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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We examined a pain-related syndrome, which includes mechanical allodynia and autotomy, in rats after ischemic spinal cord injury photochemically induced by laser irradiation for 5-20 min. This procedure results in an acute allodynia-like phenomenon which lasts for several days and is possibly related to dysfunction of the GABAB system in the spinal cord. In some animals this is followed by a chronic allodynia-like symptom with an onset varying between 1 week and 1.5 months after injury, expressed as a clearly painful reaction to light pressure applied to a skin area at or near the dermatome of the injured spinal segments. In the majority of rats the allodynia persists over several months, in some cases accompanied by autotomy of the hind paws. Pharmacological studies indicated that the allodynia in the majority of rats could be relieved by systemic tocainide (75 mg/kg). Morphine was only effective at a sedative dose (5 mg/kg). The allodynia was not relieved by baclofen, muscimol, clonidine or carbamazepine. Low-dose systemic pentobarbital (5 mg/kg) had a slight beneficial effect. Guanethidine (20 mg/kg, s.c.) did not abolish the allodynia in most of the rats. Histological examination revealed massive damage in the spinal cord. The dorsal roots of the irradiated segments were also injured. No morphological abnormalities were seen in the dorsal root ganglia. The mechanism that may account for this chronic pain-related syndrome in spinally injured rats probably involves abnormalities in the central nervous system. The allodynia seen in chronic spinally injured rats was similar to some painful symptoms in patients after spinal cord injury or stroke. It is suggested that the chronic allodynia-like phenomenon may represent an animal model for studying the mechanisms of chronic central pain.
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PMID:Chronic pain-related syndrome in rats after ischemic spinal cord lesion: a possible animal model for pain in patients with spinal cord injury. 158 48

Recently, it has been proposed that shoulder subluxation in hemiplegia is accompanied by 1) the appearance of a V-shaped articular configuration occurring between the humeral head and glenoid fossa and 2) the presence of chronic pain. The main purpose of this study was to investigate the validity of these statements. We evaluated 40 hemiplegic subjects over 3 months. Radiographs of the affected and nonaffected shoulders were taken at both a frontal plane (0 degree) and a 45 degree incidence. From these patients, subluxed (n = 19) and nonsubluxed (n = 21) groups were formed. Pain was evaluated using the Present Pain Intensity index of the McGill Pain Questionnaire. On these x-ray films, measurements were taken of the V-shaped space, abduction of the arm, and rotation of the scapula. The statistical analysis (analysis of variance for repeated measures) contrasted the results obtained from the nonaffected side with those from the affected side over the 3 months studied. At the 45 degree angle, which better exposes the articular configuration of the shoulder, the difference in the V angle between the affected and nonaffected shoulders was significant for the subluxed group (p less than 0.01), indicating that such a V-shaped space can be identified. The measures taken also indicate that a downward subluxation of the humeral head occurs relative to the scapula without any systematic abduction of the humerus or downward rotation of the scapula. None of the results obtained from the frontal plane x-ray films was significant. Finally, no significant relation was found between subluxation and shoulder pain.
Stroke 1991 Jul
PMID:Clinical significance of the V-shaped space in the subluxed shoulder of hemiplegics. 185 6

A hypertensive man had a long standing history of contumacious hyperpathia in the right upper extremity, resistant to medical therapy, secondary to a lacunar infarct in the left thalamus. A second cerebrovascular accident caused a small lesion in the left corona radiata, interrupting the thalamoparietal interconnections, and terminated the pain instantly. Interruption of the subcortical parietal white matter may more effectively control pain than cortical lesions. A few surgeons have successfully treated rebellious chronic pain with stereotaxic operations in the corona radiata, resulting in lesions very similar to our patient's. This overlooked and nearly forgotten technique may still have value in treating selected cases.
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PMID:Disappearance of thalamic pain after parietal subcortical stroke. 205 98

Chronic low back pain (CLBP) is one of the most pervasive and costly problems facing medicine today. In addition to personal suffering, CLBP accounts for a greatly disproportionate amount of consumer health care over-utilization, employee absenteeism, lowered work productivity, disability and compensation payments. Recent research in the area has called attention to the complex nature of the problem and the need for an interdisciplinary approach to identification and management. Toward this end, a panel of health care professionals with skill in the assessment and treatment of chronic pain was convened on November 17, 1988. Sponsored by the Institute for Behavioral Medicine in Providence and with funding from the National Institute for Neurological Disorders and Stroke, Stroke and Trauma Program, the purpose of the panel discussion was to bring together clinicians and researchers from distinctly different specialties but who all work with CLBP patients. Topics of discussion included etiology, current status of medical diagnostics and treatments for chronic pain, conceptual and systems issues, and directions for future research.
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PMID:Interdisciplinary perspectives on mechanisms and management of low back pain. 213 53

Although abdominal and groin injuries are not unique to the game of tennis, the very mechanics of the ground stroke and overhead volley predispose participants in this sport to the chronic pain and frustration of these injuries. Careful consideration must be given not only to the muscular anatomy of the region but also to the visceral and neurologic anatomy. A patient, controlled program of rehabilitation, emphasizing flexibility and subsequent strengthening, must be stressed if recurrence is to be avoided.
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PMID:Abdominal and groin injuries in tennis. 296 51

Transcutaneous stimulation is a proven effective way to relieve pain. Its optimal use requires an accurate patient diagnosis. Treatment of pain as a symptom only is likely to fail. There must be a careful psychosocial evaluation, for the majority of patients who come to the doctor complaining of pain have major psychological, social, or behavioral factors that are most important in the genesis of the complaint. Drug abuse must be corrected. Related symptoms, such as anxiety and depression, must be treated. Then, a thorough trail of transcutaneous stimulation is mandatory. A desultory use will undoubtedly lead to failure. This trial must begin with patient education by experienced personnel. Then the electrodes must be properly applied, and there must be a regular follow-up of stimulation to be certain the patient is utilizing it correctly. The patient must be supported through an adequate trial which should extend over 2-4 weeks before purchase of the device is contemplated. Furthermore, all related nursing and physician personnel must be educated in the proper use of the technique. The uninformed professional who denigrates the therapy is a very effective deterrent to appropriate use. In this situation, transcutaneous electrical stimulation will be of great value in the treatment of acute musculoskeletal injury and acute postoperative pain. It will be effective in the treatment of peripheral nerve injury pain, chronic musculoskeletal abnormalities, chronic pain in the patient who has undergone multiple operations upon the low back and neck, visceral pain, some of the reflex sympathetic dystrophies, and postherpetic neuralgia. Stimulation will not help a complaint which is psychosomatic in origin. It will not influence drug addiction. It is not likely to be useful in any situation where secondary gain is important. The metabolic neuropathies, pain of spinal cord injury, and pain from cerebrovascular accident will not respond frequently enough to warrant more than hopeful trials. The technique is inexpensive, places the patient in control of his own pain, and has no known serious side effects. Its widespread application awaits the development of reasonable systems to provide this service to physicians and patients. Stimulation-induced analgesia deserves a place in the armamentarium of every physician dealing with the complaint of pain.
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PMID:Stimulation of the peripheral nervous system for pain control. 623 44

Hydroxyurea can increase fetal hemoglobin (HbF) and improve the clinical course of sickle cell disease (SCD) patients. However, several issues of hydroxyurea therapy remain unresolved, including differences in patients' drug clearance, predictability of drug response, reversibility of sickle cell disease-related organ damage by hydroxyurea, and the efficacy of elevated HbF. We treated two patients with hydroxyurea for periods of 1 to 4 years, monitoring clinical course and laboratory parameters at regular intervals. The first patient (patient A) had a history of chronic pain and extensive hospitalizations. The second patient (patient B) had a history of stroke and refused to continue with chronic transfusion therapy and chelation. Both patients showed a fivefold to tenfold increase in HbF (5% to 25%, 3% to 31%). However, patient A developed an acute chest syndrome, despite an HbF level of 20%. After red blood cell transfusions for hypoxia, the HbF level decreased to 5%. When hydroxyurea dosage was increased, pancytopenia developed and was not resolved until 2 months after hydroxyurea was discontinued; Patient B developed a cerebral hemorrhage on hydroxyurea; he died shortly thereafter. His HbF level was 21% before death. We noted an increase in HbF and a general improvement in the two patients. However, both experienced major SCD-related complications despite HbF levels over 20%. Our findings also suggest that the progressive vascular changes associated with SCD are unlikely to be dramatically affected by increased HbF levels. Because neither the efficacy nor the toxicity of hydroxyurea have been thoroughly investigated, physicians should be cautious in prescribing hydroxyurea for patients with SCD before completion of the National Clinical Trial.
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PMID:A cautionary note regarding hydroxyurea in sickle cell disease. 750 9

Stellate ganglion block (SGB) is an established procedure for the diagnosis and treatment of chronic pain. SGB results in an acute sympathetic denervation of a part of the left ventricular (LV) wall innervated by the blocked ganglion, which may impair regional contractility. The resulting imbalance of myocardial contractility in different LV regions may affect LV function adversely by increasing LV asynchrony. Seven anesthetized open chest dogs were instrumented for measurement of aortic and LV pressure (tip manometers), cardiac output (CO, thermodilution), and regional LV wall thickness (WT, sonomicrometry) in the anteroapical (predominantly innervated by the right stellate ganglion) and posterobasal wall (left stellate ganglion). The contractility of both regions was assessed using the relationship between preload recruitable stroke work and end-diastolic WT relationship (MW). The timing of regional myocardial wall motion was evaluated by means of the phase of the first harmonic of the Fourier transform of the WT signals, LV asynchrony by the phase difference (PD) between both regions, and LV diastolic function by the time constant of isovolumic relaxation (tau). Measurements were performed before and after left SGB (LSGB). Mean arterial pressure was 105 +/- 25 (mean +/- SD) before and 97 +/- 10 mm Hg after LSGB (not significant). CO remained unchanged (3.09 +/- 1.03 vs 2.93 +/- 1.07 L/min). LSGB significantly reduced contractility in the posterobasal myocardium (MW -162 +/- 26 vs -80 +/- 7 mm Hg; P < 0.01), accompanied by a delay of regional wall motion within the cardiac cycle (phase 202 +/- 18 vs 223 +/- 17 degrees; P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Left stellate ganglion block impairs left ventricular function. 797 30

A study was done to determine how well residents in Physical Medicine and Rehabilitation (PM&R) believe their educational needs are being met in various clinical and didactic areas. Surveys were sent in April 1989 to the 814 persons on the 1989 American Academy of Physical Medicine and Rehabilitation resident physician registry. Residents were asked to rate how much experience they thought they were getting in their residency for each of 22 clinical and didactic topics such as stroke, spinal cord injury, head injury, prosthetics, chronic pain, sports medicine, pediatric rehabilitation, cardiopulmonary rehabilitation, electromyography, and physical modalities. In addition, they were asked to rate how much they believed they should be given with respect to these same topics. The response rate was 532 out of 814 (65%). Residents expected somewhat more than what they were getting overall; however, there were exaggerated discrepancies in a few specific areas. Residents believed they should be getting significantly more clinical and didactic experience in Industrial Medicine, Sports Medicine, Computer Applications, Therapeutic Injections, and Administration. The results should serve as guidelines for residency training and the study should serve as a model for future routine assessments.
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PMID:Physical medicine and rehabilitation residents' educational needs assessment. 832 87

A study of the literature describing research on alternative medicine showed that, in general, the research was of poor quality. Any clinical effect of kinesiology had not been documented. Only few studies on reflexology had been controlled. Several controlled studies on healing showed significant effect, mainly in patients with psychosomatic disorders, or when the patient had great faith in the healer. Acupuncture seems to be effective against nausea, in patients with chronic pain and in patients who have had stroke. The data do not support the claim that acupuncture is effective for asthma or addiction. In the case of homeopathy the evidence from clinical trials is positive but not sufficient to draw a definite conclusion, for example, is it better than placebo? The majority of studies seems to disregard the principle of homeopathy, i.e. that the treatment should be individualised. Even if the documented effect of alternative medicine is not convincing, the effect is favourable empirically and may in itself be sufficient to give practitioners of alternative medicine an authorization. The term "alternative medicine" should be replaced by "complementary medicine".
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PMID:[Research in alternative medicine. What is documented, and what is documentation?]. 926 7


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