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PubMedDate not supplied

[Pathogenesis of tendon-/muscle pain with special reference to posture--a concept related contribution to the understanding of generalized tendomyopathy].

Tendomyopathies (TM) comprise two subgroups. Both are caused by the irritation of nociceptors (IN). Type I results from IN within muscles and tendons with the consequence of local pain, whereas type II refers to TM occurring at a site distant from IN anywhere in the body. Such TM-type II are understood to serve for the protection of the organism from further IN and depend on the regulatoric role of the central nervous system ("reflectoric TM"). Reflectoric shoulder pain emerging from arthritis in carpal joints (Hiemeyer et al.: Z. Rheumatol. 48, 1989, 139-143) is quoted as an example of such "regulatoric pain". Abnormal spinal posture (ASP) is believed to cause IN at various sites of the sceletomotoric system with the consequence of localized or generalized fibromyalgic syndromes (FS) of the type II subgroup. Now clinical signs of TM such as pain during motion, compression or stretching as well as muscular stiffness and fatigue are characteristic for so called primary FS; in addition, the majority of such patients exhibits ASP, especially increased thoracospinal kyphosis (Hiemeyer et al.: Akt. Rheumatol. 14, 1989, 193-201). For these reasons we arrive at the conclusion that ASP is a disposing factor for the development of FS. Therefore FS should not be called primary unless spinal posture has not been examined thoroughly. As a result of this concept we consider control of spinal posture by physiotherapy as an essential part in the causal treatment of FS.

Fibromyalgia↗
PubMed2005

Prognostic factors for low back pain in patients referred for physiotherapy: comparing outcomes and varying modeling techniques.

STUDY DESIGN: Data were derived from a randomized controlled trial on the (cost-) effectiveness of the implementation of the clinical guidelines on physiotherapy for low back pain in primary care. OBJECTIVES: To describe the course of low back pain in patients who are referred to physiotherapy, to identify clinically important prognostic factors on different outcomes, and to evaluate the influence of different statistical techniques in developing a prognostic model. SUMMARY OF BACKGROUND DATA: Several studies have aimed to identify prognostic factors for low back pain in primary care. These studies focused on different outcome measures and used various statistical techniques. METHODS: Primary outcomes were perceived recovery, improvement in pain, improvement in functioning, and presence of disabling low back pain at 3 and 12 months follow-up. Multivariate logistic regression analyses were performed for each outcome variable. Two cut-off points were used to determine significance with respect to the univariate analysis, and two selection methods were used to build the final multivariate models. The resulting prognostic models were compared. RESULTS: A total of 500 patients were included. Pain and disability reduced considerably in the first 3 months, but further reduction was only modest. Prognostic factors varied for different outcomes, but the duration of the current episode was included in all models generated. Varying the statistical techniques also resulted in a different prognostic model with some change to the amount of variance explained. CONCLUSIONS: A substantial proportion of patients still experienced some pain and disability at 12 months follow-up. The most stable predictor of prognosis in low back pain was the duration of the current episode. The choice of statistical method influenced the final model; however, changes in the explained variance were small.

Adult↗
PubMed1990

Computer-aided decision support in acute abdominal pain, with special reference to the EC concerted action.

This presentation describes the use of computer aided decision support in acute abdominal pain. The need for such support is explored and the feasability of providing support is described with reference to studies involving nearly 100,000 patients. It is argued that the provision of computer aided decision support can lead to substantial and practical benefit in clinical care--but this is mostly due to the constant stimulus towards "doing it right". This in turn depends upon the provision of a consensus view of "good medicine" in the area concerned; and on an international level strongly argues the case for multi-national cooperative studies to define good medicine and make it available. One such study (the European Community Concerted Action on Acute Abdominal Pain) is described.

Abdominal Pain↗
PubMedDate not supplied

Chest pain in children referred to a cardiology clinic.

One hundred consecutive patients (54 girls, 46 boys) referred to a pediatric cardiology department with the primary complaint of chest pain were evaluated. The age distribution was 2.5-16.0 years (mean 11.3 years for girls and 9.9 years for boys). The history showed 17% of patients with chest pain, 22% with heart disease, and 19% with recent death in the family. The time course of the pain was longer than 1 week in 92 patients. Localization was on the left precordium in 60 patients, and there was no radiation from the original site in 66 cases. Ninety-two percent of cases were idiopathic in origin. Of the 74 patients who had a psychiatric interview, 55 (74%) had psychiatric symptoms and 5 required psychiatric care. Anxiety, conversion disorder, and depression were the main psychiatric symptoms.

Adolescent↗
PubMed1987

Referred sensations in chronic pain patients.

This clinical note describes an unusual phenomenon of referred sensation reported in a sample of 98 chronic pain patients during electrical stimulation. Thirty-nine percent reported a variety of sensations referred to different parts of the body. Of these, 74% reported the sensations referred to the painful region. Among the sensations were paresthesias, pain, temperature changes, and pressure or constriction. The patients who had referred sensations had lower ratings of depression and had undergone more surgical operations than those who did not report referred sensations. Three case reports of patients with phantom limb pain are presented to illustrate the vividness with which these sensations are experienced. These data suggest that deafferentation due to disease, injury or other lesions of the CNS lead to a hypersensitivity and an increased likelihood of referred pain of long duration.

Amputation Stumps↗
PubMedDate not supplied

Evaluation of stereotactic thalamotomies for pain relief with reference to pulvinar intervention.

Stereotactic thalamotomies were carried out in 51 cases of malignant and 9 cases of other painful conditions. The patients were divided into two groups--those with a relatively small lesion created in the basal part of the CM nucleus and those with a larger lesion extending into the pulvinar. In total, 50% of the cases showed complete pain relief, 20% partial relief and 30% no effect. The group with pulvinar intervention showed better results, especially those with malignancies.

Follow-Up Studies↗
PubMed1997

[Proprioceptive capacities of patients with retropatellar knee pain with special reference to effectiveness of an elastic knee bandage].

In the presented study, knee joint proprioception of 43 patients with a patellar pain syndrome of the knee joint was evaluated. In a control group, the proprioception of 30 healthy volunteers with clinical and an-amnestic inconspicous knee joints was examined. We tested the proprioceptive capability of the subjects with a passive angle reproduction test. Additionally, all knee joints were measured with and without an elastic knee bandage. The patient group showed significant deterioration of angle reproduction capability (13.2 degrees +/- 6.1 degrees) compared to the control group (7.8 degrees +/- 2.8 degrees). After applying an elastic knee bandage, the angle reproduction capability significantly improved to 9.2 degrees +/- 4.5 degrees. Proprioception of the contralateral, noninvolved knee joint in the patients (11.6 degrees +/- 6.3 degrees) was worse compared to the control group. Applying an elastic knee bandage did not significantly improve the proprioception of the uninjured knee joint.

Adult↗
PubMed1997

The effect of compensation involvement on the reporting of pain and disability by patients referred for rehabilitation of chronic low back pain.

STUDY DESIGN: In this prospective, observational, cohort study of 192 individuals with chronic low back pain, the group of individuals was divided based on compensation involvement, and their presentation pain and disability, treatment recommendations, and compliance were compared. For 85 of these individuals who completed a spine rehabilitation program, their pain and disability at 3 and 12 months were compared. OBJECTIVES: To test the theory that individuals with compensation involvement presented with greater pain and disability and would report less change of pain and disability after rehabilitation efforts. BACKGROUND: Previous studies have produced conflicting results concerning this issue. METHODS: Individuals were recruited as consecutive patients referred for consultation at a spine rehabilitation center. Pain, depression, and disability were assessed using self-report questionnaires at evaluation and at 3 and 12 months. Rehabilitation services consisted of aggressive, quota-based exercises aimed at correcting impairments in flexibility, strength, endurance, and lifting capacity, identified through quantification of back function. Multifactoral analysis of variance models were used to control for baseline differences between compensation and noncompensation patients during analysis of target variables. RESULTS: The compensation group included 96 patients; these patients reported more pain, depression, and disability than the 96 patients without compensation involvement. These differences persisted when baseline differences were controlled for with multifactoral analysis of variance models. Treatment recommendations and compliance were not affected by compensation. For patients completing the spine rehabilitation program, length of treatment, flexibility, strength, lifting ability, and lower extremity work performance before and after treatment and patient satisfaction ratings were similar for the compensation and noncompensation groups. At 3 and 12 months, improvements in depression and disability were noted for both groups, but were statistically and clinically less substantial for the compensation group. At the 12 month follow-up visit, pain scores improved for the noncompensation group, but not for the compensation group. CONCLUSIONS: In chronic low back pain, compensation involvement may have an adverse effect on self-reported pain, depression, and disability before and after rehabilitation interventions.

Adult↗
PubMed1988

A critical look at the subluxation hypothesis.

Historically, manipulation has been applied to manage spinal and extremity joint lesions that produce pain. The cause of this local or referred joint pain often has been attributed to subluxation or partial dislocation. This paper looks at the historical roots of the subluxation hypothesis, and reviews the literature to see if any valid research exists supporting the hypothesis that slight subluxations correlate with local or referred pain or is a cause of fixation. Also examined is whether proof exists that manipulation reduces subluxation. Associations between subluxation and the manipulable lesion are outlined, and suggestions for use of the word subluxation are addressed. The term somatic dysfunction is forwarded as an appropriate descriptive diagnosis of the manipulable lesion.

Humans↗
PubMed1976

The anatomy of the lumbar intervertebral disc syndrome.

Four elements of the nervous system may be involved in the production of the lumbar intervertebral disc syndrome. These are the lumbosacral nerve roots, the spinal nerves, the dorsal rami and the sinuvertebral nerves. Each nerve is associated with a particular group of pathological conditions which may irritate the nerve and produce symptoms. The anatomy of each nerve determines which particular conditions may irritate it. Moreover, one or both of two mechanisms may be involved in symptom production. The type of nerve irritated determines which mechanism is involved. In the first mechanism, low back pain and referred lower limb symptoms are produced when afferent fibres from dorsal and ventral rami are stimulated where they pass in common through spinal nerves or nerve roots. In the second mechanism, dorsal rami or sinuvertebral nerves are stimulated. This directly produces low back pain, but referred pain is produced by reflex mechanisms in the spinal cord.

Back Pain↗
PubMed2005

Relationship between pain symptoms and referred sensory and trophic changes in patients with gallbladder pathology.

The relationship was investigated between algogenic potential of gallbladder pathology and occurrence/extent of sensory and trophic changes in the referred area. Five groups of subjects were studied, with: symptomatic gallbladder calculosis (3-20 colics); asymptomatic calculosis; symptomatic gallbladder shape abnormality (8-18 colics); asymptomatic shape abnormality; normal gallbladder/no symptoms. At the cystic point (CP) and contralaterally, all underwent measurement of: pain thresholds to electrical stimulation of skin, subcutis and muscle; thickness of subcutis and muscle via ultrasounds. Contralaterally to CP, all thresholds were not significantly different in the five groups. At CP, subcutis and muscle thresholds were significantly lower in symptomatic vs asymptomatic patients and/or normals (0.0001<P< 0.05). In symptomatic cases, at CP compared to contralaterally, subcutis and muscle thresholds were significantly lower (0.0001<P<0.02), subcutis thickness was significantly higher and muscle thickness significantly lower (0.006<P<0.02). Subcutis and muscle thresholds at CP in symptomatic patients were significantly and inversely correlated linearly to the number of colics (P<0.0004; P<0.0001). Patients with symptomatic calculosis were re-evaluated after 6 months; those not presenting further colics showed a significant increase in subcutis and muscle thresholds at CP, while those who continued presenting colics showed a further significant threshold decrease (0.01<P<0.05); tissue thickness did not vary. Referred hyperalgesia and altered trophism from the gallbladder only occur in painful pathology, their extent being modulated by the amount of perceived pain. The results suggest different mechanisms by which visceral nociceptive inputs trigger sensory vs trophic changes in the referred area.

Abdominal Pain↗