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Biomedical subjects

W C Parris

Publications and source records attributed to W C Parris.

At least 19 recordsLinked to original sources
PubMed1993

Immunoreactive substance P in human saliva. A possible marker of chronic pain.

In all patients and volunteers, the levels of immunoreactive SP measured in saliva were about 100 times higher than the levels measured in plasma. SP per mg protein was consistently lower in both plasma and saliva of chronic pain patients than in healthy volunteers. These findings suggest that a simple noninvasive objective method of determining SP in saliva may become useful in the evaluation and treatment of chronic pain.

Adult↗
PubMed1992

Early detection measures and triage procedures for suicide ideation in chronic pain patients.

There is a dearth of writings about early detection of potential suicide patients in chronic pain centers. Early detection measures used at the Vanderbilt Pain Control Center include a Symptom Checklist-90, with questions about depressive symptomatology and "Thoughts of Ending Your Life"; medical and psychological interviews; monitoring of changes in emotional disturbance; and, if warranted, administration of the Scale of Suicidal Ideation. Three case studies are presented that indicate that the results of an assessment measure should be tempered with clinical judgment. Suicidal behavior, including suicidal ideation, is a medical emergency; therefore, there is great need for early detection and triage measures.

Adult↗
PubMed1991

The effects of neurokinin A, neurokinin B, and eledoisin on substance P analysis.

Commercial sources for neuropeptide radioimmunoassays have made this sensitive tool available to clinical investigators for monitoring the potential involvement of neuropeptides in pain modulation. We measured substance P-like immunoreactivity in the plasma, saliva, and pericardial fluid of subjects with and without pain (chronic and acute) to determine if substance P levels are altered. Some recent studies have suggested that substance P in various body fluids may be a correlate of chronic pain. To test this correlation it is important to ensure that the assay is measuring what it was designed to measure. Therefore, the influence of three tachykinins on the analysis of substance P concentrations was assessed with a commercially available radioimmunoassay kit. A small (approximately 2 to 6%), apparently nonspecific elevation in measured substance P was found when alpha-neurokinin, beta-neurokinin, or eledoisin was incubated with substance P and its antibody. Our results also indicate an apparent specific affinity of the substance P antibody for alpha-neurokinin (above 1,000 pg/ml) and beta-neurokinin (above 5,000 pg/ml). Substance P levels in the body fluids we tested ranged from 0.47 to 62.88 pg/mg protein (47.4 to 230.8 pg/ml). Levels of the tested tachykinins have not been determined in body fluids. If alpha-neurokinin or beta-neurokinin is found to be present in high concentrations in these fluids, this commercially available substance P kit may overestimate substance P levels. The concentrations of tachykinins necessary to interfere specifically with the assay are 10- to 100-fold higher than substance P in body fluids.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1991

The relationship between cigarette smoking and chronic low back pain.

This study investigated the extent to which habitual cigarette smoking relates to physical and psychological indices of chronic pain. From a review of patient records, 54% of back pain patients referred for treatment of their pain admitted to smoking cigarettes. Response from a smoking questionnaire showed that 57% of the patients who smoked reported having a need to smoke when they were in pain. Most patients (91%), however, believed that smoking had no effect on their pain intensity. When smoking and nonsmoking back pain patients were compared, the smokers showed significantly higher levels of emotional distress, they tended to remain inactive, and they relied on medication more often than the nonsmoking patients. The results further suggest that pain patients are at risk for increasing smoking behavior when they are experiencing periods of heightened pain intensity.

Adaptation, Psychological↗
PubMed1991

Somatosensory evoked potentials are unchanged by reflex sympathetic dystrophy and by stellate ganglion block.

Median nerve somatosensory evoked potentials (SEPs) were monitored in patients with chronic pain before and after stellate ganglion blockade. A change caused by the syndrome or by the block would suggest that SEPs might be useful in the diagnosis and treatment of chronic pain. We observed 20 subjects. Group I (n = 10) had chronic pain not involving the upper extremity. Group II (n = 8) had reflex sympathetic dystrophy of the arm. All patients underwent unilateral stellate ganglion block using an anterior paratracheal approach. The SEPs were recorded by median nerve stimulation on the blocked (affected) side and unblocked (unaffected) side before and 30 min after the block. Recording sites were ipsilateral brachial plexus, the cervical spinal cord, and the contralateral sensory cortex. There were no between-group differences before or after the block. Paired analysis within each group showed that the SEPs were not different from baseline (unaffected side before block) at any time throughout the study. We conclude that since SEPs are not changed by the reflex sympathetic dystrophy or stellate ganglion block, they would not be useful in the evaluation of pain or in determining the effectiveness of sympathetic block. Both the pain and the block appear to involve alteration of conducting pathways separate from those monitored by median nerve SEPs.

Adolescent↗
PubMed1990

In vitro effects of fluoride and bromide on pseudocholinesterase and acetylcholinesterase activities.

The in vitro effects of two metabolites of inhalational anaesthetics, fluoride and bromide, on pseudocholinesterase (PCHE) and acetylcholinesterase (ACHE) activities in the blood samples of seven healthy patients were studied. The PCHE and ACHE activities were determined by kinetic spectrophotometric methods. Fluoride at the levels achieved with clinical concentrations of enflurane and sevoflurane (25-75 microM.L-1) inhibited PCHE activity by 28-65 per cent (P less than 0.01) and ACHE activity by less than five per cent (P greater than 0.05). Bromide at the levels achieved with clinical concentrations of inhalational anaesthetics had no significant effect on either PCHE or ACHE activity. We recommend caution when succinylcholine and/or ester type local anaesthetics are used in the immediate postoperative period following enflurane or sevoflurane anaesthesia. We also recommend that blood drawing for PCHE activity be delayed at least until 24 hr following enflurane or sevoflurane anaesthesia.

Acetylcholinesterase↗
PubMed1990

Effects of significant weight gain on chronic pain patients.

This study examined the effect of significant weight gain on physical, demographic, behavioral, and psychosocial factors in a representative sample of chronic pain patients. One hundred fifty-five chronic pain patients who reported gaining more than 15 pounds since the onset of their pain were compared with 341 pain patients who stated that their weight had remained the same since the onset of their pain. All patients were given a medical examination and each patient completed a comprehensive pain questionnaire and an SCL-90. Results showed that a significant relationship exists between weight gain and decreased physical activity, increased emotional distress, and accident liability. This study suggests that the inclusion of weight management training in multidisciplinary pain centers may play an important part in the rehabilitation of chronic pain patients.

Adolescent↗
PubMed1990

Immunoreactive substance P is decreased in saliva of patients with chronic back pain syndromes.

Substance P, a neuropeptide associated with pain perception, is widely distributed in the central nervous system and is decreased in the cerebrospinal fluid of chronic pain patients as compared with that of healthy human volunteers. In this study, we have demonstrated the presence of immunoreactive substance P in saliva and further, that both saliva and plasma levels of immunoreactive substance P are lower in patients with chronic low back pain than in healthy human volunteers. To our knowledge, this is the first time that substance P has been identified in human saliva. These findings, together with the noninvasive nature of saliva collection, suggest that substance P in saliva may be useful as an alternative neurochemical correlate of chronic low back pain when collection of cerebrospinal fluid and plasma samples for substance P analysis is unacceptable or inappropriate.

Back Pain↗
PubMed1989

Intrapleural analgesia for post-thoracotomy pain and blood levels of bupivacaine following intrapleural injection.

An epidural type catheter was placed in the pleural space under direct vision before the closure of the chest in 24 patients who underwent thoracotomy for various types of lung or aortic surgery. All patients received intrapleural injections of 20 ml of 0.5 per cent bupivacaine with or without epinephrine as initial pain therapy. Patients also received subsequent doses of a similar volume of 0.375 per cent bupivacaine with epinephrine 1:200,000 up to four times a day for a maximum duration of seven days. Good pain relief was achieved in patients who underwent lateral and posterior thoracotomies. No pain relief was achieved in patients who underwent anterior thoracotomy or in patients in whom there was excessive bleeding in the pleural space. Bupivacaine blood concentrations were measured in 11 patients following the initial dose of 20 ml of 0.5 per cent bupivacaine (with epinephrine 1:200,000 in five of the 11 patients). The mean peak plasma concentration of bupivacaine when used with epinephrine was 0.32 +/- 0.02 microgram.ml-1. The mean peak plasma concentrations of bupivacaine when used without epinephrine was 1.28 +/- 0.48 microgram.ml-1. Our present data show that intrapleural analgesia is useful in the management of postoperative pain in patients who undergo thoracotomy. Our data also show that there is a significant decrease in peak plasma concentrations of bupivacaine when epinephrine is added to the solution (P less than 0.05).

Adult↗
PubMed1989

Pseudocholinesterase activity in human cerebrospinal fluid.

Pseudocholinesterase (PCHE) activity and dibucaine numbers (DN) in the cerebrospinal fluid (CSF) and plasma of 10 ASA physical status 1 and 2 patients were measured using a kinetic method. CSF had a mean PCHE activity of 0.018 +/- 0.013 unit/ml with a DN of 59 +/- 4. Whereas, PCHE activity and DN in the plasma were 0.960 +/- 0.12 units/ml and 84 +/- 3, respectively. We also measured PCHE activity and DN in the CSF and plasma of 4 patients in whom there was a recent history of intraventricular bleeding. These patients had a CSF PCHE activity of 0.340 +/- 0.07 units/ml (DN = 78 +/- 3) and a plasma PCHE activity of 0.950 +/- 0.10 units/ml (DN = 82 +/- 2). Our data show that there is a low activity of PCHE in CSF, 1/20-1/100th that of plasma. Our data also show that PCHE activity increased to 1/4 to 1/2 that of plasma in CSF of patients with bleeding into CSF.

Adult↗
PubMed1988

Empirically derived Symptom Checklist 90 subgroups of chronic pain patients: a cluster analysis.

Four hundred fifty-three chronic pain patients completed a Symptom Checklist 90 (SCL-90) and a comprehensive pain evaluation questionnaire. All patients were evaluated by a physician and rated on degree of pain pathology and pain behavior. The SCL-90 data were analyzed using two clustering procedures and replicated over two similar samples. Three distinct profiles emerged and represented high, medium, and low scores on the SCL-90. No differences were found between subgroups on demographic characteristics, compensation status, pain duration, or pain ratings. Patients in the high-profile subgroup showed the most emotional distress, reported that their pain interfered the most with all activities, and were most often judged to have high pain behavior. Little evidence was found to support a "denial" profile, as previously predicted. Further support was found for using the SCL-90 in assessing chronic pain patients.

Activities of Daily Living↗
PubMed1988

Effect of sevoflurane on P50 and on measurement of oxygen tension.

Fresh samples of heparinized human blood from 10 healthy nonsmoking volunteers were used to study the effect of the inhaled anesthetic sevoflurane on the oxygen half-saturation pressure of hemoglobin (P50) and on polarographic measurements of oxygen tension at low values. Control samples had a baseline P50 of 26.9 +/- 0.2 mm Hg. When the blood samples were exposed to 1.75% (1 minimum alveolar concentration, MAC), 2.75%, and 3.5% (2 MAC) of sevoflurane, the P50 values were 27.0 +/- 0.5 mm Hg, 27.1 +/- 0.4 mm Hg, and 26.9 +/- 0.5 mm Hg, respectively. Our present data show that 1 to 2 MAC sevoflurane has no significant effect on P50 (P greater than 0.05). Our data also show that sevoflurane did not interfere with polarographic measurements of oxygen tension (P greater than 0.05). Other inhaled agents--halothane, enflurane, and isoflurane--do interfere with these measurements, and we cannot explain the difference.

Anesthesia, Inhalation↗
PubMed1988

Pre-treatment with somatostatin in the anaesthetic management of a patient with carcinoid syndrome.

Carcinoid syndrome produces flushing, bronchoconstriction and gastrointestinal hypermotility secondary to serotonin, histamine, bradykinin and prostaglandin release. A variety of drugs, foods and anaesthetic agents may provoke this syndrome. Under anaesthesia, the flushing produced may be associated with acute hypotension and cardiovascular collapse; this phenomenon is called a carcinoid crisis. Recently, somatostatin analogue has been used successfully to treat intraoperative carcinoid crisis. In this report, we present a 66-year-old lady with carcinoid syndrome who was pre-treated with 50 micrograms somatostatin analogue IV and IM prior to surgical manipulation. The anaesthetic course was relatively uneventful and the patient did well postoperatively.

Aged↗