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)

A double-blind, placebo-controlled crossover study was undertaken to assess the efficacy and tolerability of sumatriptan in patients with atypical facial pain. Patients were aged 18-65 years and had at least a 6 months history of atypical facial pain. A total of 19 patients were recruited and assessed for pain scores (total, sensory and affective) by using a short form McGill pain questionnaire preinjection and and at 60 and 120 minutes after subcutaneous injection of sumatriptan (6 mg) or placebo. Safety and tolerability was assessed by recording adverse events during and after the injection. One patient received only one treatment since her pain symptoms resolved after the first treatment. Rest of the patients returned to the clinic 3-6 weeks later and received alternate treatment for atypical facial pain in the same fashion as on the first occasion. Treatment of patients with sumatriptan produced significant relief in sensory, affective and total pain at 120 minutes postinjection (P < .05). Sumatriptan failed to produce a significant reduction in sensory and total pain scores at 60 minutes following treatment, however the result was statistically significant for the affective pain score (P < .05). No death or other serious adverse events were reported. No patient was withdrawn from the study due to an adverse event. However, all the patients treated with sumatriptan experienced one or more adverse events. The most common reported adverse symptoms during the sumatriptan treatment period were injection site reactions, headache, feeling of heaviness, warm or hot sensation and disorders of mouth or tongue. However, most of these side effects were mild and transient. In conclusion, this study points towards some beneficial effect of a single subcutaneous injection of sumatriptan in the treatment of atypical facial pain. However, this data is not sufficient to suggest the clinical utility of subcutaneous sumatriptan (6 mg) for the management of atypical facial pain. Further studies are necessary to test the effects of prolonged subcutaneous and oral multiple dose administration of sumatriptan for the treatment of atypical facial pain.
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PMID:A double-blind, placebo-controlled, crossover, study to evaluate the efficacy of subcutaneous sumatriptan in the treatment of atypical facial pain. 888

Clinical evaluation of outcome after Colles fracture has not been standardized. To assess the relative responsiveness of various clinical and questionnaire measures for the assessment of outcome after Colles fracture, 21 patients were surveyed on the day fracture immobilization was discontinued and again 3 months after that date with the following measures: a short form general health survey (SF-36), the Arthritis Impact Measurement Scale (AIMS2), the Brigham and Women's Hospital carpal tunnel questionnaire; pinch strength, grip strength, pressure sensibility, range of motion, and dexterity. Significant changes, all in the direction of improved health status, occurred in the following scales or measures: AIMS2 mobility, hand and finger function, arm function, household tasks, "arthritis" (fracture) pain, self-care, satisfaction, physical health, affect, and tension; Brigham function; SF-36 physical role and mental health; and grip, pinch, dexterity, and range of motion. The impairments that occur after Colles fracture are multidimensional and are only partially captured by traditional physical measures. Questionnaires such as the SF-36, AIMS2, and Brigham and Women's instruments provide a mechanism to capture the function and symptom dimensions objectively.
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PMID:Outcome after Colles fracture: the relative responsiveness of three questionnaires and physical examination measures. 889 74

That substance P (SP) contributes in some way to spinal nociceptive processing has been known for many years. However, the contribution of SP and NK-1 receptors to the generation and maintenance of inflammatory hyperalgesia or persistent chemical hyperalgesia is not clear. The purpose of this study was to test the hypothesis that SP contributes to the generation but not maintenance of hyperalgesia using two models of inflammatory pain: carrageenan, which allows for testing of acute noxious thermal and mechanical stimuli, and formalin, a model of spontaneous pain. Intrathecal pretreatment with the NK-1 receptor antagonist CP-96,345 (100, 50, 25 nmol) dose-dependently attenuated the thermal (46%, 27% and 16%, respectively) and mechanical (66%, 37% and 3%, respectively) hyperalgesia produced by 2 mg carrageenan, but not 6 mg carrageenan, 3 h after the induction of inflammation. The attenuation was still apparent at 5 h for the greatest dose, but at 7 h the magnitude of hyperalgesia was equal to rats pretreated with saline. Posttreatment with 100 nmol CP-96,345 following the establishment of hyperalgesia had no effect. Intrathecal pretreatment with 125 nmol CP-96,345 prior to formalin (1% or 5%) injection into the hindpaw produced an overall 29% or 23% attenuation, respectively, of the nociceptive behavior during the 1-h observation period. For both 1% and 5% formalin injections, the phase 2 response, but not the phase 1 response, was significantly lower than that from rats pretreated both saline. Pretreatment with 100 or 125 nmol of the inactive enantiomer, CP-96,344, was no different than pretreatment with saline. A dose of 250 nmol CP-96,345 produced voluntary paralysis yet the flexion reflex to noxious pinch remained. These results support the hypothesis that SP contributes to the generation of inflammatory hyperalgesia but once established, the contribution of SP to maintaining the state of hyperalgesia is reduced. The interaction of SP, NK-1 receptors and spinal NMDA receptors in relation to inflammatory pain is discussed.
Pain 1996 Sep
PMID:The spinal contribution of substance P to the generation and maintenance of inflammatory hyperalgesia in the rat. 889 43

One hundred eleven patients with advanced cancer and pain newly referred to a palliative care center completed the Brief Pain Inventory (BPI) weekly for up to 4 weeks. The aims were (a) to review the numbers and causes of pain, (b) to consider the usefulness of the BPI in the evaluation of pain in cancer patients, and (c) to determine the impact of treatment. A total of 370 pains were recorded initially, a median of 3 per patient; 85% had more than 1 pain and more than 40% had 4 or more pains. Causes of pain were cancer (46%), debility (29%), treatment (5%), concurrent disorder (8%), and no stated cause (12%). The top 10 individual causes accounted for 73% of the pains. Seventy-six (68%) of the patients completed two BRIs, but only 46 (41%) completed 5. After 4 weeks, the median number of pains had fallen to 1.5; 78% still had more than 1 pain, but only 20% had 4 or more pains. Intensity of pain also declined, particularly in the first 2 weeks. With their last BPI, 23% had become completely pain free and a further 27% achieved acceptable relief (worst pain scores 1-4), compared with none and 24% initially. Of those who completed all five BPIs, the final respective figures were 22% and 29%. In contrast, 23% of patients still had unacceptable severe pain noted on their last BPI (worst pain scores 8-10), compared with 36% initially. Of those who completed five BPIs, the final figure was 20%. Highly significant correlations were observed between all seven interference factors and present, worst, and average pain intensities. After 4 weeks, the pattern was more variable, particularly in relation to present pain, suggesting that interference factors may have a limited utility as a measure of satisfactory pain management. Many patients did not answer all the questions in the BPI. It was concluded that the BPI is not brief enough for routine clinical use, and that the short form of the BPI (BPI-SF) is too short. A pain diary card will be developed comprising mainly pain scores, a pain relief score and a satisfaction with pain management score.
J Pain Symptom Manage 1996 Nov
PMID:A survey of pain in patients with advanced cancer. 894 22

Severe or prolonged tissue or nerve injury can induce hyperexcitability of dorsal horn neurons of the spinal cord, resulting in persistent pain, an exacerbated response to noxious stimuli (hyperalgesia), and a lowered pain threshold (allodynia). These changes are mediated by NMDA (N-methyl-D-aspartate)-type glutamate receptors in the spinal cord. Here we report that activation of the NMDA receptor causes release of substance P, a peptide neurotransmitter made by small-diameter, primary, sensory 'pain' fibres. Injection of NMDA in the cerebrospinal fluid of the rat spinal cord mimicked the changes that occur with persistent injury, and produced not only pain, but also a large-scale internalization of the substance P receptor into dorsal horn neurons, as well as structural changes in their dendrites. Both the pain and the morphological changes produced by NMDA were significantly reduced by substance P-receptor antagonists or by elimination of substance P-containing primary afferent fibres with the neurotoxin capsaicin. We suggest that presynaptic NMDA receptors located on the terminals of small-diameter pain fibres facilitate and prolong the transmission of nociceptive messages, through the release of substance P and glutamate. Therapies directed at the presynaptic NMDA receptor could therefore ameliorate injury-evoked persistent pain states.
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PMID:NMDA-receptor regulation of substance P release from primary afferent nociceptors. 910 89

Dorsal column stimulation (DCS) is used clinically to provide pain relief from peripheral vascular disease and has the benefit of increasing cutaneous blood flow to the affected lower extremities. The purpose of this study was to examine the role of dorsal roots, calcitonin gene-related peptide (CGRP), and substance P in the cutaneous vasodilation induced by DCS. Male rats were anesthetized with pentobarbital sodium (60 mg/kg ip). A unipolar ball electrode was placed unilaterally on the spinal cord at the L1-L2 spinal segment. Blood flow was recorded in each hindpaw foot pad with laser Doppler flowmeters. Blood flow responses were assessed during 1 min of DCS (either 0.2 mA subdural or 0.6 mA epidural at 50 Hz, 0.2-ms pulse duration). Dorsal rhizotomy of L3-L5 (n = 5) abolished the cutaneous vasodilation to subdural DCS, whereas removal of T10-T12 (n = 5) and T13-L2 dorsal roots (n = 5) did not attenuate the DCS-induced vasodilation. The CGRP antagonist, CGRP-(8-37) (2.6 mg/kg iv, n = 7), eliminated the epidural DCS-induced vasodilation, whereas the substance P receptor antagonist, CP-96345 (1 mg/kg iv, n = 6), had no effect. In summary, L3-L5 dorsal roots and CGRP are essential for the DCS-induced vasodilation. We propose that DCS antidromically activates afferent fibers in the dorsal roots, thus causing peripheral release of CGRP, which produces cutaneous vasodilation.
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PMID:Cutaneous vasodilation during dorsal column stimulation is mediated by dorsal roots and CGRP. 912 59

LY303870 is a competitive, high affinity NK-1 receptor antagonist. It was tested in the trigeminal stimulation-induced neurogenic dural inflammation model of migraine. The neurogenic inflammation theory of migraine pain proposes that substance P, acting through NK-1 receptors, causes dural inflammation which enhances migraine pain. LY303870 administration potently inhibited neurogenic dural inflammation as measured by plasma protein extravasation caused by electrical stimulation of the trigeminal ganglion in guinea pigs. It was active in this model when administered via intravenous, oral or inhalation routes. LY306155, the enantiomer of LY303870 with lower affinity for the NK-1 receptor, was much less potent than LY303870 in this model. LY303870, at oral doses of 1, 10 and 100 microg/kg, produced a long, dose-dependent inhibition of dural inflammation, demonstrating a suitable duration of action for a potential use in acute migraine and migraine prophylaxis.
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PMID:The non-peptide NK-1 receptor antagonist LY303870 inhibits neurogenic dural inflammation in guinea pigs. 912 77

In order to establish effective postoperative analgesia we studied the incidence and significance of pain following maxillofacial surgery. The trial included 102 patients undergoing one of six different surgical procedures. Postoperative pain was assessed using a visual analogue scale (VAS) and the short form of the McGill Pain Questionnaire (SF-MPQ) up to the third postoperative day. Postoperative pain intensity was significantly correlated to operating time, the frequency of analgesic demand and the type of surgery (orthognathic surgery > TMJ surgery > osteosynthetic surgery > osteotomy of impacted third molars > tumor resection > removal of osteosynthetic materials). Patient's age, sex and ethnic origin did not significantly affect the severity of postoperative pain.
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PMID:[Postoperative pain after interventions in the area of the mouth-jaw-face]. 941 Jun 33

The objective of the study was to test an instrument for measuring health-related quality of life (HRQL) for women with osteoporosis and back pain caused by vertebral fractures related to osteoporosis. A longitudinal cohort study design was used in which women were seen at baseline, after 2 weeks, and after 6 months. The setting was a secondary care rheumatology practice in Canada and four separate secondary care metabolic bone disease practices in the United States. The patients were 226 women suffering from osteoporosis and back pain with a mean bone mineral density of 0.84 +/- 0.14 g/cm2 and a mean of 2.78 (median 2, range 1-11) vertebral fractures. We administered the Osteoporosis Quality of Life Questionnaire (OQLQ) with 30 items distributed across five domains: Symptoms, Physical Function, Activities of Daily Living, Emotional Function, and Leisure. In addition, we administered the Sickness Impact Profile (SIP), the 36-item short form of the Medical Outcomes Survey instrument (MOS SF-36), and the Brief Pain Inventory (BPI). On the basis of what women told us about the areas of their lives adversely affected by their osteoporosis, we constructed the OQLQ. Reliability coefficients between baseline and 2-week follow-up varied from 0.80 to 0.89 for the five domains. Cross-sectional correlations between OQLQ domains and other measures were consistently higher than predicted (0.51-0.81). The OQLQ proved to be as powerful or more powerful than alternative instruments for detecting improvement or deterioration in patients whose status changed. Sample sizes of less than 150 per group should be required to detect minimally important differences in parallel-group clinical trials. Longitudinal correlations between OQLQ and other measures were generally lower than predicted. This may be due to limitations in either the OQLQ or the other instruments. It is concluded that the OQLQ may prove to be a useful instrument for discriminating between women with different levels of impaired HRQL, and for evaluating change in women undergoing treatment for back pain related to osteoporosis.
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PMID:Measuring quality of life in women with osteoporosis. Osteoporosis Quality of Life Study Group. 942 7

To adapt the DUKE Health Profile, a 17-item self-report generic health related quality of life measure cross-culturally in french. A multidisciplinary expert committee was provided with three translations independent of each other, each backtranslated to the original language, and produced a synthesis version equivalent to the original. A cohort of 963 persons from the general population filled in the questionnaire twice in three months. The internal consistency was acceptable (Cronbach's alpha = 0.63-0.81) except in social dimension. Convergent validity was evidenced by a significant correlation with overall health. The test-retest reproducibility in stable subjects (601) was satisfactory (intraclass coefficient correlation r = 0.63-0.78) except in pain and disability dimensions. There was a significant modification of scores in the same direction as overall health change in subjects improved (n = 128) or worsened (n = 187). Age-adjusted scores were lower in females, in subjects with lower education, urban residency, unemployed and living alone and in subjects reporting a chronic disease. This short form questionnaire similar to the original version proved simple to use in the general population.
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PMID:[The DUKE health profile: a generic instrument to measure the quality of life tied to health]. 943 14


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