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

Breast reconstruction with transverse rectus abdominis muscle (TRAM) flap raises two contradictory questions: the vascular safety of the flap and the late abdominal wall sequellae. In order to analyse these sequellae, 71 patients with TRAM flap breast reconstruction at the Institut Curie had a late postoperative evaluation by both a physiotherapist and a surgeon, an average 28 months after their reconstruction. 12 had had a double pedicled TRAM (DPT) and 59 a single pedicled TRAM (SPT). Hernias and bulges were systematically recorded, and all patients had an evaluation of their abdominal wall function by questioning (subjective evaluation) and muscular testing (objective evaluation). The overall hernia rate (including bulges) was 5.6%. This rate was 2.5% when mesh was used, and 9.5% when direct closure was performed. This hernia rate was not influenced by the type of TRAM (SPT or DPT). 20% of patients complained of residual abdominal pain, and 36% of a decrease of their abdominal strength after SPT. Both these figures were 75% after DPT. Testing showed that these sequellae were related to an impairment of the supraombilical portion of the rectus, this impairment being much higher after DPT than SPT: none of the 12 patients with DPT were able, from a lying position, to sit down without using their hands (not reaching 4 in Lacote's test), whereas 47% of the SPT could do it. The oblique muscles were also impaired, as less than 20% of patients reached Lacote 4. However, this impairment was not influenced by the type of flap harvested. Testing was also equivalent after both techniques of SPT (standart or "supercharged"). The post-operative hernia rate was not higher for DPT and seemed related to the technique used for abdominal wall closing (mesh vs direct closure). However, the functional sequellae (pain, muscle strength decrease) were much higher after DPT than SPT. It thus confirms us in our attitude to restrict the indications of DPT, when feasible, to the profit of microsurgical flaps.
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PMID:[Functional evaluation of the abdominal wall after raising a rectus abdominis myocutaneous flap]. 976 48

Ablative functional neurosurgery can be useful in some selected patients for the treatment of harmful spasticity in the lower limbs. Microsurgical drezotomy was introduced in 1972, on the basis of anatomical studies of the human dorsal root entry zone (DREZ) showing a topographical segregation of the afferent fibers according to their size and thus functional destinations. It consists of a 3 mm deep microsurgical lesion directed at a 45 degree angle in the postero-lateral sulcus, penetrating the DREZ in its ventro-lateral aspect, at the level of all the rootlets considered as involved in spasticity (and pain). It destroys mainly the lateral (nociceptive) and central (myotatic) afferent fibers as well as the facilitatory medial part of the Lissauer tract, whilst sparing most of the medial (lemniscal) fibers and the inhibitor lateral part of the Lissauer tract. We report a series of 121 bedridden patients suffering from harmful spasticity in one (15) or both (106) lower limbs and treated with microsurgical drezotomy. Surgery was decided on because of abnormal postures in flexion in two-thirds of the patients and in hyperextension in one-third, additional pain in 75 of them, and hyperactive bladder in 38 cases. The post-operative results were evaluated after a mean follow-up time of 5 years and 6 months. Both spasticity and spasms were significantly decreased or suppressed respectively in 78% and 88% of the patients. When present, pain was relieved without abolition of sensation in 82%. These benefits resulted in either disappearance or marked reduction of the abnormal postures and articular limitation in 90% of the patients. When present preoperatively, urinary leakage disappeared in 85% of the cases. Mild to severe complications occurred in 32 patients and precipitated or were responsible for death in 6 cases (5%). This is explained by the fact that most of the patients, especially those affected by multiple sclerosis, were in very precarious general and neurological conditions. Microsurgical drezotomy has however enabled a large majority of these severely disabled patients to sit and lie comfortably, and allowed them to reach a significantly improved quality of life.
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PMID:[Microsurgical drezotomy for the treatment of spasticity of the lower limbs]. 982 38

Most Americans are or will be facing a threat more real than crimes or terrorism-it is the threat of cancer. Indeed, one-fourth of all Americans alive today will ultimately die from cancer. Yet the level of funding for cancer research in 1998 and beyond remains in doubt. The Senate Appropriations Committee has proposed a higher funding figure than the House and the difference will be resolved in negotiations this September. President Clinton has recommended a meager 2.5% increase in spending on cancer. This sum is simply not enough. Although Americans may fool themselves into thinking the government has been at war against cancer, the current funding ceiling for the National Institutes of Health (NIH) budget demonstrates that this so-called offensive is little more than a skirmish. Careful scrutiny of this budget reveals that every time a citizen pays ten dollars in taxes, only one penny goes to cancer research. What the government is spending in cancer research would not buy or maintain two stealth bombers-hardly evidence of a major military strike. For those of us fighting the deadly scourge of cancer, the 1,550 Americans killed each day by this disease are painful and enduring casualties. Imagine five fully loaded jumbo jets crashing with no survivors on the same day. These headlines would generate fast and effective calls for funding for improved safety regulations, and yet cancer takes this number of lives daily-and in one year more lives than all the U.S. combat fatalities in this century. And yet there is a virtual silence as Congress meets to determine the level of monies to direct to cancer research efforts which might halt this carnage. In the past, medical research stopped the horrors of pain associated with amputations and operations conducted without anesthesia, and research stopped the epidemic of polio and the massive deaths from typhoid fever. Soon research will stop the deaths from AIDS. Will cancer be prevented or cured within your lifetime? It should and can be, but only if Americans speak up and demand Congress do its part to advance promising research by supporting NIH and efforts to control cancer. Cancer has stricken almost every family and we urgently need more defense. We must not sit waiting quietly any longer. It is time for a wake-up call to arms, to declare a war effort that demands results. The U.S. paid thirty times more for the Gulf War than the annual budget allotment for cancer research, and five times more to maintain the space program. Today, three-fourths of all cancer research grants approved by critical scientific review still go inactive. These instances represent more lost opportunities, more lost time, more lost lives. We must do better than this. Cancer strikes at the heart and fabric of our society. For the 1.3 million Americans diagnosed with cancer this year, the cost to our economy will exceed $100 billion. Thus, the $2.4 billion now being spent on research is insufficient medically and morally. Several clear-sighted congressional leaders who understand the critical need for increased funding have worked to assure expanded resources for the NIH and for cancer research. Unfortunately, their voices are too often drowned out by legislators with different agendas. Even with limited funds, America's past 25 years of cancer research has paid off. We have already cured some types of cancers, especially those that strike our young people. From 1973 to 1990, the cancer death rate from birth to 19 years of age decreased 38%; from 20 to 40 years, 20%; and from 45 to 54 years, 10%. Over this same period, the government invested $56 million on testicular cancer research. This effort yielded a 91% cure rate and produced an annual savings of $166 million that will last forever. The financial investment was repaid in six months, and the victims have an increased life expectancy of 40 years. These examples and others are proof of the principle that the support of cancer research pays off. However, we have not yet won such hard-fought victories on the more prevalent forms of cancers such as breast, prostate, and lung. Whether it is by cure or prevention, cancers must also be controlled and it can only be accomplished through research. On December 23, 1971, President Richard Nixon signed the National Cancer Act that was to provide, ".a total commitment of Congress and the president. to provide the funds. for the conquest of cancer." Somewhere this contract with America got lost. We are now faced with more losses. The new upheaval in American medicine threatens clinical research in cancer investigation to test new therapies and to support the training of new research soldiers to join the battle. The bottom-line approach of insurance and managed care policies no longer cares about these essential components; they say it is no longer their responsibility. This loss of financial support, combined with the tepid endorsement of funding of research from the government, occurs just when there is an explosion of new discoveries and opportunities becoming available to attack cancer. It is time to dramatically increase our efforts and no time to retreat. If we really want to defend against the terrorism of cancer, we need to attack it with a real war effort. If we can go to Mars, we can go to war on cancer, but only if Americans can speak louder than their elected government leaders. They need to hear our opinion, now.
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PMID:The Cost of Biological Terrorism. 1038 77

The cell soma of primary afferent neurons in the dorsal root ganglion (DRG) is assigned by classical neurophysiology the role of a metabolic depot, charged with supporting the peripheral sensory ending, the conducting axon, and the central synaptic terminals. However, certain peculiarities of DRG morphology and physiology do not sit well with this being its only role. For example, why are DRG cell somata electrically excitable, why are some able to fire repetitively on sustained depolarization, and why does the DRG lack a blood-nerve barrier? Consideration of these and related questions leads to several intriguing hypotheses: (1) Electrical excitability of the soma may be required to insure the reliable propagation of impulses past the DRG T-junction and into the spinal cord. (2) Invasion of the afferent spike into the cell soma may provide an essential feedback signal necessary for the cell soma to regulate the excitability of the sensory ending. 3) The subpopulation of DRG neurons that have repetitive firing capability may be responsible for generating the background sensation that we feel as our body schema. Moreover, these neurons may be chemical sensors that provide essential information about our body's internal milieu.
Pain 1999 Aug
PMID:Unexplained peculiarities of the dorsal root ganglion. 1049 70

Thirteen patients (18 hips) with cerebral palsy and painful hip subluxation or dislocation underwent proximal femoral resection-interposition arthroplasty (PFRIA) as a salvage procedure for intractable pain or seating difficulty. Eleven patients (14 hips) had a prior failed soft-tissue or bony reconstruction. The average age at surgery was 26.6 years (range, 10.7-45.5 years), and average follow-up was 7.4 years (range, 2.2-20.8 years). All patients/caregivers noted significant improvement in subjective assessment of pain after the surgery. Upright sitting tolerance improved from an average preoperative value of 3.2-8.9 h postoperatively (p < 0.01). Four patients who were unable even to sit in a customized wheelchair before the operation could be easily seated in a custom chair after surgery. Hip range of motion including flexion, extension, and abduction was significantly improved postoperatively (p < 0.05). Single-dose radiation therapy was used postoperatively for five hips and resulted in a significantly lower grade of heterotopic ossification at final follow-up (p < 0.005). Skeletal traction in the postoperative period did not prevent proximal migration of the femur compared with skin traction. Maximal pain relief was achieved at an average of 5.6 months postoperatively (range, 0.03-14 months). Complications included transient postoperative decubitus ulceration (four patients), pneumonia (two patients), and symptomatic heterotopic bone (two patients). The significant improvements in pain management, sitting tolerance, and range of motion suggest that PFRIA is a reasonable salvage procedure for the painful, dislocated hip in cerebral palsy. Resolution of pain may not be immediate, as was noted in this series.
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PMID:Resection arthroplasty of the hip for patients with cerebral palsy: an outcome study. 1057 53

Erythema ab igne (EAI) is a red-brown net-like hyperpigmentation due to repetitive exposure to submaximal heat over a long period of time. This rash is typically seen on the anterior lower legs of people who sit in front of open fireplaces or coal stoves and on the trunk of patients with chronic disorders who seek pain relief by long-term use of hot-water bottles or heating pads. EAI can not only be a diagnostic sign for underlying internal diseases including malignant tumors but can also give rise to cutaneous malignancies. We report on a 75-year-old female patient who developed several thermal keratoses and squamous cell carcinomas at the site of erythema ab igne caused by chronic heat exposure over several years.
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PMID:[Squamous epithelial carcinoma in erythema ab igne]. 1081 Jun 62

Lateral premalleolar bursitis develops on the dorsolateral aspect of the foot in people who sit on their feet for prolonged periods. Twenty-nine premalleolar bursae in 21 patients were diagnosed. The patients presented with one or more of the complaints of swelling, pain and difficulty in wearing shoes. One bursa was infected. Initial treatment was non-surgical. With avoidance of the sitting position, the problem resolved in eight of the sixteen patients who were followed. Four bursae were injected with cortisone, three without success. Six bursae were surgically excised, and four of them, with a minimum of one year follow-up were doing well.
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PMID:Lateral premalleolar bursitis as a result of sitting on the foot. 1120 27

OBJECTIVE: To investigate whether artificial neural networks (ANNs) can categorize healthy subjects, chronic low-back-pain (LBP) patients, and subjects pretending to have low-back pain problems, based upon patterns of stand-sit-stand manoeuvres. DESIGN: A non-invasive laboratory study of human subjects. BACKGROUND: Normal strategies for sit-stand manoeuvres are modified in cases of chronic LBP. Subtle changes and many parameters are unsuitable for conventional statistics. METHODS: Fourteen healthy subjects, 10 chronic LBP patients, and 12 subjects pretending to have LBP participated. Forces and centres of pressure at the feet and knees, plus hip and lumbar movements provided inputs into a three-layer feed-forward ANN with sigmoidal transfer functions. The ANN was trained with data from 35 of the 36 subjects, and its ability to classify the left-out subject was tested. This was repeated with each subject omitted from training in turn. RESULTS: The ANN correctly classified 31 of 36 subjects. The subjects were also classified by nine physiotherapists from videos of the manoeuvres. Their success rate was significantly lower that that of the ANN, which is not surprising for an unusual procedure without training. CONCLUSIONS: ANNs should be considered as additional tools in assessment and possible diagnosis of pathological movements. RELEVANCE: The capacity of ANNs to discriminate patterns of human movement offers a technique that may prove to be a useful tool for assessment and diagnosis.
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PMID:The use of artificial neural networks to identify patients with chronic low-back pain conditions from patterns of sit-to-stand manoeuvres. 1141 32

By collecting data from 45 students at a ski high school, we found that a total of 73% of the students reported activity-related pain/injuries of the knee. Sixty-one percent had overuse injuries, 27% malalignment, and 12% had indistinct knee pain. Females suffered more knee pain/injuries (88%) than males (57%). Significantly higher Q-angle degrees were recorded for females (16) than for males (10). "Jumper's knee" was found in all competitive students with a KT manual maximum difference (MMD) of 3 mm or more (mean 4 mm), with a hard endpoint, whereas this was less common among the other competitive students (P < 0.05). The students were given counselling about training and physiotherapy. In the follow-up study 1 year later, a significant reduction of knee pain/overuse injuries, from 73% to 35%, was recorded. This may be related to better equipment, the development of techniques, and training of the muscles. A high volume of training and knee instability, with MMD of 3 mm or more, seemed to be correlated with an increased risk for "jumper's knee" and, possibly, for skiing injuries. By identifying those at increased risk, preseason recommendations can be made and ski injuries may be prevented.
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PMID:Activity-related knee injuries and pain in athletic adolescents. 1142 Jul 87

These cases represent individuals who feel they have a severe impairment and are "disabled." They have been labeled with fibromyalgia. They are truly distressed. Their symptoms, their courses, are more chronic and refractory than those of medically ill patients, and they are high users of medical services, laboratory investigations, and surgical procedures. These patients see multiple providers simultaneously and frequently switch physicians. They are difficult to care for, and they reject psychosocial factors as an influence on their symptoms. Such persons "see themselves as victims worthy of a star appearance on the Oprah Winfrey show. A sense of bitterness emerges...." Shorter, a historian, believes that fibromyalgia is "heaven-sent to doctors as a diagnostic label for pain patients who display an important neurotic component in their illness. Our culture increasingly encourages patients to conceive vague and nonspecific symptoms as evidence of real disease and to seek specialist help for them; and the rising ascendancy of the media and the breakdown of the family encourage patients to acquire the fixed belief that they have a given illness...." Regarding the finding of "disability," this is a social construct, and many authors believe it is society and the judicial system who must decide who can work. To remain objective, the physician should report the objective clinical information. Physicians need not and should not sit in judgment of the veracity of another human being.
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PMID:Disability evaluation of fibromyalgia. 1147


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