Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 30-year-old parturient requested epidural analgesia during labor. Immediately after the epidural space was presumably identified using the loss-of-resistance-to-air technique, she reported severe back pain, followed by neck pain, which progressed to severe unrelenting headache. An emergency computerized tomographic (CT) scan performed during labor showed air in the intracranial subarachnoid space.
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PMID:Ascending back pain and headache during attempted epidural placement. 183

In acute whiplash injuries, early physiotherapy has been shown to reduce pain and increase cervical movement, but the cost-effectiveness of this treatment has been questioned. It is unclear whether the benefits result from manipulative physiotherapy or from the patient's ability to perform the accompanying home exercise programme when instructed about its importance. In a single blind prospective randomized trial 71 patients who received out-patient physiotherapy were shown to have significant improvement in severity of neck pain (P less than 0.01) and cervical movement (P less than 0.01) at 1 and 2 months post-injury when compared with 33 patients who received analgesia and a cervical collar. Sixty-six patients who were offered comprehensive advice for home mobilization by a physiotherapist showed a similar improvement. There appears to be no difference in effectiveness between outpatient physiotherapy and home mobilization.
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PMID:The role of physiotherapy in the management of acute neck sprains following road-traffic accidents. 271 85

Four postpartum patients with complaints of headache and neck pain were examined. All had received epidural analgesia and had a long second stage associated with prolonged pushing. Many similarities to postdural puncture headache were noted. The headache started the day after delivery and involved the occipital region primarily, along with the neck and shoulder girdle areas. However, the pain did not change with positional changes and was associated with marked tenderness of muscles at specific anatomic points. A diagnosis of cervical myofascial pain was made. All patients responded quickly to physical therapy. The authors suggest that many patients initially considered to have postdural puncture headache may actually have postpartum cervical myofascial pain.
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PMID:Postpartum cervical myofascial pain syndrome: review of four patients. 397 77

We present an unusual case of postoperative headache in a child after an epidural block. A seven-year-old girl (ASA 1) was scheduled to undergo a urological procedure under general anaesthesia combined with an epidural technique for intra- and postoperative analgesia. Although there was no evidence of dural puncture when the block was performed, the patient developed a headache postoperatively. The headache, which was accompanied by neck pain, appeared in the sitting or standing position and was relieved by decubitus. According to the mother, her child had never complained of those symptoms in the past. After independent evaluation by an anaesthetist and a neurologist, a postdural puncture headache (PDPH) was considered the most likely diagnosis. As oral analgesics failed to provide relief, and epidural blood patch (EBP) using 10 ml autologous blood was performed under light sedation. This was followed by resolution of the symptoms. Epidural injections of opioids and local anaesthetics are becoming increasingly popular for pain management in children. This implies that there may be an increasing number of unintentional dural punctures that may result in more PDPHs in children. Epidural blood patches are effective in treating PDPHs in adults but their use has been reported very rarely in children. Resolution of the patient's symptoms following EBP supported the diagnosis while illustrating that EBP can be useful in the treatment of PDPH in children.
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PMID:Epidural blood patch in a seven-year-old child. 755 1

It is estimated that between 15 and 30% of car occupants will suffer neck pain after accidents, and many will remain symptomatic for a prolonged period. This has often been attributed to the effect of associated litigation as a financial deterrent to recovery. Conventional treatment uses an old orthopaedic principle of rest until the symptoms resolve and analgesia is widely accepted, although its use is unlikely to influence the ultimate outcome. Mobilization programmes have become popular, particularly with physiotherapists, but they are often based upon personal experience and are largely scientifically untested. An improvement in both the cervical range of movement and a reduction in the severity of neck pain was claimed in a study in 1986 using early mobilization. In an attempt to identify which features of physiotherapeutic practice appeared to correspond with improved outcome, I studied the outcomes of differing treatment regimens in acute whiplash patients in three randomized groups and showed that after 1 and 2 months there was a significant improvement in cervical movements and in the patients' perception of their neck pain severity, in actively mobilized patients, including those who were instructed about postural correlation and mobilization techniques. The benefit conferred on this group was still evident 2 years post injury. It therefore seems that self-reliance with exercises used when symptoms are troublesome and postural advice can play a significant role in the recovery process.
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PMID:[Treatment of dislocations of the cervical vertebrae in so-called "whiplash injuries"]. 797 Jun 86

This randomized, double-masked, placebo-controlled, multicenter trial was conducted in 9 countries to assess the safety and efficacy of 2 doses of intravenous ondansetron (8 and 16 mg) for the control of opioid-induced nausea and vomiting. A total of 2574 nonsurgical patients who presented with pain requiring treatment with an opioid analgesic agent participated in this trial. The most common presenting painful condition was back or neck pain, reported by approximately one third of patients. A total of 520 patients (317 females, 203 males) developed nausea or vomiting after opioid administration and were randomly assigned to receive a single dose of 1 of 3 study treatments: placebo (n = 94), ondansetron 8 mg (n = 215), or ondansetron 16 mg (n = 211). Ondansetron 8 and 16 mg led to complete control of emesis in 134 of 215 patients (62.3%) and 145 of 211 patients (68.7%), respectively. Results with both doses were significantly better than those seen with placebo (43 of 94 patients [45.7%]). Complete control of nausea was achieved in 6.8% of placebo patients, 14.8% of ondansetron 8-mg-treated patients, and 19.4% of ondansetron 16-mg treated patients; only ondansetron 16 mg was significantly better than placebo (P = 0.007). Significantly more patients who received ondansetron 8 mg than patients who received placebo were satisfied/very satisfied with their antiemetic treatment, as assessed by 4 patient-satisfaction questions. Significantly more patients who received ondansetron 16 mg compared with placebo were satisfied/very satisfied on 2 of 4 satisfaction questions. In conclusion, based on the observed incidence of opioid-induced nausea and vomiting in this study, it may be more appropriate to treat symptoms on occurrence rather than administering antiemetic agents prophylactically. The results of this study demonstrate that intravenous ondansetron in doses of 8 or 16 mg is an effective antiemetic agent for the control of opioid-induced nausea and vomiting in nonsurgical patients requiring opioid analgesia for pain.
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PMID:Intravenous ondansetron for the control of opioid-induced nausea and vomiting. International S3AA3013 Study Group. 1046 19

Headache is the most common symptom after closed head injury, persisting for more than 2 months in 60% of patients. Rarely does headache occur in isolation. Cervical pain is a frequent accompaniment. Post-traumatic headache is often one of several symptoms of the postconcussive syndrome, and therefore may be accompanied by additional cognitive, behavioral, and somatic problems. Acute post-traumatic headaches may begin at the time of injury and continue for up to 2 months post-injury. Although onset proximate to the time of injury is most common, any new headache type occurring within this period of time is referred to as an acute post-traumatic headache. If such headaches persist beyond the first two months post-injury, they are subsequently referred to as chronic post-traumatic headaches. Over time, post-traumatic headaches may take on a pattern of daily occurrence. If aggressive treatment is initiated early, posttraumatic headache is less likely to become a permanent problem. Once "windup" of post-traumatic headaches occurs, the cycle of ongoing headaches is more difficult to interrupt. The mechanism of post-traumatic headache is poorly understood. Trauma-induced headaches are usually heterogeneous in nature, often including both tension-type pain and intermittent migraine-like attacks. Rebound-headaches may develop from overuse of analgesic medications, and the occurrence of such may complicate significantly the diagnosis of post-traumatic headache. Adequate treatment typically requires both "peripheral" and "central" measures. Understanding the general principles of treatment, especially appropriate use of preventive and abortive medications, will most usefully guide treatment. There is scant literature with which to direct treatment selection for post-traumatic headache. Consequently, treatments for post-traumatic headache are based on those prescribed for phenomenologically similar but etiologically distinct headache disorders. Delayed recovery from post-traumatic headache may be a result of inadequately aggressive or ineffective treatment, overuse of analgesic medications resulting in analgesia rebound phenomena, or comorbid psychiatric disorders (eg, post-traumatic stress disorder, insomnia, substance abuse, depression, or anxiety).
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PMID:Post-traumatic Headache. 1173 6

A prospective controlled, longitudinal study investigated the immediate and delayed complications of epidural analgesia in labour. One hundred and twenty-two parturients were studied: 81 had epidurals in labour and 41 had other forms of analgesia. Each parturient was studied over a period of 6 weeks. Epidural analgesia in labour and delivery is generally safe. Although the epidural group recorded more complications, they tended to be minor ones such as backache, headaches, shoulder and neck pain. Epidural blocks have an added advantage of being helpful in complicated labours like breech presentations, multiple pregnancies, pre-eclampsia, in situations where caesarean section is anticipated and in manual removal of the placenta.
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PMID:Immediate and delayed complications of epidural analgesia in labour and delivery. 1551 33

Acupuncture (AP) is effective for the treatment of postoperative and chemotherapy-induced nausea/vomiting and for postoperative dental pain. Several recent randomized trials have provided strong evidence for beneficial AP effects on chronic low-back pain and pain from knee osteoarthritis. For many other chronic pain conditions, including headaches, neck pain, and fibromyalgia, the evidence supporting AP's efficacy is less convincing. AP's effects on experimental pain appear to be mediated by analgesic brain mechanisms through the release of neurohumoral factors, some of which can be inhibited by the opioid antagonist naloxone. In contrast to placebo analgesia, AP-related pain relief takes considerable time to develop and to resolve. Thus, some of the long-term effects of AP analgesia cannot be explained by placebo mechanisms. Furthermore, it appears that some forms of AP are more effective for providing analgesia than others. Particularly, electro-AP seems best to activate powerful opioid and non-opioid analgesic mechanisms.
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PMID:Mechanisms of acupuncture analgesia: effective therapy for musculoskeletal pain? 1817 1

We report a case of acute neck cellulitis and mediastinitis complicating a continuous interscalene brachial plexus block. A 61-yr-old man was scheduled for an elective arthroscopic right shoulder rotator cuff repair. A continuous interscalene block was done preoperatively and 20 mL of 0.5% bupivacaine and 20 mL of 2% mepivacaine were injected through the catheter. Postoperative analgesia was provided by a continuous infusion of bupivacaine, 0.25% at 5 mL/h for 39 h using a 240-mL elastomeric disposable pump. The day after surgery, the patient complained of neck pain. The analgesic block was not fully effective. He was discharged home. Three days later, the patient was readmitted with neck edema and erythema, fever and fatigue. Neck ultrasonography and computed tomographic scan revealed an abscess of the interscalene and sternocleidomastiod muscles and cellulitis, as well as acute mediastinitis. Two blood cultures and surgical samples were positive for Staphylococcus aureus. The infection was treated with surgery, the site was surgically debrided, and a 2-mo course of vancomycin, imipenem, and oxacilline. The technique of drawing local anesthetic from the bottle and filling the elastomeric pump was the most likely cause of infection. This case emphasizes the importance of strict aseptic conditions during puncture, catheter insertion, and management of the local anesthetic infusate.
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PMID:Acute neck cellulitis and mediastinitis complicating a continuous interscalene block. 1880 8


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