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Results for “Referred Pain”

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PubMed1984

[Calcitonin in bone-metastasizing breast carcinoma. Results of a pilot study].

48 patients with metastatic breast cancer and extensive bone involvement were treated with salm-calcitonin and polychemo-therapy or hormonal treatment. They were compared with a control group of 73 patients without calcitonin therapy. One third of the patients from the calcitonin group referred pain relief which was obviously independent from the therapy effects of the polychemo or hormonal treatment. Since only subjective criteria for sceletal pains were used and no therapy arm with calcitonin alone was studied, the results of our study have to be critically analyzed together with other reports about calcitonin and bone metastases in the literature.

Adult↗

PubMed1977

Clinical evaluation of TMJ arthroplasties with insertion of articular eminence prosthesis on ninety patients (an eight year study).

This paper represents an analysis, accomplished over an eight-year period, of 90 individuals who have been operated on for various arthritic diseases of their temporomandibular joints (TMJ). In arthritic changes of the joint, several changes may occur: perforation of the disc, flattening of the articular eminence, asymmetrical condylar movement, and chronic synovitis. This may result in increased synovial pressure on nerve fibers within the capsule of the joint, and a variety of referred pain symptoms. Prior to operation, a careful differential diagnosis was made by an otolaryngologist and, frequently, by a neurologist/neurosurgeon and a psychologist. The prosthesis inserted during surgery was a metallic device which fits over the articular eminence in the upper portion of the joint. This prosthesis accomplished primarily three functions: elimination of the crepitus; restoration of the contour of the eminence; separation of the articular surface of the joint.

Adolescent↗

PubMed1999

Longitudinal limb deficiencies and the sclerotomes. An analysis of 378 dysmelic malformations induced by thalidomide.

The pathogenesis of longitudinal reduction deformities of the limbs, or dysmelia, is still a matter of debate. Their morphological pattern was defined from a large collection of radiographs of children with dysmelia following the thalidomide disaster. We compared radiographs of 378 of these limbs with the sclerotomes which are areas of segmental sensory innervation of the limb skeleton defined by the radiation of referred pain. The pattern of dysmelia matched the sclerotomes closely in 279 limbs (73.5%). The principles of skeletal reduction in dysmelia are explained by the arrangement of the sclerotomes. The congruence between two separate and independent data sets shows that both patterns are expressions of the underlying segmental sensory innervation of the skeleton, and that the sensory nervous system is involved in the process of limb morphogenesis and teratogenesis.

Abnormalities, Drug-Induced↗

PubMed2003

Nerve lesions associated with limb-lengthening.

BACKGROUND: Nerve injury is one of the most serious complications associated with limb-lengthening. We examined the risk, assessment, and treatment of nerve lesions associated with limb-lengthening. METHODS: We retrospectively studied the records on 814 limb-lengthening procedures. Nerve lesions were defined by clinical signs and symptoms of motor function impairment, sensory alterations, referred pain in the distribution of an affected nerve, and/or positive results of quantitative sensory testing with use of a pressure specified sensory device. RESULTS: Seventy-six (9.3%) of the limbs had a nerve lesion. Eighty-four percent of the nerve lesions occurred during gradual distraction, and 16% occurred immediately following surgery. The pressure specified sensory device showed 100% sensitivity and 86% specificity in the detection of nerve injuries. The patients in whom the lesion was diagnosed with this method, or with this method as well as with nerve conduction studies, had significantly faster recovery than did those diagnosed on the basis of clinical symptoms or nerve conduction studies alone (p = 0.02). Patients undergoing double-level tibial lengthening and those with skeletal dysplasia were at higher risk for nerve lesions (77% and 48%, respectively). Nerve decompression was performed in fifty-three cases (70%). The time between the diagnosis and the surgical decompression was strongly associated with the time to recovery (p = 0.0005). Complete clinical recovery was achieved in seventy-four of the seventy-six cases. CONCLUSIONS: Early detection based on signs and symptoms or testing with a pressure specified sensory device improves the prognosis for nerve injury that occurs during limb-lengthening. Of the methods that we used to identify neurologic compromise, testing with the pressure specified sensory device was the most sensitive. Aggressive early treatment (slowing the rate of lengthening and/or performing decompression) allows continued lengthening without incurring permanent nerve injury. When indicated, decompression of the affected nerve should be performed as soon as possible, thereby improving the chances of and shortening the time to complete recovery.

Bone Lengthening↗

PubMedDate not supplied

Nonsurgical versus endoscopic sinonasal surgery for rhinogenic headache.

Headaches of sinonasal origin have been described lately. Terms such as middle turbinate syndrome have been used to describe this entity. The true incidence of this headache is unknown. A concha bullosa or a hypertrophied middle turbinate have been associated with these cases. Mucosal contact between the middle turbinate and the nasal septum or the lateral wall of the nose have been attributed as the cause of referred pain in the face. We present data on 23 individuals with refractory primary headache in the absence of any significant sinus symptoms. The duration of the symptoms of these individuals ranged between 4 and 13 years with a mean of 7.2 years. Fifteen patients agreed to undergo surgery, whereas eight refused surgery. After a mean of 23 months of follow-up, all those who did not have surgery continued to have pain that required excessive medications, whereas 60% of those who had surgery reported marked relief of their headaches. Those who had symptoms for less than 7 years had a greater chance of success (OR = 2). Sinonasal surgery seems to be helpful in alleviating primary headaches, especially in individuals whose duration of symptoms is less than 7 years.

Adult↗

PubMed2005

Musculoskeletal imaging in physical therapist practice.

This article presents an overview of current concepts of evidence-based diagnosis using a variety of imaging modalities for a broad spectrum of musculoskeletal conditions and syndromes. There is limited but increasing evidence that physical therapists appropriately use diagnostic studies in clinical practice. Pathology revealed by diagnostic studies must be viewed in the context of the complete examination, as pathology is common in the asymptomatic population. Special diagnostic challenges are presented by patients with areas of referred pain, multiple injuries or multiple areas of pathology, neoplasms, and infections. Plain film radiographs have been overused in the clinical management of many conditions, including low back pain. Clinical decision rules provide simple evidence-based guidelines for the appropriate use of imaging studies.

Diagnostic Imaging↗

PubMed1983

Segmental acupuncture therapy.

Studies of referred pain aid the assessment and treatment of many puzzling conditions--once the source of the pain or distress can be located and its segmental innervation is known. Furthermore as this survey suggests, these studies tend to confirm many traditional Chinese medical observations--particularly when a beneficial effect occurs following an insertion of an acupuncture needle in an apparently remote region that shares the same segmental supply as the patient's complaint.

Acupuncture Therapy↗

PubMed2002

Infrared thermoimages display of body surface temperature reaction in experimental cholecystitis.

AIM: To display the thermoimages of the body surface in experimental cholecystitis, to observe the body surface temperature reaction in visceral disorders, and to study if the theory of body surface-viscera correlation is true and the mechanism of temperature changes along the meridians. METHODS: By injecting bacteria suspension into the stricture bile duct and gallbladder, 21 rabbits were prepared as acute pyogenic cholangiocholecystitis models, with another 8 rabbits prepared by the same process except without injection of bacteria suspension as control. The body surface infrared thermoimages were continuously observed on the hair shaven rabbit skin with AGA-782 thermovision 24h before, 1-11 d after and (2,3 wk) 4 wk after the operation with a total of over 10 records of thermoimages. RESULTS: Twelve cases out of 21 rabbits with cholecystitis revealed bi-lateral longitudinal high temperature lines in its trunk; with negative findings in the control group. The high-temperature line appeared on d1-d2, first in the right trunk, after the preparation of the model, about 7 d after the model preparation, the lines appeared at the left side too, persisting for 4 wk. The hyper-temperature line revealed 1.1-2.7 degrees higher than before the model preparation, 0.7-2.5 degrees higher than the surrounding skin. The length of the high temperature line might reach a half length of the body trunk, or as long as the whole body itself. CONCLUSION: The appearance of the longitudinal high temperature lines at the lateral aspects of the trunk in the experimental group is directly bound up with the experimental animals pyogenic cholecystitis, with its running course quite similar to that of the Gallbladder Channel of Foot Shaoyang, but different to the zones of hyperalgesia and site of referred pain in cholecystitis.

Animals↗

PubMed1988

Intramedullary osteosclerosis. A report of the clinicopathologic features of five cases.

The clinicopathologic features of five patients with intramedullary osteosclerosis are presented. The patients, ranging in age from 8 to 52 years (mean 31 years), all presented with pain referred to the lower extremity. The sclerotic lesions involved the entire lower extremity in 1 patient, mid-tibial shaft in 2, distal tibia in 1, and distal fibula in 1 patient. The histopathologic features of intramedullary osteosclerosis overlap with those of melorheostosis. The differential diagnosis also includes a spectrum of entities, each characterized by osteosclerosis and each of which is compared and contrasted to the cases presented.

Adolescent↗

PubMed2005

Rubber-band ligation for hemorrhoids in a colorectal unit. A prospective study.

INTRODUCTION: Nowadays the rubber band ligation technique is one of the most worldwide used and effective treatment of the hemorrhoidal disease. OBJECTIVES: Our study has as a goal to analyze the success or failure of the rubber band ligation in hemorrhoids grade 1,2 and 3, to analyze their complications and to see if all symptomatic hemorrhoids should be treated with ligation at the first visit. PATIENTS AND METHOD: A prospective and descriptive study was designed for patients who came to the Colorectal Unit with hemorrhoidal disease from September 1997 to December 2001. First, second and third degree patients were treated according to the classification of hemorrhoids of St. Mark's Hospital. The technique of ligation after Barron was applied. RESULTS: From 261 patients with a mean age of 48.3 (range: 16-86), 181 (99 M/82 W) have been treated with Barron's method and 80 with rich fiber diet and water. Rectal bleeding was the most common symptom (91.16%). Anuscopy showed hemorrhoidal disease in all the cases. From 181 patients, 19.33% were hemorrhoids degree I, 51.93% degree II and 29.83% degree III. Two hundred and eighty-seven ligation sessions were done and the balance of ligations per patient was 2.45 and 1.5 rubber band per session. The 32% of the patients referred pain after ligation. A 13.81% of cases were operated due to persistent rectal bleeding or hemorrhoidal prolapse. CONCLUSIONS: Symptomatic hemorrhoids degree I and II with a short clinical history should be treated initially with a rich fiber and water diet. The technique of Barron is an effective therapy to treat the hemorrhoids degree 1, 2 and in 74% of success in cases with degree 3.

Adolescent↗

PubMed1999

[A bifid ureter with a blind branch].

OBJECTIVE: To report on a case of bifid ureter with a blind-ending branch. METHODS: A case of bifid right ureter with a blind-ending branch and complete duplication of the contralateral ureter in a 38-year-old female patient is described. The patient had consulted for pain referred to the right iliac fossa and recurrent urinary infection. RESULTS: An excretory urogram disclosed the ureteric anomaly, which was confirmed by retrograde pyelography. Uretero-ureteric reflux to the blind-ending branch was found during surgery and excision of the blind-ending branch was performed. CONCLUSIONS: This ureteric anomaly is basically diagnosed radiologically. Treatment is initially conservative, although complications or severe symptoms may warrant surgical excision of the blind-ending ureter.

Adult↗

PubMed1999

Pain: friend or foe.

Pain, the most urgent of symptoms usually signals the presence of potential or on-going injury to tissue which requires attention. The warning that pain provides is, therefore, a good thing and in a way friendly. When pain continues or resumes after the healing process of injury is complete, it is no longer signalling on-going tissue damage but becomes a disease in its own right. That, in essence, is the presentation of most chronic pain syndromes referred to Pain Clinics for investigation and treatment.

Ambulatory Care↗

PubMed2000

Otalgia in children.

Otalgia is a common symptom in the pediatric age group. The most common cause is acute otitis media, followed by otitis externa. In the majority of cases, the diagnosis can be established by a thorough history and a careful otologic examination. When the otologic findings are normal and the etiology is obscure, a thorough work-up to determine the source of referred pain is essential. Laboratory investigations are usually not necessary. Treatment should always be directed at the underlying cause.

Child↗

PubMed2001

The value of MR neurography for evaluating extraspinal neuropathic leg pain: a pictorial essay.

SUMMARY: Fifteen patients with neuropathic leg pain referable to the lumbosacral plexus or sciatic nerve underwent high-resolution MR neurography. Thirteen of the patients also underwent routine MR imaging of the lumbar segments of the spinal cord before undergoing MR neurography. Using phased-array surface coils, we performed MR neurography with T1-weighted spin-echo and fat-saturated T2-weighted fast spin-echo or fast spin-echo inversion recovery sequences, which included coronal, oblique sagittal, and/or axial views. The lumbosacral plexus and/or sciatic nerve were identified using anatomic location, fascicular morphology, and signal intensity as discriminatory criteria. None of the routine MR imaging studies of the lumbar segments of the spinal cord established the cause of the reported symptoms. Conversely, MR neurography showed a causal abnormality accounting for the clinical findings in all 15 cases. Detected anatomic abnormalities included fibrous entrapment, muscular entrapment, vascular compression, posttraumatic injury, ischemic neuropathy, neoplastic infiltration, granulomatous infiltration, neural sheath tumor, postradiation scar tissue, and hypertrophic neuropathy.

Adolescent↗

PubMed2002

[[Primary psoas abscess. Presentation of 3 cases].

OBJECTIVE: To present 3 cases of primary abscess of the psoas muscle. The clinical features, diagnostic tests, treatment and outcome are discussed. METHODS/RESULTS: Three patients that presented with fever and pain referred to the renal and/or iliac fossa are described. Physical examination showed psoas involvement in only one patient. Among the complementary tests performed, ultrasound demonstrated the abscess in one of the cases; the definitive diagnosis was made by contrast-enhanced CT. One of the cases was treated only with antibiotics while the other two cases were treated with CT-guided percutaneous drainage and appropriate antibiotic therapy. CONCLUSIONS: Psoas abscess is an uncommon pathology whose presenting features are usually unspecific. CT with contrast enhancement is considered to be the technique of choice for the diagnosis and to corroborate the resolution of the condition. Recently, the use of CT or US-guided percutaneous drainage has replaced surgery as the initial therapeutic approach for this condition.

Adult↗

PubMedDate not supplied

[The use of parenteral clodronate in elderly women with postmenopausal osteoporosis: compliance, effects on bone mineral density and on bone turnover].

The aim of the study was to evaluate parenteral clodronate (CLD) compliance in patients with postmenopausal osteoporosis and intolerance to aminobisphosphonates. Moreover, we have also assessed the effects of CLD on bone mineral density (BMD) and bone turnover. Eighty-four consecutive postmenopausal women with osteoporosis (range 62-74 years) were enrolled and randomly allocated to three groups: group A included 26 women who received CLD i.v., 300 mg/2 weeks and oral supplemental calcium carbonate (500 mg x 2/day) and vitamin D3 (400 IU x 2/day); group B included 28 women who received CLD i.m., 100 mg/week, and the same dose of calcium and vitamin D3 administered to group A; group C, the control group, included 30 women receiving only calcium and vitamin D3 at the same doses as the other two groups. The lumbar spine (L1-L4) and femoral neck (FN) BMD were measured by dual energy X-ray absorbiometry at time 0 (T0) and after 6 (T6), 12 (T12), 18 (T18) and 24 (T24) months. At the same time, the serum bone specific alkaline phosphatase and amino-terminal telopeptide of type I collagen normalized by creatinine (NTx/cr) were determined at T0, T6, T12, T18, and T24. Eighty (95.2%) women completed the study, 24 in group A, 27 in group B and 29 in group C. In groups A and B, after 6 months of treatment we found a significantly greater (p < 0.05) increase in the L1-L4 BMD with respect to group C. After 12 months of therapy, in group A the L1-L4 BMD (1.8 +/- 0.5%) was significantly higher (p < 0.05) than that in group B (0.9 +/- 0.3%). At the end of the study, in groups A (1.2 +/- 0.5%) and B (1.1 +/- 0.4%) the percentage increase in the FN BMD was significantly greater (p < 0.05) than in group C (0.6 +/- 0.5%). After 24 months of therapy, there was no difference in the FN BMD between groups A and B. Since the sixth month, both the bone specific alkaline phosphatase and NTx/cr were found to be more markedly and significantly decreased (p < 0.05) in groups A and B with respect to group C. After 18 months, in group A (NTx/cr -16.7 +/- 0.8%) we observed a significantly reduced (p < 0.05) bone resorption with respect to group B (NTx/cr -11.0 +/- 0.5%). In group B, only 3 patients (11.2%) referred pain at the site of drug administration. Our data demonstrate that compliance to parenteral CLD is satisfactory and that this drug reduces bone turnover, increases the L1-L4 BMD and decreases the FN BMD loss. Parenteral CLD administration can represent an effective alternative treatment for postmenopausal women with osteoporosis, especially those who do not tolerate oral aminobisphosphonates.

Aged↗

PubMedDate not supplied

The facet syndrome.

Injection of irritant fluid precisely into the facet joint causes referred pain patterns indistinguishable from the pain complaints frequently associated with the "disk syndrome." Even straight leg raising and diminished reflex signs can be obliterated by precise local anesthetic injection into the facet joint. The use of radiographically localized injection of steroids and local anesthetic into the facet joint has been presented as a diagnostic-therapeutic procedure. Clinical experience with a group of 100 consecutive patients suggests that this treatment alone can achieve long-term relief in one-fifth of the patients with lumbago and sciatica and partial relief in another one-third of these patients. This information suggests that the structures related to the facet joint can be a persistent contributor to the chronic pain complaints of individuals with low back and leg pain.

Adult↗

PubMedDate not supplied

[Mucinous papillary cystadenoma of the pancreas].

The case of a 15-years-old female patient is presented, who referred pain and presence of a mass in the left upper quadrant of the abdomen. Diagnostic imaging showed a 9 cm diameter cystic lesion in the tail of the pancreas which was removed surgically. Histology demonstrated a pancreatic mucinous cystadenoma with borderline biological behaviour. A review of the literature related to cystic neoplasms of the pancreas is realized.

Adolescent↗