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

A possible role of the dorsal column (DC) in the processing of visceral pain has gained attention after studies in the rat have revealed that the DC transmits a major part of the pelvic visceral nociceptive input from the colon into the thalamus. Furthermore, clinical interventions aimed at interrupting ascending DC axons near the midline were successful in relieving the pain suffered by patients with cancer of the pelvic organs. The purpose of this study was to check whether a DC lesion in monkeys would reduce the responses of thalamic neurons to graded colorectal distension (CRD) as in rats. Experiments were done on anesthetized male monkeys (Macaca fascicularis). Extracellular single cell recordings were made in the ventrolateral complex of the thalamus, mainly the ventral posterolateral (VPL) nucleus, in response to visceral and cutaneous stimulation. Of 80 VPL cells isolated, CRD activated 25, inhibited 25, and had no effect on 30 neurons. The responses of six viscerosensitive VPL neurons were recorded before and after a lesion of the DC at or above the T10 spinal segment. Lesions of other spinal tracts were made after the DC lesion. The results show that the DC lesion significantly reduced the responses of the thalamic neurons tested with CRD by >50%. Lesions of other tracts did not have a consistent effect. These results corroborate findings in the rat and support the proposal that the DC plays an important role in transmitting nociceptive visceral input into the thalamus and subsequently in visceral pain.
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PMID:A role for the dorsal column in nociceptive visceral input into the thalamus of primates. 963 14

The common diagnoses in low back pain are lumbar strain, lumbosacral radiculopathy, osteoarthritis, degenerative disc disease, spinal stenosis, and sacroiliac joint dysfunction. Unusual causes of low back pain that have been previously identified include abdominal aortic aneurysms, pelvic neoplasms, and retroperitoneal hemorrhages. This report describes a case of back pain that was apparently caused by a duodenal ulcer. A 54-year-old man with no significant medical history presented with a complaint of mid to low back pain (T10-L2), which was diagnosed as joint dysfunction. A comprehensive treatment program was prescribed and the patient was instructed to return to clinic in 4 weeks. Three weeks later, he experienced a syncopal episode followed by coffee ground emesis. He immediately sought medical attention at an emergency room, where he was admitted to the hospital with a diagnosis of upper gastrointestinal bleed. Esophagogastroduodenoscopy showed a large duodenal ulcer, and the patient underwent vagotomy and pyloroplasty. He returned to his physiatrist's office 3 weeks after hospital discharge with minimal back pain. The cause of the back pain proved to be referred visceral pain from his duodenal ulcer. This case is presented to reemphasize the need to include the uncommon phenomena in the differential diagnosis of low back pain.
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PMID:Low back pain caused by a duodenal ulcer. 974 98

A 33-year old man with acquired immunodeficiency syndrome was admitted to Severance hospital following 1 year of diarrhea and 2 to 3 months of low sternal pain. The patient had progressive generalized lymphadenopathy for the previous 3 years. Whole body bone scan for evaluation of bone pain showed multiple abnormal hot uptakes at the low sternal body and T8 and T10 vertebra. Chest CT showed multifocal cortical erosion of the bone with soft tissue mass at the low sternal body and spine MRI showed multiple low-signal density in T1WI and high-signal density in T2WI at the T8 and T10 vertebral body. Biopsy was performed at the sternochondral junction and it showed high-grade malignant lymphoma of the large cell immunoblastic type. Immunostaining showed positive for the B-cell markers (CD79a and L26) and negative for the T-cell marker (UCHL1). Radiotherapy of 3,000 cGy was delivered to the sternum and vertebra. Since then, systemic chemotherapy with m-BACOD regimen (except dexamethasone) and anti-retroviral therapy with a combination of 3 drugs (didanosine, lamivudine, indinavir) has been performed. This is the first case report of primary bone lymphoma associated with acquired immunodeficiency syndrome in Korea.
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PMID:A case of primary bone lymphoma associated with acquired immunodeficiency syndrome. 975 6

Axial rotation of the trunk is commonly associated with back injury and pain. However, the behaviour of trunk muscles in axial rotation is poorly understood. The objective of this study was to measure spectral parameters from the EMG of erector spinae at T10 and L3 levels, latissimus dorsi, external and internal oblique, rectus abdominis and pectoralis major muscles bilaterally in a standardized repeatable axial rotation at 60% MVC to fatigue. Twelve young and healthy subjects were recruited after screening for musculoskeletal disorders. Surface electrodes were applied to the named seven trunk muscles bilaterally. Subjects were seated in the device called Axial Rotation Tester and stabilized such that they could rotate only their thoracolumbar spine. Other motions were prevented. Subjects held 60% of their MVC for a period of 2 min. Samples (2.1 s) were obtained at every 10 s interval at a sampling frequency of 1 KHz. Samples were subjected to FFT analysis. The total power and the median frequencies were analyzed. The median frequency for different muscles were different (p < 0.001). The slopes of decline of the median frequencies of the agonists were different for different muscles (p < 0.001). This differential fatiguing rate could conceivably create a force imbalance potentiating back injury.
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PMID:Spectral parameters of trunk muscles during fatiguing isometric axial rotation in neutral posture. 977 99

Percutaneous spinal cord stimulation (SCS) (Medtronic model 3487A PISCES-Quad lead) was carried out in 10 patients with rest pain from advanced peripheral vascular disease of the lower limb, who were unsuitable for conventional treatment. Trial stimulation ranged from 1-20 weeks and was associated with pain relief in nine of the patients. Claudication distance was improved in six patients. Trophic lesions improved in one patient with small artery disease. Spinal cord stimulation did not reverse the course of acute gangrenous lesions. The distal arterial pressure measured by Doppler Ankle/Brachial Pressure Index, (ABPI), showed no change. The capillary blood flow and skin temperature of both feet, measured, respectively, by Laser Doppler flowmetry and skin thermistor, showed a tendency to decrease when the stimulation was at the higher level, above T10, compared with an increase when the stimulation was at the lower level T12. Transcutaneous oxygen tension monitoring of the symptomatic foot showed an increase in four out of five patients. Pain relief was not dependent on circulatory changes, but it was more significant when the circulatory changes showed an impressive increase in the blood flow. The mechanism of these circulatory changes is probably by modulation of the sympathetic nervous system. Recognition of the optimal sitting of SCS may be critical in the clinical use of this technique, which seems to be a valuable option in the treatment of patients with advanced peripheral vascular disease (PVD).
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PMID:The differential effect of the level of spinal cord stimulation on patients with advanced peripheral vascular disease in the lower limbs. 1007 Apr 41

A limited midline myelotomy at T10 can relieve pelvic cancer pain in patients. This observation is explainable in light of strong evidence in support of the existence of a visceral pain pathway that ascends in the dorsal column (DC) of the spinal cord. In rats and monkeys, responses of neurons in the ventral posterolateral thalamic nucleus to noxious colorectal distention are dramatically reduced after a lesion of the DC at T10, but not by interruption of the spinothalamic tract. Blockade of transmission of visceral nociceptive signals through the rat sacral cord by microdialysis administration of morphine or 6-cyano-7-nitroquinoxaline-2,3-dione shows that postsynaptic DC neurons in the sacral cord transmit visceral nociceptive signals to the gracile nucleus. Retrograde tracing studies in rats demonstrate a concentration of postsynaptic DC neurons in the central gray matter of the L6-S1 spinal segments, and anterograde tracing studies show that labeled axons ascend from this region to the gracile nucleus. A similar projection from the midthoracic spinal cord ends in the gracile and cuneate nuclei. Behavioral experiments demonstrate that DC lesions reduce the nocifensive responses produced by noxious stimulation of the pancreas and duodenum, as well as the electrophysiological responses of ventral posterolateral neurons to these stimuli. Repeated regional blood volume measurements were made in the thalamus and other brain structures in anesthetized monkeys in response to colorectal distention by functional MRI. Sham surgery did not reduce the regional blood volume changes, whereas the changes were eliminated by a DC lesion at T10.
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PMID:A visceral pain pathway in the dorsal column of the spinal cord. 1039 79

The results of DREZlesioning procedure used for the treatment of chronic intractable pain due to deafferentation caused by gunshot injuries at the thoracolumbar (T10-L1) spine level are reported in six patients. The specificity of these cases arises from the fact that all the patients underwent, after decompressive laminectomy, an implantation of vascularized omental graft on the injured cord segments, 4-17 months after injury. Because of the failure of this method, which did not improve spinal function nor hinder the development of pain, surgery in the DREZ was performed 2-5 years after implantation. The results of the microsurgical DREZotomy procedure in those patients, 7-12 months after the surgery were: 4 patients with complete pain relief and 2 patients with pain relieved of 80%. All the patients with well-confined segmental pain were completely cured.
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PMID:DREZ surgery on conus medullaris (after failed implantation of vascular omental graft) for treating chronic pain due to spine (gunshot) injuries. 1067 2

We present a case of liver capsule pain after blunt abdominal trauma. The patient was unable to tolerate patient-controlled i.v. opioids, and epidural infusion of local anaesthetic was considered undesirable because of the potential risk of complications. Pain was managed successfully with paravertebral infusion of local anaesthetic at the right T10 level. Innervation of the liver and possible mechanisms of visceral pain processing are discussed.
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PMID:Paravertebral block in the management of liver capsule pain after blunt trauma. 1069 Jan 52

This study was conducted to determine somatosensory perception thresholds in 97 immunocompetent patients with herpes zoster (HZ), and to evaluate their associations with the development of post-herpetic neuralgia (PHN). Warm, cold and heat pain thresholds were tested by Thermotest (SOMEDIC) and tactile thresholds by Semmes-Weinstein monofilaments. To establish reference values, 103 healthy subjects underwent somatosensory testing, from which values were calculated for both genders for four age groups (<60, 60-69, 70-79 and >/=80years) in five dermatomal levels (VI, C3, T3, T10 and S1). Patients with HZ underwent quantitative somatosensory testing within the affected dermatome, its mirror image dermatome and an adjacent dermatome bilaterally. The follow-up visits with somatosensory testing took place at 2 weeks, 6 weeks, 3 months and 6 months. When evaluated as means of the results, warm and cold thresholds were significantly elevated in the affected dermatome from the initial visit until 3 and 6 months, respectively. By contrast, heat pain thresholds were lowered at the initial visit but normalized by 2 weeks, and tactile thresholds remained unchanged. These threshold changes were associated neither with further development of PHN nor each other. It is concluded that measurement of somatosensory perception thresholds in early stages of HZ shows evidence of impaired neural function but is not helpful in predicting which patient will go on to develop PHN. Copyright 1999 European Federation of Chapters of the International Association for the Study of Pain.
Eur J Pain 1999 Dec
PMID:Thermal and tactile perception thresholds in acute herpes zoster. 1070 Mar 65

Based on a hypothesis of neural system involvement in the initial absorption and further processing of the millimeter electromagnetic waves (MW) signal, we reproduced, quantitatively assessed and compared the analgesic effect of a single MW treatment, exposing areas of skin possessing different innervation densities. The cold water tail flick test (cTFT) was used to assess experimental pain in mice. Three areas of exposure were used: the nose, the glabrous skin of the right footpad, and the hairy skin of the mid back at the level of T5-T10. The MW exposure characteristics were: frequency = 61.22 GHz; incident power density = 15mW/cm2; and duration = 15 min. The maximum hypoalgesic effect was achieved by exposing to MW the more densely innervated skin areas--the nose and the footpad. The hypoalgesic effect in the cTFT after MW exposure to the murine back, which is less densely innervated, was not statistically significant. These results support the hypothesis of neural system involvement in the systemic response to MW.
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PMID:Hypoalgesic effect of millimeter waves in mice: dependence on the site of exposure. 1082 49


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