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Stress-induced pain and muscle activity in patients with migraine and tension-type headache.
Leistad R, Sand T, Westgaard R, Nilsen K, Stovner Lj.
Department of Neuroscience, Norwegian University of Technology and Science and Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim, Norway.
We recorded deep pain and surface electromyographic (EMG) responses to stress in 22 migraineurs during headache-free periods, 18 patients with tension-type headache (TTH), and 44 healthy controls. Sixty minutes of cognitive stress was followed by 30 min relaxation. EMG and pain (visual analogue scale) in the trapezius, neck (splenius), temporalis and frontalis areas were recorded. TTH patients had higher pain responses in temporalis and frontalis (with similar trends for trapezius and splenius) and more potentiation of pain during the test than controls. Migraine patients developed more pain in the splenius and temporalis than controls. Muscle pain responses were more regional (more pain in the neck and trapezius compared with the temporalis and frontalis) in migraine than in TTH patients. TTH patients had delayed pain recovery in all muscle regions compared with controls, while migraine patients had delayed pain recovery in a more restricted area (trapezius and temporalis). EMG responses were not different from controls in headache patients, and EMG responses did not correlate with pain responses. TTH patients had delayed EMG recovery in the trapezius compared with controls and migraine patients. These results support the concept that (probably central) sensitization of pain pathways and the motor system is important in TTH. Less pronounced and more regional (either peripheral or central) trigeminocervical sensitization seems to be important in migraine. Surface-detectable muscular activation does not seem to be causal for pain during cognitive stress either in migraine or in TTH.
PMID: 16396668 [PubMed - in process]
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The course of high-sensitive C-reactive protein in correlation with pain and clinical function in patients with acute lumbosciatic pain and chronic low back pain - A 6 months prospective longitudinal study.
Gebhardt K, Brenner H, Sturmer T, Raum E, Richter W, Schiltenwolf M, Buchner M.
Orthopaedic Clinic at the University of Heidelberg, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany.
In this prospective longitudinal study with a follow-up of 6 months, the course of serum concentration of C-reactive protein was measured by an ultrasensitive immunoassay in 31 patients with acute lumbosciatic pain and 41 patients with chronic low back pain. High-sensitive CRP (hsCRP), pain and clinical function were assessed at ten fixed time-points during follow-up. The course of hsCRP values was assessed in relation to the course of pain and clinical function adjusting for possible confounding factors. At the beginning of the study, there were no statistically significant differences in mean hsCRP levels in patients with acute lumbosciatic pain (1.49mg/l) compared to the levels obtained in patients with chronic low back pain (1.30mg/l) and those in a control group from the general population (1.26mg/l). In patients with acute lumbosciatic pain, hsCRP declined significantly in the initial period of 3 weeks with a corresponding decrease in pain and improvement in function and clinical evaluation as assessed with the straight leg raising test (SLR), whereas after this period, the course of the hsCRP did not correspond with the clinical parameters. In patients with chronic low back pain, hsCRP remained approximately constant throughout the whole period with no correlation with pain or function. As a conclusion, according to this study levels of hsCRP do not have a major clinical relevance when evaluating the long-term course of patients with acute lumbosciatic pain and chronic low back pain and therefore should not be taken into primary consideration when decisions on therapy are made.
PMID: 16403662 [PubMed - as supplied by publisher]
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Antinociceptive, brain-penetrating derivatives related to improgan, a non-opioid analgesic.
Hough LB, Nalwalk JW, Lu Q, Shan Z, Svokos K, Wentland MP, Montero MJ.
Center for Neuropharmacology and Neuroscience, Albany Medical College MC-136, NY 12208, USA. hough1@mail.amc.edu
The antinociceptive profile of selected histamine H(2) and histamine H(3) receptor antagonists led to the discovery of improgan, a non-brain-penetrating analgesic agent which does not act on known histamine receptors. Because no chemical congener of improgan has yet been discovered which has both antinociceptive and brain-penetrating properties, the present study investigated the antinociceptive effects of a series of chemical compounds related to zolantidine, a brain-penetrating histamine H(2) receptor antagonist. The drugs studied presently contain the piperidinomethylphenoxy (PMPO) moiety, hypothesized to introduce brain-penetrating characteristics. Following intracerebroventricular (i.c.v.) dosing in rats, six of eight drugs produced dose- and time-related antinociception on both the tail flick and hot plate tests over a nearly eight-fold range of potencies. Ataxia and other motor side effects were observed after high doses of these drugs, but two of the compounds (SKF94674 and loxtidine) produced maximal antinociception at doses which were completely devoid of these motor effects. Consistent with the hypothesis that PMPO-containing drugs are brain-penetrating analgesics, SKF94674 and another derivative (JB-9322) showed dose-dependent antinociceptive activity 15 to 30 min after systemic dosing in mice, but these effects were accompanied by seizures and death beginning 45 min after dosing. Other drugs showed a similar pattern of antinociceptive and toxic effects. In addition, loxtidine produced seizures without antinociception, whereas zolantidine produced neither effect after systemic dosing in mice. Although several of the drugs tested have histamine H(2) receptor antagonist activity, neither the antinociception nor the toxicity was correlated with histamine H(2) receptor activity. The present results are the first to demonstrate the existence of brain-penetrating antinociceptive agents chemically related to zolantidine and improgan, but further studies are needed to understand the mechanisms of both the pain relief and toxicity produced by these agents.
PMID: 16216240 [PubMed - indexed for MEDLINE]
Endoscopic thoracic microdiscectomy.
Oskouian RJ, Johnson JP.
Department of Neurological Surgery, University of Virginia Health Systems, Charlottesville, Virginia, USA.
OBJECT: The purpose of this clinical study was to evaluate prospectively surgical and neurological outcomes after endoscopic thoracic disc surgery. METHODS: The authors assessed the following quantifiable outcome data in 46 patients: operative time, blood loss, duration of chest tube insertion, narcotic use, hospital length of stay (LOS), and long-term follow-up neurological function and pain-related symptoms. In patients who presented with myelopathy there was a postoperative improvement of two Frankel grades. Pain related to radiculopathy was improved by 75% and in one patient it worsened postoperatively. The authors also present operative data, surgical outcomes, and complications. CONCLUSIONS: Thoracoscopic discectomy can be used to achieve acceptable results. It has several distinct advantages such as reduced postoperative pain, morbidity, and LOS compared with traditional open procedures.
Publication Types:
PMID: 16381208 [PubMed - indexed for MEDLINE]
Computerized tomography-guided kryorhizotomy in 76 patients with lumbar facet joint syndrome.
Staender M, Maerz U, Tonn JC, Steude U.
Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians- University, Munich, Germany. marko.staender@med.uni-muenchen.de
OBJECT: The authors prospectively evaluated the therapeutic effect of computerized tomography (CT)-guided kryorhizotomy in the treatment of patients with lumbar facet joint syndrome (LFJS) and assessed prognostic factors that predict this effect. METHODS: Between February 2001 and March 2004, CT-guided kryorhizotomy of facet joints was performed in 76 patients with LFJS. A diagnosis was established after three positive CT-guided medial nerve branch blocks. Outcome was determined by evaluating the results of a standardized questionnaire, including visual analog scale (VAS) score, use of medication, ability to work, and physical conditions. Measurement was performed before treatment and repeated postoperatively at 3 days, 3 months, and every 6 months thereafter. On September 2004 all patients underwent clinical reevaluation. The median follow-up period was 22.5 months (range 6-43 months); the median interval to pain reduction was 6 months (range 0.1-31 months) after the first kryorhizotomy. The mean VAS pain score was 6.7 preoperatively and 2.9, 3.2, and 3.4 at 3 days, 3 months, and 6 months postoperatively, respectively. In 40% of patients pain was reduced for 12 months or longer. In patients in whom there was no prior surgical treatment of the relevant spinal segment, the duration of pain relief was significantly longer than in patients who had previously undergone surgery (p < 0.03). Eighteen patients underwent a second, seven a third, and one a fourth kryorhizotomy. No patient reported any side effect. The use of CT guidance guarantees an exact needle-tip position control and documentation for repeated procedures. CONCLUSIONS: Computerized tomography-guided kryorhizotomy is a minimally invasive and repeatable treatment that yields good long-term results in patients with LFJS.
Publication Types:
PMID: 16381206 [PubMed - indexed for MEDLINE]
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Comment on:
Fetal pain.
Sites BD.
Publication Types:
PMID: 16403924 [PubMed - indexed for MEDLINE]
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Comment on:
Fetal pain.
Myers LB, Bulich LA, Mizrahi A, Santangelo S.
Publication Types:
PMID: 16403923 [PubMed - indexed for MEDLINE]
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Comment on:
Fetal pain.
Lyman BJ.
Publication Types:
PMID: 16403922 [PubMed - indexed for MEDLINE]
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Case records of the Massachusetts General Hospital. Case 1-2006. A 64-year-old male lung-transplant recipient with fever, cough, hemoptysis, and abdominal pain.
Rubin RH, Gilman MD, Kradin RL.
Division of Infectious Disease, Brigham and Women's Hospital, Boston, USA.
Publication Types:
PMID: 16407514 [PubMed - indexed for MEDLINE]
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The big chill--inserting the DEA into end-of-life care.
Quill TE, Meier DE.
Center for Palliative Care and Clinical Ethics at the University of Rochester School of Medicine, Rochester, NY, USA.
PMID: 16394295 [PubMed - indexed for MEDLINE]
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Quality of life for children with functional abdominal pain: a comparison study of patients' and parents' perceptions.
Youssef NN, Murphy TG, Langseder AL, Rosh JR.
Center for Pediatric Functional Gastrointestinal and Motility Disorders, Goryeb Children's Hospital/Atlantic Health System, Morristown, NJ 07962, USA. nader.youssef@ahsys.org
OBJECTIVE: Children with chronic abdominal pain of nonorganic origin, termed functional abdominal pain (FAP), experience school absences and social withdrawal and report impaired physical ability. The aim of this study was to assess patients' and parents' perceptions of health-related quality of life (QoL) for children with FAP. METHODS: Between October 2002 and November 2003, 209 children (including 125 girls; age: 11.2 +/- 3.5 years) and 209 parents were recruited from a pediatric referral center. At the time of their initial evaluations, participants completed a validated, health-related QoL instrument (Pediatric Quality of Life Inventory), which was scored on a scale of 0 (poor) through 100 (best). Children with FAP (n = 65) and their families were compared with control groups of healthy children (n = 46) and children with histologically proven inflammatory bowel disease (IBD) (n = 42) or gastroesophageal reflux disease (GERD) (n = 56). RESULTS: Children with FAP had self-reported QoL scores (score: 78) that were similar to those for children with GERD (score: 80) or IBD (score: 84). Children with FAP had lower QoL scores than did healthy children (score: 88). Parents of children with FAP reported lower QoL scores, compared with their children's scores (scores: 70 vs 78). CONCLUSIONS: Children with FAP reported lower QoL, compared with their healthy peers, and had the same QoL scores as did children with IBD or GERD. Parents' perceptions of QoL for children with FAP were lower than their children's self-reported scores. These findings highlight the clinical significance of FAP and may provide insight into one facet of the disease's biopsychosocial etiology.
PMID: 16396860 [PubMed - in process]
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Pain: clinical and imaging risk factors.
Ledlie J.
Tyler Neurosurgical Associates, PA, Tyler, TX, USA.
Publication Types:
PMID: 16395160 [PubMed - in process]
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