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Capecitabine induces severe angina-like chest pain.
Kuppens IE, Boot H, Beijnen JH, Schellens JH, Labadie J.
Publication Types:
PMID: 15023730 [PubMed - in process]
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Pain: moving from symptom control toward mechanism-specific pharmacologic management.
Woolf CJ; American College of Physicians; American Physiological Society.
Neural Plasticity Research Group, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts 02129, USA. cwoolf@partners.org
PMID: 15023710 [PubMed - in process]
Comment on:
Results of eVALuate study of hysterectomy techniques: degree of pain cannot be commented on.
Saunders SM.
Publication Types:
PMID: 15016703 [PubMed - indexed for MEDLINE]
An anatomic study of the sacral hiatus: a basis for successful caudal epidural block.
Sekiguchi M, Yabuki S, Satoh K, Kikuchi S.
Department of Orthopedic Surgery, Fukushima Medical University, School of Medicine, 1-Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. miho-s@fmu.ac.jp
STUDY DESIGN: An anatomic study of the sacral hiatus using isolated sacra. OBJECTIVES: To clarify the anatomic variations of the sacral hiatus using the bony landmarks of the sacrum for improving the reliability of caudal epidural block (CEB). BACKGROUND DATA: The CEB has been widely used for the diagnosis and treatment of lumbar spinal disorders. The reliability of CEB is 70%-80% in the literatures. The cause of failure of CEB may depend on anatomic basis. METHODS: A total of 92 isolated sacra were used in this study. The bony landmarks were sacral hiatus and sacral cornua. Morphologic types of the sacral hiatus were classified using these landmarks. Also, location of the apex of sacral hiatus, diameter of the sacral canal at the apex of sacral hiatus, and the distance between bilateral cornua were measured. Two orthopedic surgeons performed measurements independently. RESULTS: Forty-two percent of the cases have both hiatus and cornu. Four percent of the cases showed the absent hiatus. The apex of sacral hiatus existed at the level of S4 vertebrae in 64% of the cases. The average diameter of the sacral canal was 6.0 +/- 1.9 mm. The average distance of bilateral sacral cornua was 10.2 +/- 0.35 mm. There were closed hiatus in 3% of cases. CONCLUSIONS: The sacral hiatus has anatomic variations. Understanding of these variations may improve the reliability of CEB.
PMID: 14668657 [PubMed - indexed for MEDLINE]
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Complementary and alternative medicine: is it just a case of more tools for the medical bag?
Berman B.
Complementary Medicine Program, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD 21207, USA. bberman@compmed.umm.edu
Publication Types:
PMID: 14668648 [PubMed - indexed for MEDLINE]
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Hip pain in a 6-year-old girl.
Hosalkar HS, Chatoo MB, Jones S, McHugh K, Monsell F, Jones DH.
Division of Pediatric Orthopaedics, Great Ormond Street Hospital for Children, London.
Publication Types:
PMID: 15021170 [PubMed - in process]
Comment on:
Can oral midazolam provide relief of discomfort or analgesia?
Hussain S, Siddiqui MS, Mayhew JF.
Publication Types:
PMID: 14760285 [PubMed - indexed for MEDLINE]
Patient-controlled transdermal fentanyl hydrochloride vs intravenous morphine pump for postoperative pain: a randomized controlled trial.
Viscusi ER, Reynolds L, Chung F, Atkinson LE, Khanna S.
Department of Anesthesiology, Thomas Jefferson University, Philadelphia, Pa 19107, USA. eugene.viscusi@jefferson.edu
CONTEXT: Patient-controlled analgesia (PCA) with morphine is commonly used to provide acute postoperative pain control after major surgery. The fentanyl hydrochloride patient-controlled transdermal system eliminates the need for venous access and complicated programming of pumps. OBJECTIVE: To assess the efficacy and safety of an investigational patient-controlled iontophoretic transdermal system using fentanyl hydrochloride compared with a standard intravenous morphine patient-controlled pump. DESIGN, SETTING, AND PATIENTS: Prospective randomized controlled parallel-group trial conducted between September 2000 and March 2001 at 33 North American hospitals, enrolling 636 adult patients who had just undergone major surgery. INTERVENTIONS: In surgical recovery rooms, patients were randomly assigned to intravenous morphine (1-mg bolus every 5 minutes; maximum of 10 mg/h) by a patient-controlled analgesia pump (n = 320) or iontophoretic fentanyl hydrochloride (40- microg infusion over 10 minutes) by a patient-controlled transdermal system (n = 316). Supplemental analgesia (morphine or fentanyl intravenous boluses) was administered as needed before and for the first 3 hours after activation of the PCA treatments. Patients then used the PCA treatments without additional analgesics for up to 72 hours. MAIN OUTCOME MEASURES: The primary efficacy variable was patient global assessment of the method of pain control during the first 24 hours. Additional efficacy measures were the proportion of patients discontinuing the study because of inadequate analgesia for any reason, patient-reported pain intensity scores on a 100-mm visual analog scale (VAS), and patient global assessments at 48 and 72 hours. Adverse effects were also recorded. RESULTS: Ratings of good or excellent after 24 hours of treatment for the method of pain control were given by 73.7% of patients (233/316) who used transdermal fentanyl PCA and 76.9% of patients (246/320) who used intravenous morphine PCA; treatment difference was -3.2% (95% confidence interval, -9.9% to 3.5%; P =.36). Early patient discontinuations (25.9% fentanyl vs 25.0% morphine; P =.78) and last pain intensity scores (32.7 fentanyl vs 31.1 morphine on the VAS; P =.45) were not different between the 2 treatments. With continued treatment for up to 48 or 72 hours, more than 80% of patient assessments in each treatment group were good or excellent. The incidence of opioid-related adverse events was similar between the groups. CONCLUSION: An investigational PCA transdermal system using iontophoresis to deliver fentanyl provided postsurgical pain control equivalent to that of a standard intravenous morphine regimen delivered by a PCA pump.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15026400 [PubMed - indexed for MEDLINE]
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Comment on:
Treatment of shoulder complaints.
Klauser A, Frauscher F.
Publication Types:
PMID: 14962537 [PubMed - indexed for MEDLINE]
A randomized, double-blind, placebo controlled study on analgesic effects of botulinum toxin A.
Voller B, Sycha T, Gustorff B, Schmetterer L, Lehr S, Eichler HG, Auff E, Schnider P.
Department of Clinical Pharmacology, University of Vienna, Austria. vollerb@ninds.nih.gov
OBJECTIVE: Botulinum toxin type A (BTXA) is used to treat neurologic disorders associated with increased muscle tone. Its use is often associated with pain relief. METHODS: A possible direct analgesic effect of BTXA on C and Adelta fibers was studied on 16 healthy volunteers receiving 30 U BTXA into one forearm and pure saline into the other. To exclude the secondary effect due to muscular tone reduction, BTXA was injected intradermally. Thermal sensory testing of heat pain (threshold and tolerance) and neuroselective current sensory testing of current pain threshold/tolerance were performed at baseline and 3, 14, and 28 days after treatment. Thereafter, on day 28, capsaicin was administered simultaneously into both forearms to evaluate a possible peripheral effect and central effect on pain processing and on the axon reflex flare. RESULTS: The authors observed no significant difference in any of the perception outcome measures between BTXA and placebo pretreated areas. Flare areas as a result of the release of neuropeptides after capsaicin application showed no differences. CONCLUSIONS: The results suggest that pain reduction after BTXA treatment is mediated through its effect on muscle tone rather than a direct analgesic effect.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14557564 [PubMed - indexed for MEDLINE]
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Some cases of severe post-mastectomy pain syndrome may be caused by an axillary haematoma.
Blunt C, Schmiedel A.
Department of Anaesthesia, Russells Hall Hospital, Dudley DY1 2HQ, UK.
Post-mastectomy pain syndrome (PMPS) is experienced by 20-65% of patients who undergo breast surgery for cancer. The etiology of this chronic neuropathic pain syndrome is unclear and most likely multi-factorial. Symptoms may be mild, not requiring treatment, or severe, considerably restricting quality of life. The effectiveness of available pharmacological and pain management therapies is unknown. Certainly, some women remain under-treated with poor pain control. We report three women undergoing wide local excision for cancer of the breast and block dissection of axillary lymph nodes who subsequently developed severe PMPS. In these cases the symptoms were completely relieved by the aspiration or formal drainage of an encapsulated haematoma in the axilla. The removal of a minimal amount of blood brought instant improvement suggesting that pressure within the haematoma could be an etiological factor. An axillary haematoma, which may not be clinically obvious, should be considered as a possible cause of PMPS.
PMID: 15030949 [PubMed - in process]
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Central representation of muscle pain and mechanical hyperesthesia in the orofacial region: a positron emission tomography study.
Kupers RC, Svensson P, Jensen TS.
CFIN, Aarhus University and Aarhus University Hospitals, Aarhus, Denmark.
Functional neuroimaging studies of the human brain have revealed a network of brain regions involved in the processing of nociceptive information. However, little is known of the cerebral processing of pain originating from muscles. The aim of this study was to investigate the cerebral activation pattern evoked by experimental jaw-muscle pain and its interference by simultaneous mechanical stimuli, which has been shown to evoke hyperesthesia. Ten healthy subjects participated in a PET study and jaw-muscle pain was induced by bolus injections of 5% hypertonic saline into the right masseter muscle. Repeated von Frey hair stimulation (0.5 Hz) of the skin above the masseter muscle was used as the mechanical stimulus. Hypertonic saline injections caused strong muscle pain spreading to adjacent areas. von Frey stimulation was rated as non-painful but produced hyperesthesia during jaw-muscle pain. Jaw-muscle pain was associated with significant increases in regional cerebral blood flow (rCBF) in the dorsal-posterior insula (bilaterally), anterior cingulate and prefrontal cortices, right posterior parietal cortex, brainstem, cavernous sinus and cerebellum. No rCBF changes occurred in primary or secondary somatosensory cortices. In contrast, von Frey stimulation produced a significant rCBF increase in the contralateral SI face representation. Mechanical hyperesthesia was associated with significant rCBF increases in the subgenual cingulate and the ventroposteromedial and dorsomedial thalamus. These results suggest that the cerebral processing of jaw-muscle pain may differ from the processing of cutaneous pain and that mechanical hyperesthesia, which often is encountered in clinical cases, has a unique representation in the brain.
PMID: 15030948 [PubMed - in process]
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Using the self-regulatory model to cluster chronic pain patients: the first step towards identifying relevant treatments?
Hobro N, Weinman J, Hankins M.
Department of Psychology, Berkshire Healthcare NHS Trust, 25 Erleigh Road, Reading, Berkshire RG1 5LR, UK.
The pain literature indicates that, despite extensive investigations and recommendations, treatment outcomes can be poor. This study assesses whether a theoretical approach using the self-regulatory model (SRM) could usefully categorise chronic pain patients on the basis of their illness representations, since these have been shown to influence outcomes for other health-related conditions. One hundred and thirty newly referred patients of a pain relief clinic completed the revised Illness Perceptions Questionnaire and other measures. Cluster analysis supported the utility of a theoretical model of illness representations to identify pain groups, with the groups so identified differing in measures of pain, mood, and functioning. This study can be viewed as a preliminary step for future research employing stronger design methodologies to explore the validity of the SRM for classifying chronic pain patients, and to compare efficacy of treatment choice and outcome for this population based on illness representations.
PMID: 15030947 [PubMed - in process]
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Development and validation of the Neuropathic Pain Symptom Inventory.
Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, Masquelier E, Rostaing S, Lanteri-Minet M, Collin E, Grisart J, Boureau F.
Service de Biostatistique, Hopital Necker, Paris, France.
This study describes the development and validation of the Neuropathic Pain Symptom Inventory (NPSI), a new self-questionnaire specifically designed to evaluate the different symptoms of neuropathic pain. Following a development phase and a pilot study, we generated a list of descriptors reflecting spontaneous ongoing or paroxysmal pain, evoked pain (i.e. mechanical and thermal allodynia/hyperalgesia) and dysesthesia/paresthesia. Each of these items was quantified on a (0-10) numerical scale. The validation procedure was performed in 176 consecutive patients with neuropathic pain of peripheral [Formula: see text] or central [Formula: see text] origin, recruited in five pain centers in France and Belgium. It included: (i) assessment of the test-retest reliability of each item, (ii) determination of the factorial structure of the questionnaire and analysis of convergent and divergent validities (i.e. construct validity), and (iii) evaluation of the ability of the NPSI to detect the effects of treatment (i.e. sensitivity to change). The final version of the NPSI includes 10 descriptors (plus two temporal items) that allow discrimination and quantification of five distinct clinically relevant dimensions of neuropathic pain syndromes and that are sensitive to treatment. The psychometric properties of the NPSI suggest that it might be used to characterize subgroups of neuropathic pain patients and verify whether they respond differentially to various pharmacological agents or other therapeutic interventions.
PMID: 15030944 [PubMed - in process]
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Changes in the expression of tetrodotoxin-sensitive sodium channels within dorsal root ganglia neurons in inflammatory pain.
Black JA, Liu S, Tanaka M, Cummins TR, Waxman SG.
Department of Pharmacology and Toxicology, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Nociceptive neurons within dorsal root ganglia (DRG) express multiple voltage-gated sodium channels, of which the tetrodotoxin-resistant (TTX-R) channel Na(v)1.8 has been suggested to play a major role in inflammatory pain. Previous work has shown that acute administration of inflammatory mediators, including prostaglandin E(2) (PGE(2)), serotonin, and adenosine, modulates TTX-R current in DRG neurons, producing increased current amplitude and a hyperpolarizing shift of its activation curve. In addition, 4 days following injection of carrageenan into the hind paw, an established model of inflammatory pain, Na(v)1.8 mRNA and slowly-inactivating TTX-R current are increased in DRG neurons projecting to the affected paw. In the present study, the expression of sodium channels Na(v)1.1-Na(v)1.9 in small (<==25micromdiameter) DRG neurons was examined with in situ hybridization, immunocytochemistry, Western blot and whole-cell patch-clamp methods following carrageenan injection into the peripheral projection fields of these cells. The results demonstrate that, following carrageenan injection, there is increased expression of TTX-S channels Na(v)1.3 and Na(v)1.7 and a parallel increase in TTX-S currents. The previously reported upregulation of Na(v)1.8 and slowly-inactivating TTX-R current is not accompanied by upregulation of mRNA or protein for Na(v)1.9, an additional TTX-R channel that is expressed in some DRG neurons. These observations demonstrate that chronic inflammation results in an upregulation in the expression of both TTX-S and TTX-R sodium channels, and suggest that TTX-S sodium channels may also contribute, at least in part, to pain associated with inflammation.
PMID: 15030943 [PubMed - in process]
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Sex differences in pain perception and anxiety. A psychophysical study with topical capsaicin.
Frot M, Feine JS, Bushnell MC.
Anesthesia Research Unit, Faculty of Medicine, McGill University, Montreal, Que., Canada.
Much evidence indicates that women experience painful stimuli as more intense than men do. Nevertheless, some data suggest that sustained low-level pain may be more disturbing to men than to women. The current experiment evaluated the hypothesis that pain is more disturbing for men than for women by comparing across genders sensory and emotional aspects of pain evoked by capsaicin. Ten men and 10 women (aged 20-46 years) received topical capsaicin for 30 min on the face in one session and on the ankle in another. The subjects rated on visual analog scales pain intensity, unpleasantness and anxiety each minute during capsaicin application and for 30 min after its removal. During capsaicin application, females rated both pain intensity [Formula: see text] and unpleasantness [Formula: see text] higher than did males. Further, subjects rated pain intensity and unpleasantness higher on the face than on the ankle, although the physical stimulus was the same. Despite their lower pain ratings, men reported more pain-related anxiety than women [Formula: see text] Moreover, men showed a significant positive correlation between anxiety and pain intensity and unpleasantness, whereas women did not. After removing the capsaicin, there was no overall effect of sex on either intensity [Formula: see text] or unpleasantness [Formula: see text] of the residual sensation. However, men still showed a positive correlation between anxiety and the intensity and unpleasantness of the sensation. Our data confirm with the topical capsaicin model that women rate pain higher than men, but despite their lower pain ratings, males have more anxiety related to pain.
PMID: 15030942 [PubMed - in process]
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Adolescent chronic pain: patterns and predictors of emotional distress in adolescents with chronic pain and their parents.
Eccleston C, Crombez G, Scotford A, Clinch J, Connell H.
Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.
Adolescents with chronic pain also report severe disability and emotional distress. A clinical sample of 80 adolescents and accompanying parents were investigated to first measure the extent of distress, and second to investigate the relationships between adolescent distress, parental distress and adolescent coping. Measures of pain intensity, anxiety, depression, disability and coping were obtained from adolescents. Parents completed measures including their own anxiety, depression and parenting stress. Overall, adolescents reported high levels of disability, depression and anxiety, and parents reported high levels of depression, anxiety and parenting stress. Multiple regression analyses revealed that the best predictors of adolescent emotional distress were the extent to which the adolescents catastrophize and seek social support to cope with the pain. There were no clear predictors of parental anxiety or depression but the specific pattern of parenting stress was best predicted by the younger age of the adolescent, the greater the chronicity of the problem, and the greater the extent of adolescent depression. These findings suggest that emotional coping is a critical variable in the distress associated with adolescent chronic pain. It is argued that adolescent emotional coping may best be understood within a relational context of seeking emotional support.
PMID: 15030941 [PubMed - in process]
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Central poststroke pain and reduced opioid receptor binding within pain processing circuitries: a [(11)C]diprenorphine PET study.
Willoch F, Schindler F, Wester HJ, Empl M, Straube A, Schwaiger M, Conrad B, Tolle TR.
Department of Neurology, Technische Universitat Munchen, Klinikum rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany.
Based on concepts that endogenous opioids participate in neural transmission of pain, the present study in central poststroke pain (CPSP) patients investigated changes in opioid receptor (OR) binding in neural structures centrally involved in the processing of pain. Five patients with central pain after lesions in the brain stem, thalamus or parietal cortex and twelve healthy volunteers underwent a [(11)C]diprenorphine positron emission tomography study. Binding potentials were calculated using a reference region model in all subjects. Statistical parametric mapping was applied for t-statistical analysis on voxel-basis. Binding potential values for each individual were extracted from a volume of interest at each identified significant peak. Spectral analysis was applied for quantification of global values. Significant regional reduced (11)C-diprenorphine binding (corrected for multiple tests) was detected in contralateral thalamus, parietal, secondary somatosensory, insular and lateral prefrontal cortices, and along the midline in anterior cingulate, posterior cingulate and midbrain gray matter. Individual extracted binding values disclosed a reduced binding in these regions in all patients independent from the particular lesion site. The poststroke pain syndrome is associated with a characteristic pattern of reduced OR binding within the neural circuitry processing pain. It is suggested that an imbalance of excitatory-inhibitory mechanisms in certain brain structures, as evidenced in decreased [(11)C]diprenorphine binding, is one of the causes or the consequences of poststroke pain.
PMID: 15030940 [PubMed - in process]
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Communicating the experience of pain: the role of analogy.
Schott GD.
National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
PMID: 15030939 [PubMed - in process]
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Toward an integrated model of pain over the life course.
Walco GA.
Publication Types:
PMID: 15030938 [PubMed - in process]
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Central pain: distributed effects of focal lesionsSee related article, by Willoch et al., in this issue.
Casey KL.
Neurology Service, University of Michigan, V.A. Medical Center, 2215 Fuller Rd, Ann Arbor, MI 48105, USA.
Publication Types:
PMID: 15030937 [PubMed - in process]
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An unusual case of painful phantom-limb sensations during regional anesthesia.
Paqueron X, Lauwick S, Le Guen M, Coriat P.
OBJECTIVE: The objective of this article is to describe a late-onset phantom-limb pain during a continuous analgesic popliteal nerve block after foot surgery and its alleviation and recurrence when stopping and resuming the local anesthetic infusion.Case report A 29-year-old woman undergoing a left hallux valgus repair received a continuous popliteal sciatic nerve block for postoperative analgesia. Postoperatively, 6 hours after the commencement of a ropivacaine 0.2% infusion, she reported feelings of tingling, clenching pain, and missing-limb sensation below the ankle. The surgical site remained painless. Sensation elicited by touch and propioception were normally perceived. Only sensations for pinprick and heat were impaired. The ropivacaine infusion was stopped, followed 2.5 hours later by the complete regression of any abnormal sensation. Meanwhile, pain at the surgical site was scored at 50 mm on a 100-mm visual analogic scale. As the infusion of ropivacaine was resumed, the abnormal sensations reappeared. The catheter was removed, and abnormal sensations again disappeared. The patient was discharged from hospital without further complications. CONCLUSIONS: This observation suggests that phantom-limb pain can be of late-onset and might occur during a continuous infusion of low-concentration local anesthetic responsible only for an analgesic block, as shown by the fact that only thermal and pinprick sensations, known to depend on Adelta-fibers and C-fibers, were altered. Therefore, this case contradicts the usual belief that a profound block is necessary to elicit phantom-limb pain.
PMID: 15029554 [PubMed - in process]
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Constipation--modern laxative therapy.
Klaschik E, Nauck F, Ostgathe C.
Department of Anaesthesiology, Intensive Care, Pain Therapy and Palliative Medicine, Malteser Hospital, University of Bonn, Bonn, Germany. anaesthesie.bonn@malteser.de
It is estimated that one third of the population in Western industrial countries suffers from constipation at least from time to time. Constipation may have somatopathic or functional causes. Furthermore, a great number of substances are known to cause medication-induced constipation, i.e. opioid-induced constipation is caused by linkage of the opioid to opioid receptors in the bowel and the central nerve system. Whenever possible, causal therapy should be undertaken. Patients in palliative care mostly suffer from chronic functional constipation. The treatment consists of basic measures and the application of laxatives. According to their mode of action, they are divided into bulk-forming laxatives, osmotic laxatives, stimulant laxatives, lubricating agents and others. Bulk-forming laxatives are not recommended for use in palliative care patients, for such patients are normally not able to take in the required amount of fluids. Osmotic laxatives are divided into (magnesium) salts, saccharine, alcohols and macrogols. Lactulose is the most popular saccharine laxative. Because of its side effects (flatulence, bloating and abdominal cramping), lactulose is not a laxative of our choice; instead, we prefer to give macrogol. Orally administered, macrogol is not metabolised and pH value and bowel flora remain unchanged. Macrogol hydrates hardened stools, increases stool volume, decreases the duration of colon passage and dilates the bowel wall that then triggers the defecation reflex. Even when given for some time, the effectiveness of macrogol will not decrease. Because of its high effectiveness and commonly good tolerance, macrogol has become the laxative of first choice in palliative care patients with all kinds of chronic constipation, if these patients are able to take in the necessary amount of fluids. From the general medical point of view, lubricating agents have become obsolete. In palliative care patients, however, they are still important laxatives for prophylactic treatment or therapy of constipation. Due to clinical experience, in palliative care a laxative ladder has proven successful.
Publication Types:
PMID: 14505158 [PubMed - indexed for MEDLINE]
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