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

Interest in alternative medical treatments, including acupuncture, is increasing. Alternative treatments must be subjected to the same objective standards as all medical treatments. A non-blinded pilot study of the safety, tolerability, and efficacy of acupuncture (ACUPX) for the symptoms of (PD) was performed. Twenty PD patients (mean age, 68 years; disease duration, 8.5 years; Hoehn and Yahr [H&Y] stage, 2.2; Unified Parkinson's Disease Rating Scale score [UPDRS], 38.7) each received acupuncture treatments by a licensed acupuncturist. All patients were treated with two acupuncture treatment sessions per week. The first seven patients received 10 treatments and the last 13 patients 16 treatments. Patients were evaluated before and after ACUPX with the Sickness Impact Profile (SIP); UPDRS; H & Y; Schwab and England (S & E); Beck Anxiety Inventory (BAI); Beck Depression Inventory (BDI); quantitative motor tests, including timed evaluations of arm pronation supination movements, finger dexterity, finger movements between two fixed measured points, and the stand-walk-sit test; and a patient questionnaire designed for the study. Following ACUPX, there were no significant changes in the UPDRS, H&Y, S&E, BAI, BDI, quantitative motor tests, total SIP or the two SIP Dimension scores. Analysis of the 12 SIP categories not corrected for multiple comparisons revealed a post-ACUPX improvement in the sleep and rest category only (P = 0.03). On the patient questionnaire, 85% of patients reported subjective improvement of individual symptoms including tremor, walking, handwriting, slowness, pain, sleep, depression, and anxiety. There were no adverse effects. ACUPX therapy is safe and well tolerated in PD patients. A range of PD and behavioral scales failed to show improvement following ACUPX other than sleep benefit, although patients reported other discrete symptomatic improvements. A broad battery of tests in PD patients suggested that ACUPX resulted in improvement of sleep and rest only. This finding needs to be verified using more in-depth and controlled evaluation of ACUPX for PD-related sleep disturbance.
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PMID:Acupuncture therapy for the symptoms of Parkinson's disease. 1221 Aug 79

Intrathecally delivered baclofen has been used as a treatment for severe spasticity since 1984. A systematic literature review was conducted from 1984 to December 2002 to analyze the results of this treatment and to collect data on complications. Studies were included if the following criteria were met: clear selection of patients suffering from spasticity of spinal or cerebral origin, clear measurements of outcome (Ashworth score, Spasm score and/or reflex score and/or functional scales), average follow-up of at least 6 months. Almost all the studies had open follow-up with no control groups (controls were used to examine the effect of test doses of baclofen rather than to assess long-term results). Studies often included heterogeneous patients groups with different causes of spasticity (spinal and/or cerebral etiology) and functional outcome was measured using different scales from one study to another. This literature review shows evidence that intrathecally administered baclofen is effective in reducing the positive signs of spasticity (tone, spasms, reflex activity). Significant reductions in spasm-related pain were noted. The reduction in spasticity led to improvement in ability to transfer and ease of nursing care in the majority of patients. Significant improvements were noted in terms of mobility. Benefits were most notable in bedridden patients who became able to sit in a wheelchair. Many benefited from improved wheelchair mobility, ability to sit down comfortably, and improvement in their ability to transfer. Such benefits were approved by all the patients as an improvement of their quality of life. Ambulatory patients could also benefit from an improved gait but were less often treated because they usually relied upon their spasticity for support during ambulation. Complications were rather rare and mainly were not life-threatening, although there was a high rate of catheter dysfunction (10 to 45%) leading to reoperation. Wound complications were the leading cause of explantation in children with cerebral palsy. Despite the risks, patient satisfaction was high and was related to the improvement of the quality of life.
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PMID:[Intrathecal baclofen. Literature review of the results and complications]. 1274 3

The independence of elderly and arthritic patients as well as persons with disabilities is influenced considerably by their ability to stand from a chair. The presence of pain, reduced joint range of motion, stiffness, and muscle weakness often limit the ability to achieve a sit-to-stand position (STS). Realizing the enormous implications of STS performance, physicians, scientists, and industry have joined together to design and manufacture a wide variety of adaptive seating systems that facilitate therising process. These systems can be divided into three groups: those without mechanical devices, those with mechanical lifts, and those that can lift, tilt in space, recline, or rock. The design of mechanical seating systems without mechanical assists have been influenced by several factors, including chair height, armrest height, and foot position of the occupant. The evaluation of STS performance involves a variety of measurements to include joint angles and moments, speed of time to rise, functional reach and sway, and perception of patient stability (or perceived safety) in rising from a chair. These studies reported that chair seat height, use of armrest, and foot position had a major influence on the ability to do a STS movement. The use of higher chair seats resulted in lower moments at the knee and hip level. Investigators reported that lowering the chair height increased the need for momentum generation or repositioning of the feet to lower the needed moments. They found that the use of an armrest reduced the moments needed at the hip without altering the range of motion of the joints. These investigators found that repositioning of the feet influenced the strategy of STS movement, allowing lower mean extension moments at the hipwhen the foot position changed from anterior to posterior. Adaptive seating systems with lifts include the spring-booster chair spring-loaded flap seat, and ejector chair. Innovative investigators reported that increased seat height complemented by the mechanical lift enhanced STS transfers by persons with disabilities. The investigators noted that it was easier to perform STS transfer when using a mechanical lift than when rising unassisted or from a raised seat height. The latest adaptive seating system, the elevator chair, has the unique ability to assist the occupant to the STS position. The rear section of this chair remains in a fixed position to support the buttocks of the user during the mechanical lift. The front portion of the seat folds down incrementally as the chair rises to allow the feet of the user to be positioned firmly on the floor. Using an elevator chair, the height that the chair rises will vary with the length of the occupant's legs. When the user reaches a point when his/her legs are comfortably straight and the body is in an erect position, the occupant will walk unassisted from the chair. This elevator chair will soon be available with a tilt-in-space capability as well as a gently rocking motion. The elevator chairs are ideally suited for offices, waiting rooms, hospitals, long-term care facilities, and homes. While persons with disabilities appreciate the benefits of these adaptive seating systems, which allow them to achieve a STS position without assistance, healthcare personnel also value the benefits of these adaptive seating systems because they eliminate their need to lift the occupant to a standing position--an invitation for a potentially serious back injury.
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PMID:Revolutionary advances in adaptive seating systems for the elderly and persons with disabilities that assist sit-to-stand transfers. 1282 47

This study compared overuse injuries, small abnormalities, and pain alone in different types of skiing and activity levels. Subjects were 45 ski high school athletes aged 15-19 years. We found the back and knees significantly more prone to activity-related injuries and pain than other body regions. Thirty subjects (67%) had low back pain on the first examination, and 17 had pain caused by overuse of the back. This was more frequent among active, young competitive boys in the cross-country skiing group, with mature height less than 99%, than among noncompetitive boys in the same group or among the alpine skiers. Neck pain was reported only by girls. Eight subjects had low back pain related to small abnormalities. The subjects were given counseling about training and physiotherapy. The 1-year follow-up found a significant reduction in back pain due to overuse injuries (from 17 to 3 subjects) and indistinct neck pain (from 10 to 2) but no reduction in pain in those with small abnormalities in the low back. Low back pain was common in young athletes, particularly in cross-country skiers. Excessively rapid progression of training and faulty technique increased back pain complaints from 36% when entering the school to 67% at the first examination. A proper evaluation and treatment of overuse injuries and accurate counseling of training types, volume, and progression reduced the low back pain problems to 29% of subjects 1 year later in spite of a maintained high activity level. A minimum entrance requirement to conditioning seems mandatory for students attending a ski high school.
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PMID:Back injuries and pain in adolescents attending a ski high school. 1453 Aug 45

Functional constipation is a common condition. In the majority of cases the constipation develops as a result of a complex weave of factors including specific triggers, e.g. reduced fluid intake following a viral infection or periods of restricted access to the toilet. The passage of large painful stools perpetuates the problem when the child begins to associate pain with defecation. The management of constipation can often be a challenge in children, who initially may be reluctant to sit on the toilet. This article will discuss the contributory factors to the cause of constipation and identify the keys to successful treatment, including ensuring a holistic child-focused approach with effective initial evacuation and appropriate maintenance therapy.
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PMID:Management of functional constipation in childhood. 1468 61

Isolated fractures of the distal sacrum are usually caused by direct trauma. Undisplaced fractures are easily missed on conventional X-ray films. CT scans can disclose the full extent of the fracture. Undisplaced, or minimally displaced fractures can be treated conservatively with analgesics and a restriction to seat for six weeks. In cases of major displacement or neurological symptoms, a digital transanal reduction of the fracture under local or regional anaesthesia can be attempted. If this manoeuvre fails, open reduction and internal fixation are required. Stabilisation is challenging because of the thin bone and the complex shape of the sacrum. In a 15 year old girl with major horizontal displacement and comminution of S4, following a snowboard accident, we achieved sufficient and stable fixation with the new LCP (Locking Compression Plate) system. For six weeks after the operation, the patient was not allowed to sit down. Thereafter, she was free of pain and unrestricted in daily activities and sport. The LCP system has a number of advantages in the fixation of fractures in osteoporotic or thin bone, but clinical experience/skill and careful planning of the operation are crucial.
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PMID:[Open reduction and internal fixation of a displaced transverse fracture of the sacrum with a locking compression plate]. 1475 59

The TRAM-flap has become a well-established method for breast reconstruction. Even though the aesthetic result is superior to implant reconstruction, a main disadvantage is the potential risk to create weakness of the abdominal wall. For evaluation of abdominal wall function, an imaging method has to be used which is able to prove functional properties of the remaining muscle. This study was undertaken in order to verify if ultrasound imaging is a reasonable method to examine muscle movements after TRAM-flap procedures in addition to clinical examination. In 8 patients, a DIEP-flap, in 11 patients, a free TRAM-flap, and in 3 patients, a pedicled TRAM-flap were used for breast reconstruction. Patients were examined 10-72 months (mean, 32 months) after surgery. Ultrasound imaging of the abdominal wall was performed in longitudinal as well as cross sections (multifrequent, 13 Mhz; Siemens Elegra, Erlangen, Germany). The diameter of the remaining muscle was measured 2 cm below the rib bow, at the level of the umbilicus, and at the level of the skin scar. The operated side was compared to the nonoperated contralateral side. In order to evaluate the contractility of the remaining rectus muscle, patients were invited to perform sit-ups during ultrasound monitoring of muscle movement. Clinically the functional testing was performed by the method of Janda (Muskelfunktionsdiagnostik, 2nd ed. Berlin: Volk- und Gesundheit; 1986). The abdominal wall was inspected for bulging or hernia formation. Additionally, patients answered a six-scale self-designed questionnaire concerning the impairment of daily living and pain. Muscle contractility as well as muscle diameter were graded into four degrees from 0-3. The highest degree of 3 with normal muscle contractility and muscle diameter was found in 1 of 5 patients after DIEP-flap. Degree 2, with reduced muscle contractility and reduced muscle diameter, was found in 10 of 22 patients, especially after unilateral TRAM-flap. Degree 1, with no muscle contractility and remaining muscle, and degree 0, with scar tissue, were found in 11 patients. Impairment in daily-life activity was found in 10 patients, while 8 patients complained of pain. Muscle strength scored by the method of Janda (Muskelfunktionsdiagnostik, 2nd ed. Berlin: Volk- und Gesundheit; 1986) reached 4 and 5 in 19 patients after all kinds of flap harvesting; 3 patients reached Janda 2 and 3 after unilateral free TRAM or unilateral DIEP-flap. In one patient, a hernia was detected after unilateral DIEP-flap; 10 patients showed bulging of the abdominal wall. Functional testing of the abdominal wall by the method of Janda as well as CT-scans or MRI for evaluation of the remaining muscle is reported in the literature. As there is a need for cost reduction in medical treatment, we were looking for a more cost-effective evaluation method compared to CT-scan or MRI. Ultrasound imaging of the donor site after TRAM-flap harvesting in order to evaluate the remaining function of the rectus muscle is not yet reported in the literature. We consider ultrasound imaging to be superior to CT-scan or MRI in terms of functional evaluation and cost effectiveness.
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PMID:Clinical and ultrasound evaluation of donor site morbidity after tram-flap for breast reconstruction. 1516 Mar 74

The surgical treatment of secondary dislocation of the hip is one of the most challenging issues in cerebral palsy. The selection and application of adequate surgical techniques require an outstanding knowledge of pathophysiology in order to achieve a good outcome with minimal operative expenditure. The hips of cerebral palsied children show no pathological findings at birth. The dislocation of the hip is a secondary process, due to the influence of permanently deteriorating muscle dysbalances that first cause a decentration and finally result in a complete dislocation. Physiotherapeutic treatment supports the development of gait, muscle balance and weight bearing in the early childhood, however, severe hip dislocation can not be prevented with physiotherapy alone. Surgical treatment aims to prevent hip dislocation in order to maintain the ability to walk and to sit, and to avoid secondary skin ulcers. Soft tissue release is performed to neutralize muscle dysbalances. Progressive dislocation requires extended surgical treatment. The combination of soft tissue release, varisation osteotomy and acetabular osteotomy enable an adequate repositioning of the hip and have proved to preserve hips from reluxation. Palliative operations including soft tissue release in combination with angulation osteotomy, and proximal femoral head resection are restricted to failed reconstruction operations or severe luxations, and are performed to attempt pain reduction or the facilitation of perineal care. Surgical planning distinguishes patients able to walk from those who are unable to walk or to sit without support. The manifestation of cerebral palsy and the aim of adequate pain reduction and the maintenance of statomotoric abilities also have a great impact on surgical planning. The treatment of secondary hip dislocation in cerebral palsy is facilitated by the use of a graduated treatment concept with early preventive soft tissue release, extended reconstruction and optional palliative care.
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PMID:[Surgical treatment of secondary hip dislocation in cerebral palsy]. 1525 34

Abdominal hysterectomy is associated with moderate to severe postoperative pain. We randomly divided 40 patients (ASA status I-II) undergoing elective abdominal hysterectomy into 2 groups: group P received an infusion of normal saline 5 mL/h via a catheter placed intraperitoneally at the end of surgery, and group L received 0.25% levobupivacaine 12.5 mg/h (5 mL/h). Ketobemidone was administered IV via a patient-controlled analgesia pump as a rescue analgesic in all patients. The catheter was removed after 24 h. Incisional pain, deep pain, and pain on coughing were assessed 1, 2, 3, 4, 8, 16, and 24 h after surgery by using a visual analog scale. Ketobemidone consumption during 0-72 h was recorded. Time to sit, walk, eat, and drink; home discharge; and plasma concentrations of levobupivacaine were also determined. Pain at the incision site, deep pain, and pain on coughing were all significantly less in group L compared with group P at 1-2 h after surgery. After 4 h, the mean visual analog scale pain scores at rest and during coughing remained <3 cm during most time periods. Total ketobemidone consumption during 4-24 h was significantly less in group L compared with group P (mean, 19 versus 31 mg, respectively). A less frequent incidence of postoperative nausea, but not vomiting, was also found during 4-24 h in group L compared with group P (P < 0.025). Total and free plasma concentrations of levobupivacaine were small. We conclude that levobupivacaine used as an infusion intraperitoneally after elective abdominal hysterectomy has significant opioid-sparing effects.
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PMID:Postoperative pain after abdominal hysterectomy: a double-blind comparison between placebo and local anesthetic infused intraperitoneally. 1538 71

Surgical or multimodal therapy of tumors of the pelvis often results in complex defects leading to functional and structural deficits, with the inability to sit or even lie without pain. Multimodal therapy may cause induration of soft tissues and muscles, obstruction of the small bowel, fistulas, and infected cavities. Early soft tissue reconstruction, preferably with myocutaneous flaps, reduces postoperative problems in these patients by early coverage of defects, closure of cavities, and prevention of wound healing complications and therefore allows earlier rehabilitation.
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PMID:[Plastic reconstructive therapy for postoncologic defect wounds in the pelvis]. 1550 88


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