Comment on "Greater trochanteric pain syndrome in patients referred to orthopedic spine specialists".
Explore the source record for details and available documents.
Femur↗
SEARCH · PubMed Health
Results for “Referred Pain”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The relationship between cigarette smoking and chronic low back pain.
This study investigated the extent to which habitual cigarette smoking relates to physical and psychological indices of chronic pain. From a review of patient records, 54% of back pain patients referred for treatment of their pain admitted to smoking cigarettes. Response from a smoking questionnaire showed that 57% of the patients who smoked reported having a need to smoke when they were in pain. Most patients (91%), however, believed that smoking had no effect on their pain intensity. When smoking and nonsmoking back pain patients were compared, the smokers showed significantly higher levels of emotional distress, they tended to remain inactive, and they relied on medication more often than the nonsmoking patients. The results further suggest that pain patients are at risk for increasing smoking behavior when they are experiencing periods of heightened pain intensity.
Adaptation, Psychological↗
Validation of thermography in the diagnosis of reflex sympathetic dystrophy.
OBJECTIVES: To examine the validity of several thermogram-derived indices of autonomic functioning in the diagnosis of reflex sympathetic dystrophy (RSD). DESIGN: A series of chronic pain patients were classified diagnostically based on thermogram results using discriminant function analysis, and validity measures (e.g., sensitivity, specificity) were used to determine the accuracy of computerized thermographic pixel analysis in discriminating RSD from other pathology. SETTING: The study was conducted at the Rush Pain Center, a multidisciplinary outpatient pain clinic. PATIENTS: A series of 46 chronic pain patients referred for suspected sympathetically mediated pain. INTERVENTIONS: All patients underwent computerized thermographic examination under a baseline condition after acclimating to a climate-controlled room, immediately after a cold challenge was applied to the contralateral uninvolved extremity (4 degrees C for 90 s) and 20 min after the cold challenge. OUTCOME MEASURES: Temperature during the three experimental periods, degree of temperature asymmetry between affected and nonaffected limbs during the three periods, response to cold challenge, and recovery following cold challenge were measured. RESULTS: Temperature asymmetry accurately discriminated between RSD and non-RSD patients, with the most accurate asymmetry measures obtained at baseline. Responses to cold challenge and actual temperature values did not discriminate between RSD and non-RSD pain patients. CONCLUSIONS: Thermography can be a useful component of RSD diagnosis. In situations where sensitivity and specificity are equally important, an asymmetry cutoff of 0.6 degree C appears optimal. If specificity (i.e., accurately ruling out non-RSD cases) is more important, a cutoff of 0.8 degree C or 1.0 degree C may be considered as well.
Adult↗
Amitriptyline in the prophylaxis of central poststroke pain. Preliminary results of 39 patients in a placebo-controlled, long-term study.
BACKGROUND AND PURPOSE: We performed a double-blind, placebo-controlled study to investigate the effectiveness of amitriptyline for the prophylactic treatment of patients with acute thalamic stroke in preventing central poststroke pain. METHODS: Subject received, in a randomized sequence, either amitriptyline titrated from 10 to 75 mg in extended-release form or placebo over a therapy period of 365 days. We documented the time when pain developed; the intensity, type, site, and distribution of pain; and the presence/absence and type of allodynia. RESULTS: Thirty-nine patients (23 women and 16 men; age range, 36 to 68 years) with central poststroke pain participated. The placebo group showed a pain rate of 21% within 1 year after the diagnosis of thalamic stroke compared with 17% in the group under prophylactic treatment with amitriptyline. Average (SE) time to pain was 318 (23) days for patients in the placebo group and 324 (24) days for patients in the amitriptyline group. CONCLUSIONS: With the achieved sample sizes of this study and a pain rate of approximately 21% in the placebo group, any near-perfect pain protection would have been detected. Near-perfect pain protection, in this context, refers to pain in <2.4% of the recruited patients treated with amitriptyline or in approximately 89% of placebo-treated patients. Larger studies are recommended to test the hypothesis that prophylactic amitriptyline reduces but does not completely prevent central poststroke pain.
Acute Disease↗
The effect of transcutaneous electrical nerve stimulation on ocular pain.
The effect of transcutaneous electrical nerve stimulation (TENS) on pain originating in the eye was studied in 10 patients. All three patients subjected to TENS during panretinal photocoagulation reported marked reduction in pain. Three of five patients who had persistent pain following scleral buckling and/or vitrectomy reported partial or complete relief of pain during the application of TENS. One patient had equivocal relief of pain when TENS was used during retinal cryopexy; 1 patient with acute pain following paracentesis and 1 patient with persistent pain following cyclocryotherapy had no relief. Among those patients whose pain was reduced by TENS, referred brow pain was relieved more than globe pain.
Adult↗
[Pain epidemiology and health-related quality of life in patients with chronic non-malignant pain].
This paper presents the results of a detailed study of the pain epidemiology and health related quality of life (HRQL) in 150 chronic non-malignant pain patients referred to a Danish multidisciplinary pain centre. Mean pain intensity was 71.6 (SD 18.5) on the VAS scale. HRQL was evaluated using the questionnaires: SF-36, HAD and PGWB. Compared with the normal population (NP) both physical, psychological and social well-being was severely reduced, and 58% were found to have a depressive or anxiety disorder. Sixty-three percent of the patients had neurogenic pain conditions. Of these, only 25% were treated with antidepressants or anticonvulsants. At referral 73% were treated with opioids. Mean opioid consumption was 64 mg of morphine per day. Patients had used the health care system five times more often than the NP (p < 0.001). The study showed that HRQL of chronic non-malignant pain patients is among the lowest observed for any medical condition.
Adult↗
Evaluation of recalcitrant pain in HIV-infected hospitalized patients.
Chronic refractory severe pain in HIV-infected patients is a common and often neglected problem. Little data exist evaluating its epidemiology, clinical features, and treatment. Our study assessed all HIV-infected inpatients referred to the pain control service over a 2-year span. All (24) inpatients with HIV infection with chronic refractory severe pain referred to the pain control service (PCS) over a 2-year period were prospectively followed daily by trained specialists who graded the pain, recommended appropriate therapy, and assessed outcome. Ten surviving patients had further long-term outpatient follow-up. The patients included 14 intravenous drug abusers, five of whom were on methadone maintenance. Localized lower-extremity pain was present in 58%. Pain had been present for > or = 1 month in 21 (88%) and for > or = 6 months in 12 (50%). No patient had been on pain control around the clock. After PCS consultation, all surviving patients (21 of 21, 100%) had partial or total pain relief within 2 weeks (eight within 1 week) using around-the-clock opioid analgesia adjusted daily as necessary. No differences were seen between substance abusing/methadone patients and others. No significant adverse reactions or new addiction problems were found. Our conclusion is that effective pain control can be achieved using around-the-clock opioid analgesia in terminal HIV-infected patients with severe, chronic, refractory pain, even if the patients are substance abusers.
Administration, Cutaneous↗
The presentation and management of female breast symptoms in general practice in Sheffield.
BACKGROUND: Relatively little is known about the incidence of breast symptoms in primary care consultations and GPs' patterns of referral to secondary care. OBJECTIVE: We aimed to identify the consultation rate for breast symptoms in general practice and to describe the management of those symptoms, including patterns of referral to secondary care. METHOD: Prospective data were collected by 248 GPs concerning 508 women consulting for breast symptoms. A verification study was carried out in nine practices to compare the data collected prospectively with information recorded contemporaneously in the same patients' notes. Main outcome measures were number of patients with lump, pain, nipple discharge, skin or nipple problems, family history or other symptoms at first or subsequent consultation, management action, age of patient and number of patients meeting study criteria for whom GPs did not record information in the prospective study. RESULTS: The mean number of consultations per GP over the 4-week recording period was 2.05. However, examination of a patient's notes from a sample of nine practices participating in the verification study suggested that GPs recorded only slightly over half of the consultations for breast symptoms on the study pro forma. At their first consultation, 40% of women presented with a breast lump and 40% with breast pain. Fifty-eight per cent of women with lumps were referred for specialist evaluation after a first or subsequent consultation, whereas the comparable percentage for women referred for pain was 17%. CONCLUSIONS: At an initial consultation for breast symptoms, GPs refer approximately one-third of women to secondary care. Women are most likely to be referred for a lump or for a family history of breast cancer and least likely to be referred for breast pain. The verification study suggests that relying on GPs to collect data on a specific group of patients may produce an underestimate of the consultation rates for a specified condition.
Adolescent↗
The posteromedial hypothalamus and pain, behavior, with special reference to endocrinological findings.
Stereotactic intervention into the posterior hypothalamus gives satisfactory results for controlling both aggressive, violent behavioral disorders and intractable pain. From the endocrinological point of view, this procedure activates the hypothalamic-hypophyseal axis only temporarily, without causing any serious dysfunctions.
Adolescent↗
[Differential diagnosis of otalgia].
BACKGROUND: Otalgia is the sensation of pain in the ear, while referred otalgia is pain felt in the ear but originating from a nonotologic source. Ear pain is a diagnostic problem when examination of the ear shows no pathology. This article reviews the anatomic basis for referred otalgia and shows the common etiologies responsible for this symptom. OTALGIA: Pain in the ear can be caused by inflammation of the external meatus or the middle ear. Nonotogenic otalgia may be due to referred or reflex pain, neuralgia, or to a psychogenic problem. Otalgia may be referred also from primary carcinoma of the head and neck. A thorough understanding of the anatomy of the head and neck is required. A basic knowledge of neuroanatomy, with emphasis on the cranial nerves, their course, distribution, and function, is also necessary. Referred pain is due to irritative lesions involving the fifth, ninth, or tenth cranial nerve and spinal nerves C2 and C3. If pathologic problems in the area supplied by these nerves have been ruled out, the neuralgia should be considered in the differential diagnosis. Psychogenic factors must be identified and treated before any type of surgical therapy is recommended. The complexity of this field may sometimes require the treating physician to call for consultations from colleagues in the fields of oral surgery, orthopaedics, neurology, or neurosurgery.
English Abstract↗
Reference fields in phantom tooth pain as a marker for remapping in the facial territory.
Six patients with chronic phantom tooth pain were studied for the presence of reference fields for their phantom sensation. In five of them, pain or dysesthesia in the affected oral structures was elicited by thermal or mechanical stimulation of areas that were well separate from these structures. However, a relation of topographical proximity between the stimulated areas and the areas of reference could be traced in the sensory maps. Therefore, denervation of small structures with coarse sensitivity can yield the plastic changes that have previously been described for larger deafferentations of areas endowed with finer discriminative capacity.
Adult↗
Sex differences in investigation results and treatment in subjects referred for investigation of chest pain.
OBJECTIVE: To evaluate differences in investigation results and treatment between men and women referred for diagnostic treadmill exercise testing and coronary arteriography. DESIGN: Cohort study. SETTING: Tertiary cardiology centre. SUBJECTS: 1522 subjects referred by primary care physicians to an open access chest pain clinic for initial investigation of chest pain, of whom 485 were subsequently referred for coronary arteriography; and a similar cohort of 107 subjects referred directly by secondary care physicians for diagnostic coronary arteriography. MAIN OUTCOME MEASURES: Rates of positive exercise tests and rates for referral for arteriography and revascularisation according to sex. RESULTS: Overall, women were less likely to be referred for arteriography and revascularisation than men. However, men were more likely to have positive exercise tests, and for various exercise test diagnostic end points men were also more likely to have significant coronary artery disease. After taking this into account, there was no sex difference in referral rates for arteriography or revascularisation. CONCLUSIONS: There was no evidence of a sex bias resulting in inappropriate underinvestigation or undertreatment of women. However, the positive predictive value of treadmill exercise testing is low for women and further research is needed into how best to investigate women with chest pain.
Aged↗
The management of chronic pain: an evaluation of recent developments, with special reference to the regional anesthesia and the pain clinic.
Explore the source record for details and available documents.
Anesthesia, Conduction↗
[Pain therapy other than with drugs with special reference to headache].
Pain-control and pain-therapy becomes most efficient within a systematic polypragmasy combining pharmacological and non-pharmacological means. the non-pharmacological means as well have to be combined in a rational (not casual) way. Plurality of methods should be controlled by a holistic medical view, not to become monomaniac. On the other hand specialized development in methods must be stimulated. Within our own working group we have developed a special model of group therapy combining autogenic training and analytical approach. We also apply respiratory feedback combined with suggestive formula implanted into the hypnoid state.
Acupuncture Therapy↗
Complexities in ETS-domain transcription factor function and regulation: lessons from the TCF (ternary complex factor) subfamily. The Colworth Medal Lecture.
The ETS-domain transcription factor family can be divided into a series of subfamilies. Elk-1 represents the founding member of the ternary complex factor (TCF) subfamily. By focusing on the TCF subfamily, we can demonstrate the complexities that exist in the function and regulation of ETS-domain transcription factors. This article focuses on Elk-1 in detail and summarizes the functions of other TCFs. The key themes covered include the domain structure of the TCFs, the mechanisms of complex formation with serum response factor, regulation of TCFs by mitogen-activated protein kinase cascades, and transcriptional regulatory properties of the TCFs. Finally, the emerging role of the TCFs in vivo is discussed. A picture is developing indicating that, while these proteins exhibit significant sequence and functional conservation, key differences in their structure and regulation are being identified which may relate to unique functions of these proteins in vivo.
Amino Acid Sequence↗
[Functional somatic pain syndromes-nomenclature].
A significant number of pain syndromes to be found in all medical specialties, including pain therapy, can be ascribed to a group that according to the classification of the International Association for the Study of Pain (IASP) is referred to as "pain syndromes with dysfunctional etiology," or according to internal medical terminology as "functional somatic syndromes" (functional disorders), or based on psychiatric nomenclature as "somatoform disorders." Frequent syndromes exhibiting pain as the major symptom include fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), chronic pelvic pain (CPP), tension headache, chronic myoarthropathies of the masticatory system (MAP), and prostatodynia. It is important for practitioners of both somatic and psychosocial medicine to be aware of the terminology used in other fields and the frequency of comorbidities of the individual syndromes. To improve communication between somatic and psychosocial medicine as well as with patients, the authors recommend that pain therapists base their diagnosis on the ICD-10 classification and refrain from using a separate pain therapy nomenclature.
Diagnosis, Differential↗
Breakthrough pain: definition, prevalence and characteristics.
In the cancer population, the term breakthrough pain typically refers to a transitory flare of pain in the setting of chronic pain managed with opioid drugs. The prevalence and characteristics of this phenomenon have not been defined, and its impact on patient care is unknown. We developed operational definitions for breakthrough pain and its major characteristics, and applied these in a prospective survey of patients with cancer pain. Data were collected during a 3 month period from consecutive patients who reported moderate pain or less for more than 12 h daily and stable opioid dosing for a minimum of 2 consecutive days. Of 63 patients surveyed, 41 (64%) reported breakthrough pain, transient flares of severe or excruciating pain. Fifty-one different pains were described (median 4 pains/day; range 1-3600). Pain characteristics were extremely varied. Twenty-two (43%) pains were paroxysmal in onset; the remainder were more gradual. The duration varied from seconds to hours (median/range: 30 min/1-240 min), and 21 (41%) were both paroxysmal and brief (lancinating pain). Fifteen (29%) of the pains were related to the fixed opioid dose, occurring solely at the end of the dosing interval. Twenty-eight (55%) of the pains were precipitated; of these, 22 were caused by an action of the patient (incident pain), and 6 were associated with a non-volitional precipitant, such as flatulence. The pathophysiology of the pain was believed to be somatic in 17 (33%), visceral in 10 (20%), neuropathic in 14 (27%), and mixed in 10 (20%). Pain was related to the tumor in 42 (82%), the effects of therapy in 7 (14%), and neither in 2 (4%). Diverse interventions were employed to manage these pains, with variable efficacy. These data clarify the spectrum of breakthrough pains and indicate their importance in cancer pain management.
Humans↗
MR imaging of the hip abductors: normal anatomy and commonly encountered pathology at the greater trochanter.
Lateral hip pain, also referred to as the greater trochanteric pain syndrome, is a commonly encountered clinical problem with a broad set of differential considerations. A detailed understanding of the osseous anatomy of the greater trochanter, the correspond-ing attachment sites of the abductors of the hip, and the spatial and anatomic relations of their corresponding bursae is crucial to the accurate characterization and localization of pathologic findings in these structures. This article reviews the anatomy and pathologic findings of the osseous and soft tissue anatomy of the greater trochanter.
Bursa, Synovial↗