance compared with those receiving the unpalatable food, the neutral food, or nothing. These data constitute the first demonstration that "palatability-induced antinociception" (PIA) can occur in human adults.
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PMID:Antinociceptive effects of palatable sweet ingesta on human responsivity to pressure pain. 903 63

An international working team of 13 investigators met on two occasions to develop guidelines for standardizing the procedures used to test gastrointestinal muscle tone and sensory thresholds using a barostat. General recommendations were: (1) Use a thin-walled plastic bag that is infinitely compliant until its capacity is reached. Maximum diameter of the bag should be much greater than the maximum diameter of the viscus. (2) The pump should be able to inflate the bag at up to 40 ml/sec. (3) Pressure should be monitored inside the bag, not in the pump or inflation line. (4) Subjects should be positioned so that the bag is close to the uppermost surface of the body. (5) For rectal tests, bowel cleansing should be limited to a tap water enema to minimize rectal irritation. Oral colonic lavage is recommended for studies of the proximal colon, and magnesium citrate enemas for the descending colon and sigmoid. (6) If sedation is required for colonic probe placement, allow at least one hour for drug washout and clearance of insufflated air. Ten to 20 min of adaptation before testing is adequate if no air or drugs were used. (7) The volumes reported must be corrected for the compressibility of gas and the compliance of the pump, which is greater for bellows pumps than for piston pumps. (8) Subjects should be tested in the fasted state. For evaluation of muscle tone: (9) The volume of the bag should be monitored for at least 15 min. For evaluation of sensory thresholds; (10) It is recommended that phasic distensions be > or = 60 sec long and that they be separated by > or = 60 sec. (11) Sensory thresholds should be reported as bag pressure rather than (or in addition to) bag volume because pressure is less vulnerable to measurement error. (12) Tests for sensory threshold should minimize psychological influences on perception by making the amount of each distension unpredictable to the subject. (13) Pain or other sensations should be reported on a graduated scale; not "yes-no." The working team recommends verbal descriptor scales, containing approximately seven steps, or visual analog scales in which subjects place a mark on a straight line marked "none" on one end and "maximum" on the other end. (14) It is recommended that subjects should be asked to rate the unpleasantness of distensions separately from their intensity.
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PMID:Standardization of barostat procedures for testing smooth muscle tone and sensory thresholds in the gastrointestinal tract. The Working Team of Glaxo-Wellcome Research, UK. 969 Mar 74

The intake of saccharin solutions for relatively long periods of time causes analgesia in rats, as measured in the hot-plate test, an experimental procedure involving supraspinal components. In order to investigate the effects of sweet substance intake on pain modulation using a different model, male albino Wistar rats weighing 180-200 g received either tap water or sucrose solutions (250 g/l) for 1 day or 14 days as their only source of liquid. Each rat consumed an average of 15.6 g sucrose/day. Their tail withdrawal latencies in the tail-flick test (probably a spinal reflex) were measured immediately before and after this treatment. An analgesia index was calculated from the withdrawal latencies before and after treatment. The indexes (mean +/- SEM, N = 12) for the groups receiving tap water for 1 day or 14 days, and sucrose solution for 1 day or 14 days were 0.09 +/- 0.04, 0.10 +/- 0.05, 0.15 +/- 0.08 and 0.49 +/- 0.07, respectively. One-way ANOVA indicated a significant difference (F(3, 47) = 9.521, P < 0.001) and the Tukey multiple comparison test (P < 0.05) showed that the analgesia index of the 14-day sucrose-treated animals differed from all other groups. Naloxone-treated rats (N = 7) receiving sucrose exhibited an analgesia index of 0.20 +/- 0.10 while rats receiving only sucrose (N = 7) had an index of 0.68 +/- 0.11 (t = 0.254, 10 degrees of freedom, P < 0.03). This result indicates that the analgesic effect of sucrose depends on the time during which the solution is consumed and extends the analgesic effects of sweet substance intake, such as saccharin, to a model other than the hot-plate test, with similar results. Endogenous opioids may be involved in the central regulation of the sweet substance-produced analgesia.
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PMID:Sucrose ingestion causes opioid analgesia. 936 28

In a prospective, open study, 78 patients with terminal cancer received proctoclysis (rectal hydration) in four different centers. In all cases, a #22 French nasogastric catheter was inserted approximately 40 cm into the rectum and an infusion of normal saline (2 cases) or tap water (76 cases) was administered at a rate of 250 +/- 63 cc/hr. Hydration was maintained for 15 +/- 8 days. The main reason for discontinuation of hydration was death (60 cases). The mean visual analogue score for discomfort after infusion (0 = no discomfort, 100 = worst possible discomfort) was 19 +/- 14. The costs of proctoclysis was estimated at Can$0.08 compared with Can$4.56 per day for hypodermoclysis, and Can$2.78 per day for intravenous hydration. Our results suggest that proctoclysis is a safe, effective, and low-cost technique for the delivery of hydration in terminally ill cancer patients.
J Pain Symptom Manage 1998 Apr
PMID:Proctoclysis for hydration of terminally ill cancer patients. 960 Nov 55

A sense of humor can be a positive coping tool in times of stress, illness, and pain. Perioperative nurses are in the unique position to assess the patient's ability to cope and to suggest and model a repertoire of coping strategies that use humor. This article also explores self-care knowledge and ways that nurses can tap into their own resource potential for healing through humor.
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PMID:Healing with humor. 980 65


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