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Query: UMLS:C0184567 (acute pain)
 3,962 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The back pain syndrome which accompanies involutional osteoporosis presents a marked heterogeneity. Acute pain may be due to vertebral fractures, whereas chronic pain may eventually accompany established osteoporosis in which clinical and instrumental evidence are present. Back pain is the consequence of the mechanical (internal or external pressure) or chemical stimulation of pain receptors present in bone tissue, along the vessels, in cartilage, joints, disk, ligaments, and also in soft tissue and muscle (with secondary antalgic contracture). The compression of spinal nerves may contribute to the pain as well. An evident alteration of mood is usually present and represents an important element in the syndrome. This phenomenon interferes with the evolution of pain, in particular as regards its intensity. Besides scales for the evaluation of pain and inability, it is possible to check objective data by means of particular algometers (not easy to employ) or by electromyographic measurements of antalgic secondary contracture of spinal muscle. Gait examination (basography) of patients with painful hip prosthesis may provide objective evaluation regarding specific antalgic activity on bone of drugs. Usually the effective drugs for osteoporosis possess antalgic properties as well, with different mechanisms of action. Three drugs with evident activity are taken into consideration: calcitonin, ipriflavon, aminobutane-bisphosphonate (alendronate). Though each of them possesses some particular activity, the main mechanism of action is dependent on their effect on the local microenvironment, particularly at the level of bone tissue (calcium, cytokine and prostaglandin local concentration), on the modulation of osteoclast activity. In particular alendronate (intermittently administered intravenously) exerts the most evident antalgic activity. Subjective chronic back pain relief is accompanied by (secondary) reduction of antalgic contracture at vertebral muscle level. The activity of the substance against the painful hip prosthesis (documented by basographic gait recording) leads us to conclude that the substance really exerts a direct antalgic action at the level of bone tissue.
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PMID:[Treatment experience with chronic spinal pain in involutional osteoporosis]. 129 92

This chapter has reviewed research on psychological and social factors associated with the onset and progression of low back pain. From this review it can be concluded that psychosocial traits appear to be important contributors to the course of pain and disability though methodologically well-designed longitudinal studies are rare. For this reason it is difficult to assess the relative importance of, for example, psychological distress compared with work stress. Furthermore, the mechanisms by which specific variables effect back pain remain unknown. The answer, no doubt, lies in longitudinal studies which employ multicausal models. It has been noted the psychosocial treatments which have proven effective for chronic pain populations are rarely assessed with acute pain patients. Some problems are the inaccessibility of acute back pain sufferers to psychologists, the difficulty of isolating the effect of one component of a multidisciplinary programme and the lack of uniform practice of psychosocial techniques. None the less, programmes which include psychosocial interventions appear to have superior results to those which do not. Since these techniques are often simple and inexpensive to include they should be incorporated into all treatment programmes where the potential for chronic pain syndrome exists. Gaps and flaws in current research methodologies have been identified and suggestions for future investigations have been proposed. In addition we have attempted to provide some practical guidelines for health care professionals to help them identify salient psychosocial issues which may effect the course of their patient's treatment. Recommendations for assessment and referral are also provided.
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PMID:Psychosocial issues in the prevention of chronic low back pain--a literature review. 147 96

The relationship between pain modifying factors, pain duration, and the role of anxiety in low-back pain experience were studied. Three groups of patients with low-back pain were examined using the Tourniquet Pain Test, McGill Pain Questionnaire, Rating Scale of Pain Intensity, State-Trait Anxiety Inventory, and Psychological Discomfort Questionnaire. Significant differences in all measured features emerged between acute and chronic pain groups. Groups of acute and subchronic pain and groups of subchronic and chronic pain differed only in several parameters, suggesting an intermittent phase in acute pain transition into chronicity. While pain prolonged, pain experience gradually but irregularly changed, exaggerating pain perception. The changes concerned mainly emotional factors and were related to the chronicity itself. Anxiety also played a significant role.
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PMID:Low-back pain. Perception and tolerance. 293 33

Patients with chronic low-back pain and depression were treated double blind with desipramine or doxepin. During this treatment several hypotheses regarding the modes of action of these drugs were examined. A low serotonin hypothesis was supported by the fact that patients who had pain relief following an acute challenge with fenfluramine, a relatively pure releaser of serotonin, were significantly more likely to have pain relief on either antidepressant. The antidepressants did not change cerebrospinal fluid (CSF) beta-endorphin levels, acute pain tolerance, or electromyogram (EMG) levels. The nonsedating antidepressant desipramine was as effective as doxepin; 60% of patients had significant pain relief. Pain relief was associated with depression relief, but several patients had only pain or depression relief. Patients who had a substantial physical basis for their pain responded as well as those who did not.
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PMID:Tricyclic antidepressants for chronic low-back pain. Mechanisms of action and predictors of response. 294 34

One hundred patients with complaints of low-back pain and leg pain, consistent with a diagnosis of sciatica, were evaluated. All patients had complaints for longer than 6 months and had recently undergone electrodiagnostic testing and computed tomography (CT). Correlation was made between symptoms, straight leg raising, clinical neurological deficits, electrodiagnostic and CT findings. The radiation of pain above or below the knee and pain on straight leg raising did not show a high correlation with each other or with neurological deficits or CT findings. Electrodiagnostic studies often defined a radiculopathy in patients with equivocal clinical signs. CT findings did not predict the nature of symptoms or clinical and electrodiagnostic findings. Electrodiagnostic abnormalities showed the greatest ability to predict CT abnormalities. It is concluded that in chronic sciatica patients, no single diagnostic parameter is conclusive and a combination of clinical and laboratory findings is necessary to reach a diagnosis. In addition, many assumptions, valid in patients with acute pain cannot be extrapolated to patients with chronic sciatica.
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PMID:Computed tomography, electrodiagnostic and clinical findings in chronic workers' compensation patients with back and leg pain. 296 67

To determine the prevalence and nature of pain in multiple sclerosis, we evaluated by questionnaire, interview, and chart review 159 patients residing in Middlesex County and followed in the MS Clinic at University Hospital, London, Ontario, Canada. Eighty-eight patients (55%) had either an acute or chronic pain syndrome at some time during their disease. Fifteen patients (9%) with acute pain syndromes had episodes of paroxysmal tic-like pain diagnosed in seven as trigeminal neuralgia. Chronic pain syndromes, present for a mean duration of 4.9 years, occurred in 76 patients (48%) and included dysesthetic extremity pain (29%), back pain (14%), painful leg spasms (13%), and abdominal pain (2%). MS patients with pain were similar to the pain-free group in mean age of onset (34.0 versus 31.9 years), average duration of disease (13.3 versus 12.1 years), spinal cord involvement (97% for each group), and mean rating on Kurtzke Disability Status Scale (4.2 versus 3.5). They differed in sex ratio with a higher female-to-male ratio in the pain group (3:1 versus 1.4:1). Chronic pain is a common feature of well-established MS and is usually associated with a myelopathy. Therapy must be individualized for each specific pain syndrome.
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PMID:Pain syndromes in multiple sclerosis. 273 10

Workers' compensation laws influence recovery from injury. They affect the "cause" of disease, access to care, diagnostic evaluation, treatment, response to treatment and residual disability. Paradoxically, financial compensation may discourage return to work, the appeal process may increase disability, an open claim may inhibit return to work and recovering patients may be unable to return to work. Physicians may help improve the prospects of returning patients to work by providing care that is medical, caring and independent. It is essential that the treatment of back pain be based on the known natural history and on the understanding that the management of acute pain differs from that of chronic pain. Increased awareness of the factors controlling return to work should motivate legislative bodies, labor and industry to alter those features of the compensation system that interfere with the return to work of injured workers.
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PMID:Compensation and recovery from injury. 623 94

An adolescent girl with chronic myelogenous leukemia was treated with hypnosis for several disease- and treatment-related problems during the last 4 months of her life. Data were collected before and after hypnosis on the nature and intensity of the patient's acute pain and anxiety during bone marrow aspirations, chronic headache and backache, nausea and vomiting during chemotherapy, anorexia, and the discomfort associated with spiking temperatures. Comparisons of baseline and posthypnosis reports suggest that hypnosis was successfully used for acute and chronic pain, anxiety, unpleasant body sensations and, possibly, nausea and vomiting. The hypnotic techniques used, the limitations of hypnosis and clinical issues in this case are presented and discussed.
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PMID:Use of hypnosis for multiple symptoms in an adolescent girl with leukemia. 645 20

The high economical costs produced by the impact of low back pain on sick-listing and loss of manpower at work encouraged the search for personal or situational characteristics that indicate an increased risk for an acute onset of back pain or for its continuation towards chronicity. Risk factors for the onset of acute pain identified at the workplace refer to mechanical and psychomental strain. Vibration as well as lifting and carrying of heavy loads, especially if combined with a twisting of the trunk, are the most prominent mechanical risks, whereas dissatisfaction with the job or the working conditions, especially if there is a lack of social support either at the workplace or at home by the family or the spouse, increase the risk on a psychosocial level. Although these risks continue to be effective in the process of chronicity, other risks pertaining to behavioral and emotional reactions to the acute pain episode gain in importance. At the acute level, avoidance of physical and social activities are often encouraged by physicians who prescribe bed rest or give advice to regulate the active reinvolvement in daily life by assessing pain levels ('let the pain guide'). On the other hand, with regard to the prevention of chronicity, a strategy of graded early activation aiming at a reinforcement of healthy behaviors has more beneficial effects. After a short period of bed rest, no longer than two days, if at all necessary, patients are taught to maintain their daily activities and to practice specified exercises, while receiving time-contingent pain medication.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Chronification process of backache]. 804 19

Presented is a diagnostic instrument to assess chronic and acute pain, that allows multifaceted and standardized quantification of pain experience. This tool--the Pain Experience Scale ("Schmerzempfindungsskala"--SES)--measures two dimensions of subjectively felt pain, the affective characterization as well as modes of sensory characterization of pain. Applications range from degenerative or inflammatory joint and back pain to headache/migraine, neuropathias and other pain-related diseases (age 16 to 80 years). Completion, evaluation, and interpretation are done easily. Scale development had comprised 3 steps of research for obtaining a model of invariant structure and homogenous factors. Scale analyses demonstrated the instrument's reliability, and numerous studies illustrated the validity of the scale. They showed that factorial, convergent and discriminant validity can be regarded as given. Moreover, the scale proved to be sensitive in experimental pain studies. Additionally, specific patterns of scores could be observed validly for 18 different groups of disease/pain. Special efforts were invested to show its sensitivity to change in the course of pains. Here, the Pain Experience Scale proved to be suitable in postoperative pain, drug-based pain therapies, different psychological pain management approaches, physiotherapeutic prevention, and a multimodal treatment programme of a specialized pain clinic. In German-speaking countries, the SES has been in use for several years as a well-proven instrument in medical care, clinical research as well as field evaluation.
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PMID:[The Pain Perception Scale--a differentiated and change-sensitive scale for assessing chronic and acute pain]. 857 Aug 98


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