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

The arthropathic activity of mouse recombinant IL-1 (mrIL-1) after intraarticular (i.a.) injection into rat ankles was investigated. Nanogram quantities of either mrIL-1 alpha or mrIL-1 beta induced an acute transient arthritis. Arthritis induced by i.a. mrIL-1 developed more rapidly and was more severe in ankles previously injured by i.a. injection of group A streptococcal peptidoglycan-polysaccharide (PG-APS) fragments. In addition, a protracted pain response, as judged by severe limping, occurred 60 to 90 min after mrIL-1 injection into joints previously injured by PG-APS or 4 to 6 h after mrIL-1 injection into naive joints. The severity of arthritis was related to the mrIL-1 dose. Arthropathic activity of mrIL-1 alpha was neutralized by goat anti-mouse IL-1 alpha IgG, and the activity of both the alpha and beta preparations was heat labile. Repeated episodes of acute inflammation were induced by repeated i.a. injection of mrIL-1. In naive ankles this led to chronic synovitis without histologic evidence of erosions. However, in joints previously injured by PG-APS, repeated mrIL-1 injection induced a more severe chronic synovitis with a 50% incidence of early pannus formation and limited marginal erosions of cartilage and subchondral bone. Thus, mrIL-1 induces an acute exacerbation of arthritis in joints previously injured by PG-APS and repeated exposure of these joints to mrIL-1 promotes chronic erosive synovitis. These studies provide evidence for an in vivo function of IL-1 and are consistent with its role as one of the mediators in the local regulation of inflammation in recurrences of arthritis induced by bacterial cell wall polymers.
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PMID:Exacerbation of arthritis by IL-1 in rat joints previously injured by peptidoglycan-polysaccharide. 328 41

The possible pathways conducting pain are still being discussed. One of the possible pathways may pass through the centrum medianum (CM). In the present study the activity of neurones of CM in cats was recorded using glass-micropipettes. 3-aminopropansulphonic acid (3-APS), which is a GABA analogue was administered intravenously in a dose of 0.1, 0.2, 0.5 and 1.0 mmol/kg. The depressive effect starts at the dose of 0.2 mmol/kg. The duration of the effect depends on the dose of 3-APS. Hence 3-APS has a very strong effect on other thalamic neurones so that it may be used for influencing their activity.
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PMID:The influence of 3-aminopropansulphonic acid (3-APS) on thalamic neurons. 625 Jan 75

The problem of unresolved pain in hospitalized patients is costly both in monetary terms and in patient comfort. Concern about patients' satisfaction and well-being led to a study to determine the characteristics of the pain experience as reported by the hospitalized patients. This study also examined the recently revised American Pain Society Patient Outcome Questionnaire (APS-POQ), particularly in regard to results from newly added items and overall reliability and validity. The data provide a cross-sectional description of patients' experience with pain in a large, urban teaching hospital. One hundred fifty-seven adult subjects reported moderate to high levels of current pain intensity, worst pain, and general level of pain in the last 24 hr, as well as moderate to high rates of pain-related interference with care activities. While patients indicated that they were satisfied with their pain management and with the responses of physicians and nurses to complaints of pain, patient satisfaction was inversely and significantly correlated with pain now and general level of pain in the last 24 hr. When patients with high pain intensity (> 7) were separated into satisfied and dissatisfied groups for analysis, no significant differences were found regarding pain-related interference with various activities including mood, relationships, sleep, etc. The majority of patients indicated that they were still in pain, but 41% did not wish to receive a stronger dose of pain medication. Significant differences between those who did and did not want more pain medication were found in that younger patients were more likely to want more pain medication. Additionally, analysis of these two groups found that patients who were still in pain and desired more pain medication reported significantly higher levels of pain-related interference with activity and sleep. The inverse correlation of current pain intensity and general level of pain with overall satisfaction with pain management differs from findings of previous studies. One added item queried patients regarding approaches they had used to manage pain in the last 24 hr. Oral pain medications, prayer, intravenous and intramuscular injections were the top-ranked methods. The findings guide further analysis of the APS-POQ questionnaire. Recommendations of items to be retained in the questionnaire are made based on data analysis. Refining the questionnaire will allow health-care providers to increase their understanding of issues related to pain management. The findings provoke several questions for further study, such as what are age and ethnic differences regarding pain intensity and satisfaction, as well as the predictors of aversion of receiving more pain medication when pain persists.
J Pain Symptom Manage 1998 Jul
PMID:Assessing clinical outcomes: patient satisfaction with pain management. 970 55

We report organisation principles and three year experience of Acute Pain Service in general surgery clinic. 481 patients were treated after abdominal and vascular interventions, hemorrhoidal varices and mammectomies. Continuous epidural, combined spinal-epidural, intrapleural anaesthesia and continuous brachial plexus block were used for pain control. Time of analgesia varied from 1 to 4 days. The level of analgesia was assessed as good (VAS 3) in 94.8% of cases. Complications were mainly technical due to catheter or antibacterial filter failure. In 2% of cases cardiovascular complications were observed. Respiratory depression occurred in 1 patient. The work of APS team was assessed as very good by both surgeons and patients.
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PMID:[Organization of services for treatment of postoperative pain--3-year experience]. 985 8

Despite unprecedented interest in understanding pain mechanisms and pain management, a significant number of patients continue to experience unacceptable pain after surgery. Recent surveys show that there has been no apparent improvement since an early study in 1952 (15). It is increasingly clear that the solution to the problems of postoperative pain management lies not so much in the development of new techniques but in developing an organization to exploit existing expertise. The most obvious components of an acute pain team include anesthesiologists, surgeons, nurses, and physiotherapists. Protocols encourage consistent standards of safe and effective care and should be used as a framework to individualize treatment. The concept of skilled pain therapists collaborating to provide improved postoperative analgesia within the framework of an organized APS appears to be universally applicable. Acute pain service models have been described from the United States, the United Kingdom, Germany, Switzerland, and Sweden. The U.S. model, which consists of anesthesiologist-based comprehensive pain management teams, is quite effective but is more expensive, and it is not transferable to Europe. A recent United Kingdom survey showed that there is a large degree of variation in what is thought to constitute an APS in the U.K. (16). A nurse-based anesthesiologist-supervised APS in which pain is evaluated in every patient who undergoes surgery has been developed in Sweden. Pain above 3 on the 10-grade VAS is promptly treated. Clearly, neither the anesthesiologist nor the APN guarantees good pain management on wards. In this low-cost model, the role of the anesthesiologist is to teach and train ward nurses, to supervise the APN, and to select patients for special pain therapies such as epidural, PCA, and peripheral nerve blocks. All senior anesthesiologists (section chiefs) working in the operating room are part of this APS. The means of providing satisfactory analgesia are already present in most hospitals. Careful planning and a multidisciplinary approach to pain management will ensure that resources are optimally utilized, and the quality of pain management is consistently maintained.
Reg Anesth Pain Med
PMID:10 years of acute pain services--achievements and challenges. 995 98

The current study was designed to examine the neurophysiological and hypoalgesic effects of three types of electrical stimulation. Following approval by the University's Research Ethical Committee, healthy volunteers (n=40; 20 males and 20 females; age 20-40 years; mean age 26.18 years) were recruited and screened for contraindications. Subjects were randomly allocated in equal numbers to the following groups: control, transcutaneous electrical nerve stimulation (TENS; 150 Hz, 125 micros), interferential therapy (IFT; 150 Hz, 125 micros) or action potential stimulation therapy (APS; 153 Hz, 6.4 ms). All treatments were applied under double-blind conditions for 15 min over the course of the median nerve in the subject's right forearm. Antidromic median nerve compound action potentials (CAPs) were recorded pretreatment, immediately post-treatment (i.e. at 15 min) and then at 25, 35 and 45 min. Immediately following CAP recording, mechanical pain threshold (MPT) was recorded from two sites on the palmar surface of the right hand. Statistical analysis showed significant differences between groups for peak to peak amplitude (PPA) at 25, 35 and 45 min (Kruskal-Wallis: P=0.01, 0.01 and 0.02). Mann-Whitney U-tests indicated a significant increase in PPA in the IFT group compared with all other groups at 25 and 35 min and compared with the TENS and APS groups at 45 min. No significant differences were found for the MPT data. This study has therefore demonstrated that none of the aforementioned modalities produced a significant hypoalgesic effect; however, IFT produced a significant change in PPA compared with TENS and APS.
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PMID:The effect of three electrotherapeutic modalities upon peripheral nerve conduction and mechanical pain threshold. 1172 78

Recent surveys show that many patients still receive inadequate post-surgical analgesia, this problem is international in character. Analgesia techniques like patient-controlled analgesia (PCA) and spinal opioids alone or in combination with local anaesthetics provide superior pain relief compared to intermittent i.m. injections of opioids. Patient satisfaction with these techniques is high; however, reduced pain and suffering or high patient satisfaction is not considered sufficient in this age of diminished health care budgets. There is no overwhelming evidence that effective postoperative pain relief assures good postoperative outcome. Most studies lack sufficient statistical power to detect clinically significant differences. A meta-analysis showed higher patient satisfaction with i.v. PCA compared to i.m. opioid injection. Although PCA still is the standard of care there's little rational or scientific evidence that i.v. PCA improves outcome. A meta-analysis of randomized, controlled trials to assess the effects of seven analgesic therapies on postoperative pulmonary function after various procedures has shown that postoperative epidural pain control can significantly decrease the incidence of pulmonary morbidity. None of the other analgesic techniques had a significant impact on pulmonary outcome. There are few outcome studies with peripheral nerve blocks. Evidence that peripheral nerve blocks are better than PCA and safer than epidural increases. One reason why improved outcome is difficult to demonstrate is that pain management strategies are not integrated with overall perioperative care and postoperative rehabilitation of the patient. The importance of a good APS in developing cost-effective, evidence-based pain treatment strategies for different surgical procedures should not be underestimated.
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PMID:Treating postoperative pain improves outcome. 1177 18

To establish an effective method of continuous quality control of acute pain service, a retrospective study on incident reporting during postoperative analgesia period was conducted. Incidents were reported and analyzed in 1507 patients who received epidural postoperative analgesia, and the results of satisfaction of pain relief was compared with those of incident analysis. In this study, an incident was defined as any factor that might or had affected patient's safety during analgesia period. Our results showed that 1203 incidents were reported in 641 of 1507 patients, of which 122 incidents were critical. 78.3% of all incidents were detected by acute pain service stuff. The most common incidents included complications, insufficient analgesia and problems with delivery circuits. Human factors were involved in 28.9% of the incidents, most being associated with technical failure due to unskillfulness, poor communications between APS stuff and patients and lack of cooperation with surgeons and nurses. The general satisfaction rate of the patients was 90.8%. There was a very significant difference between the satisfaction of the patients who suffered from incidents and who did not (P < 0.001). It is concluded that incidents affect the satisfaction of the patients who received postoperative pain relief. Incident reporting is a more effective method for quality control of acute pain service.
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PMID:Quality control of postoperative acute pain service. 1293 26

This essay looks at the historical significance of three APS classic papers that are freely available online: Cannon WB and de la Paz D. Emotional stimulation of adrenal secretion. Am J Physiol 28: 64-70, 1911 (http://ajplegacy.physiology.org/cgi/reprint/28/1/64). Cannon WB. The emergency function of the adrenal medulla in pain and the major emotions. Am J Physiol 33: 356-372, 1914 (http://ajplegacy.physiology.org/cgi/reprint/33/2/356). Cannon WB. Studies on the conditions of activity in endocrine glands. V. The isolated heart as an indicator of adrenal secretion induced by pain, asphyxia and excitement. Am J Physiol 50: 399-432, 1919 (http://ajplegacy.physiology.org/cgi/reprint/50/3/399).
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PMID:Discovering the role of the adrenal gland in the control of body function. 1547 96

In the spring of 2003, the board of directors of the American Pain Society asked the APS Ethics Committee to formulate a position statement for the Society concerning the use of placebos in clinical practice (cf, reference ). A subset of the Ethics Committee under my direction composed such a statement based on the available scientific and ethical literature. We then sought feedback from the entire ethics committee as well as numerous prominent voices in the literature and presented the statement to the membership for discussion at the 2004 annual APS meeting in Vancouver, British Columbia, at both a symposium and an ethics special interest group meeting. The resultant document was approved by the APS Board and is published here for widespread distribution to the membership.
J Pain 2005 Apr
PMID:APS position statement on the use of placebos in pain management. 1582 Sep 8


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