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Biomedical subjects

W J Meijler

Publications and source records attributed to W J Meijler.

17 recordsLinked to original sources
PubMed2006

[Nociception and sensitisation].

In accordance with current views on pain, a distinction is made, on a physiological basis, among 'normal', or nociceptive pain, inflammatory pain and neuropathic pain. 'Normal', nociceptive pain is a reaction to possible or actual tissue damage. Inflammatory pain is a response to actual tissue damage, in which not only nociception occurs but the sensitivity of nocisensors changes through morphological transformation. This phenomenon is called sensitization and lies at the root of multiple types of chronic pain. Sensitization also plays an important role in neuropathic pain as a result of damage to the neuronal structures themselves.

Diagnosis, Differential↗
PubMed2003

Sprain of the neck: quality of life and psychological functioning. A 4-year retrospective study.

Aim of the study was to analyse quality of life and psychological functioning in patients with sprain of the neck, to analyse the relationship between complaints, quality of life, psychological functioning and personality factors, and to analyse the profile of patients with whiplash associated disorders (WAD), 4 years after trauma. From the University Hospital Groningen 193 patients with the diagnose sprain of the neck filled out a questionnaire. Of this group 100 subjects did not have complaints before the accident and were therefore at risk for the development of complaints as a result of sprain of the neck. Quality of life and psychological functioning were assessed using the RAND-36 and the SCL-90, respectively. Personality was assessed by means of the Dutch Personality Questionnaire. Of the group at risk (56% women and 44% men, mean age: 33.9, SD: 14.6) quality of life was significantly worse in subjects with complaints (mean: 78.4, SD: 15.5) compared to subjects without complaints (mean: 87.5, SD: 8.7). Psychological functioning did not differ significantly between the group with complaints compared to group without complaints. Personality did not differ between the groups. Personality and complaints together were significantly related to quality of life (r: 0.77) and psychological functioning (r: 0.85). No specific profile of WAD patients was found. In conclusion, personality and complaints influence quality of life and psychological functioning to a considerable extent.

Activities of Daily Living↗
PubMed2001

Applying the Quebec Task Force criteria as a frame of reference for studies of whiplash injuries.

Research prior to 1995 showed a diversity of either inclusion or exclusion criteria (or both) for diagnosing whiplash injury. As a consequence, the Quebec Task Force (QTF) developed expert-based criteria, which may be considered as a the 'new' gold standard. Here, we examined the inclusion criteria and exclusion criteria used in research populations from the major 82 research studies performed during the period 1980-1998, comparing their similarities and dissimilarities to the QTF standard. None of the articles satisfied the QTF definitions completely, either before or after their introduction in 1995. Nevertheless, the QTF still seems to have had some impact on either the published inclusion or exclusion criteria. We observed that both sets of criteria showed a qualitative shift following the QTF publication in 1995. For the inclusion criteria, we found both a statistically significant increase in use of the QTF definition (acceleration-deceleration mechanism, rear-end collision, motor vehicle collision or other mishaps) and in the criterion 'neck pain'. We also observed some smaller changes in both inclusion and exclusion criteria but none of these was significant statistically.

Cervical Vertebrae↗
PubMed2001

Migraine and function of the immune system: a meta-analysis of clinical literature published between 1966 and 1999.

Mechanisms underlying migraine precipitation are largely unknown. A role of the immune system in migraine precipitation is a matter of debate because of the association of atopic disorders and migraine. Recently, it was demonstrated that migraineurs benefit from eradication of a Helicobacter pylori infection, which substantiates a possible role for (sub-clinical) infections in precipitation of migraine. Since 1966, about 45 clinical investigations have reported on alterations of immune function in migraine patients, which we present in this review. Changes of serum levels of complement and immunoglobulins, histamine, cytokines and immune cells were found in some of these studies but in most cases not corroborated by others. Migraineurs suffering from comorbid atopic disorders show elevated plasma IgE levels but not patients without a type I hypersensitivity. Histamine plasma levels are chronically elevated in migraineurs, and interictally decreased lymphocyte phagocytotic function and increased plasma tumor necrosis factor alpha (TNFalpha) levels were found, and may be related to increased infection susceptibility. The cause of this increased susceptibility is unclear but most likely is a result of chronic stress, a well-known suppressor of the immune system. Stress relief enhances immune activity and triggers a burst of circulating vasoactive compounds that function as mediators of inflammation and potential precipitators of a migraine attack in vulnerable subjects. In conclusion, in the clinical literature of the past decades, there is no clear-cut evidence of an immune dysfunction in migraineurs, but we cannot totally exclude the possibility of an altered immune function in migraineurs. Discrepancies in the literature most likely are caused by the divergent patterns of sample collection relative to the time of the attack. We propose stringent definition of sample collection times for future studies of immune function in migraine patients.

Adult↗
PubMed2001

Trigeminal nociception-induced cerebral Fos expression in the conscious rat.

Little is known about trigeminal nociception-induced cerebral activity and involvement of cerebral structures in pathogenesis of trigeminovascular headaches such as migraine. Neuroimaging has demonstrated cortical, hypothalamic and brainstem activation during the attack and after abolition with sumatriptan. This has led to the conclusion that the dorsal raphe and locus coeruleus may initiate events that generate migraneous headache. Using a conscious rat model of trigeminal nociception and cerebral Fos expression as histochemical markers of neuronal activity, we characterized the pattern of brain activity after noxious trigeminal stimulation with capsaicin (250 and 1000 nm). A significantly increased Fos immunoreactivity was found in the trigeminal nucleus caudalis (layers I and II), the area postrema, the nucleus of the solitary tract, the parvicellular reticular nucleus, the locus coeruleus, the parabrachial nucleus and the raphe nuclei. In addition, the ventrolateral periaqueductal grey, the intralaminar thalamic and various hypothalamic areas, showed an enhanced Fos expression after the intracisternal administration of capsaicin. Other responding areas were the amygdala, the upper lip and forelimb regions of the primary somatosensory cortex, and the insula. Many of these areas participate in (anti)-nociception, although we cannot exclude the possibility that in conscious animals the pain-associated physiological and behavioural responses that are an intrinsic and necessary part of coping with pain have generated the increased Fos expression. Trigeminal stimulation-induced locus coeruleus, dorsal raphe and hypothalamic activation are opposed to a suggested pathogenic role of these nuclei in migraine and cluster headache, respectively.

Animals↗
PubMed2000

[Driving ban for patients on chronic opioid therapy unfounded].

Dutch law states that persons who are on treatment with morphine preparations, even if these are slow-release drugs, are unfit to drive a motor vehicle. There is no scientific basis for such a measure, however. On the contrary, current evidence indicates that e.g. cancer patients using 209 mg morphine daily for three months do not differ significantly from a control group with respect to thinking abilities, alertness, concentration, reaction speed and dividing attention. For obvious reasons utmost care must be observed with the use of morphine by traffic participants. But a rigorous prohibition of driving for patients requiring chronic alleviation of severe pain needlessly restricts their mobility.

Automobile Driving↗
PubMed2000

Clinical efficacy, safety and pharmacokinetics of a newly developed controlled release morphine sulphate suppository in patients with cancer pain.

OBJECTIVE: To compare the efficacy, safety and pharmacokinetics of a newly developed controlled-release suppository (MSR) with MS Contin tablets (MSC) in cancer patients with pain. METHODS: In a double-blind, randomised, two-way cross-over trial, 25 patients with cancer pain were selected with a morphine (M) demand of 30 mg every 12 h. Patients were divided into two groups. Group 1 received active MSC (30 mg) and placebo MSR, followed by placebo MSC and active MSR (30 mg) each for a period of 5 days. Group 2 started with active MSR and placebo MSC, followed by active MSC and placebo MSR, each for a period of 5 days. Blood for determination of plasma concentration of morphine (M) and its 3- and 6-glucuronides (M3G, M6G) was collected, and area under the plasma concentration-time curve (AUC)0-12 h, peak plasma concentration (Cmax), time to reach Cmax (tmax), and CO and C12 of M, M6G and M3G were determined on day 5 and day 10. Intensity of pain experienced by each patient was assessed every 2 h on a 0-10 scale, while side effects and rescue medication were recorded. RESULTS: Twenty patients (ten patients in each group) completed the study. A pronounced inter-patient variability in plasma concentrations of M, M3G and M6G was observed after administration of both forms. Apart from the C0 and C12, no significant differences in AUC0-12 h, tmax and Cmax of morphine between the rectal and oral route of administration were found. In the case of the metabolites, it was found that AUC0-12 h and Cmax of M6G, and AUC0-12 h, Cmax, C0 and C12 of M3G after rectal administration were significantly lower than after oral administration. However, apart from the tmax of M6G, none of the pharmacokinetic parameters of M, M6G or M3G met the criteria for bioequivalence. There were no significant (P = 0.44) differences in pain intensity score between the oral and rectal forms within the two groups, regardless of the treatment sequence. No treatment differences in nausea, sedation or the demand on escape medication (acetaminophen tablets) between the rectal and oral forms were observed. CONCLUSION: The newly developed controlled-release M suppository is safe and effective and may be a useful alternative for oral morphine administration in patients with cancer pain.

Adult↗
PubMed2000

Neck sprain after motor vehicle accidents in drivers and passengers.

Neck sprain is a general term denoting a soft tissue injury of the neck, which seldom causes major disability but is considered a modern epidemic. The purpose of the present study was to determine the prevalence of sprain of the neck injury due to motor vehicle accidents (MVAs) in both drivers and passengers. In addition, the degree of seat belt wearing in both driver and passenger was analysed. A second aim was to identify groups at risk by analysing the age and gender distribution of patients with neck sprain. The results of this population-based study revealed a sharp increase in neck sprain from 1989 through 1995, whereas a more or less stable pattern was found for seat belt use. The sharp increase was found to be attributable to outpatients. Finally, we found a driver predominance as well as a female predominance; groups at risk were the 20- to 24-year-olds for drivers and 15- to 19-year-olds for passengers.

Accidents, Traffic↗
PubMed2000

Intracisternal octreotide does not ameliorate orthodromic trigeminovascular nociception.

Octreotide is a long-acting somatostatin analogue that has been effectively used to treat migraine. Octreotide poorly penetrates the blood-brain barrier, but has potential central target sites in the trigeminal nucleus caudalis, which is the primary central relay station for trigeminal nociceptive information in the brain. We studied the effect of intracisternally applied octreotide in a model of trigeminovascular stimulation in the unrestrained rat using intracisternal capsaicin infusion to stimulate intracranial trigeminal nerves. Fos expression in the outer layers of the trigeminal nucleus caudalis (TNC I-II) and behavioural analysis were used to measure the effects of octreotide on capsaicin-induced trigeminovascular activation. Increases of head grooming and scratching behaviour are an indication of octreotide-induced trigeminal activation. However, octreotide did not alter the average capsaicin-induced Fos expression in the TNC I-II and capsaicin sensitive behaviours were not modified by octreotide pretreatment. This argues against a role for central (TNC I-II) somatostatin receptors in the processing of the nociceptive trigeminovascular signals.

Animals↗
PubMed2000

The effects of a postgraduate course on opioid-prescribing patterns of general practitioners.

BACKGROUND: The objective of this study is to evaluate whether a single palliative cancer care workshop, which included information about drug prescribing, had an effect on the opioid-prescription patterns of general practitioners in daily practice. METHOD: The opioid-prescription figures of 68 general practitioners who had participated in the workshop were aggregated from the computer system of the Regional Sick Fund. The prescription figures of a year before and a year after the workshop were compared and a control group of non-participants was included. RESULTS: This study showed a limited efficacy of a palliative cancer care workshop on the morphine-prescription figures of the general practitioners in daily practice. This limited effect did not accord with the results of a pre- and post-workshop questionnaire evaluating the attitudes of the same practitioners. CONCLUSION: A single workshop can not effectuate substantial changes in prescription behaviors. Possibilities for more reinforcements are discussed.

Drug Utilization↗
PubMed1999

Learning effects of a workshop in palliative cancer care for general practitioners.

BACKGROUND: Cancer patients may unnecessarily suffer from pain and other symptoms due to insufficient knowledge on the part of their doctors. In The Netherlands, the general practitioner is considered to be the key provider of palliative care for the cancer patient. Therefore, the authors developed and conducted workshops to teach symptom control to general practitioners. These workshops contained learning objectives from which they selected 18 items to form a questionnaire with five-point response scales. The goal of this study was to investigate changes in the knowledge and attitude scores of the participating general practitioners. METHODS: The participants were asked to complete the questionnaire at the start of the workshop and also four months later. RESULTS: Responses were obtained from 120 general practitioners for the pre-workshop and 96 for the post-workshop questionnaires. The majority of the scores increased toward the desired effect, and some items' scores improved by almost two points. CONCLUSION: The results suggest improvements in general practitioners' knowledge and attitude scores with regard to cancer pain and symptom management. Future studies should try to link these improvements with quality-of-life parameters of terminal cancer patients and their families.

Curriculum↗
PubMed1998

Neck sprain in patients injured in car accidents: a retrospective study covering the period 1970-1994.

During the 25-year period 1970-1994 694 patients were diagnosed with neck sprain resulting from a car accident at the Emergency Room of the University Hospital Groningen. The purpose of the present study was to analyse the prevalence, groups at risk and trends in these patients, taking into account changes in the number of cars per inhabitant and the average number of kilometres driven. We defined the population as car accident victims diagnosed with neck sprain. Binominal tests were used to obtain measures of statistical significance. Over the 25-year period a steady increase in the number of these patients was observed, from 10 in 1970 to 122 in 1994. The highest prevalence was found for the age group 25- to 29-year olds (28.3 per 100,000), followed by 40- to 44-year-olds (27.9 per 100,000). Across the life span, the male: female ratio was 1: 0.98. Eight percent of the victims were treated as inpatients. The increase in the number of car accident victims with neck sprain appears not to be an isolated phenomenon, because a parallel rise in the number of cars per inhabitant and in the average number of kilometres driven was found. No direct relation was observed between seat belt legislation and the increase in neck sprain injuries. The effect of the media on awareness of the consequences of car accidents is discussed.

Accidents, Traffic↗
PubMed1998

Neck sprain not arising from car accidents: a retrospective study covering 25 years.

During the 25-year period 1970-1994, 680 patients were diagnosed with neck sprain due to causes other than car accidents at the Emergency Room of the University Hospital Groningen. The purpose of the present study was to analyse the prevalence, groups at risk and trends in patients with neck sprain. We defined the population as patients diagnosed with neck sprain that was not due to a car accident (NCA). The binominal test was used to obtain measures of statistical significance, deltax was used to obtain both the total increase in the number of neck sprain victims over the whole period (1970-1994) and the relative contribution of successive 5-year periods. Over the 25-year period a steady increase in the number of patients was observed from 55 in 1970-1974 to 241 in 1990-1994. The highest prevalence was found among 15- to 19-year-olds (3.92 per 10,000), followed by 10- to 14-year-olds (3.40 per 10,000). The major causes of neck sprain NCA were accidental falls (25%), sports injuries (24%) and bicycling injuries. Across the life span, the male: female ratio was 0.63. Ten percent of patients were treated as inpatients. The increase in neck sprain NCA can be only partly attributed to increased media attention. The reduction of working hours resulting in more leisure time activities, which in turn increases the exposure time in at risk situations, and the awareness of both patients and physicians is discussed.

Accidental Falls↗
PubMed1998

Symptoms and functional status of patients with disseminated cancer visiting outpatient departments.

Considerable research has focused on pain and other symptoms in terminal cancer patients referred to hospices and palliative care services. These patients differ from Dutch cancer patients in the palliative stage of their disease because the latter are cared for by general practitioners at home and medical specialists in outpatient departments. To clarify the experience of these Dutch patients, a study was started to investigate the prevalence and severity of pain and other symptoms as well as the functional status of consecutive patients visiting oncology outpatient departments for follow-up. After randomization, one group (I) of patients was interviewed at home by a general practitioner using structured questionnaires. The other group (II) received the questionnaires by mail, and scored the symptoms independently. The results of the symptom assessment show that patients in groups I and II suffered 2.4 (SD = 1.7) and 2.8 (SD = 2.0) symptoms, respectively. Between 30% and 40% of all patients reported constipation, nausea, loss of appetite, coughing, and dyspnea. These percentages were 50% lower when only moderate, severe, or extremely distressing symptoms were included. Sixty percent of all patients had pain, and 20% indicated a daytime pain score of 5 or greater on a scale of 0 to 10. Functional status was measured by the COOPWONCA charts; the mean score for the charts "physical fitness" and "daily activities" was 1.5 points lower for cancer patients than a random sample from the community of the same age and gender. The findings of this study should motivate doctors to put more energy in symptom assessment and interventions in palliative care.

Adult↗
PubMed1997

Trigeminovascular stimulation in conscious rats.

Intracisternal infusion of capsaicin was used to induce intracranial trigeminovascular stimulation in conscious rats. Both behaviour and trigeminal nucleus caudalis c-fos expression were examined. Exploratory behaviour was dose-dependently reduced and different types of behaviours were induced with various doses of capsaicin. Head grooming and scratching show that intracranial activation of trigeminal afferents can be referred as extracranial trigeminal stimulation. Analysis of behaviour exhibited during trigeminovascular stimulation may provide a powerful tool to study effects of central acting anti-migraine drugs.

Analysis of Variance↗
PubMed1997

Pain and patienthood.

OBJECTIVE: The objective of this study was to identify possible differences between chronic pain patients (consumers) and persons with chronic pain lasting > 1 year who had not consulted a doctor because of the pain during the last year (nonconsumers). Group differences were studied from the perspective of a stress-response model and a taxometric approach to chronic pain. METHODS: Both samples were compared on data acquired through questionnaires. Data-reduction techniques were applied. RESULTS: Nonconsumers differ from patients who are still seeking a medical solution for their pain problem. These differences are reflected in lower levels of distorted cognition, less pain-related distress, higher activity levels, and higher levels of internal orientation. Furthermore, nonconsumers used fewer analgesics. CONCLUSIONS: Nonconsumers appear to lead a "better life" with pain than do chronic pain patients who still wish to lead a life without pain. The idea of having learned to live with pain can be very meaningful and could cause a change in quality of life (QOL). We suggest that this may be a very legitimate goal for interventions.

Adaptation, Psychological↗