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At least 361 records · Page 20Linked to original sources
PubMed2006

Central sensitization in patients with non-cardiac chest pain: a clinical experimental study.

OBJECTIVE: Patients with non-cardiac chest pain (NNCP) suffer from unexplained and often intractable pain which can pose a major clinical problem. The aim of this study was to investigate nociceptive processing in NNCP patients and their response to experimentally acid-induced oesophageal hyperalgesia using a multimodal stimulation protocol. MATERIAL AND METHODS: Ten highly selected patients with NCCP (mean age 43 years, 1 M) were compared with an age- and gender-matched group of 20 healthy subjects. After preconditioning, the distal oesophagus was painfully distended with a balloon using "impedance planimetry". This method assesses the luminal cross-sectional area of the oesophagus based on the electrical impedance of the fluid inside the balloon. The baseline distensions were done before and after pharmacological relaxation of the smooth muscle with 20 mg butylscopolamine. After baseline distensions, a series of up to 10 mechanical stimuli was performed (temporal summation). The stimulations were repeated after sensitization of the oesophagus induced by acid perfusion. The sensory intensities were assessed during the stimulations and the referred pain area was mapped. RESULTS: At baseline distensions, no differences were seen between patients and controls before and after relaxation of the smooth muscles. The patients tolerated fewer repeated distensions than controls (4.8+/-0.5 versus 9.1+/-0.9; p=0.04) and had an increased size of the referred pain areas to the mechanical stimulations (32.9+/-6.2 versus 64.9+/-18.3 cm2; p=0.01). After sensitization with acid, the patients developed hyperalgesia (p<0.001), whereas no significant changes were seen in controls. CONCLUSIONS: NCCP patients showed facilitated central pain mechanisms (temporal summation and visceral hyperalgesia after sensitization). This could be used in the diagnosis and understanding of the symptoms in these patients.

Acids↗
PubMed2004

When should patients with chest pain be referred for coronary angiography?

When evaluating patients with possible coronary artery disease, it is necessary to combine physiologic assessment (measurements of ischemia) with anatomic pathologic assessment (coronary angiography). Coronary angiography currently is the only way to assess the anatomic pathology of the coronary circulation with precision. When it is combined with ventriculography and tests for myocardial ischemia, one can make clinical decisions related to the significance of the coronary artery disease observed. Common sense really demands that coronary angiography is only indicated when the information derived from this diagnostic procedure will facilitate therapeutic decisions in the individual patient.

Chest Pain↗
PubMed2006

Clinical predictors of lumbar provocation discography: a study of clinical predictors of lumbar provocation discography.

Discography is the only available method of directly challenging the discs for pain sensitivity. However, it is invasive, expensive and there is a debate about its clinical value. There is a need to identify clinical signs that may indicate the need for a discography examination. Pain centralization (retreat of referred pain to towards the spinal midline) has been associated with positive discography and possesses specificity between 80 and 100% depending on levels of disablement and psychosocial distress. Less than half of positive discography patients reports centralization and there is a need to identify other potentially valuable predictors. This study estimated the diagnostic accuracy of clinical variables in relation to provocation discography. In a blinded, prospective reference standard design in a private interventional radiology clinic, chronic low back patients received a detailed clinical examination followed by discography. Patients were typically disabled with high levels of psychosocial distress. Logistic regression modelling identified potentially useful clinical variables, and sensitivity, specificity and likelihood ratios were calculated for promising specific variables and combinations of variables. Of 118 consecutive discography cases, 107 had unconfounded data on discography results. History of persistent pain between acute episodes, a significant loss of extension and a subjective report of 'vulnerability' in what is termed as the 'neutral zone' had specificities of 83-92% and likelihood ratios between 2.0 and 4.1. Two combinations of variables were highly specific to positive discography, but no suitable screening test useful for ruling out positive discography was established. Three clinical variables have modest predictive power in relation to lumbar discography results and two combinations of variables were highly specific to positive discography.

Adult↗
PubMed1992

Comparison of "Rose Questionnaire Angina" to exercise thallium scintigraphy: different findings in males and females.

Validation of the London School of Hygiene (Rose) Questionnaire with objective measures of myocardial ischemia is incomplete. Therefore, we compared the Rose Questionnaire with exercise thallium-201 myocardial scintigraphy in 147 male and 97 female patients with chest pain referred for clinical exercise testing. Of those with "Rose Questionnaire angina", 26% of the females and 73% of the males had positive thallium-201 scans. Negative results on both the Rose Questionnaire and thallium-201 scintigraphy were observed in 71% of the females and 47% of the males. The sensitivity of the Rose Questionnaire was similar in females (41%) and males (44%). The specificity was 77% in males, while in females it was significantly lower at 56%. The specificity values reflect the higher (p less than 0.05) prevalence of "false positive" Rose Questionnaire results in females (75%) compared with males (27%). In addition, males had a greater (p less than 0.05) number of "false negative" results (53%) than females (29%). The accuracy of the Rose Questionnaire for myocardial ischemia was 0.19 in females, 0.48 in males, and 0.29 overall when including both males and females. Our results indicate a generally poor relationship between Rose Questionnaire angina and thallium-201 scintigraphy, an objective measure of myocardial ischemia in patients with chest pain referred to clinical exercise testing. Further, there are gender-specific differences in this relationship between the questionnaire and exercise thallium-201 imaging.

Aged↗
PubMed1994

Phantom limb pain. Mechanism-based management.

Clinically significant phantom limb pain occurs among a large minority of amputees. Most suffer at least occasional episodes. It is becoming increasingly apparent that although psychological factors are not important in the cause of phantom pain, a variety of physiologic problems related to the residual limb are critical to it. Referred pain, initiated by decreased blood flow and microspasms in the residual limb along with problems caused by prosthetics account for most of the phantom pain problems seen clinically. Some pain is referred to the phantom pain from other sites in the body such as the back. Treatments for phantom pain that are not based on recently elucidated physiologic mechanisms have proven to be ineffective for the vast majority and cannot be applied indiscriminantly with any hope of consistent success. Mechanism-based treatments related to specific symptoms can be effective when used appropriately. They include the use of peripheral vasodilators, muscle relaxants, and biofeedback to correct specific problems with blood flow and muscle tension in the residual limb.

Anxiety↗
PubMed1992

Types and causes of pain in cancer of the head and neck.

In a series of 25 patients with head and neck cancer who had severe pain, the type and cause of the pain were analyzed. There were two types of pain: nociceptive and non-nociceptive. Nineteen (76%) patients had nociceptive pain that could be subdivided into actual nociceptive pain (9 patients), nociceptive nerve pain (8 patients), or referred pain (2 patients). The cause of nociceptive pain was secondary to tumor recurrence in 16 patients and secondary to benign inflammation in 3 patients. Of the six (23%) cases of non-nociceptive pain, all were diagnosed as neuropathic pain secondary to the sequels of neck dissection. World Health Organization guidelines were applied for the treatment of symptomatic pain of nociceptive pain; if necessary, nerve blocks were used after this treatment. Non-nociceptive pain was usually treated with amitriptyline or carbamazepine. If tumor recurrence was the cause of the pain, antitumor-directed therapy was applied, when possible. Relief was achieved in 52% of the patients after two attempts to treat pain, in 64% after three attempts, and in up to 72% after four attempts. Pain could not be controlled in 28% of the patients. Patients with tumor recurrence had a short median survival time of 3 months, regardless of pain control. Patients with neuropathic pain had a survival time of 16 months or more (median not reached). The authors conclude that the type and cause of the pain in cancer of the head and neck can be determined; this can lead to the administration of proper symptomatic therapy or treatment directed at the underlying cause. In most cases, several successive attempts to treat pain were made before relief was achieved.

Analgesics↗
PubMed2001

Comparison of short-term versus long-term epidural analgesia after limited thoracotomy with special reference to pain score, pulmonary function, and respiratory muscle strength.

To determine the optimal duration of epidural analgesia (EA) after lung cancer surgery, a retrospective analysis was conducted to compare chest pain, pulmonary function, and respiratory muscle strength between patients given EA until postoperative day (POD) 3 and those given EA until POD 8. Each group comprised 25 lung cancer patients who underwent a lobectomy under anterior limited thoracotomy and given continuous thoracic EA using morphine until POD 3 (POD3-EA group) or POD 8 (POD8-EA group). The two groups were matched by sex and age. Postoperative pain from PODs 1 to 12 was evaluated by the pain score and analgesic requirements. The pulmonary function and respiratory muscle strength were measured on POD 7. The POD3-EA group did not experience any increase in pain after withdrawal, but the POD8-EA group did show a significant increase in pain the day after withdrawal (P < 0.05). The pain scores on PODs 8 and 9 in the POD8-EA group were significantly higher than those in the POD3-EA group (P < 0.05). There was no significant difference in pulmonary function and respiratory muscle strength on POD 7 between the two groups. Although the postoperative thoracic EA did not affect pulmonary function and respiratory muscle strength, prolonged thoracic EA after a limited thoracotomy significantly increased the pain after withdrawal, thus negatively affecting postoperative pain control.

Aged↗
PubMed2001

Regional myofascial pain syndrome and headache: principles of diagnosis and management.

Myofascial pain is frequently overlooked in dealing with headache pain. Myofascial pain is defined as pain and/or autonomic phenomena referred from active trigger points, with associated dysfunction. The trigger point is a focus of hyperirritability in the muscle, that when compressed, is locally tender, and if sensitized, gives rise to referred pain and tenderness. The therapy for myofascial pain requires enhancing central inhibition through pharmacology or behavioral techniques and simultaneously reducing peripheral inputs through physical therapies including exercises and trigger point-specific therapy.

Combined Modality Therapy↗
PubMed2004

Myofascial pain: diagnosis and management.

Clinical understanding and management of myofascial pain is overlooked frequently when dealing with pain. Myofascial pain is defined as pain or autonomic phenomena referred from active trigger points, with associated dysfunction. The trigger point is a focus of hyperirritability in the muscle that, when compressed, is locally tender and, if sensitized, gives rise to referred pain and tenderness. The pain quality is dull or achy and associated with autonomic changes. Myofascial pain is poorly understood, which results too often in underdiagnosis and poor management. The pathogenesis likely has a central mechanism with peripheral clinical manifestations. The therapy for myofascial pain requires enhancing central inhibition through pharmacology or behavioral techniques and simultaneously reducing peripheral inputs through physical therapies including exercises and trigger point-specific therapy.

Analgesics↗
PubMed1989

Afferents and efferents of the rat cuneiformis nucleus: an anatomical study with reference to pain transmission.

Small iontophoretic application of wheat-germ-agglutinin conjugated to horseradish peroxidase, was used to simultaneously observe, in the rat, the afferent and the efferent connections of the cuneiformis nucleus (Cnf), in the same animal. The results demonstrate that the main Cnf afferent connections originate from: (1) 6 regions of the forebrain: the nucleus centralis of the amygdala, the zona incerta, the dorsomedial, ventromedial and the lateral area of the hypothalamus and the periventricular gray matter and (2) 4 regions of the midbrain: the substantia nigra pars lateralis, the peripeduncular area, the periaqueductal gray matter and the other side Cnf. In contrast to the wealth of origins of afferent fibers, most projections of the Cnf are concentrated to the B3 area and the bordering reticular nuclei. It is proposed that the Cnf, which mostly receives afferent connections from the forebrain and the midbrain, and which in turn densely projects on the B3 area, is a relay for the modulation of pain processes.

Animals↗
PubMed1995

[Principles of organization of a center for pain evaluation and treatment].

Since the development during the sixties of the pioneer pain clinics in the United-States, the need of a pluridisciplinary approach of the chronic pain patient has progressively compelled recognition. The principles of organization of this new care units--the pin center--are now clearly determined. It has become classic to compare acute pain as a warning symptom with chronic pain as an illness in itself with its constellation of psychosocial factors. Chronic pain refers to a daily pain persisting for 3 to 6 months. Neurophysiological, neuropsychological and behavioral differences legitimate the acute/chronic distinction. We will consider the following items: the types of patient, the multidisciplinary model, the team functioning, the initial consultation, the multidisciplinary synthesis discussion, the somatician role, the psychiatrist role and the possible disadvantages. Beside the care mission, multidisciplinary pain centers also have a key role in clinical research and teaching.

Humans↗
PubMed1982

Evaluation of pericranial tenderness and oral function in patients with common migraine, muscle contraction headache and 'combination headache'.

Oral function was evaluated in a group of 13 patients with muscle contraction headache (MCH), 7 patients with common migraine (CM) and 18 patients with 'combination headache' (CM + MCH) and in a control group of 25 normal persons who had never had a headache. Malocclusion and loss of molars were rare in both groups. Impaired denture function and joint disturbances were more frequent in the headache patients but not significantly so. Clenching and grinding teeth and tongue pressure were all significantly more common in headache patients. Tenderness of pericranial muscles was present in all headache patients with severity increasing in the order CM, MCH, CM + MCH; it was absent in all the controls. On the average 9 tender spots were found per patient. Pressure on tender spots evoked pain in other areas (referred pain) in 29 of 38 headache patients. The abnormal tonic hyperactivity in the masticatory muscles and the neck may be the cause of tenderness which again may be an important source of pain in these patients.

Adult↗
PubMed2004

Validation of the Brief Pain Inventory for chronic nonmalignant pain.

UNLABELLED: The Brief Pain Inventory (BPI; Cleeland and associates) has been used primarily to assess patients with cancer-related pain. Although it has been validated in many languages and is widely used, there has not yet been research published to validate its use for patients with chronic nonmalignant pain as the primary presenting problem. This study was designed to fill this gap by examining the psychometric properties of the BPI in 440 patients with chronic intractable pain referred to a chronic pain clinic at a metropolitan tertiary-care teaching hospital. Results indicated acceptable internal consistency (Cronbach alpha coefficients were.85 for the intensity items and.88 for the interference items). A factor analysis resulted in 2 distinct and independent factors, supporting the validity of the 2-factor structure of the BPI. Zero-order correlations indicated that the association with a measure of disability (the Roland-Morris Disability Questionnaire [RMDQ]) was significantly higher for BPI interference (r = 0.57) than for BPI intensity (r = 0.40, t = 5.71, P <.01) and that the correlation with BPI interference was not more than 0.80, supporting the conclusion that these scales assess related, but also distinct, dimensions. Finally, the finding that both BPI scales showed statistically significant improvement with treatment confirms the responsivity of BPI in detecting and reflecting improvement in pain over time. PERSPECTIVE: This paper validated the psychometric properties of a pain Assessment instrument (The Brief Pain Inventory) originally developed to assess cancer pain and extended its use for the chronic nonmalignant pain population. This provides an important and widely used diagnostic tool for the clinician treating chronic pain.

Chronic Disease↗
PubMedDate not supplied

Acute herpetic neuralgia and postherpetic neuralgia in the head and neck: response to gabapentin in five cases.

BACKGROUND AND OBJECTIVES: The clinical presentations and pharmacologic management of three patients with acute herpetic neuralgia (AHN) and two patients with postherpetic neuralgia (PHN), confined to the head and neck region, are described. METHODS: Two patients had pain in the ophthalmic division of the trigeminal nerve, two had pain confined to the C2-C4 dermatomes, and one patient had C2 pain with radiating and referred pain to the second and third divisions of the trigeminal nerve. RESULTS: Gabapentin, an anticonvulsant drug, was effective in treating these patients, including the two cases of AHN. All patients reported complete pain relief after titration with gabapentin up to 1,800 mg/d. The patients noted a dose-dependent decrease in pain almost immediately after starting gabapentin. Specifically, reduction in the frequency and intensity of allodynia, burning pain, shooting pain, and throbbing pain were noted. None of the patients experienced side effects from the drug. CONCLUSIONS: In view of the results in these patients, blinded, controlled studies are needed to determine the efficacy of gabapentin for treating AHN and PHN.

Acetates↗