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At least 757 records · Page 42Linked to original sources
PubMed2005

Accuracy of the clinical examination to predict radiographic instability of the lumbar spine.

Forty-nine patients with low-back pain referred for flexion-extension radiographs due to suspicion of lumbar instability were studied to examine the relationship between the clinical presentation and the presence of radiographic instability of the lumbar spine. Patients had a mean age of 39.2 (+/-11.3) years, with a mean Oswestry score of 20.4% (+/-13.3). The median duration of symptoms was 78 days. All patients underwent both a radiographic and clinical examination. The reliability of the radiographic variables was high, while the reliability of clinical variables ranged from moderate to good. Twenty-eight patients (57%) had radiographic instability based on published norms. Clinical variables related to the presence of radiographic instability were age, lumbar flexion range of motion, total extension range of motion, the Beighton scale for general ligamentous laxity, and segmental intervertebral motion testing. The presence of at least 53 degrees of lumbar flexion or a lack of hypomobility with intervertebral motion testing resulted in a positive likelihood ratio of 4.3 (95% CI: 1.8, 10.6), for predicting radiographic instability. The results of this study indicate that various factors from the clinical examination are useful for predicting radiographic instability. If the findings of this study can be replicated, these clinical factors could be used to inform treatment decision-making without a sole reliance on radiographic assessment.

Adult↗
PubMed1993

Evaluation of a chronic pain programme by referring physicians.

A neglected source of treatment outcome evaluation is the opinion of the referring physicians. We report on 179 patients with chronic pain who were admitted to a 6 week inpatient inter-disciplinary pain programme. A retrospective 2 page mail questionnaire accompanied by initial letters of referral was sent to the referring physicians. We hypothesized that the main reason family physicians referred patients was to establish a management plan. The physician response rate was 70%, encompassing 72% of the patients. Intra-observer reliability was tested by a second mailing 3 months later (68% response rate). Test-retest reliability, and correlations between questions were significant and are reported for: reasons for referral, the utility of the discharge summary, coping, and behavioural changes at discharge and at time of the questionnaire. This appears to be the first report of a survey of the evaluation of a pain programme by referring physicians.

Adaptation, Psychological↗
PubMed1996

Variant slips of psoas and iliacus muscles, with splitting of the femoral nerve.

In bilateral dissections of 68 cadavers, four examples were found unilaterally of variant slips of iliacus and psoas major muscles. In three of them the femoral nerve was pierced by the variant slip. One of these variants was a previously undocumented accessory slip of iliacus, originating from the iliolumbar ligament, passing inferiorly anterior to iliacus, and traversing the femoral nerve; its tendon split to be attached proximally to the lesser trochanter of the femur and distally to an unknown insertion. Such anomalies might cause tension on the femoral nerve resulting in referred pain to the hip and knee joints and to the lumbar dermatomes L2,3 and 4.

Femoral Nerve↗
PubMed1981

Splenic rupture in patients with hematologic malignancies.

Five cases of pathologic rupture of the spleen in patients with hematologic malignancy are presented along with a review of the 48 cases previously described in the English literature. Pathologic splenic rupture occurred most commonly in patients with acute leukemia but has been well documented in chronic leukemias and in lymphoma as well. Nearly all patients experience abdominal pain at the time of rupture; however, this pain was frequently confused clinically with that of biliary tract obstruction, aortic aneurysm, perforated viscus, pancreatitis, and angina pectoris. Pain referred to the left shoulder (Kehr's sign) was present in only 17% of patients. Hypotension was documented in 66%, fever in 74%, and tachycardia in 75%. The most effective diagnostic procedure was paracentesis, which confirmed intraabdominal hemorrhage in each of the nine cases in which the procedure was used. A correct preoperative diagnosis of splenic rupture was reported in only 10 of the 53 cases reviewed. Fifty-two percent of the patients underwent laparotomy; 48% died without operation. Of those that underwent surgery, 78% survived the procedure and the immediate postoperative period. The survival rate of all patients was 38%. There was no correlation of the type of hematologic malignancy, occurrence or type of treatment, peripheral blood counts, or spleen size to survival. The most important factor in predicting survival was appropriate surgery.

Adult↗
PubMed1981

Branching of sensory axons in the peripheral nerve of the rat.

The currently accepted concept of a primary sensory cell is a cell that gives rise to a central process which passes through the dorsal root to the spinal cord and a peripheral process which passes to the periphery via a peripheral nerve. If this is correct, then there should be equal numbers of sensory axons in the dorsal root, dorsal root ganglion cells, and sensory axons in the proximal peripheral nerve. The present study obtains these counts in animals in which extraneous axons have been removed from the peripheral nerve and root. The counts indicate that there are approximately 2.3 sensory axons in the dorsal root and proximal peripheral nerve for each ganglion cell in the sacral segments of the rat. We interpret these data as indicating that there is significant branching of sensory axons in the dorsal root and proximal peripheral nerve and thus the generally accepted picture of a dorsal root ganglion cell is not correct for some, perhaps all, of these cells. We offer the speculation that this peripheral branching may be an indication of single sensory neurons having receptive fields in two separate locations, and thus this may be an anatomical explanation for certain types of referred pain.

Animals↗
PubMed1984

The ratio of dorsal root ganglion cells to dorsal root axons in sacral segments of the cat.

Processes of dorsal root ganglion cells are depicted as being unbranched until they reach the spinal cord or periphery. This is an important concept because, for example, branching of these processes might be a basis for referred pain. Recently several studies indicate that axons of rat dorsal root ganglion cells branch in or near the ganglion. The present study extends this work by showing that there are approximately 1.4 dorsal root axons for each dorsal root ganglion cell in sacral segments of the adult cat, and these data are interpreted as indicating that many dorsal root axons in this animal also branch. Thus this study provides further evidence to indicate that a revision of our ideas about the organization of primary sensory cells is desirable. In addition, this study provides data to indicate that the numbers of both dorsal root ganglion cells and dorsal root axons differ on the right as compared to the left side of the same segment.

Animals↗
PubMed1987

Appendicitis revisited: a comparative study of Malawian and English appendices.

The incidence of appendicitis shows a marked variation between populations which has been attributed to dietary differences. Neural mechanisms and serotonin discharge from subepithelial neurosecretory cells have been previously implicated in pain referable to the appendix and appendicitis. Forty consecutive appendicectomy specimens from Malawi were studied by staining with haematoxylin and eosin, an alcian blue - PAS diastase sequence coupled with lead haematoxylin (PbH) and immunohistology for serotonin and NSE. The findings were compared with those in appendices removed at the Middlesex Hospital, London, to see if there were any differences between a population with a low risk of appendicitis (Malawi) and a high risk population (England). Acute transmural appendicitis was seen in fewer appendices from Malawi (27.5 per cent) than in English appendices (58 per cent). Subepithelial neurosecretory cells identified with PbH were present in 20 per cent of appendices from Malawi and 69 per cent of English appendices. These cells in both series showed immunohistochemical staining for serotonin. Nerve hyperplasia identified by staining for NSE in the appendix was present in 17.5 per cent and 81 per cent of non-inflamed appendices from Malawi and England respectively. Appearance of subepithelial neurosecretory cells and hyperplasia appear to be concomitants of an increased risk of appendicitis. Neural mechanisms may participate in adapting to a low residue diet and in some cases may generate appendicitis.

Appendicitis↗
PubMed1996

Can a pharmacological pain analysis be used in the assessment of chronic low back pain?

A battery of pharmacological tests was used to differentiate the pain in patients with chronic low back pain (CLBP) referred for pain diagnosis and assessment of whether surgery was indicated or not. Forty patients (mean age 39 years, range 22-51 years) suffering from CLBP (mean pain duration 5.9 years, range 1-12 years) participated. Three pharmacological approaches were used: (1) intravenous infusion of morphine, (2) intravenous infusion of lidocaine and (3) a diagnostic epidural opioid blockade. The patients were tested in a single-blind, placebo-controlled fashion. The pain was considered nociceptive if it decreased by 50% or more in response to both intravenous morphine and epidural fentanyl, but increased in response to intravenous naloxone. The pain was considered neuropathic if it decreased by 50% or more in response to both intravenous lidocaine and the epidural local anaesthetic. Patients who registered a pain decrease of 50% or more in response to saline were classified as placebo responders. Those who registered less than 50% pain decrease in all the tests were considered nonresponders. According to the results of the tests, 16 of the patients were classified as having nociceptive pain, 8 neuropathic pain, 2 were placebo responders, 10 non-responders and 4 were unclassified. The results support the idea that this battery of pharmacological tests can be used in the classification of CLBP patients into different pain categories. This approach may prove useful as a guide for further patient evaluation and as a basis for choice of a suitable treatment strategy.

Adult↗
PubMed1979

Quantitative histological study of spinal afferent innervation on the ventral surface of the cat stomach by horseradish peroxidase (HRP) method.

Retrograde axonal transport of horseradish peroxidase (HRP) was applied to the ventral surface of the cat stomach. We investigated the number, size and distribution of HRP-positive cells in spinal ganglia. The unexpected finding was the wide distribution of these cells from T3 down to L3. This would result in a diffuse pattern of referred pain.

Afferent Pathways↗
PubMed1988

Costo-vertebral arthropathy. Diagnostic and therapeutic value of arthrography.

The authors report five cases of costo-vertebral (CV) joint arthropathies, without osteo-arthritis. The patients had referred pain, with misleading irradiations to the loin or to the abdomen, so that the diagnosis was difficult. The authors have performed in these five cases an arthrography of T11 and T12 CV joints. In every case, the arthrography triggered pain at one of these levels. The arthrography was followed by intra-articular injection of corticosteroid derivative in the symptomatic joint. In these cases, this procedure was a valuable diagnostic and therapeutic method. CV joint arthropathies are frequent, but often lead to incorrect diagnosis. These preliminary results encourage further use of this procedure in CV arthropathies.

Adult↗
PubMedDate not supplied

Somatovisceral interactions in visceral perception: abdominal masking of colonic stimuli.

Clinical and experimental evidence on referred pain and spinal-afferent convergence demonstrates a close relationship between visceral and somatosensory perception, which is important for current models of symptom perception and central body representation. The study uses a psychophysical approach to quantify these interactions at the perceptual level, taking into account problems of comparable intermodal scaling and the role of awareness. An experiment on somatosensory masking of distension stimuli in the colon is reported in which a multiple staircase method of forced choice discrimination with concurrent sensation ratings was employed. Results showed perceptual masking of visceral by abdominal stimuli but not vice versa. The masking effect was not enhanced by intratomal placement of the abdominal stimulus in the lower left quadrant. This contradicts the spinal sensory convergence model and points to perceptual interactions at higher brain levels. Loglinear analysis of relations between discrimination and subjective sensation revealed qualitative differences of somatovisceral perception at the preconscious as compared to the conscious level. This argues for a two-process model of integrative body perception.

Adult↗
PubMedDate not supplied

Somatovisceral interactions in visceral perception: abdominal masking of colonic stimuli.

Clinical and experimental evidence on referred pain and spinal-afferent convergence demonstrates a close relationship between visceral and somatosensory perception, which is important for current models of symptom perception and central body representation. The study uses a psychophysical approach to quantify these interactions at the perceptual level, taking into account problems of comparable intermodal scaling and the role of awareness. An experiment on somatosensory masking of distension stimuli in the colon is reported in which a multiple staircase method of forced choice discrimination with concurrent sensation ratings was employed. Results showed perceptual masking of visceral by abdominal stimuli but not vice versa. The masking effect was not enhanced by intratomal placement of the abdominal stimulus in the lower left quadrant. This contradicts the spinal sensory convergence model and points to perceptual interactions at higher brain levels. Loglinear analysis of relations between discrimination and subjective sensation revealed qualitative differences of somatovisceral perception at the preconscious as compared to the conscious level. This argues for a two-process model of integrative body perception.

Abdomen↗
PubMed1989

The somato-visceral divergent projections of peripheral processes of substance P-containing spinal ganglionic neurons--tri-labeling study of combining fluorescein tracing with immunocytochemistry.

The chemical nature of the spinal ganglionic neuron with peripheral processes projecting divergently to the somatic and visceral areas, has been identified by means of tri-labeling method of combining fluorescein tracing with immunocytochemistry. 10 rats were used. First, 2 microliters of 2% fast blue(FB) were injected into the left coeliac ganglion. Two days later, 2% nuclear yellow (NY) was injected into left 9-11 intercostal nerves, 1 microliter for each. On the 4th day, the animal was perfused with 10% formalin in 0.1 mol phosphate buffer. The left T9-11 spinal ganglia were removed and cut into sections by cryostat. The sections were observed under fluorescence microscope and photographed. The results showed that there were three kinds of neurons in the spinal ganglia: 1) single FB labeled cells with blue fluorescent cytoplasm accounted for 38.8% of total cells; 2) single NY labeled cells with yellow fluorescent nuclei accounted for 52.7%; 3) FB and NY double-labeled cells, mostly small or medium in size, accounted for 8.5%. Then, the sections containing double-labeled cells were further processed by substance P-demonstrating PAP immunocytochemical staining. The photographs with immunostaining and fluorescein labelings in the same section were compared. We found that the labeling ratio of SP/NY was 1.4%, SP/FB was 7%, and SP/NY + FB was 28.8%. The present study detected not only the convergence of somato-visceral sensation in the spinal ganglia but also the chemical nature of these neurons containing substance P (SP) for the first time. In addition, these results may provide a morphological basis for the mechanisms of referred pain and somato-visceral reflection.

Animals↗
PubMed2005

Role of capsaicin-sensitive primary afferent inputs from the masseter muscle in the C1 spinal neurons responding to tooth-pulp stimulation in rats.

The aim of the present study was to demonstrate the convergence of inputs from masseter muscle (MM) and tooth pulp (TP) onto C1 spinal neurons and to determine whether the afferent fibers express the functional vanilloid receptor (VR1). Extracellular single-unit recordings were made from 61 C1 units responding to TP electrical stimulation with a constant temporal relationship to a digastric electromyogram signal in pentobarbital anesthetized rats. Eighty-four percent of C1 neurons responding to TP stimulation also responded to the ipsilateral MM stimulation. Of these neurons, 61% were considered to be afferent inputs from Adelta-fibers and the remaining units (39%) were C-fibers, based on calculation of the nerve conduction velocity. Intramuscular injection of capsaicin (0.05 and 0.1%) produced a reduction in a MM-induced C1 neuronal activity in a dose-dependent manner and this effect was antagonized by pretreatment with an antagonist of VR1, capsazepine. Some of these units were also excited by noxious heat stimulation (> 43 degrees C). The trigeminal root ganglion (TRG) neurons that innervated the MM were retrogradely labeled with Fluorogold (FG) and the small-diameter FG-labeled TRG neurons expressed the immunoreactivity for VR1. After intramuscular mustard oil injection (noxious chemical stimulation), the C1 neuronal activity induced by both touch and pinch stimuli was enhanced and their receptive field sizes were significantly expanded. These changes were reversed within 15-20 min. These results suggest that there may be the convergence of noxious afferents inputs from the MM and TP afferents on the same C1 neurons in rats, and that the afferent fibers expressing the functional VR1 may contribute to the hyperalgesia and/or referred pain associated with temporomandibular joint disorder.

Action Potentials↗
PubMed2006

Activation of alpha2-adrenoreceptors suppresses the excitability of C1 spinal neurons having convergent inputs from tooth pulp and superior sagittal sinus in rats.

The aim of the present study was to test the hypothesis that activation of alpha(2)-adrenoreceptors modulates the excitability of C1 neurons having convergent inputs from both the tooth pulp (TP) and the superior sagittal sinus (SSS), by using the microiontophoretic techniques of drug application and immunohistochemical approaches. Extracellular single-unit recordings were made from 38 C1 neurons responding to electrical stimulation of TP under pentobarbital-anesthetized rats. Seventy-one percent of C1 neurons (27/38) that responded to TP stimulation also responded to electrical stimulation of the SSS. In these neurons, L: -glutamate-evoked C1 neuronal discharge firings were increased in a dose-dependent manner. The mean glutamate-evoked firing rates were dose-dependently inhibited after microiontophoretic application of clonidine (alpha(2)-adrenoreceptor/imidazoline I(1) receptor agonist). The inhibition of glutamate-evoked C1 mean firings by clonidine was antagonized by the co-application of idazoxan (alpha(2)-adrenoreceptor/imidazoline I(2) receptor antagonist), yohimbine (alpha(2)-adrenoreceptor) but not the alpha(1)-adrenoreceptor antagonist, prazosin with affinity for alpha(2B)- and alpha(2C)-adrenoreceptors. The mean spontaneous discharge frequencies were significantly inhibited by the microiontophoretic application of clonidine and this inhibition was reversed by the co-application of idazoxan, yohimbine. Microiontophoresis of clonidine also resulted in a reduction of TP-/SSS-evoked activity and this effect was reversed by the co-application of yohimbine. Immunoreactivity for alpha(2A)-adrenoreceptor was found in the superficial layers of I-III in the C1 region. These results suggest that alpha(2)-adrenoreceptor agonist clonidine inhibits the excitability of C1 neurons having convergent inputs from TP and SSS afferents, and that the activation of alpha(2A)-adrenoreceptors onto C1 dorsal horn neurons may contribute as a useful therapeutic target for the alleviation of trigeminal referred pain associated with migraine and tooth pain.

Action Potentials↗
PubMed2003

[Diagnosis and therapy of myofascial trigger points].

AIM: Myofascial trigger points (MTrPs) are hyperirritable tender spots in palpable tense bands of skeletal muscle. Muscle is an orphan organ, no medical specialty claims muscle as its organ. The article aims at filling some of the gaps in the current knowledge of MTrPs. METHODS: The presented findings were partly obtained in experiments on anesthetised rabbits, partly they are the result of ample experience with patients suffering from MTrPs. DIAGNOSIS: Each muscle has a characteristic elicited referred pain pattern that, for active MTrPs, is familiar to the patient. Without a laboratory test or imaging method, diagnosis of MTrPs depends entirely on history and physical examination. MTrP symptoms follow muscle overload, are activated acutely by sudden overload, or develop gradually with prolonged contractions or repetitive activity. The diagnostic skill required depends on considerable innate palpation ability, authoritative training, and extensive clinical experience. THERAPY: Effective treatment methods include manual stretching by trigger-point pressure release, contract-relax, vapo coolant spray-and-stretch, and dry needling or injection of MTrPs. CONCLUSIONS: The integrated hypothesis presents an explanation for the pathophysiology of MTrPs and begins with excessive release of acetylcholine from involved motor endplates. It depends on a new understanding of the abnormality of endplate noise. Biopsies demonstrate segmental shortening of groups of sarcomeres in individual muscle fibres and possibly waves of contracted sarcomeres to account for palpable taut bands.

Animals↗
PubMed2006

Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome.

In addition to the debilitating fatigue, the majority of patients with chronic fatigue syndrome (CFS) experience chronic widespread pain. These pain complaints show the greatest overlap between CFS and fibromyalgia (FM). Although the literature provides evidence for central sensitization as cause for the musculoskeletal pain in FM, in CFS this evidence is currently lacking, despite the observed similarities in both diseases. The knowledge concerning the physiological mechanism of central sensitization, the pathophysiology and the pain processing in FM, and the knowledge on the pathophysiology of CFS lead to the hypothesis that central sensitization is also responsible for the sustaining pain complaints in CFS. This hypothesis is based on the hyperalgesia and allodynia reported in CFS, on the elevated concentrations of nitric oxide presented in the blood of CFS patients, on the typical personality styles seen in CFS and on the brain abnormalities shown on brain images. To examine the present hypothesis more research is required. Further investigations could use similar protocols to those already used in studies on pain in FM like, for example, studies on temporal summation, spatial summation, the role of psychosocial aspects in chronic pain, etc.

Fatigue Syndrome, Chronic↗