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

Previous animal stress studies have illustrated the marked impact of coping on subsequent behavior and physiology by using shock as the stressor. The current study evaluates the generality of shock stress controllability effects in a new swim stress paradigm on several dependent measures: behavioral despair, analgesia, shuttlebox escape, and alcohol reactivity. In this new paradigm, rats in the escape group are able to learn the behavioral response as evidenced by significant reduction in the acquisition of a lever press response. Both escape and yoked subjects showed "behavioral despair" in comparison to both restrained and home cage controls when tested 24 h later. In the standard shuttlebox escape task 24-h post-stress, no group differences emerged, although a trend for poorer performance in the yoked subjects was evident. No group differences were observed in pain sensitivity after the first or second forced swim exposure. Finally, stress controllability effects were observed in behavioral reactivity to alcohol 2-h post-stress as measured by rotarod performance. This effect is opposite to the previous observations with the tailshock stress controllability paradigm. These results suggest that (1) there are certain similarities, but some fundamental differences between the behavioral endpoints measured following intermittent swim stress in comparison to the well-established effects of the intermittent tailshock stress model and (2) the qualitative nature of a stressor may markedly influence the behavioral and physiological consequences of stress and coping.
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PMID:Behavioral analysis of stress controllability effects in a new swim stress paradigm. 1126 31

The Hartshill Horseshoe cage is a titanium implant that is inserted after removal of the disc in anterior lumbar interbody fusion. The authors use corticocancellous iliac crest graft, which is contained within the confines of the implant. The cage and the motion segment are stabilized by inserting screws into the adjacent vertebral bodies through holes in the implant. Between 1995 and 1997, 27 patients had this implant inserted. Minimum follow-up was 2.1 years (mean: 2.9 years). Patients were assessed using the Oswestry disability index, a core set of six questions, a pain drawing, and psychometrically using the Zung Depression Scale and the Modified Somatic Perception Questionnaire. The patients' subjective assessment was also obtained. Twenty-one patients (77.8%) improved significantly on the Oswestry disability index and 22 patients (81.5%) improved by subjective assessment using the "core set" of six questions. There was no evidence of pseudarthrosis, loosening, or osteolysis around the implant or the screws. The cage prevents graft extrusion, collapse, or sinkage through the endplates. The normal lumbar lordosis is restored and, by restoring normal intervertebral disc space height, the Horseshoe opens up the neural foraminae. This cage stabilizes the motion segments and secures the graft, preventing micromotion at the graft vertebral body interface and providing a conducive environment for fusion.
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PMID:Containment and stabilization of bone graft in anterior lumbar interbody fusion: the role of the Hartshill Horseshoe cage. 1128 21

The effects of dexamethasone pretreatment on clonidine-induced antinociception and locomotor hypoactivity were investigated in mice. In the hot-plate and the tail-flick tests, dexamethasone administered intraperitoneally at a dose of 1 mg kg(-1), 30 or 60 min before clonidine, reduced clonidine antinociception in both tests and reduced clonidine-induced locomotor hypoactivity in the activity cage. When administered 15 min before clonidine, dexamethasone had no effect on clonidine antinociception. A higher dexamethasone dose (10 mg kg(-1)) induced the same effects observed at a dose of 1 mg kg(-1) in the hot-plate and the tail-flick tests, but the former dose had a stronger effect on locomotor hypoactivity. Dexamethasone (10 ng/mouse) administered intracerebroventricularly 30 min before clonidine was also able to reduce both clonidine-induced antinociception and locomotor hypoactivity. The protein synthesis inhibitor, cycloheximide, administered intraperitoneally at the dose of 10 mg kg(-1), 2 h before clonidine, was able to prevent dexamethasone effects on clonidine-induced antinociception. The glucocorticoid receptor antagonist RU-38486, administered intracerebroventricularly at the dose of 1 ng/mouse, was also able to block dexamethasone effects on clonidine-induced antinociception and locomotor hypoactivity, whereas both cycloheximide and RU-38486 per se did not influence pain sensitivity or locomotor activity. These results suggest that the dexamethasone effects on clonidine-induced antinociception and locomotor hypoactivity depend on the stimulating effects that dexamethasone exert, on the protein synthesis via the glucocorticoid receptor in the brain.
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PMID:Clonidine-induced antinociception and locomotor hypoactivity are reduced by dexamethasone in mice. 1129 50

To determine the positive rate of the CAGE questionnaire in an outpatient palliative radiotherapy clinic and to examine the association between problem drinking, pain control, and analgesic consumption, patients referred for palliative radiotherapy were screened with the CAGE questionnaire and asked to rate their symptom distress using the modified Edmonton Symptom Assessment System (ESAS). The latter instrument uses 11-point numeric scales (0 = best, 10 = worst). Their daily analgesic consumption in oral morphine equivalent was recorded. A total of 128 patients participated in the study. Only 9 patients answered one of the four CAGE questions affirmatively (positive group). All the rest answered negatively (negative group). The mean pain intensity at index site/overall pain was 4.97 +/- 3.31/3.27 +/- 2.76 for the negative group and 6.29 +/- 4.42/2.89 +/- 3.37 for the positive group. The mean total daily oral morphine equivalent for the negative and positive group were 112.35 +/- 233.58 mg and 36.82 +/- 58.85 mg, respectively. There was no significant difference found in other symptoms in the modified ESAS between these two groups. The positive rate of the CAGE in patients with advanced cancer attending an out-patient radiotherapy clinic was only 7%, and analyses were limited by the small sample size of those with a positive CAGE. Whether our observed low positive rate of CAGE represents the true prevalence of problem drinking or the CAGE questionnaire is an insensitive tool for screening problem drinking in an outpatient palliative radiotherapy clinic requires further investigation. We did not find a statistically significant worse pain intensity nor higher analgesic consumption in patients who screened positive for CAGE questionnaire.
J Pain Symptom Manage 2001 Jun
PMID:Use of the CAGE questionnaire for screening problem drinking in an out-patient palliative radiotherapy clinic. 1139 7

Our objective in this study was to review the characteristics, symptom intensity and satisfaction of patients referred to a half-day symptom control clinic (SCC) for advanced cancer patients. This was a retrospective study. The setting was a multidisciplinary symptom control clinic in a cancer centre. Those taking part were 166 consecutive advanced cancer patients referred to the half-day multidisciplinary SCC because of symptom distress. Patients referred to the clinic were assessed in a private room by a physician, a nurse, a pharmacist, a psychologist, and social, rehabilitation, nutrition, respiratory and pastoral care workers. Symptom distress (multiple visual analogue scales), cognition, and CAGE (alcoholism) were determined. Recommendations were given to the patient and sent to the oncologist, family physician and home care nurse. For 110 patients a second assessment was carried out 1 week later, and 64 patients underwent a telephone assessment 2 weeks after the second visit. Symptom intensity was determined during initial and follow-up visits, as well as during two follow-up telephone assessments. In addition, demographics and patient satisfaction with the SCC were determined. Overall symptom distress, depression, anxiety and sensation of wellbeing improved significantly from the first (n = 166) to the second clinic visit (n = 110). Further significant improvement was observed in overall symptom distress, pain, anxiety, sense of wellbeing and depression at the 2- (n = 64) and 4-week (n = 38) telephone follow-up assessments. Mean satisfaction with the SCC (0-10) was 7.7 +/- 2. Our findings suggest that the work of the SCC results in long-term effectiveness in symptom control and high levels of patient satisfaction. The SCC allows for better integration of care between a cancer center and community-based physicians and nurses. It also allows patients access to multiple disciplines that are not available outside tertiary centers.
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PMID:Multidisciplinary symptom control clinic in a cancer center: a retrospective study. 1140 Nov

Methadone is recommended as being free of some of the neuropsychological side effects noticed with morphine, which are attributed to active metabolites. A patient that received methadone for cancer-associated pain developed myoclonus as a side effect. This has rarely been reported before in the literature. The pathophysiology and management of myoclonus are discussed.
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PMID:Methadone-induced myoclonus in advanced cancer. 1140 80

Technical improvement in perioperative morbidity and mortality with improved long-term survival associated with pancreaticoduodenectomy for patients with pancreatic carcinoma has clearly established a role for this operation when performed with curative intent. Most patients with pancreatic adenocarcinoma will not be candidates for surgical resection of their disease. These patients will experience significant symptoms potentially requiring surgical and nonsurgical palliative interventions to treat unrelieved cancer-associated pain, obstructive jaundice, or the development of GOO. The primary goal for palliative interventions should be to relieve symptoms with minimal morbidity and to maintain or improve the quality of life for patients with an expected limited survival.
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PMID:Palliative strategies for locally advanced unresectable and metastatic pancreatic cancer. 1145 79

The objective of this study was to establish an effective post-operative analgesic regimen for Sprague-Dawley (SD) and Dark Agouti (DA) rats. Buprenorphine (0.01 or 0.05 mg/kg), a partial mu opioid agonist, was administered subcutaneously immediately on completion of a standardized surgical procedure, involving anaesthesia, laparotomy and visceral manipulation. Two of the four treatment groups and the saline control group received a second injection 9 h later. Behavioural observations by three independent observers provided no information in assessing pain in this model. All rats lost weight, consumed less food and water after surgery. On the first day, both SD and DA rats receiving buprenorphine lost less weight than untreated control groups. Using weight loss as an efficacy criterion, low-dose buprenorphine, given once or twice, provided effective analgesia in SD rats. A higher single dose provided no additional benefit and a second dose was detrimental, reducing body weight and food intake. In DA rats, the high dose, given twice, appeared to be more effective than the lower dose. All DA cage cohorts consumed < 10% pre-operative food despite buprenorphine treatment, suggesting a higher dosage may be necessary. However, all SD and 80% DA rats who received no buprenorphine gained body weight on the second day, whereas most of the buprenorphine-treated rats continued to lose weight for another 2 days, despite increased food consumption by both strains. Buprenorphine may adversely affect intestinal function over a number of days due to its enterohepatic circulation; this effect may be more severe in DA rats. Adverse metabolic effects of buprenorphine and other opioids may preclude their use in the future if it can be shown that non-steroidal anti-inflammatory drugs (NSAIDs) provide equally effective analgesia.
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PMID:Influence of buprenorphine analgesia on post-operative recovery in two strains of rats. 1145 4

A 15-year-old black male presented with shortness of breath, leg weakness, and pain in his back and rib cage. Four years previously he had noticed a lump in his upper back and complained of pain when playing basketball, especially on contact to that area. Recently, the pain had become more constant and increased in intensity. This was associated with loss of control in his legs, weakness, and paraesthesia. General physical examination revealed a palpable mass in the right midline upper back. Laboratory results were within normal limits. Radiographic scans demonstrated a destructive soft tissue mass at T6 vertebral body with scattered stippled calcification (Figure 1). The patient underwent a biopsy followed by excision of the mass (Figure 2) and decompressive laminectomy with reconstruction.
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PMID:Pathology quiz: small cell osteosarcoma. 1148 38

Patients with discrete breast lumps, irrespective of age, should be referred for assessment. Premenopausal women with equivocal lumps can be re-checked two weeks later and, if still present or dubious, sent to a breast clinic. Almost all women with breast pain do not need referral unless the symptoms are severe or prolonged. Careful examination will detect those individuals with underlying rib cage pain who can be reassured and given analgesics, if necessary, but not referred. Blood-containing nipple discharge is an indication for referral but such cases can be reassured that, in the absence of a lump, it is unlikely they have breast cancer. Most women who suspect their family history of breast cancer places them at increased risk can be safely reassured and do not need to be kept under surveillance. All those women who are eligible for the NHS screening programme should be encouraged to attend when invited.
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PMID:Assessment of breast problems. 1159 55


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