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 prospective study of blocking T10-L1 with local anaesthetic, bilaterally in 30 patients undergoing caesarean section under general anaesthesia has been shown to provide effective postoperative analgesia thus requiring significantly less narcotics (mean 66.6 mg of pethidine) compared to the 30 patients in the control group (mean 163 mg of pethidine). A cocktail of 0.5% of bupivacaine with adrenaline and xylocaine 1% produced analgesia for the duration ranging from 8 to 12 hours (mean 8.4 hours). Patients with abdominal field block were awake, alert and comfortable during the immediate postoperative period. They were pain-free sufficiently to put the babies to the breast early and frequently.
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PMID:Abdominal nerve blockade for postoperative analgesia after caesarean section. 837 64

Young women with right iliac fossa pain are commonly referred to general surgeons as possible acute appendicitis. The differential diagnosis that includes pelvic visceral disease may be very difficult to determine clinically, especially when the history and physical signs are equivocal. We believe that diagnostic accuracy may be improved by eliciting precisely the site of abdominal pain. Right-sided low inguinal pain may be referred from the female pelvic viscera in the same way as testicular pain may be referred to the groin, as these viscera derive their autonomic nerve supply from the T10-L2, mainly T12-L1, spinal segments in both sexes. There are no previous reports of the value of the symptom of right-sided low inguinal pain in differentiating pelvic visceral disease from acute appendicitis in young women. This paper reports a prospective study of the discriminant value of this symptom in such patients.
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PMID:Right-sided low inguinal pain in young women. 919 21

c-Fos has been used as a marker for activity in the spinal cord following noxious somatic or visceral stimulation. Although the viscera receive dual afferent innervation, distention of hollow organs (i.e. esophagus, stomach, descending colon and rectum) induces significantly more c-Fos in second order neurons in the nucleus of the solitary tract and lumbosacral spinal cord, which receive parasympathetic afferent input (vagus, pelvic nerves), than the thoracolumbar spinal cord, which receives sympathetic afferent input (splanchnic nerves). The purpose of this study was to determine the contribution of sympathetic and parasympathetic afferent input to c-Fos expression in the nucleus of the solitary tract and spinal cord, and the influence of supraspinal pathways on Fos induction in the thoracolumbar spinal cord. Noxious gastric distention to 80 mmHg (gastric distension/80) was produced by repetitive inflation of a chronically implanted gastric balloon. Gastric distension/80 induced c-Fos throughout the nucleus of the solitary tract, with the densest labeling observed within 300 microns of the rostral pole of the area postrema. This area was analysed quantitatively following several manipulations. Gastric distension/80 induced a mean of 724 c-Fos-immunoreactive nuclei per section. Following subdiaphragmatic vagotomy plus distention (vagotomy/80), the induction of c-Fos-immunoreactive nuclei was reduced to 293 per section, while spinal transection at T2 plus distention (spinal transection/80) induced a mean of 581 nuclei per nucleus of the solitary tract section. Gastric distension/80 and vagotomy/80 induced minimal c-Fos in the T8-T10 spinal cord (50 nuclei/section), but spinal transection/80 induced 200 nuclei per section. Repetitive bolus injections of norepinephrine produced transient pressor responses mimicking the pressor response produced by gastric distension/80. This manipulation induced minimal c-Fos in the nucleus of the solitary tract and none in the spinal cord. It is concluded that noxious visceral input via parasympathetic vagal afferents, and to a lesser extent sympathetic afferents and the spinosolitary tract, contribute to gastric distention-induced c-Fos in the nucleus of the solitary tract. The induction of c-Fos in the nucleus of the solitary tract is significantly greater than in the viscerotopic segments of the spinal cord, which is partially under tonic descending inhibition, but is not subject to modulation by vagal gastric afferents. Distention pressures produced by noxious gastric distention are much greater than those produced during feeding, suggesting that c-Fos induction in the nucleus of the solitary tract to noxious distention is not associated with physiological mechanisms of feeding and satiety. The large vagal nerve-mediated induction of c-Fos in the nucleus of the solitary tract following gastric distension suggests that parasympathetic afferents contribute to the processing of noxious visceral stimuli, perhaps by contributing to the affective-emotional component of visceral pain.
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PMID:Differential c-fos expression in the nucleus of the solitary tract and spinal cord following noxious gastric distention in the rat. 888 83

The present report provides evidence that axons in the medial part of the posterior column at T10 convey ascending nociceptive signals from pelvic visceral organs. This evidence was obtained from human surgical case studies and histological verification of the lesion in one of these cases, along with neuroanatomical and neurophysiological findings in animal experiments. A restricted lesion in this area can virtually eliminate pelvic pain due to cancer. The results remain excellent even in cases in which somatic structures of the pelvic body wall are involved. Following this procedure, neurological testing reveals no additional neurological deficit. There is no analgesia to pinprick stimuli applied to the body surface, despite the relief of the visceral pain. Since it is reasonable to attribute the favorable results of limited midline myelotomies to the interruption of axons of visceral nociceptive projection neurons in the posterior column, we have performed experiments in rats to test this hypothesis. The results in rats indicate that the dorsal column does indeed include a nociceptive component that signals pelvic visceral pain. The pathway includes neurons of the postsynaptic dorsal column pathway at the L6-S1 segmental level, axons of these neurons in the fasciculus gracilis, and neurons of the nucleus gracilis and the ventral posterolateral nucleus of the thalamus.
Pain 1996 Oct
PMID:Is there a pathway in the posterior funiculus that signals visceral pain? 895 23

A 52 year old female with Parry-Romberg syndrome presented with gradual atrophy of the subcutaneous fat and muscle on her chest and back. The disease process was limited to the C3 to T2 dermatomes on the right side. In addition, there was muscle atrophy of the right arm and extending down the back to T10, als well as right sided paralysis of the diaphragm. Sympathetic nerve blockage reduced pain and hyperesthesia; no progression was seen over several months using NMR to monitor the patient. The Parry-Romberg syndrome has been defined in many ways; in view of this unusual case, we review the literature, attempting to provide a more accurate case definition.
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PMID:[Parry-Romberg syndrome. Summary and new knowledge based on an unusual case]. 896 1

In a randomized double-blind study, the use of continuous epidural lidocaine during surgery combined with preoperative epidural morphine was compared with that of preoperative epidural morphine alone for postoperative analgesia in 20 patients undergoing hepatectomy. Morphine 2 mg was administered through a catheter inserted epidurally at T10-11 before surgery, followed by continuous epidural administration of 1% lidocaine 5ml.h-1 in group Lid (n = 10) or normal saline 5ml.h-1 in group NS (n = 10) during surgery. Anesthesia was maintained with N2O-O2-isoflurane in both groups. On admission to the ICU, the visual analog scale score (VAS; mm) was 20 +/- 7 (mean +/- SE) in group Lid and 38 +/- 10 in group NS, and the number of patient with VAS < or = 30 was 9 in group Lid and 4 in group NS; these differences were significant (P < 0.05). Pain score during mobilization in group Lid was significantly lower than that in group NS (P < 0.05). All patients in both groups had adequate analgesia for the remainder of their stay in the ICU. No patient had any serious adverse effect. We conclude that continuous epidural administration of lidocaine during hepatectomy combined with administration of epidural morphine just before surgery results in better pain relief during the early postoperative period than that obtained with epidural morphine alone, and is without serious side effects.
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PMID:[Intraoperative continuous epidural lidocaine combined with preoperative administration of epidural morphine for post-hepatectomy pain relief]. 902 91

We determined the early postoperative analgesia using intraoperative continuous epidural infusion of lidocaine during general anesthesia in patients undergoing upper abdominal surgery in a prospective double-blind manner. After insertion of an epidural catheter at the T10-T11 interspace, general anesthesia was induced. Thirty patients were randomly allocated to receive continuous epidural infusion of either 0.5% (n = 15) or 1% (n = 15) plain lidocaine at 10 ml/hr. The infusion was continued from 10 to 15 minutes before surgery until the end of surgery. Visual analog pain scale (0-10) within 30 minutes after the end of surgery was significantly lower in the 1% lidocaine group (5.6 +/- 0.9, mean +/-SE) than in the 0.5% lidocaine group (8.2 +/- 0.8), however, it was unsatisfactory in both groups. Plasma concentrations of lidocaine and its principal metabolite, monoethylglycinexylidide, gradually increased through epidural infusion, but remained below the toxic range in both groups. We conclude that continuous epidural lidocaine during general anesthesia offered limited analgesia in the early postoperative period.
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PMID:Intraoperative continuous epidural lidocaine for early postoperative analgesia. 904 50

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

Ganglionic and synovial cysts (juxta-facet cysts) causing nerve root compression are very rare. Magnetic resonance imaging is the best means of diagnosis. The treatment of choice is surgical removal of the cysts, though spontaneous remissions do occur. CT-guided aspiration of the cysts and corticosteroid injection can lead the symptoms to disappear, but only for a short time. In a retrospective study covering a period of 16.5 years, we discovered 24 juxta-facet cysts (10 ganglionic and 14 synovial cysts) with clinical symptoms in a total of 19,107 lumbar and thoracic operations performed to relieve nerve root compression: 16 cysts were located at the level L4-5,3 at the level L5-S1,2 at L3-4, and 1 each at the levels L2-3, L1-2, and T10-1. Seven patients complained of radicular pain, and the other 17 patients also had neurological deficits. Fourteen cysts were resected, and in 10 cases the lumbar disc was removed simultaneously. The average follow-up in 23 of the 24 patients was 26.6 months. Most (74%) of the patients became free of pain. Pareses disappeared in 89% and sensory deficits in 73% of cases.
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PMID:[Juxta-facet cysts as space-occupying intraspinal processes]. 931 86

The sites of renal pain processing in the rat spinal cord were studied by mapping the spinal cord neurons expressing c-fos after acute ureteral distension due to obstruction. A new experimental model is presented. A nylon knot was loosely placed around the ureter and the ends of the thread exteriorized through the retroperitoneal wall. Eight days later, when all c-fos expression due to nociceptive input from the abdominal wound and the manipulation of the intestines had disappeared, the nylon ends were pulled to produce ureteral occlusion. C-fos activation occurred at spinal segments T10-L4 with a peak at L1-L2. The activated neurons were concentrated in laminae I, lateral IV-V, medial VII and X. While in lamina I nearly all Fos-immunoreactive cells were ipsilateral, in the deeper laminae taken together 60% cells were ipsilateral and 40% contralateral to the distended ureter. It is suggested that renal nociceptive input giving rise to conscious pain perception is transmitted through ipsilateral lamina I, whereas input triggering autonomic reflexes may be mainly processed, ipsi- and contralaterally, in the deep laminae.
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PMID:Sites of renal pain processing in the rat spinal cord. A c-fos study using a percutaneous method to perform ureteral obstruction. 947 Jan 45


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