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Visceral Pain: The Neurophysiological Mechanism  

PubMed Central

The mechanism of visceral pain is still less understood compared with that of somatic pain. This is primarily due to the diverse nature of visceral pain compounded by multiple factors such as sexual dimorphism, psychological stress, genetic trait, and the nature of predisposed disease. Due to multiple contributing factors there is an enormous challenge to develop animal models that ideally mimic the exact disease condition. In spite of that, it is well recognized that visceral hypersensitivity can occur due to (1) sensitization of primary sensory afferents innervating the viscera, (2) hyperexcitability of spinal ascending neurons (central sensitization) receiving synaptic input from the viscera, and (3) dysregulation of descending pathways that modulate spinal nociceptive transmission. Depending on the type of stimulus condition, different neural pathways are involved in chronic pain. In early-life psychological stress such as maternal separation, chronic pain occurs later in life due to dysregulation of the hypothalamic–pituitary–adrenal axis and significant increase in corticotrophin releasing factor (CRF) secretion. In contrast, in early-life inflammatory conditions such as colitis and cystitis, there is dysregulation of the descending opioidergic system that results excessive pain perception (i.e., visceral hyperalgesia). Functional bowel disorders and chronic pelvic pain represent unexplained pain that is not associated with identifiable organic diseases. Often pain overlaps between two organs and approximately 35% of patients with chronic pelvic pain showed significant improvement when treated for functional bowel disorders. Animal studies have documented that two main components such as (1) dichotomy of primary afferent fibers innervating two pelvic organs and (2) common convergence of two afferent fibers onto a spinal dorsal horn are contributing factors for organ-to-organ pain overlap. With reports emerging about the varieties of peptide molecules involved in the pathological conditions of visceral pain, it is expected that better therapy will be achieved relatively soon to manage chronic visceral pain.

Sengupta, Jyoti N.



[New drug therapies for intractable chronic pain: preface and comments].  


Recently, new drugs for intractable chronic pain are available in Japan. The following articles describe topics of new drugs for intractable chronic pain including transdermal fentanyl, tramadol/acetaminophen combination tablets, buprenorphine transdermal patch, pregabalin, and duloxetine. Treatment of constipation in chronic pain patients and management of opioid induced nausea and vomiting are also described to prevent complication of pain-relief drug therapy. PMID:23905399

Hanaoka, Kazuo



Bilateral Anterior Cingulectomy for the Relief of Intractable Pain  

Microsoft Academic Search

Bilateral anterior cingulectomies were performed on 23 patients for the relief of intractable pain. 19 patients suffered from pain due to metastatic disease, 3 from arachnoiditis and 1 from a phantom limb syndrome. Of those patients suffering from pain due to metastatic disease, 10 (52.1%) obtained pain relief. Among the patients suffering from arachnoiditis, 1 obtained pain relief. The case

Donald H. Wilson; Alfred E. Chang



Central sensitisation in visceral pain disorders  

PubMed Central

The concepts of visceral hyperalgesia and visceral hypersensitivity have been examined in a variety of functional gastrointestinal disorders (FGIDs). Although the pathophysiological mechanisms of pain and hypersensitivity in these disorders are still not well understood, exciting new developments in research have been made in the study of the brain?gut interactions involved in the FGIDs

Moshiree, B; Zhou, Q; Price, D D; Verne, G N



Stimulation of primary motor cortex for intractable deafferentation pain  

Microsoft Academic Search

The stimulation of the primary motor cortex (M1) has proved to be an effective treatment for intractable deafferentation pain.\\u000a This treatment started in 1990, and twenty-eight studies involving 271 patients have been reported so far. The patients who\\u000a have been operated on were suffering from post-stroke pain (59%), trigeminal neuropathic pain, brachial plexus injury, spinal\\u000a cord injury, peripheral nerve injury

Youichi Saitoh; T. Yoshimine


Spinal cord stimulation in 60 cases of intractable pain.  

PubMed Central

Sixty patients with spinal cord stimulators implanted for intractable pain lasting up to 50 years were followed for up to nine years. Forty seven per cent derived significant benefit, 23% modest benefit, 20% experienced no effect and 6.7% were made worse. Two were made worse after initial benefit. Complications, indications and factors relevant to the mode of action are discussed.

Simpson, B A



Continuous intrathecal hydromorphone and clonidine for intractable cancer pain.  


The use of hydromorphone and clonidine, delivered intrathecally by an implanted infusion pump, is described in a patient with intractable cancer pain. The patient was a 48-year-old woman with uterine cervical cancer-related pain that was poorly responsive to conventional oral narcotics. Hydromorphone was used because of the patient's history of morphine intolerance. When progressive intrathecal hydromorphone dosages were required, intrathecal clonidine (an alpha 2 adrenergic agonist) was infused concomitantly. Intrathecal hydromorphone and clonidine successfully controlled this patient's pain without the necessity to resort to destructive neurosurgery. PMID:2422332

Coombs, D W; Saunders, R L; Fratkin, J D; Jensen, L E; Murphy, C A



Visceral Pain - the Ins and Outs, the Ups and Downs  

PubMed Central

Purpose of review Visceral pain represents a major clinical problem, yet far less is known about its mechanisms compared to somatic pains, e.g. from cutaneous and muscular structures. Recent findings In this review we describe the neuroanatomical bases of visceral pain signalling in the peripheral and central nervous system, comparing to somatic pains and also the channels and receptors involved in these events. We include an overview of potential new targets in the context of mechanisms of visceral pain and hypersensitivity. Summary This review should inform on the recognition of what occurs in patients with visceral pain, why co-morbidities are common and how analgesic treatments work.

Sikandar, Shafaq; Dickenson, Anthony H



Role of oxidative stress in animal model of visceral pain  

Microsoft Academic Search

Reactive oxygen species play an important role both in physiological and pathophysiological reactions. The aim of this study was to determine the role of free radicals and antioxidants in the development of visceral pain. Visceral pain was produced by colorectal distension (CRD) in adult rats. CRD was caused by insertion of a lubricated latex balloon into the descending colon and

Simon Vaculin; Miloslav Franek; Martin Vejrazka



Vagus nerve stimulation modulates visceral pain-related affective memory.  


Within a biopsychosocial model of pain, pain is seen as a conscious experience modulated by mental, emotional and sensory mechanisms. Recently, using a rodent visceral pain assay that combines the colorectal distension (CRD) model with the conditioned place avoidance (CPA) paradigms, we measured a learned behavior that directly reflects the affective component of visceral pain, and showed that perigenual anterior cingulate cortex (pACC) activation is critical for memory processing involved in long-term visceral affective state and prediction of aversive stimuli by contextual cue. Electrical vagus nerve stimulation (VNS) has become an established therapy for treatment-resistant epilepsy. VNS has also been shown to enhance memory performance in rats and humans. High-intensity VNS (400 ?A) immediately following conditional training significantly increases the CRD-induced CPA scores, and enhanced the pain affective memory retention. In contrast, VNS (400 ?A) had no effect on CPA induced by non-nociceptive aversive stimulus (U69,593). Low-intensity VNS (40 ?A) had no effect on CRD-induced CPA. Electrophysiological recording showed that VNS (400 ?A) had no effect on basal and CRD-induced ACC neuronal firing. Further, VNS did not alter CRD-induced visceral pain responses suggesting high intensity VNS facilitates visceral pain aversive memory independent of sensory discriminative aspects of visceral pain processing. The findings that vagus nerve stimulation facilities visceral pain-related affective memory underscore the importance of memory in visceral pain perception, and support the theory that postprandial factors may act on vagal afferents to modulate ongoing nature of visceral pain-induced affective disorder observed in the clinic, such as irritable bowel syndrome. PMID:22940455

Zhang, Xu; Cao, Bing; Yan, Ni; Liu, Jin; Wang, Jun; Tung, Vivian Oi Vian; Li, Ying



The role of c-AMP-dependent protein kinase in spinal cord and post synaptic dorsal column neurons in a rat model of visceral pain  

Microsoft Academic Search

Visceral noxious stimulation induces central neuronal plasticity changes and suggests that the c-AMP-dependent protein kinase (PKA) signal transduction cascade contributes to long-term changes in nociceptive processing at the spinal cord level. Our previous studies reported the clinical neurosurgical interruption of post synaptic dorsal column neuron (PSDC) pathway by performing midline myelotomy effectively alleviating the intractable visceral pain in patients with

Jing Wu; Guangxiao Su; Long Ma; Xuan Zhang; Yongzhong Lei; Qing Lin; Haring J. W. Nauta; Junfa Li; Li Fang



Renal Artery Embolization Controls Intractable Pain in a Patient with Polycystic Kidney Disease  

SciTech Connect

A 65-year-old man with adult polycystic kidney disease (APKD) and chronic renal failure suffered from intractable abdominal pain and distension for 2 weeks. Meperidine infusion did not alleviate his pain. However, pain and abdominal distension were successfully controlled by embolization of both renal arteries.

Hahn, Seong Tai; Park, Seog Hee; Lee, Jae Mun; Kim, Choon-Yul [Department of Radiology, St. Mary's Hospital, Catholic Medical Center, Catholic University of Korea, 62, Youido-dong, Yongdungpo-gu, Seoul, 150-010 (Korea, Republic of); Chang, Yoon Sik [Department of Internal Medicine, St. Mary's Hospital, Catholic Medical Center, Catholic University of Korea, 62, Youido-dong, Yongdungpo-gu, Seoul, 150-010, Korea (Korea, Republic of)



Efficacy of reflexology in managing chronic pain and difficulty in lower limb movement involving intractable epilepsy  

Microsoft Academic Search

This study aims at estimating the efficacy of reflexology in managing pain under 4 diseased conditions viz., mastalgia, osteoarthritis, neuropathy with type-II diabetic mellitus and lower limb pain involving intractable epilepsy. The efficiency of reflexology was determined in terms of improvement of pain score, quality of life and the other associated symptoms. The sample size of the randomized clinical trials

K. Dalal; V. B. Maran; D. Elanchezhiyan; A. Srivastava; A. B. Dey; M. Tripathi



Translational pain research: Evaluating analgesic effect in experimental visceral pain models  

PubMed Central

Deep visceral pain is frequent and presents major challenges in pain management, since its pathophysiology is still poorly understood. One way to optimize treatment of visceral pain is to improve knowledge of the mechanisms behind the pain and the mode of action of analgesic substances. This can be achieved through standardized experimental human pain models. Experimental pain models in healthy volunteers are advantageous for evaluation of analgesic action, as this is often difficult to assess in the clinic because of confounding factors such as sedation, nausea and general malaise. These pain models facilitate minimizing the gap between knowledge gained in animal and human clinical studies. Combining experimental pain studies and pharmacokinetic studies can improve understanding of the pharmacokinetic-pharmacodynamic relationship of analgesics and, thus, provide valuable insight into optimal clinical treatment of visceral pain. To improve treatment of visceral pain, it is important to study the underlying mechanisms of pain and the action of analgesics used for its treatment. An experimental pain model activates different modalities and can be used to investigate the mechanism of action of different analgesics in detail. In combination with pharmacokinetic studies and objective assessment such as electroencephalography, new information regarding a given drug substance and its effects can be obtained. Results from experimental human visceral pain research can bridge the gap in knowledge between animal studies and clinical condition in patients suffering from visceral pain, and thus constitute the missing link in translational pain research.

Olesen, Anne Estrup; Andresen, Trine; Christrup, Lona Louring; Upton, Richard N



Sacral Nerve Stimulation for Treatment of Intractable Pain Associated with Cauda Equina Syndrome  

PubMed Central

Sacral nerve stimulation (SNS) is an effective treatment for bladder and bowel dysfunction, and also has a role in the treatment of chronic pelvic pain. We report two cases of intractable pain associated with cauda equina syndrome (CES) that were treated successfully by SNS. The first patient suffered from intractable pelvic pain with urinary incontinence and fecal incontinence after surgery for a herniated lumbar disc. The second patient underwent surgery for treatment of a burst fracture and developed intractable pelvic area pain, right leg pain, excessive urinary frequency, urinary incontinence, voiding difficulty and constipation one year after surgery. A SNS trial was performed on both patients. Both patients' pain was significantly improved and urinary symptoms were much relieved. Neuromodulation of the sacral nerves is an effective treatment for idiopathic urinary frequency, urgency, and urge incontinence. Sacral neuromodulation has also been used to control various forms of pelvic pain. Although the mechanism of action of neuromodulation remains unexplained, numerous clinical success reports suggest that it is a therapy with efficacy and durability. From the results of our research, we believe that SNS can be a safe and effective option for the treatment of intractable pelvic pain with incomplete CES.

Kim, Jong-Hoon; Hong, Joo-Chul; Kim, Min-Su



Bedside Testing for Chronic Pelvic Pain: Discriminating Visceral from Somatic Pain  

PubMed Central

Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+) and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0), pCA-2.91 (1.19, 7.11), aMTRP-4.19 (1.46, 12.0), pMFTP-1.35 (0.86, 2.13), and RPT-1.14 (0.85, 1.52), respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain.

Jarrell, John; Giamberardino, Maria Adele; Robert, Magali; Nasr-Esfahani, Maryam



Association of Neuromyelitis Optica With Severe and Intractable Pain  

PubMed Central

Objective To contrast differences in pain and treatment outcomes between neuromyelitis optica (NMO) and multiple sclerosis (MS). Design Retrospective, cross-sectional cohort study. Setting Academic MS center. Patients Complete ascertainment of an academic MS center cohort of NMO and an MS comparison sample cohort. Main Outcome Measures Current pain was quantified by a 10-point scale and the McGill Pain Questionnaire. Expanded Disability Status Scale score and number of involved spinal cord levels were collected in addition to testing for cognition, fatigue, depression, and quality of life. Number and types of pain medications were tabulated. Results Current pain was more common in subjects with NMO (n=29) vs MS (n=66) (86.2% vs 40.9%; P<.001) and more severe on a 10-point scale (5.38 vs 1.85; P <.001). Pain remained more common after controlling for disability and number of spinal cord segments (P=.03). Prescription pain medication was used more frequently in subjects with NMO compared with subjects with MS (75.9% vs 37.8%; P<.001), often requiring more than 1 medication (65.5% vs 15.2%; P<.001). No subject with NMO taking pain medication (22 of 29) rated their current pain as 0 of 10, whereas almost half of those taking pain medication with MS were currently free of pain (0% vs 48%; P=.006). Conclusions Neuromyelitis optica is frequently associated with severe pain that appears insufficiently controlled by pharmacologic interventions. Future studies should evaluate the efficacy of a multidisciplinary and multimodal approach to pain management.

Qian, Peiqing; Lancia, Samantha; Alvarez, Enrique; Klawiter, Eric C.; Cross, Anne H.; Naismith, Robert T.



Targeting the visceral purinergic system for pain control.  


Experimental evidence is presented to support the hypothesis that purinergic mechanosensory transduction can initiate visceral pain in urinary bladder, ureter, gut and uterus. In general, physiological reflexes are mediated via P2X3 and P2X2/3 receptors on low threshold sensory fibres, while these receptors on high threshold sensory fibres mediate pain. Potential therapeutic strategies are considered for the treatment of visceral pain in such conditions as renal colic, interstitial cystitis and inflammatory bowel disease by purinergic agents, including P2X3 and P2X2/3 receptor antagonists that are orally bioavailable and stable in vivo and agents that modulate ATP release and breakdown. PMID:22036885

Burnstock, G



Percutaneous Cordotomy--A Simplified Approach to the Management of Intractable Pain  

PubMed Central

Cordotomy for palliation of intractable pain was simplified by the use of a stereotactic percutaneous technique. The procedure is performed at the high cervical level and has been found to give good results for pain in the upper as well as the lower extremity and the trunk. Respiratory complications are the major hazard, but they may be reduced by careful selection and evaluation of patients. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.

Batzdorf, Ulrich; Weingarten, Seth M.



[Management of intractable cancer pain: from intrathecal morphine to cell allograft].  


The durable effectiveness of intrathecal morphine administration is well established for the management of intractable cancer pain, after failure of systemic opioids, secondary to the persistence of non-reversible undesirable side effects. Many patients are referred to late in the disease course. This conservative method to control pain of malignant origin must not be reserved for last resort treatment for terminal patients. Intra-cerebro-ventricular morphine administration is a very effective and generally safe method for controlling intractable cancer pain. Because of the chronic implantation of an intra-ventricular catheter this method is somewhat invasive. Its indications remain a simple and effective alternative when the topography of nociceptive pain is diffuse or cephalic. In clinical practice, intrathecal and/or intra-cerebro-ventricular administration of opioids is limited by cost, the need for specialized maintenance and mechanical malfunctions if implantable drug delivery systems, or by the risk of bacterial contamination and ambulatory constraints when repeated daily injections via an intrathecal access port are used. To answer these limitations, cell therapy using intrathecal chromaffin cell allograft is a promising approach for the management of cancer pain refractory to traditional drug therapy and pain lesion surgery. The basic rationale and preclinical studies on experimental pain models have enabled starting prospective clinical trials. Prior to transplantation, handling and preparation of the chromaffin tissue is critical for allograft viability. The initial results of clinical trials with human chromaffin cell grafts from intractable cancer pain have reported long-lasting pain relief, in correlation with met-enkephalin release into the CSF. Convincing evidence will require controlled studies. The limitations of this innovative cell therapy and especially the lack of human adrenal gland availability point to the need for new sources of cells. Perspectives include xenogenic or engineered cell lines. PMID:11084478

Lazorthes, Y; Sallerin, B; Verdie, J C; Sol, J C; Duplan, H; Tkaczuk, J; Tafani, M; Bastide, R; Bes, J C



Bedside testing for chronic pelvic pain: discriminating visceral from somatic pain.  


Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+) and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0), pCA-2.91 (1.19, 7.11), aMTRP-4.19 (1.46, 12.0), pMFTP-1.35 (0.86, 2.13), and RPT-1.14 (0.85, 1.52), respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain. PMID:22135736

Jarrell, John; Giamberardino, Maria Adele; Robert, Magali; Nasr-Esfahani, Maryam



Ketamine treatment for intractable pain in a patient with severe refractory complex regional pain syndrome: a case report.  


In this case report, we describe the effect of ketamine infusion in a case of severe refractory complex regional pain syndrome I (CRPS I). The patient was initially diagnosed with CRPS I in her right upper extremity. Over the next 6 years, CRPS was consecutively diagnosed in her thoracic region, left upper extremity, and both lower extremities. The severity of her pain, combined with the extensive areas afflicted by CRPS, caused traumatic emotional problems for this patient. Conventional treatments, including anticonvulsants, bisphosphonates, oral steroids and opioids, topical creams, dorsal column spinal cord stimulation, spinal morphine infusion, sympathetic ganglion block, and sympathectomy, failed to provide long-term relief from pain. An N-methyl-d-aspartate (NMDA) antagonist inhibitor, ketamine, was recently suggested to be effective at resolving intractable pain. The patient was then given several infusions of intravenous ketamine. After the third infusion, the edema, discoloration, and temperature of the affected areas normalized. The patient became completely pain-free. At one-year of follow-up, the patient reported that she has not experienced any pain since the last ketamine infusion. Treatment with intravenous ketamine appeared to be effective in completely resolving intractable pain caused by severe refractory CRPS I. Future research on this treatment is needed. PMID:18523505

Shirani, Peyman; Salamone, Alicia R; Schulz, Paul E; Edmondson, Everton A


The role of c-AMP-dependent protein kinase in spinal cord and post synaptic dorsal column neurons in a rat model of visceral pain  

PubMed Central

Visceral noxious stimulation induces central neuronal plasticity changes and suggests that the c-AMP-dependent protein kinase (PKA) signal transduction cascade contributes to long-term changes in nociceptive processing at the spinal cord level. Our previous studies reported the clinical neurosurgical interruption of post synaptic dorsal column neuron (PSDC) pathway by performing midline myelotomy effectively alleviating the intractable visceral pain in patients with severe pain. However, the intracellular cascade in PSDC neurons mediated by PKA nociceptive neurotransmission was not known. In this study, by using multiple experimental approaches, we investigated the role of PKA in nociceptive signaling in the spinal cord and PSDC neurons in a visceral pain model in rats with the intracolonic injection of mustard oil. We found that mustard oil injection elicited visceral pain that significantly changed exploratory behavior activity in rats in terms of decreased numbers of entries, traveled distance, active and rearing time, rearing activity, and increased resting time when compared to that of rats receiving mineral oil injection. However, the intrathecal infusion of PKA inhibitor, H 89 partially reversed the visceral pain-induced effects. Results from Western blot studies showed that mustard oil injection significantly induced the expression of PKA protein in the lumbosacral spinal cord. Immunofluorescent staining in pre-labeled PSDC neurons showed that mustard oil injection greatly induces the neuronal profile numbers. We also found that the intrathecal infusion of a PKA inhibitor, H89 significantly blocked the visceral pain-induced phosphorylation of c-AMP –responsive element binding (CREB) protein in spinal cord in rats. The results of our study suggest that the PKA signal transduction cascade may contribute to visceral nociceptive changes in spinal PSDC pathways.

Wu, Jing; Su, Guangxiao; Ma, Long; Zhang, Xuan; Lei, Yongzhong; Lin, Qing; Nauta, Haring J.W.; Li, Junfa; Fang, Li



Extrasegmental analgesia of heterotopic electroacupuncture stimulation on visceral pain rats.  


Acupuncture has been applied in the clinic to treat visceral pain for a long time. However, the underlying mechanism still remains unknown. In the present study, extrasegmental analgesia of electroacupuncture (EA) at orofacial acupoints on visceral pain rats was investigated. The results revealed that nociceptive EA stimulation applied at heterotopic acupoints or nonacupoints to activate A(?) and/or C fibers induced c-fos expression in the paratrigeminal nucleus (PTN) and significantly inhibited acetic acid-induced abdominal contractions and c-fos expression in the nucleus of the solitary tract (NTS). However, non-nociceptive EA or non-EA stimulation applied at heterotopic acupoints was totally ineffective. After infraorbital nerves transaction or pretreated by capsaicin, the EA analgesia was dramatically inhibited. Snake venom pretreatment had no influence on this analgesia. Consequently, heterotopic EA stimulation trigger the pain-inhibiting effect of diffuse noxious inhibitory controls (DNIC), in which PTN-NTS secondary neural pathway may be involved and small-diameter (A(?) and/or C) fibers are crucial. PMID:21163255

Liu, Jianhua; Fu, Wenbin; Yi, Wei; Xu, Zhenhua; Liao, Yuan; Li, Xinran; Chen, Jiesi; Liu, Xuefang; Xu, Nenggui



Inhaled methoxyflurane and intranasal fentanyl for prehospital management of visceral pain in an Australian ambulance service  

Microsoft Academic Search

Objective This study analysed the analgesic effect and changes in vital signs associated with administration of inhaled Methoxyflurane (MTX) and\\/or intranasal Fentanyl (INF) for prehospital management of visceral pain. Method A retrospective, observational study reviewing 1024 randomly selected records of patients with presumed visceral pain administered MTX (465), INF (397) or both (162) by the Western Australian Ambulance Service between

Steven Johnston; Garry J Wilkes; Jennifer A Thompson; Melanie Ziman; Richard Brightwell



Multimodal Stepped Care Approach Involving Topical Analgesics for Severe Intractable Neuropathic Pain in CRPS Type 1: A Case Report  

PubMed Central

A multimodal stepped care approach has been successfully applied to a patient with complex regional pain syndrome type 1 and severe intractable pain, not responding to regular neuropathic pain medication. The choice to administer drugs in creams was made because of the intolerable adverse effects to oral medication. With this method, peak-dose adverse effects did not occur. The multimodal stepped care approach resulted in considerable and clinically relevant decrease in pain after every step, using topical amitriptyline, ketamine, and dimethylsulphoxide.

Kopsky, David J.; Keppel Hesselink, Jan M.



[Illustrations of visceral referred pain. "Head-less" Head's zones].  


Reviewing anatomical, physiological and neurological standard literature for illustrations of referred visceral pain only one type of illustration can frequently be found, which is referred to as Treves and Keith. In fact, the original illustration as a model for most current pictures stems from the German edition of Sir Frederick Treves' famous book "Surgical Applied Anatomy" from 1914, which was reillustrated for didactical reasons for the German readership. While neither Treves and Keith nor the German illustrator Otto Kleinschmidt ever published any work on referred pain this illustration must have been adapted or copied from older sources by the illustrator. Therefore the comprehensive systematic original works before 1914 were reviewed, namely those of Sir Henry Head and Sir James Mackenzie. Due to the name of the phenomenon in the German literature of Head's zones, the illustrations were expected to be based mainly on Head's work. However, a comparison of all available illustrations led to the conclusion that Kleinschmidt chiefly used information from Mackenzie as a model for his illustration. Due to the inexact reproduction of Mackenzie's work by the illustrator some important features were lost that had been reported by the original authors. These include the phenomenon of Head's maximum points, which nowadays has fallen into oblivion.Therefore current charts, based on the illustration by Kleinschmidt from 1914, lack experimental evidence and appear to be a simplification of the observational results of both Head's and Mackenzie's original systematic works. PMID:21424330

Henke, C; Beissner, F



Effects of general anesthetics on visceral pain transmission in the spinal cord  

Microsoft Academic Search

Current evidence suggests an analgesic role for the spinal cord action of general anesthetics; however, the cellular population and intracellular mechanisms underlying anti-visceral pain by general anesthetics still remain unclear. It is known that visceral nociceptive signals are transmited via post-synaptic dorsal column (PSDC) and spinothalamic tract (STT) neuronal pathways and that the PSDC pathway plays a major role in

Yun Wang; Jing Wu; Qing Lin; HJ Nauta; Yun Yue; Li Fang



Historic Evolution of Open Cingulectomy and Stereotactic Cingulotomy in the Management of Medically Intractable Psychiatric Disorders, Pain and Drug Addiction  

Microsoft Academic Search

Stereotactic cingulotomy constitutes a psychosurgical procedure nowadays advocated in the treatment of medically intractable obsessive-compulsive disorder, chronic pain and drug addiction. From its theoretical conception to the first cingulectomies performed and modern stereotactic-guided cingulotomies, various target localization methods, different surgical techniques, and numerous lesioning devices have been utilized. In the current article, the authors performed a literature review related to

Alexandros G. Brotis; Eftychia Z. Kapsalaki; Konstantinos Paterakis; Joseph R. Smith; Kostas N. Fountas



Spinal cord stimulation for chronic visceral pain secondary to chronic non-alcoholic pancreatitis.  


Spinal cord stimulation (SCS) suppresses visceral response to colon distension in an animal model. In humans, it may be an effective therapy for chronic pain of pelvic origin, irritable bowel syndrome, and persistent unspecified abdominal pain. Described here is the case of SCS for 38-year-old woman with visceral pain secondary to chronic pancreatitis. Previous therapies included numerous endoscopic retrograde cholangiopancreatographies, multiple pancreatic duct stenting, chemical and surgical sympathectomies with short-lasting pain relief. After the initial evaluation, the patient underwent retrograde epidural differential block to determine possible source of pain. Delay in pain recurrence after block suggested that the origin of her pain was visceral. After the psychologic evaluation, the patient underwent SCS trial over 14 days. She had 2 trial leads placed epidurally via T9-T10 paramedian entry with the tips of both leads positioned at T6 vertebral body. During the trial, visual analog scale pain score decreased from 8 to 1 cm, Pain Disability Index from 62 to 14, and opioid use from 150 to 0 mg of morphine sulfate equivalent a day. After the completion of successful SCS trial, she was implanted with dual octrode leads and rechargeable pulse generator. Median pain scores decreased from 8 to 1 at 3 months after the implant. Pain Disability Index changed from 62 to 15. Opiate use decreased to none. It seems that SCS may have a significant therapeutic potential for the treatment of visceral pain secondary to chronic pancreatitis. PMID:18496389

Kapural, Leonardo; Rakic, Mladen



Lack of endogenous opioid release during sustained visceral pain: A [(11)C]carfentanil PET study.  


Opioidergic neurotransmission in the central nervous system is involved in somatic pain, but its role in visceral pain remains unknown. We aimed to quantify endogenous opioid release in the brain during sustained painful gastric distension. Therefore, 2 dynamic [(11)C]carfentanil positron emission tomography scans were performed in 20 healthy subjects during 2 conditions: sustained (20minutes) painful proximal gastric balloon distension at predetermined individual discomfort threshold (PAIN) and no distension (NO PAIN), in counterbalanced order. Pain levels were assessed during scanning using visual analogue scales and after scanning using the McGill Pain Questionnaire. Emotional state was rated after scanning using the Positive and Negative Affect Schedule. Distribution volume ratios in 21 volumes of interest in the pain matrix were used to quantify endogenous opioid release. During the PAIN compared to the NO PAIN condition, volunteers reported a significantly higher increase in negative affect (5.50±1.29 versus 0.10±1.08, P=.0147) as well as higher pain ratings (sensory: 74.05±9.23 versus 1.50±0.95, P<.0001; affective: 91.42±8.13 versus 4.33±6.56, P<.0001). No difference in endogenous opioid release was demonstrated in any of the volumes of interest. Thus, contrary to its somatic counterpart, no opioid release is detected in the brain during sustained visceral pain, despite similar pain intensities. Endogenous opioids may play a less important role in visceral compared to somatic pain. PMID:23792286

Ly, Huynh Giao; Dupont, Patrick; Geeraerts, Brecht; Bormans, Guy; Van Laere, Koen; Tack, Jan; Van Oudenhove, Lukas



Neuroimaging of the human visceral pain system—A methodological review  

Microsoft Academic Search

During the last decades there has been a tremendous development of non-invasive methods for assessment of brain activity following visceral pain. Improved methods for neurophysiological and brain imaging techniques have vastly increased our understanding of the central processing of gastrointestinal sensation and pain in both healthy volunteers as well as in patients suffering from gastrointestinal disorders. The techniques used are

Jens Brøndum Frøkjær; Søren Schou Olesen; Carina Graversen; Trine Andresen; Dina Lelic; Asbjørn Mohr Drewes



High-Level Cervical Spinal Cord Stimulation Used to Treat Intractable Pain Arising from Transverse Myelitis Caused by Schistosomiasis  

PubMed Central

The efficacy of spinal cord stimulation (SCS) for treatment of various chronic painful conditions is well established. Very few reports have documented the use of SCS for treatment of chronic pain after spinal cord injury. We present a case showing a good outcome after such treatment, and suggest that high cervical stimulation may be efficacious. A 53-year-old male underwent SCS on the C1-3 level for treatment of intractable neuropathic pain below the T3 level, and in the upper extremities, arising from spinal cord injury resulting from transverse myelitis caused by schistosomiasis. High cervical SCS significantly improved the pain in the upper extremities and at the T3-T10 dermatome level. The patient continues to report excellent pain relief 9 months later. The present case suggests that high cervical stimulation may improve chronic pain in the upper extremities and the T3-T10 dermatome level arising from spinal cord injury.

Kim, Jin Kyung; Hong, Seok Ho



Silver needle therapy for intractable low-back pain at tender point after removal of nucleus pulposus  

Microsoft Academic Search

Objective: To examine the use of a new silver needle therapy for treating tender points involved in intractable low-back pain after removal of nucleus pulposus.Subjects: The study involved 24 patients (17 men and 7 women) aged 26 to 67 years with a mean age of 54.5 ± 5 years.Settings: The Department of Orthopedics at the First Military Medical University, the

Li Yi-Kai; Ao Xueyan; Wang Fu-Gen



Effective management of intractable neuropathic pain using an intrathecal morphine pump in a patient with acute transverse myelitis.  


Transverse myelitis is a rare inflammatory myelopathy characterized by loss of motor and sensory function below the affected level of the spinal cord, and causes neurogenic bowel and bladder. Occasionally, it also causes neuropathic pain with spasticity. Traditional therapies for neuropathic pain are multiple, including multimodal analgesic regimens, antiepileptic or antidepressant medications, opioids, sympathetic blocks, and spinal cord stimulation. Persistent neuropathic pain can cause emotional distress by affecting sleep, work, recreation, and emotional well-being. Here we report the case of a patient suffering from intractable neuropathic pain following acute transverse myelitis that was not relieved by combinations of nonsteroidal anti-inflammatory, anti-epileptic, antidepressant, and opioid medications, or by acupuncture. Implantation of an intrathecal morphine pump controlled the pain successfully without side effects, and enabled the patient to embark on intensive rehabilitation. The patient's muscle strength has improved significantly and the patient may soon be able to use a walker with minimal assistance. PMID:23935366

Wu, Wei-Ting; Huang, Yu-Hui; Chen, Der-Cherng; Huang, Yu-Hsuan; Chou, Li-Wei



The future of neuroscientific research in functional gastrointestinal disorders: integration towards multidimensional (visceral) pain endophenotypes?  


The growing evidence for a key role of psychophysiological processes in the etiopathogenesis of functional gastrointestinal disorders (FGID) originates from various sources, including epidemiological, psychometric, physiological, and behavioural studies. Functional neuroimaging has improved our knowledge about central processing of visceral pain, a defining feature of FGID. However, results have been disappointingly inconsistent, often due to psychosocial factors not being controlled for. In this paper, we aim to show that using integrated research strategies, encompassing a number of scientific disciplines, is critical to advancing our understanding of FGID. We will illustrate this by describing recent integrative studies that may serve as good examples. More specifically, future FGID neuroimaging studies should control for psychosocial factors and incorporate methods from other branches of neuroscience outside this field, especially cognitive, affective and autonomic neuroscience. We therefore propose a framework for the development of an integrative cross-disciplinary research strategy based on advancing our understanding of visceral nociceptive physiology in health as well as vulnerability and susceptibility factors for FGID. This approach will allow the identification of factors responsible for the inter-individual differences in visceral pain perception and susceptibility to chronic visceral pain, leading to the description of multidimensional (visceral) pain "endophenotypes." These may represent the critical steps needed towards a pathophysiological, rather than symptom-based, classification of FGID, which may be more suitable for genetic association studies. This approach may ultimately culminate in individual tailoring of treatment, in addition to disease prevention, thereby improving outcomes for the patient and researcher alike. PMID:20403507

Farmer, Adam D; Aziz, Qasim; Tack, Jan; Van Oudenhove, Lukas



Sex differences in brain response to anticipated and experienced visceral pain in healthy subjects.  


Women demonstrate higher pain sensitivity and prevalence of chronic visceral pain conditions such as functional gastrointestinal disorders than men. The role of sex differences in the brain processing of visceral pain is still unclear. In 16 male and 16 female healthy subjects we compared personality, anxiety levels, skin conductance response (SCR), and brain processing using functional MRI during anticipation and pain induced by esophageal distension at pain toleration level. There was no significant difference in personality scores, anxiety levels, SCR, and subjective ratings of pain between sexes. In group analysis, both men and women demonstrated a similar pattern of brain activation and deactivation during anticipation and pain consistent with previous reports. However, during anticipation women showed significantly greater activation in the cuneus, precuneus, and supplementary motor area (SMA) and stronger deactivation in the right amygdala and left parahippocampal gyrus, whereas men demonstrated greater activation in the cerebellum. During pain, women demonstrated greater activation in the midcingulate cortex, anterior insula, premotor cortex, and cerebellum and stronger deactivation in the caudate, whereas men showed increased activity in the SMA. The pattern of brain activity suggests that, during anticipation, women may demonstrate stronger limbic inhibition, which is considered to be a cognitive modulation strategy for impending painful stimulation. During pain, women significantly activate brain areas associated with the affective and motivation components of pain. These responses may underlie the sex differences that exist in pain conditions, whereby women may attribute more emotional importance to painful stimuli compared with men. PMID:23392235

Kano, Michiko; Farmer, Adam D; Aziz, Qasim; Giampietro, Vincent P; Brammer, Michael J; Williams, Steven C R; Fukudo, Shin; Coen, Steven J



Visceral pain originating from the upper urinary tract  

Microsoft Academic Search

Pain originating from the upper urinary tract is a common problem and stone colic is one of the most intense pain conditions\\u000a that can be experienced in the clinic. The pain is difficult to alleviate and often leads to medical attention. In humans,\\u000a pain mechanisms of the upper urinary tract pain are still poorly understood, which often leads to a

Katja Venborg Pedersen; Asbjørn Mohr Drewes; Poul Christian Frimodt-Møller; Palle Jørn Sloth Osther



Intradural approach to selective stimulation in the spinal cord for treatment of intractable pain: design principles and wireless protocol  

NASA Astrophysics Data System (ADS)

We introduce an intradural approach to spinal cord stimulation for the relief of intractable pain, and describe the biophysical rationale that underlies its design and performance requirements. The proposed device relies on wireless, inductive coupling between a pial surface implant and its epidural controller, and we present the results of benchtop experiments that demonstrate the ability to transmit and receive a frequency-modulated 1.6 MHz carrier signal between micro-coil antennae scaled to the ~ 1 cm dimensions of the implant, at power levels of about 5 mW. Plans for materials selection, microfabrication, and other aspects of future development are presented and discussed.

Howard, M. A.; Utz, M.; Brennan, T. J.; Dalm, B. D.; Viljoen, S.; Jeffery, N. D.; Gillies, G. T.



Estrogen receptor ? activation is antinociceptive in a model of visceral pain in the rat  

PubMed Central

The mechanism underlying estrogen modulation of visceral pain remains unclear. Our previous studies indicate activation of estrogen receptor ? (ER?) enhances visceral pain. The purpose of the present study was to investigate the role of estrogen receptor ? (ER?) activation in spinal processing of visceral stimuli. The effects of selective ER? agonists on the visceromotor response (VMR) and dorsal horn neuronal responses to colorectal distention (CRD) were tested in ovariectomized and intact female rats. The magnitude of the VMR to CRD was significantly attenuated by ER? agonists diarylpropionitrile (DPN) and WAY200070 four hours after subcutaneous injection. Pretreatment with the estrogen receptor antagonist ICI 182,780 obscured the DPN-evoked attenuation. There was no effect of DPN on the VMR at earlier time points. Subcutaneous and spinal administration of DPN attenuated the response of visceroceptive dorsal horn neurons with a comparable time course. DPN attenuated the VMR in intact rats regardless of estrous cycle stage. The timecourse of effect of ER? activation on the visceromotor response and neuronal activity is consistent with transcriptional or translational modulation of neuronal activity. Perspective Activation of ER? is antinociceptive in the colorectal distention model of visceral pain, which may provide a therapeutic target to manage IBS in the clinic.

Cao, Dong-Yuan; Ji, Yaping; Tang, Bin; Traub, Richard J.



Is there a pathway in the posterior funiculus that signals visceral pain?  

PubMed Central

Summary The present report provides evidence that axons in the medial part of the posterior column at T10 convey ascending nociceptive signals from pelvic visceral organs. This evidence was obtained from human surgical case studies and histological verification of the lesion in one of these cases, along with neuroanatomical and neurophysiological findings in animal experiments. A restricted lesion in this area can virtually eliminate pelvic pain due to cancer. The results remain excellent even in cases in which somatic structures of the pelvic body wall are involved. Following this procedure, neurological testing reveals no additional neurological deficit. There is no analgesia to pinprick stimuli applied to the body surface, despite the relief of the visceral pain. Since it is reasonable to attribute the favorable results of limited midline myelotomies to the interruption of axons of visceral nociceptive projection neurons in the posterior column, we have performed experiments in rats to test this hypothesis. The results in rats indicate that the dorsal column does indeed include a nociceptive component that signals pelvic visceral pain. The pathway includes neurons of the postsynaptic dorsal column pathway at the L6-S1 segmental level, axons of these neurons in the fasciculus gracilis, and neurons of the nucleus gracilis and the ventral posterolateral nucleus of the thalamus.

Hirshberg, R.M.; AI-Chaer, E.D.; Lawand, N.B.; Westlund, K.N.; Willis, W.D.



Sex differences in morphine-induced analgesia of visceral pain are supraspinally and peripherally mediated.  


Increasing evidence suggests there is a sex difference in opioid analgesia of pain arising from somatic tissue. However, the existence of a sex difference in visceral pain and opioid analgesia is unclear. This was examined in the colorectal distention (CRD) model of visceral pain in the current study. The visceromotor response (vmr) to noxious CRD was recorded in gonadally intact male and female rats. Subcutaneous injection of morphine dose-dependently decreased the vmr in both groups without affecting colonic compliance. However, morphine was significantly more potent in male rats than females. Because systemic morphine can act at peripheral tissue and in the central nervous system (CNS), the source of the sex difference in morphine analgesia was determined. The peripherally restricted mu-opioid receptor (MOR) antagonist naloxone methiodide dose-dependently attenuated the effects of systemic morphine. Systemic administration of the peripherally restricted MOR agonist loperamide confirmed peripherally mediated morphine analgesia and revealed greater potency in males compared with females. Spinal administration of morphine dose-dependently attenuated the vmr, but there was no sex difference. Intracerebroventricular administration of morphine also dose-dependently attenuated the vmr with significantly greater potency in male rats. The present study documents a sex difference in morphine analgesia of visceral pain that is both peripherally and supraspinally mediated. PMID:16556902

Ji, Yaping; Murphy, Anne Z; Traub, Richard J



Targeting voltage-gated sodium channels for treatment for chronic visceral pain  

PubMed Central

Voltage-gated sodium channels (VGSCs) play a fundamental role in controlling cellular excitability, and their abnormal activity is related to several pathological processes, including cardiac arrhythmias, epilepsy, neurodegenerative diseases, spasticity and chronic pain. In particular, chronic visceral pain, the central symptom of functional gastrointestinal disorders such as irritable bowel syndrome, is a serious clinical problem that affects a high percentage of the world population. In spite of intense research efforts and after the dedicated decade of pain control and research, there are not many options to treat chronic pain conditions. However, there is a wealth of evidence emerging to give hope that a more refined approach may be achievable. By using electronic databases, available data on structural and functional properties of VGSCs in chronic pain, particularly functional gastrointestinal hypersensitivity, were reviewed. We summarize the involvement and molecular bases of action of VGSCs in the pathophysiology of several organic and functional gastrointestinal disorders. We also describe the efficacy of VGSC blockers in the treatment of these neurological diseases, and outline future developments that may extend the therapeutic use of compounds that target VGSCs. Overall, clinical and experimental data indicate that isoform-specific blockers of these channels or targeting of their modulators may provide effective and novel approaches for visceral pain therapy.

Qi, Fei-Hu; Zhou, You-Lang; Xu, Guang-Yin



The contribution of capsaicin-sensitive sensory nerves to xylene-induced visceral pain in conscious, freely moving rats  

Microsoft Academic Search

1.Intravesical instillation of xylene (10–100%, dissolved in silicone oil) through a catheter implanted into the bladder of conscious, freely-moving rats produced behavioural effects (licking of lower abdomen or perineal region) suggestive of intense visceral pain, not mimicked by topical application of the irritant on the urethral outlet.2.The xylene-induced visceral pain was prevented, to the same extent, by systemic desensitization to

Luigi Abelli; Bruno Conte; Vincenzo Somma; Carlo Alberto Maggi; Sandro Giuliani; Pierangelo Geppetti; Massimo Alessandri; Elvar Theodorsson; Alberto Meli



Cortical mapping of visceral pain in patients with GI disorders using functional magnetic resonance imaging  

Microsoft Academic Search

OBJECTIVE:We sought to identify central loci that activate in response to visceral stimuli (stool and pain). We had a particular interest in observing the anterior cingulate gyrus and frontal cortex in normals and in patients with intestinal disease, including inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS).METHODS:Subjects underwent rectal balloon distention to a sensation of stool and to a

Charles N Bernstein; Uta N Frankenstein; Patricia Rawsthorne; Marshall Pitz; Randy Summers; Michael C McIntyre



The individual and combined effects of U50,488, and flurbiprofen axetil on visceral pain in conscious rats.  


We examined the effects of U50,488, a kappa-opioid receptor agonist, and flurbiprofen axetil, a nonsteroidal antiinflammatory drug, in a visceral pain model using conscious rats. U50,488 produced visceral antinociception, but exaggerated the adverse effects on the central nervous system (CNS) at 0.9 mg/kg or more. Naloxone completely antagonized these effects. Flurbiprofen axetil produced visceral antinociception, but exaggerated the adverse effects on the CNS at 80 mg/kg. Coadministration of U50,488 (0.27 mg/kg) and flurbiprofen axetil (50 mg/kg) produced intense visceral antinociception without adverse effects on the CNS, implying therapeutic efficacies of coadministration of kappa-opioid receptor-agonists and nonsteroidal antiinflammatory drugs on visceral pain. PMID:19448232

Kitamura, Takayuki; Ogawa, Makoto; Yamada, Yoshitsugu



Lubiprostone does not Influence Visceral Pain Thresholds in Patients with Irritable Bowel Syndrome  

PubMed Central

Background In clinical trials, lubiprostone reduced the severity of abdominal pain. Aims The primary aim was to determine whether lubiprostone raises the threshold for abdominal pain induced by intraluminal balloon distention. A secondary aim was to determine whether changes in pain sensitivity influence clinical pain independently of changes in transit time. Methods Sixty-two patients with irritable bowel syndrome with constipation (IBS-C) participated in an 8-week crossover study. All subjects completed a 14-day baseline ending with a barostat test of pain and urge sensory thresholds. Half, randomly selected, then received 48 ug/day of lubiprostone for 14 days ending with a pain sensitivity test and a Sitzmark test of transit time. This was followed by a 14-day washout and then a crossover to 14 days of placebo with tests of pain sensitivity and transit time. The other half of the subjects received placebo before lubiprostone. All kept symptom diaries. Results Stools were significantly softer when taking lubiprostone compared to placebo (Bristol Stool scores 4.20 vs. 3.44, p<0.001). However, thresholds for pain (17.36 vs. 17.83 mmHg, lubiprostone vs. placebo) and urgency to defecate (14.14 vs. 14.53 mmHg) were not affected by lubiprostone. Transit time was not significantly different between lubiprostone and placebo (51.27 vs. 51.81 hours), and neither pain sensitivity nor transit time was a significant predictor of clinical pain. Conclusions Lubiprostone has no effect on visceral sensory thresholds. The reductions in clinical pain that occur while taking lubiprostone appear to be secondary to changes in stool consistency.

Whitehead, William E.; Palsson, Olafur S.; Gangarosa, Lisa; Turner, Marsha; Tucker, Jane



Ritodrine for Intractable Uterine Pain Due to Extrapelvic Malignant Tumor Metastases: A Case Report.  


BACKGROUND:: Effective pain management is an essential component of cancer treatment as approximately 75% of all cancer patients experience excruciating nociceptive pain even at maximum safe doses of nonsteroidal anti-inflammatory drugs and/or opioids. We report a case where ritodrine hydrochloride effectively controlled refractory pain due to uterine metastases from thymic carcinoma. CASE PRESENTATION:: A 40-year-old woman presented at our hospital with chest discomfort, severe right femoral pain, and intermittent hypogastralgia. Computed tomography, magnetic resonance imaging, and positron emission tomography revealed a large mass in the anterior mediastinum, multiple nodules in the lungs, and multiple metastases on the uterus, lumbar vertebrae, and pelvic bones. Needle biopsies of the mediastinal and uterine cervical tumors revealed undifferentiated carcinoma of the thymus metastasizing to the uterus. Oxycodone and nonsteroidal anti-inflammatory drugs relieved the right femoral pain but not the hypogastralgia. We speculated that hypogastralgia did not result from somatalgia but from splanchnodynia. Ritodrine was administered in an effort to inhibit uterine contractions and to reduced the refractory pain and improved her quality of life. CONCLUSION:: Ritodrine relieved the pain caused by uterine contraction due to metastases and enhanced the quality of life. PMID:23567162

Sugiura, Yasoo; Nemoto, Etsuo; Kadohira, Ikuko; Kaseda, Shizuka



Relief of intractable cancer pain by human chromaffin cell transplants: experience at two medical centers.  


In addition to its possible role as a replacement source in CNS degenerative diseases, neural transplantation may be used to augment the normal production of neuroactive substances. Our laboratory at the University of Illinois at Chicago has shown, in both acute and chronic pain models, that transplantation of adrenal medullary tissue or isolated chromaffin cells into CNS pain modulatory regions can reduce pain sensitivity in rodents. Chromaffin cells were chosen as the donor source since they produce high levels of both opioid peptides and catecholamines, substances which reduce pain sensitivity when injected locally into the spinal subarachnoid space. The analgesia produced by these transplants probably results from the release of both opioid peptides and catecholamines since it can be blocked or attenuated by both opiate and adrenergic antagonists. Studies indicate that even over long periods there is no apparent development of tolerance. Promising results have been obtained in preliminary clinical studies using allografts of adrenal medulla to relieve cancer pain. This clinical review encompasses results at two Medical Centers-University of Illinois at Chicago and University Paul Sabatier, Toulouse, France-in assessing efficacy of subarachnoid adrenal medullary transplantation for alleviating cancer pain. Our clinical and autopsy data strongly support our previous laboratory studies, i.e., that chromaffin cell transplants into the subarachnoid space represent a promising new approach to the alleviation of chronic pain. It is suggested that further clinical studies are now warranted. PMID:9090640

Pappas, G D; Lazorthes, Y; Bès, J C; Tafani, M; Winnie, A P



A visceral pain pathway in the dorsal column of the spinal cord  

PubMed Central

A limited midline myelotomy at T10 can relieve pelvic cancer pain in patients. This observation is explainable in light of strong evidence in support of the existence of a visceral pain pathway that ascends in the dorsal column (DC) of the spinal cord. In rats and monkeys, responses of neurons in the ventral posterolateral thalamic nucleus to noxious colorectal distention are dramatically reduced after a lesion of the DC at T10, but not by interruption of the spinothalamic tract. Blockade of transmission of visceral nociceptive signals through the rat sacral cord by microdialysis administration of morphine or 6-cyano-7-nitroquinoxaline-2,3-dione shows that postsynaptic DC neurons in the sacral cord transmit visceral nociceptive signals to the gracile nucleus. Retrograde tracing studies in rats demonstrate a concentration of postsynaptic DC neurons in the central gray matter of the L6-S1 spinal segments, and anterograde tracing studies show that labeled axons ascend from this region to the gracile nucleus. A similar projection from the midthoracic spinal cord ends in the gracile and cuneate nuclei. Behavioral experiments demonstrate that DC lesions reduce the nocifensive responses produced by noxious stimulation of the pancreas and duodenum, as well as the electrophysiological responses of ventral posterolateral neurons to these stimuli. Repeated regional blood volume measurements were made in the thalamus and other brain structures in anesthetized monkeys in response to colorectal distention by functional MRI. Sham surgery did not reduce the regional blood volume changes, whereas the changes were eliminated by a DC lesion at T10.

Willis, William D.; Al-Chaer, Elie D.; Quast, Michael J.; Westlund, Karin N.



Lumbar paravertebral blockade as intractable pain management method in palliative care.  


Optimal symptoms control in advanced cancer disease, with refractory to conventional pain treatment, needs an interventional procedure. This paper presents coadministration of local anesthetic (LA) via paravertebral blockade (PVB) as the alternative to an unsuccessful subcutaneous fentanyl pain control in a 71-year old cancer patient with pathological fracture of femoral neck, bone metastases, and contraindications to morphine. Bupivacaine in continuous infusion (0.25%, 5 mL · hour(-1)) or in boluses (10 mL of 0.125%-0.5% solution), used for lumbar PVB, resulted in pain relief, decreased demand for opioids, and led to better social interactions. The factors contributing to an increased risk of systemic toxicity from LA in the patient were: renal impairment; heart failure; hypoalbuminemia; hypocalcemia; and a complex therapy with possible drug-drug interactions. These factors were taken into consideration during treatment. Bupivacaine's side effects were absent. Coadministered drugs could mask LA's toxicity. Elevated plasma ?1-acid glycoprotein levels were a protective factor. To evaluate the benefit-risk ratio of the PVB treatment in boluses and in constant infusion, bupivacaine serum levels were determined and the drug plasma half-lives were calculated. Bupivacaine's elimination was slower when administered in constant infusion than in boluses (t½ = 7.80 hours versus 2.64 hours). Total drug serum concentrations remained within the safe ranges during the whole treatment course (22.9-927.4 ng mL(-1)). In the case presented, lumbar PVB with bupivacaine in boluses (? 137.5 mg · 24 hours(-1)) was an easy to perform, safe, effective method for pain control. Bupivacaine in continuous infusion (?150 mg · 12 hours(-1)) had an acceptable risk-benefits ratio, but was ineffective. PMID:24043944

Zaporowska-Stachowiak, Iwona; Kotlinska-Lemieszek, Aleksandra; Kowalski, Grzegorz; Kosicka, Katarzyna; Hoffmann, Karolina; G?ówka, Franciszek; Luczak, Jacek



Lumbar paravertebral blockade as intractable pain management method in palliative care  

PubMed Central

Optimal symptoms control in advanced cancer disease, with refractory to conventional pain treatment, needs an interventional procedure. This paper presents coadministration of local anesthetic (LA) via paravertebral blockade (PVB) as the alternative to an unsuccessful subcutaneous fentanyl pain control in a 71-year old cancer patient with pathological fracture of femoral neck, bone metastases, and contraindications to morphine. Bupivacaine in continuous infusion (0.25%, 5 mL · hour?1) or in boluses (10 mL of 0.125%–0.5% solution), used for lumbar PVB, resulted in pain relief, decreased demand for opioids, and led to better social interactions. The factors contributing to an increased risk of systemic toxicity from LA in the patient were: renal impairment; heart failure; hypoalbuminemia; hypocalcemia; and a complex therapy with possible drug-drug interactions. These factors were taken into consideration during treatment. Bupivacaine’s side effects were absent. Coadministered drugs could mask LA’s toxicity. Elevated plasma ?1-acid glycoprotein levels were a protective factor. To evaluate the benefit-risk ratio of the PVB treatment in boluses and in constant infusion, bupivacaine serum levels were determined and the drug plasma half-lives were calculated. Bupivacaine’s elimination was slower when administered in constant infusion than in boluses (t½ = 7.80 hours versus 2.64 hours). Total drug serum concentrations remained within the safe ranges during the whole treatment course (22.9–927.4 ng mL?1). In the case presented, lumbar PVB with bupivacaine in boluses (? 137.5 mg · 24 hours?1) was an easy to perform, safe, effective method for pain control. Bupivacaine in continuous infusion (?150 mg · 12 hours?1) had an acceptable risk-benefits ratio, but was ineffective.

Zaporowska-Stachowiak, Iwona; Kotlinska-Lemieszek, Aleksandra; Kowalski, Grzegorz; Kosicka, Katarzyna; Hoffmann, Karolina; Glowka, Franciszek; Luczak, Jacek



Identification of the visceral pain pathway activated by noxious colorectal distension in mice.  


In patients with irritable bowel syndrome, visceral pain is evoked more readily following distension of the colorectum. However, the identity of extrinsic afferent nerve pathway that detects and transmits visceral pain from the colorectum to the spinal cord is unclear. In this study, we identified which extrinsic nerve pathway(s) underlies nociception from the colorectum to the spinal cord of rodents. Electromyogram recordings were made from the transverse oblique abdominal muscles in anesthetized wild type (C57BL/6) mice and acute noxious intraluminal distension stimuli (100-120?mmHg) were applied to the terminal 15?mm of colorectum to activate visceromotor responses (VMRs). Lesioning the lumbar colonic nerves in vivo had no detectable effect on the VMRs evoked by colorectal distension. Also, lesions applied to the right or left hypogastric nerves failed to reduce VMRs. However, lesions applied to both left and right branches of the rectal nerves abolished VMRs, regardless of whether the lumbar colonic or hypogastric nerves were severed. Electrical stimulation applied to either the lumbar colonic or hypogastric nerves in vivo, failed to elicit a VMR. In contrast, electrical stimulation (2-5?Hz, 0.4?ms, 60?V) applied to the rectum reliably elicited VMRs, which were abolished by selective lesioning of the rectal nerves. DiI retrograde labeling from the colorectum (injection sites 9-15?mm from the anus, measured in unstretched preparations) labeled sensory neurons primarily in dorsal root ganglia (DRG) of the lumbosacral region of the spinal cord (L6-S1). In contrast, injection of DiI into the mid to proximal colon (injection sites 30-75?mm from the anus, measured in unstretched preparations) labeled sensory neurons in DRG primarily of the lower thoracic level (T6-L2) of the spinal cord. The visceral pain pathway activated by acute noxious distension of the terminal 15?mm of mouse colorectum is transmitted predominantly, if not solely, through rectal/pelvic afferent nerve fibers to the spinal cord. The sensory neurons of this spinal afferent pathway lie primarily in the lumbosacral region of the spinal cord, between L6 and S1. PMID:21390285

Kyloh, Melinda; Nicholas, Sarah; Zagorodnyuk, Vladimir P; Brookes, Simon J; Spencer, Nick J



The prostaglandin E2 receptor-1 (EP1) mediates acid-induced visceral pain hypersensitivity in humans  

Microsoft Academic Search

Background & Aims: Central sensitization, an activity-dependent increase in spinal cord neuronal excitability, has been shown to contribute to esophageal pain hypersensitivity. Prostaglandin E2 (PGE2) is a mediator in both peripheral and central sensitization, in part via the prostaglandin E2 receptor-1 (EP-1), and may be a potential target for treating visceral pain. The purpose of this study was to determine

Sanchoy Sarkar; Anthony R. Hobson; Andrew Hughes; Jim Growcott; Clifford J. Woolf; David G. Thompson; Qasim Aziz



Necrotic arachnidism and intractable pain from recluse spider bites treated with lumbar sympathetic block: a case report and review of literature.  


Brown recluse (Loxosceles reclusa) spider bites mainly occur in the southern and Midwestern United States. The clinical manifestation of brown recluse spider bites varies from skin irritation, a small area of tissue damage to neuropathic pain, necrotic arachnidism and severe systemic reactions such as acute renal failure and even death. Treatment is controversial and nonspecific. We describe a case of extensive right lower extremity tissue necrosis and intractable neuropathic pain treated with lumbar sympathetic block in a patient with a documented brown recluse spider bite. Both his pain and tissue necrosis improved significantly with lumbar sympathetic block with local anesthetic. After a series of lumbar sympathetic blocks, his symptoms resolved and lower extremity wound healed rapidly. We discuss the benefit of sympathetic blockade not only for neuropathic pain but also possibly as a treatment for necrotic arachnidism from a brown recluse spider bite. PMID:21317774

Yi, Xiaobin; AuBuchon, Jacob; Zeltwanger, Shawn; Kirby, John P



The anti-hyperalgesic actions of the cannabinoid anandamide and the putative CB2 receptor agonist palmitoylethanolamide in visceral and somatic inflammatory pain  

Microsoft Academic Search

This study assessed the effects of two N-acylethanolamides in established rat models of visceral and somatic inflammatory pain. (1) The therapeutic effects of the cannabinoid anandamide and the putative CB2 agonist palmitoylethanolamide were tested in a model of persistent visceral pain (turpentine inflammation of the urinary bladder). Both anandamide (at a dose of 25 mg\\/kg) and palmitoylethanolamide (at doses of

Sian I. Jaggar; Fauzia S. Hasnie; Senthy Sellaturay; Andrew S. C. Rice



Supraspinal antinociceptive effect of apelin-13 in a mouse visceral pain model.  


Apelin, as the endogenous ligand of the APJ receptor, is a novel identified neuropeptide whose biological functions are not fully understood. APJ receptor mRNA was found in several brain regions related to descending control system of pain, such as amygdala, hypothalamus and dorsal raphe nucleus (DRN). The present study was designed to determine whether supraspinal apelin-13 may produce antinociceptive effect observed in the acetic acid-induced writhing test, a model of visceral pain. Apelin-13 not only significantly produced preemptive antinociception at the dose of 0.3, 0.5, 1 and 3 ?g/mouse when injected intracerebroventricularly (i.c.v.) before acetic acid, but also significantly induced antinociception at a dose of 0.5, 1 and 3 ?g/mouse when injected i.c.v. after acetic acid. And i.c.v. apelin-13 did not influence 30-min locomotor activity counts in mice. Intrathecal (i.t.) administration of apelin-13 (1 and 3 ?g/mouse) significantly decreased the number of writhes, however, intraperitoneal (i.p.) injection of apelin-13 (10-100 ?g/mouse) had no effect on the number of writhes in the writhing test. The specific APJ receptor antagonist apelin-13(F13A), no-specific opioid receptor antagonist naloxone and ?-opioid receptor antagonist ?-funaltrexamine hydrochloride (?-FNA) could significantly antagonize the antinociceptive effect of i.c.v. apelin-13, suggesting APJ receptor and ?-opioid receptor are involved in this process. Central low dose of apelin-13 (0.3 ?g/mouse, i.c.v.) could significantly potentiate the analgesic potencies of modest and even relatively ineffective doses of morphine administrated at supraspinal level. This enhanced antinociceptive effect was reversed by naloxone, suggesting that the potentiated analgesic response is mediated by opioid-responsive neurons. PMID:22732665

Lv, Shuang-Yu; Qin, Yao-Jun; Wang, Ning-Bo; Yang, Yan-Jie; Chen, Qiang



Artificial ureteral calculosis in rats: behavioural characterization of visceral pain episodes and their relationship with referred lumbar muscle hyperalgesia.  


In a rat model of artificial ureteral calculosis, the aim of the study was to characterize the behavioural manifestations of direct visceral pain and to evaluate the relationship between number, duration and complexity of the visceral episodes and the extent of referred lumbar muscular hyperalgesia. As evidenced by non-stop video-tape recordings over 4-14 days, almost 98% of stone-implanted rats showed episodes similar to the writhing behaviour characteristic of noxious visceral stimulation in animals. From one rat to another, these episodes varied from very few (1-3) to a very high number (+/- 60), lasted a few minutes to over 45 min and were of variable complexity, as evaluated via an arbitrary scale on the basis of the combination of movements. Their number and duration decreased significantly, in a linear fashion, as time passed after the operation, so that they were mostly concentrated during the first 3 days. Number, duration and complexity of episodes were reduced by chronic treatment with morphine in a dose-dependent fashion. Stone-implanted rats displaying visceral episodes also showed hyperalgesia of the ipsilateral oblique musculature, as evidenced by a decrease in the vocalization threshold to electrical muscle stimulation, which was maximum on the first 3-4 days after implantation but lasted up to 10 days. The visceral episodes and the muscle hyperalgesia showed a strict relationship of interdependence: a significant, direct linear correlation was found between number and duration of episodes and tendency to also develop a contralateral muscle hyperalgesia. By applying the results of the study to the interpretation of human pathology, referred lumbar muscle hyperalgesia from ureteral calculosis would appear to be a strict function of the colic pain experienced. PMID:7478690

Giamberardino, M A; Valente, R; de Bigontina, P; Vecchiet, L



Early Life Adversity as a Risk Factor for Visceral Pain in Later Life: Importance of Sex Differences  

PubMed Central

A history of early life adversity (ELA) has health-related consequences that persist beyond the initial maltreatment and into adulthood. Childhood adversity is associated with abnormal glucocorticoid signaling within the hypothalamic-pituitary-adrenal (HPA) axis and the development of functional pain disorders such as the irritable bowel syndrome (IBS). IBS and many adult psychopathologies are more frequently diagnosed in women, and ovarian hormones have been shown to modulate pain sensitivity. Therefore, the sexually dimorphic effects of ELA and the role of ovarian hormones in visceral pain perception represent critical research concepts to enhance our understanding of the etiology of IBS. In this review, we discuss current animal models of ELA and the potential mechanisms through which ovarian hormones modulate the HPA axis to alter nociceptive signaling pathways and induce functionally relevant changes in pain behaviors following ELA.

Chaloner, Aaron; Greenwood-Van Meerveld, Beverley



Hypersensitivity to visceral and cutaneous pain in the irritable bowel syndrome  

Microsoft Academic Search

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal illnesses and is characterized by altered visceral perception. Previous studies in IBS have failed to demonstrate altered somatic or cutaneous perception. The aims of the study were to determine whether IBS patients have visceral hypersensitivity and cutaneous heat-induced hyperalgesia restricted to lumbosacral dermatomes, consistent with a localized segmental mechanism.

G. Nicholas Verne; Michael E Robinson; Donald D Price



Neural mechanisms mediating positive and negative treatment expectations in visceral pain: A functional magnetic resonance imaging study on placebo and nocebo effects in healthy volunteers.  


To elucidate placebo and nocebo effects in visceral pain, we conducted a functional magnetic resonance imaging (fMRI) study to analyze effects of positive and negative treatment expectations in a rectal pain model. In 36 healthy volunteers, painful rectal distensions were delivered after intravenous application of an inert substance combined with either positive instructions of pain relief (placebo group) or negative instructions of pain increase (nocebo group), each compared to neutral instructions. Neural activation during cued-pain anticipation and pain was analyzed along with expected and perceived pain intensity. Expected and perceived pain intensity were significantly increased in the nocebo group and significantly decreased in the placebo group. In the placebo group, positive expectations significantly reduced activation of the somatosensory cortex during anticipation and of the insula, somatosensory cortex, and amygdala during pain delivery when compared to neutral expectations. Within the nocebo group, negative expectations led to significantly increased insula activation during painful stimulation. Direct group contrasts during expectation modulation revealed significantly increased distension-induced activation within the somatosensory cortex in the nocebo group. In conclusion, the experience and neural processing of visceral pain can be increased or decreased by drug-specific expectations. This first brain imaging study on nocebo effects in visceral pain has implications for the pathophysiology and treatment of patients with chronic abdominal complaints such as irritable bowel syndrome. PMID:23867733

Schmid, Julia; Theysohn, Nina; Gaß, Florian; Benson, Sven; Gramsch, Carolin; Forsting, Michael; Gizewski, Elke R; Elsenbruch, Sigrid



A comparison of two opioid analgesics for relief of visceral pain induced by intestinal resection in rats.  


While developing a rat model for human short bowel syndrome, we noted that untreated rats as well as rats administered buprenorphine after intestinal resection exhibited behavior and appearance consistent with visceral pain and distress. To provide appropriate analgesics, we developed criteria to assess pain-related behavioral changes and conducted an experiment to evaluate the effectiveness of buprenorphine versus oxymorphone to alleviate the pain induced by intestinal resection. Rats underwent either small-bowel resection or transection surgery; in addition, animals received jugular catheterization for the delivery of total parenteral nutrition (TPN). Rats treated with buprenorphine received 0.5 mg/kg every 6 h subcutaneously, and rats treated with oxymorphone received 0.03 mg/kg hourly for 32 h via continuous intravenous (i.v.) infusion with TPN solution. Rats treated with buprenorphine exhibited behavior and appearance consistent with pain and distress for as long as 32 h postoperatively, whereas animals treated with oxymorphone exhibited behavior and appearance similar to their preoperative state. Thus, oxymorphone alleviated the pain-related behavioral changes after intestinal resection far better than did buprenorphine. Of interest, we observed that the buprenorphine was associated with a decrease in the volume of urine collected, whereas oxymorphone was associated with urine volumes similar to those of nonresected rats maintained with TPN. Because oxymorphone appeared to be a superior analgesic, we also evaluated three routes for administering this drug. Pain-related behavior changes were alleviated by the administration of oxymorphone by either Alzet mini-pump, bolus i.v. injection, or continuous i.v. infusion. We conclude that compared with buprenorphine, oxymorphone is a superior analgesic for the alleviation of visceral pain due to intestinal resection. PMID:11300671

Gillingham, M B; Clark, M D; Dahly, E M; Krugner-Higby, L A; Ney, D M



The central versus peripheral antinociceptive effects of ?-opioid receptor agonists in the new model of rat visceral pain.  


This study describes the antinociceptive effects of ?-opioid agonists, d-Ala(2),N-Me-Phe(4),Gly(5)-ol-enkephalin (DAMGO) and morphine in a model of rat visceral pain in which nociceptive responses were triggered by 2% acetic acid intraperitoneal (i.p.) injections. DAMGO and morphine were administered i.p., to the same site where acetic acid was delivered or intracerebroventricularly (i.c.v.). The antinociceptive actions of i.p. versus i.c.v. administered DAMGO or morphine were evaluated in the late phase of permanent visceral nociceptive responses. Both compounds inhibited the nociceptive responses in a dose-dependent manner and exhibited more potent agonist activity after i.c.v. than i.p. administration. DAMGO and morphine showed comparable ED(50) values after i.p. injections. However, DAMGO was much stronger than morphine after central administration. Co-administration of the peripherally restricted opioid antagonist, naloxone methiodide (NAL-M), significantly attenuated the antinociceptive effects of i.p. DAMGO or morphine. On the other hand, i.c.v. injections of NAL-M partially antagonized the antinociceptive effect of i.p. morphine and failed to affect the antinociceptive action of i.p. DAMGO indicating the partial and pure peripheral antinociceptive effects of morphine and DAMGO, respectively. These results suggest the role of either central or peripheral ?-opioid receptors (MOR) in mediating antinociceptive effects of i.p. ?-opioid agonists in the rat late permanent visceral pain model which closely resembles the clinical situation. PMID:22079588

Al-Khrasani, Mahmoud; Lackó, Erzsébet; Riba, Pál; Király, Kornél; Sobor, Melinda; Timár, Júlia; Mousa, Shaaban; Schäfer, Michael; Fürst, Susanna



Inhibitory effects of Lactobacillus reuteri on visceral pain induced by colorectal distension in Sprague-Dawley rats  

PubMed Central

Background and aims Probiotic bacteria are being investigated as possible treatments for many intestinal disorders. The present study aimed to explore the effects of live, heat killed, or gamma irradiated Lactobacillus reuteri on cardio?autonomic response and single fibre unit discharge in dorsal root ganglia to colorectal distension in healthy Sprague?Dawley rats housed under conventional conditions. The effects of this treatment on somatic pain were also examined. Methods 1×109 bacteria were given by gavage for nine days. Colorectal distension occurred under anaesthesia. Heart rate was measured through continuous electrocardiography. Single fibre unit discharge was recorded from the 6th left lumbar dorsal root ganglion. Somatic pain was evaluated by the tail flick and paw pressure tests. Results Colorectal distension caused a pressure dependent bradycardia in the control (native medium) group. Treatment with live, heat killed, or gamma irradiated bacteria as well as their products (conditioned medium) prevented the pain response even during the maximum distension pressure (80?mm?Hg). Both viable and non?viable bacteria significantly decreased dorsal root ganglion single unit activity to distension. No effects on somatic pain were seen with any treatment. Conclusions Oral administration of either live or killed probiotic bacteria or conditioned medium inhibited the constitutive cardio?autonomic response to colorectal distension in rats through effects on enteric nerves. These data may provide a novel explanation for beneficial probiotic effects on visceral pain.

Kamiya, T; Wang, L; Forsythe, P; Goettsche, G; Mao, Y; Wang, Y; Tougas, G; Bienenstock, J



Estrogen alters spinal NMDA receptor activity via a PKA signaling pathway in a visceral pain model in the rat  

PubMed Central

Pain symptoms in several chronic pain disorders in women, including irritable bowel syndrome, fluctuate with the menstrual cycle suggesting a gonadal hormone component. In female rats, estrogens modulate visceral sensitivity although the underlying mechanism(s) are unknown. In the present study the effects of 17-? estradiol on N-methyl-D-aspartate (NMDA) receptor signaling of colorectal nociceptive processing in the spinal cord were examined. Estrogen receptor alpha and the NR1 subunit of the NMDA receptor are co-expressed in dorsal horn neurons, supporting a direct action of estradiol on NMDA receptors. Intrathecal administration of the NMDA receptor antagonist D(?)-2-amino-5-phosphonopetanoic acid (APV) dose-dependently attenuated the visceromotor response with greater potency in ovariectomized (OVx) rats compared to OVx with estradiol replacement (E2) rats. Estradiol significantly increased protein expression of NR1 in the lumbosacral spinal cord compared to OVx rats. Colorectal distention significantly increased phosphorylation of NR1ser-897, a PKA phosphorylation site on the NR1 subunit in E2, but not OVx rats. Intrathecal administration of a PKA inhibitor significantly attenuated the visceromotor response, decreased NR1 phosphorylation and increased the potency of APV to attenuate the visceromotor response compared to vehicle-treated E2 rats. These data suggest that estradiol increases spinal processing of visceral nociception by increasing NMDA receptor NR1 subunit expression and increasing site specific receptor phosphorylation on the NR1 subunit contributing to an increase in NMDA receptor activity.

Tang, Bin; Ji, Yaping; Traub, Richard J



Analgesic effects of JCM-16021 on neonatal maternal separation-induced visceral pain in rats  

PubMed Central

AIM: To investigate the pharmacological effect of JCM-16021, a Chinese herbal formula, and its underlying mechanisms. METHODS: JCM-16021 is composed of seven herbal plant materials. All raw materials of the formula were examined according to the quality control criteria listed in the Chinese Pharmacopeia (2005). In a neonatal maternal separation (NMS) model, male Sprague-Dawley rats were submitted to daily maternal separation from postnatal day 2 to day 14, or no specific handling (NH). Starting from postnatal day 60, rats were administered JCM-16021 (2, 4, 8 g/kg per day) orally twice a day for 28 d. Pain threshold pressure and electromyographic activities of external oblique muscles in response to colorectal distention recorded with a Power Lab System (AD Instruments International), were tested as pain indices. Changes in serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) concentrations in the colon of rats were analyzed; the enterochromaffin cell numbers and serotonin transporter in the colon of rats were also evaluated with an immunohistochemistry method. RESULTS: NMS treatment significantly reduced pain threshold pressure (37.4 ± 1.4 mmHg), as compared to that of NH rats (57.7 ± 1.9 mmHg, P < 0.05). After JCM-16021 treatment, the pain threshold pressure significantly increased when compared to that before treatment (34.2 ± 0.9 mmHg vs 52.8 ± 2.3 mmHg in the high dose group, 40.2 ± 1.6 mmHg vs 46.5 ± 1.3 mmHg in the middle dose group, and 39.3 ± 0.7 mmHg vs 46.5 ± 1.6 mmHg in the low dose group, P < 0.05). Also JCM-16021 significantly and dose-dependently decreased electromyographic activity to the graded colorectal distension (CRD), (the mean ?AUC values were: 0.17 ± 0.03, 0.53 ± 0.15, 1.06 ± 0.18, 1.22 ± 0.24 in the high dose group; 0.23 ± 0.04, 0.68 ± 0.17, 1.27 ± 0.26, 1.8 ± 0.3 in the middle dose group; and 0.29 ± 0.06, 0.8 ± 0.16, 1.53 ± 0.24, 2.1 ± 0.21 in the low dose group for the pressures 20, 40, 60, 80 mmHg), as compared to the NMS vehicle group. The mean ?AUC values were: 0.57 ± 0.12, 1.33 ± 0.18, 2.57 ± 0.37, 3.08 ± 0.37 for the pressures 20, 40, 60, 80 mmHg (P < 0.05). JCM-16021 treatment significantly reduced the 5-HT concentrations (from high, middle and low dosage groups: 60.25 ± 5.98 ng/100 mg, 60.32 ± 4.22 ng/100 mg, 73.31 ± 7.65 ng/100 mg), as compared to the NMS vehicle groups (93.11 ± 9.85 ng/100 mg, P < 0.05); and increased the 5-HIAA concentrations (after treatment, from high, middle and low dosage groups: 54.24 ± 3.27 ng/100 mg, 50.34 ± 1.26 ng/100 mg, 51.37 ± 2.13 ng/100 mg) when compared to that in the NMS vehicle group (51.75 ± 1.98 ng/100 mg, P < 0.05); but did not change the enterochromaffin cell numbers in the colon of rats. In addition, NMS rats had higher SERT expression (n = 10) than NH rats (n = 8, P < 0.05). JCM-16021 treatment significantly decreased SERT expression when compared to the NMS group (P < 0.01-0.001). CONCLUSION: JCM-16021 can attenuate visceral hypersensitivity, and this analgesic effect may be mediated through the serotonin signaling pathway in the colon of rats.

Bian, Zhao-Xiang; Zhang, Man; Han, Quan-Bin; Xu, Hong-Xi; Sung, Joseph JY



Is there a pathway in the posterior funiculus that signals visceral pain?  

Microsoft Academic Search

The present report provides evidence that axons in the medial part of the posterior column at T10 convey ascending nociceptive signals from pelvic visceral organs. This evidence was obtained from human surgical case studies and histological verification of the lesion in one of these cases, along with neuroanatomical and neurophysiological findings in animal experiments. A restricted lesion in this area

R. M. Hirshberg; E. D. Al-Chaer; N. B. Lawand; K. N. Westlund; W. D. Willis



Reactivation of herpes zoster along the trigeminal nerve with intractable pain after facial trauma: a case report and literature review.  


We report the rare occurrence of herpes zoster reactivation after facial trauma. Herpes zoster appeared in painful groups of distended vesicles containing clear fluid on an erythematous base within the secondary division of the trigeminal nerve. The patient was treated with acyclovir (intravenous, 250 mg, every 8 hours) combined with topical steroids and anti-neuropathic pain medication. The zoster-associated neuralgia subsided gradually 1.5 months after diagnosis. We illustrate this unique case to highlight the fact that reactivation of the varicella zoster virus from childhood chicken pox can reappear at a traumatic site in late adulthood. PMID:21686763

Lin, K-C; Wang, Che-Chuan; Wang, Kai-Yuan; Liao, Yi-Chen; Kuo, Jinn-Rung



Treatment Of Intractable Discogenic Low Back Pain. A Systematic Review Of Spinal Fusion And Intradiscal Electrothermal Therapy (Idet)  

Microsoft Academic Search

Background: A growing number of pa- tients suffer from severe low back pain of discogenic origin that is not responsive to conservative medical management. These patients must consider the option of surgi- cal spinal fusion or minimally-invasive in- tradiscal electrothermal therapy (IDET). Objective: To conduct a systemat- ic review of clinical outcomes in patients undergoing spinal fusion or the intradiscal

Gunnar B. J. Andersson; Nagy A. Mekhail; Jon E. Block



Symptoms and visceral perception in patients with pain-predominant irritable bowel syndrome  

Microsoft Academic Search

OBJECTIVE:Abdominal pain is thought to be a hallmark of the irritable bowel syndrome (IBS), although currently used symptom criteria do not differentiate between abdominal pain and discomfort. By focusing on viscerosensory symptoms, we sought to determine: 1) which type of symptoms are most commonly reported by IBS patients, and 2) whether patients who report pain as their most bothersome symptom

Tony Lembo; Bruce Naliboff; Julie Munakata; Steve Fullerton; Lynn Saba; Scott Tung; Max Schmulson; Emeran A Mayer



CRF2 receptor activation prevents colorectal distension induced visceral pain and spinal ERK1/2 phosphorylation in rats  

PubMed Central

Background and aims Activation of corticotropin releasing factor 1 (CRF1) receptors is involved in stress related responses and visceral pain, while activation of CRF2 receptors dampens the endocrine and some behavioural stress responses. We hypothesised that CRF2 receptor activation may influence visceral pain induced by colorectal distension (CRD) in conscious rats, and assessed the possible sites and mechanisms of action. Methods Male Sprague?Dawley rats were exposed to CRDs (60?mm?Hg, 10?minutes twice, with a 10?minute rest interval). Visceromotor responses (VMR) were measured by electromyography or visual observation. Spinal (L6–S1) extracellular signal regulated kinase 1/2 (ERK 1/2) activation following in vivo CRD and CRF2 receptor gene expression in the T13–S1 dorsal root ganglia (DRG) and spinal cord were determined. Inferior splanchnic afferent (ISA) activity to CRD (0.4?ml, 20?seconds) was assessed by electrophysiological recording in an in vitro ISA nerve?inferior mesenteric artery (intra?arterial)?colorectal preparation. Results In controls, VMR to the second CRD was mean 31 (SEM 4)% higher than that of the first (p<0.05). The selective CRF2 agonist, human urocortin 2 (hUcn 2, at 10 and 20??g/kg), injected intravenous after the first distension, prevented sensitisation and reduced the second response by 8 (1)% and 30 (5)% (p<0.05) compared with the first response, respectively. RT?PCR detected CRF2 receptor gene expression in the DRG and spinal cord. CRD (60?mm?Hg for 10?minutes) induced phosphorylation of ERK 1/2 in neurones of lumbosacral laminae I and IIo and the response was dampened by intravenous hUcn 2. CRD, in vitro, induced robust ISA spike activity that was dose dependently blunted by hUcn 2 (1–3??g, intra?arterially). The CRF2 receptor antagonist, astressin2?B (200??g/kg subcutaneously or 20??g intra?arterially) blocked the hUcn 2 inhibitory effects in vivo and in vitro. Conclusions Peripheral injection of hUcn 2 blunts CRD induced visceral pain, colonic afferent, and spinal L6?S1 ERK 1/2 activity through CRF2 receptor activation in rats.

Million, M; Wang, L; Wang, Y; Adelson, D W; Yuan, P-Q; Maillot, C; Coutinho, S V; Mcroberts, J A; Bayati, A; Mattsson, H; Wu, V; Wei, J-Y; Rivier, J; Vale, W; Mayer, E A; Tache, Y



Patients with chronic visceral pain show sex-related alterations in intrinsic oscillations of the resting brain.  


Abnormal responses of the brain to delivered and expected aversive gut stimuli have been implicated in the pathophysiology of irritable bowel syndrome (IBS), a visceral pain syndrome occurring more commonly in women. Task-free resting-state functional magnetic resonance imaging (fMRI) can provide information about the dynamics of brain activity that may be involved in altered processing and/or modulation of visceral afferent signals. Fractional amplitude of low-frequency fluctuation is a measure of the power spectrum intensity of spontaneous brain oscillations. This approach was used here to identify differences in the resting-state activity of the human brain in IBS subjects compared with healthy controls (HCs) and to identify the role of sex-related differences. We found that both the female HCs and female IBS subjects had a frequency power distribution skewed toward high frequency to a greater extent in the amygdala and hippocampus compared with male subjects. In addition, female IBS subjects had a frequency power distribution skewed toward high frequency in the insula and toward low frequency in the sensorimotor cortex to a greater extent than male IBS subjects. Correlations were observed between resting-state blood oxygen level-dependent signal dynamics and some clinical symptom measures (e.g., abdominal discomfort). These findings provide the first insight into sex-related differences in IBS subjects compared with HCs using resting-state fMRI. PMID:23864686

Hong, Jui-Yang; Kilpatrick, Lisa A; Labus, Jennifer; Gupta, Arpana; Jiang, Zhiguo; Ashe-McNalley, Cody; Stains, Jean; Heendeniya, Nuwanthi; Ebrat, Bahar; Smith, Suzanne; Tillisch, Kirsten; Naliboff, Bruce; Mayer, Emeran A



Peripheral antinociceptive effects of the cyclic endomorphin-1 analog c[YpwFG] in a mouse visceral pain model.  


We previously described a novel cyclic endomorphin-1 analog c[Tyr-D-Pro-D-Trp-Phe-Gly] (c[YpwFG]), acting as a mu-opioid receptor (MOR) agonist. This study reports that c[YpwFG] is more lipophilic and resistant to enzymatic hydrolysis than endomorphin-1 and produces preemptive antinociception in a mouse visceral pain model when injected intraperitoneally (i.p.) or subcutaneously (s.c.) before 0.6% acetic acid, employed to evoke abdominal writhing (i.p. ED(50)=1.24 mg/kg; s.c. ED(50)=2.13 mg/kg). This effect is reversed by the selective MOR antagonist ?-funaltrexamine and by a high dose of the mu(1)-opioid receptor-selective antagonist naloxonazine. Conversely, the kappa-opioid receptor antagonist nor-binaltorphimine and the delta-opioid receptor antagonist naltrindole are ineffective. c[YpwFG] produces antinociception when injected i.p. after acetic acid (ED(50)=4.80 mg/kg), and only at a dose of 20mg/kg did it elicit a moderate antinociceptive response in the mouse, evaluated by the tail flick assay. Administration of a lower dose of c[YpwFG] (10mg/kg i.p.) apparently produces a considerable part of antinociception on acetic acid-induced writhes through peripheral opioid receptors as this action is fully prevented by i.p. naloxone methiodide, which does not readily cross the blood-brain barrier; whereas this opioid antagonist injected intracerebroventricularly (i.c.v.) is not effective. Antinociception produced by a higher dose of c[YpwFG] (20mg/kg i.p.) is partially reversed by naloxone methiodide i.c.v. administered. Thus, only at the dose of 20mg/kg c[YpwFG] can produce antinociception through both peripheral and central opioid receptors. In conclusion, c[YpwFG] displays sufficient metabolic stability to be effective after peripheral administration and demonstrates the therapeutic potential of endomorphin derivatives as novel analgesic agents to control visceral pain. PMID:20713109

Bedini, Andrea; Baiula, Monica; Gentilucci, Luca; Tolomelli, Alessandra; De Marco, Rossella; Spampinato, Santi



Paradoxic effects of propofol on visceral pain induced by various TRPV1 agonists.  


Intraperitoneal injection of propofol inhibits subsequent acetic acid-induced writhing response in mice. Propofol increases the sensitivity of dorsal root ganglion neurons to capsaicin through transient receptor potential ankyrin subtype-1 (TRPA1) and protein kinase C? (PKC?)-mediated phosphorylation of transient receptor potential vanilloid subtype-1 (TRPV1). Intraperitoneal co-injection of propofol may increase visceral nociception induced by TRPV1 agonists via sensitization of TRPV1. Therefore, we investigated the effects of intraperitoneal co-injection of propofol on nociception induced by acetic acid and capsaicin. The number of writhing movements induced by acetic acid or nociception time by capsaicin with or without propofol were counted. Neonatal capsaicin-treated mice were also used to demonstrate the role of TRPV1 in the effects of propofol on nociception, induced by TRPV1 agonists. Co-injection of propofol resulted in a pronociceptive effect on the writhing response induced by acetic acid, while the same dose of propofol ameliorated the response to capsaicin. The writhing response to intraperitoneal acetic acid was sharply inhibited following neonatal treatment with capsaicin. Co-injection with propofol reduced the number of writhing movements induced by acetic acid in neonatal capsaicin-treated mice. These results suggest that propofol binds to TRPV1 at the capsaicin-binding pocket. PMID:23596498

Ji, Wenjin; Cui, Can; Zhang, Zhiwei; Liang, Jiexian



Visceral pain decreases tolerance to blood loss in conscious female but not male rabbits.  


Pain is a component of traumatic blood loss, yet little is known about how pain alters the response to blood loss in conscious animals. We evaluated the effects of colorectal distension on the cardiorespiratory response to blood loss in six male and six female conscious, chronically instrumented New Zealand White rabbits. The goal of these experiments was to test the hypotheses that 1) colorectal distension would increase tolerance to hemorrhage (i.e., increase the blood loss required to decrease mean arterial pressure

Shafford, Heidi L; Schadt, James C



The D-alanine content of lipoteichoic acid is crucial for Lactobacillus plantarum-mediated protection from visceral pain perception in a rat colorectal distension model.  


The mechanisms leading to positive effects of probiotics in irritable bowel syndrome and inflammatory bowel disease have not been clarified, but the possible involvement of cell wall components is widely discussed. Reduction of the D-alanine content of lipoteichoic acid (LTA) in Lactobacillus plantarum (Dlt(-) mutant) enhanced its anti-inflammatory properties in a mouse colitis model. Another lactobacillus species inhibited visceral pain perception in response to colorectal distension (CRD) in rats. Therefore, we investigated if LTA modification influences the constitutive intestinal pain perception in addition to modulation of cytokine release. Male Sprague-Dawley rats were gavaged with L. plantarum, L. plantarum Dlt(-) mutant or buffer control, respectively and the responses to CRD were tested in this non-inflammatory model. Tumour necrosis factor (TNF), interferon (IFN)-gamma and interleukin (IL)-10 release were measured in colon tissue homogenates and upon anti-CD3/CD28 activation of isolated splenocytes and mesenteric lymphocytes. Control animals showed significant bradycardia following noxious CRD, whereas only the L. plantarum Dlt(-) mutant inhibited the response. The mutant also decreased the activation-induced release of TNF and IFN-gamma from mesenteric T cells and the IL-10 concentration in colonic tissue, while increasing the activation-induced secretion of IL-10 in splenocytes and mesenteric lymphocytes and the baseline IL-10 release of splenocytes. In conclusion, d-alanine depletion of LTA in L. plantarum inhibited visceral pain perception in healthy, non-inflamed rats. Regardless of the non-inflammatory nature of the model decreased visceral pain perception was seen in parallel with anti-inflammatory properties. PMID:18312544

Duncker, S C; Wang, L; Hols, P; Bienenstock, J



The antinociceptive effects of intravenous tianeptine in colorectal distension-induced visceral pain in rats: the role of 5-HT? receptors.  


Tianeptine is an unusual tricyclic antidepressant drug. In this study, we aimed to investigate the antinociceptive effect of tianeptine on visceral pain in rats and to determine whether possible antinociceptive effect of tianeptine is mediated by serotonergic (5-HT(2,3)) and noradrenergic (?(1,2)) receptor subtypes. Male Sprague Dawley rats (250-300 g) were supplied with a venous catheter, for drug administrations, and enameled nichrome electrodes, for electromyography, at external oblique musculature. Colorectal distension (CRD) was employed as the noxious visceral stimulus and the visceromotor response (VMR) to CRD was quantified electromyographically before and 5, 15, 30, 60, 90 and 120 min after tianeptine administration. Antagonists were administered 10 min before tianeptine for their ability to change tianeptine antinociception. Intravenous administration of tianeptine (2.5-20 mg/kg) produced a dose-dependent reduction in VMR. Administration of 5-HT(3) receptor antagonist ondansetron (0.5, 1 and 2 mg/kg), but not 5-HT(2) receptor antagonist ketanserine (0.5, 1 and 2 mg/kg), reduced the antinociceptive effect of tianeptine (10mg/kg). In addition, administration of ?(1)-adrenoceptor antagonist prazosin (1 mg/kg) or ?(2)-adrenoceptor antagonist yohimbine (1 mg/kg) did not cause any significant effect on the tianeptine-induced antinociception. Our data indicate that intravenous tianeptine exerts a pronounced antinociception against CRD-induced visceral pain in rats, and suggests that the antinociceptive effect of tianeptine appears to be mediated in part by 5-HT(3) receptors, but does not involve 5-HT(2) receptors or ?-adrenoceptors. PMID:22348811

Bilge, S S?rr?; Bozkurt, Ayhan; Ilkaya, Fatih; Ciftcio?lu, Engin; Kesim, Yüksel; Uzbay, Tayfun I



Neuromodulation of the cervical spinal cord in the treatment of chronic intractable neck and upper extremity pain: a case series and review of the literature.  


Electrical spinal neuromodulation in the form of spinal cord stimulation is currently used for treating chronic painful conditions such as complex regional pain syndrome, diabetic neuropathy, postherpetic neuralgia, peripheral ischemia, low back pain, and other conditions refractory to more conservative treatments. To date, there are very few published reports documenting the use of spinal cord stimulation in the treatment of head/neck and upper limb pain. This paper reports a case series of 5 consecutive patients outlining the use of spinal cord stimulation to treat upper extremity pain. All subjects had previously undergone cervical fusion surgery to treat chronic neck and upper limb pain. Patients were referred following failure of the surgery to manage their painful conditions. Spinal cord stimulators were placed in the cervical epidural space through a thoracic needle placement. Stimulation parameters were adjusted to capture as much of the painful area(s) as possible. In total, 4 out of 5 patients moved to implantation. In all cases, patients reported significant (70-90%) reductions in pain, including axial neck pain and upper extremity pain. Interestingly, 2 patients with associated headache and lower extremity pain obtained relief after paresthesia-steering reportedly covered those areas. Moreover, 2 patients reported that cervical spinal cord stimulation significantly improved axial low back pain. Patients continue to report excellent pain relief up to 9 months following implantation. This case series documents the successful treatment of neck and upper extremity pain following unsuccessful cervical spine fusion surgery. Given this initial success, prospective, controlled studies are warranted to more adequately assess the long term utility and cost effectiveness of electrical neuromodulation treatment of chronic neck and upper extremity pain. PMID:17387353

Vallejo, Ricardo; Kramer, Jeffery; Benyamin, Ramsin



A comparison of two invasive techniques in the management of intractable pain due to inoperable pancreatic cancer: neurolytic celiac plexus block and videothoracoscopic splanchnicectomy  

Microsoft Academic Search

Background and aimsPancreatic cancer is characterized by a constant deterioration in quality of life, excruciating pain and progressive cachexia. The aim of this study was to compare the effectiveness of two invasive methods of pain treatment in these patients: neurolytic coeliac plexus block (NCPB) and videothoracoscopic splanchnicectomy (VSPL) to a conservatively treated control group concerning pain, quality of life and

T. J. Stefaniak; A. Basinski; A. J. J. M. Vingerhoets; W. Makarewicz; S. Connor; L. Kaska; A. Stanek; B. Kwiecinska; A. J. Lachinski; Z. Sledzinski



Urologic myofascial pain syndromes  

Microsoft Academic Search

Treatment of pain of urogenital origin, chronic pelvic pain syndrome, can be frustrating for patients and physicians. The\\u000a usual approaches do not always produce the desired results. Visceral pain from pelvic organs and myofascial pain from muscle\\u000a trigger points share common characteristics. Referred pain from myofascial trigger points can mimic visceral pain syndromes\\u000a and visceral pain syndromes can induce trigger

Ragi Doggweiler-Wiygul



Mindfulness: overcoming intractable conflict.  


Intractable conflict involves reoccurring patterns of ineffective communication in which issues are not resolved and build over time. These situations can lead to bad feelings, damaged relationships, depression, aggression, anxiety and substance abuse. Grounded theory methods were used to study the processes involved in intractable conflicts and to identify ways of responding that promote growth and/or resolution. Results indicate that developing mindfulness over mindlessness is the basic social process that threads through three phases of working through intractable conflict. Phases include: growing awareness, self-realization, and regaining equilibrium. Mental health professionals can use this knowledge to support mindful practices as a means to protect against destructive conflict and mental health woes. PMID:14508774

Horton-Deutsch, Sara L; Horton, Janell M



Affective disturbances modulate the neural processing of visceral pain stimuli in irritable bowel syndrome: an fMRI study  

Microsoft Academic Search

ObjectiveTo address the role of anxiety and depression symptoms in altered pain processing in irritable bowel syndrome (IBS).DesignIn this functional magnetic resonance imaging study, the blood oxygen level-dependent (BOLD) response to rectal distensions delivered at previously determined individual discomfort thresholds was assessed.Patients15 female patients with irritable bowel syndrome (IBS) and with normal rectal pain thresholds, and 12 healthy women.MeasuresThe correlation

S Elsenbruch; C Rosenberger; P Enck; M Forsting; M Schedlowski; E R Gizewski



Visceral pain perception is determined by the duration of colitis and associated neuropeptide expression in the mouse  

PubMed Central

Background Even though inflammation is a traditional tool for the induction of hyperalgesia in many tissues, recent observations suggest that not all inflammatory processes produce this change. Tolerance to colorectal distension (CRD) is reduced in patients with acute ulcerative colitis but is increased in patients with chronic inflammatory bowel disease. This suggests that the nature of the inflammatory infiltrate influences visceral perception. Aim To test this hypothesis by assessing responses to CRD in mice with mild, acute or chronic colitis. Methods CRD responses were measured in mice with mild non?specific colitis, and dextran sodium sulphate (DSS)?induced acute and chronic colitis. Responses were compared with tissue infiltrate and damage, interleukin (IL)1? and myeloperoxidase (MPO) activity and substance P, ??endorphin and ? opioid receptor (MOR) expression. Results Mild and acute colitis were associated with increased responsiveness to CRD. In contrast, CRD responses were not increased in mice with chronic colitis and this difference was not due to altered colonic wall compliance. MPO and IL1? levels were greater in acute than in chronic colitis. Larger increases in tissue substance P were seen in acute than in chronic DSS, whereas CD4 T cells, ??endorphin and MOR expression were evident only in chronic colitis. An inverse correlation was seen between substance P and MOR in these tissues. Conclusions Acute colitis increased responsiveness to CRD and is accompanied by an acute inflammatory infiltrate and increased tissue substance P. Chronic DSS is accompanied by an increase in ??endorphin and MOR expression, and CD4 T cells, but no change in compliance or CRD responses. We conclude that acute inflammation generates hyperalgesia, whereas chronic inflammation involves infiltration by lymphocytes accompanied by MOR and ??endorphin up regulation, and this provides an antinociceptive input that restores normal visceral perception.

Verma-Gandhu, Monica; Verdu, Elena F; Bercik, Premysl; Blennerhassett, Patricia A; Al-Mutawaly, Nafia; Ghia, Jean-Eric; Collins, Stephen M



Visceral Injuries.  

National Technical Information Service (NTIS)

A case of high-voltage electrical injury with massive retroperitoneal muscle necrosis, focal hepatic coagulation necrosis, acute pancreatitis, and an acute coagulopathy with factor V, factor X, and platelet deficits occurred. Visceral involvement by elect...

K. Eurenius P. W. Curreri T. W. Newsome



Intractable Pruritus After Traumatic Spinal Cord Injury  

PubMed Central

Background: This report describes a young woman with incomplete traumatic cervical spinal cord injury and intractable pruritus involving her dorsal forearm. Method: Case report. Findings: Anatomic distribution of the pruritus corresponded to the dermatomal distribution of her level of spinal cord injury and vertebral fusion. Symptoms were attributed to the spinal cord injury and possible cervical root injury. Pruritus was refractory to all treatments, including topical lidocaine, gabapentin, transcutaneous electrical nerve stimulation, intravenous Bier block, stellate ganglion block, and acupuncture. Conclusions: Further understanding of neuropathic pruritus is needed. Diagnostic workup of intractable pruritus should include advanced imaging to detect ongoing nerve root compression. If diagnostic studies suggest radiculopathy, epidural steroid injection should be considered. Because the autonomic nervous system may be involved in complex chronic pain or pruritic syndromes, sympatholysis via such techniques as stellate ganglion block might be effective.

Crane, Deborah A; Jaffee, Kenneth M; Kundu, Anjana



Laser acupuncture for acute inflammatory, visceral and neuropathic pain relief: An experimental study in the laboratory rat  

Microsoft Academic Search

Laser acupuncture is defined as the stimulation of traditional acupuncture points with low-intensity, non-thermal laser irradiation. We explored the clinical efficacy of a very low level diode laser wavelength 670nm (Biolite LP020, RGM, Genoa, Italy), used to stimulate acupoints ST36 Zu San Li and TH5 Waiguan, on well-established experimental models of acute and persistent pain in the rat, e.g. acute

L. Lorenzini; A. Giuliani; L. Giardino; L. Calzà



Predictors of intractable childhood epilepsy.  


Our study sought to identify early predictive factors of medically intractable childhood epilepsy. A cohort of epileptic children from the city of Mersin was retrospectively investigated. All patients received care from the same Department of Pediatric Neurology. The epileptic cohort was divided into a drug-responsive epilepsy group and an intractable epilepsy group. Intractable epilepsy is defined as continued seizures in children despite adequate therapy with two or more antiepileptic drugs for more than 18 months. Strong univariate association was observed between intractability and several factors: age of onset, high initial seizure frequency, symptomatic etiology, mixed seizure types, previous history of status epilepticus, febrile and neonatal seizures, mental and motor developmental delay, multiple seizures in 1 day, electroencephalogram abnormalities, magnetic resonance imaging findings, and specific epileptic syndromes. Logistic regression analysis revealed that a previous history of epilepticus status, abnormal electroencephalogram results, and multiple seizures in 1 day comprise independent predictors of medically intractable childhood epilepsy. We suggest that medical intractability in childhood epilepsy can be predicted by monitoring these factors. Along with early prediction, alternative therapies may be designed to provide patients better seizure control and quality of life. PMID:23290021

Seker Yilmaz, Berna; Okuyaz, Cetin; Komur, Mustafa



Esophageal pain: Emerging concepts  

Microsoft Academic Search

Esophageal pain manifests as symptoms of heartburn, chest pain, or both. It shares features with other types of visceral pain\\u000a in that it is poorly characterized and not well localized, owing to the divergence of visceral afferents. The esophagus is\\u000a innervated by vagal and visceral spinal afferents, both of which are activated by noxious stimuli and convey information to\\u000a specific

Robert Lee; Ravinder K. Mittal



Development, plasticity and modulation of visceral afferents  

PubMed Central

Visceral pain is the most common reason for doctor visits in the US. Like somatic pain, virtually all visceral pain sensations begin with the activation of primary sensory neurons innervating the viscera and/or the blood vessels associated with these structures. Visceral afferents also play a central role in tissue homeostasis. Recent studies show that in addition to monitoring the state of the viscera, they perform efferent functions through the release of small molecules (e.g. peptides like CGRP) that can drive inflammation, thereby contributing to the development of visceral pathologies (e.g. diabetes Razavi, R., Chan, Y., Afifiyan, F.N., Liu, X.J., Wan, X., Yantha, J., Tsui, H., Tang, L., Tsai, S., Santamaria, P., Driver, J.P., Serreze, D., Salter, M.W., Dosch, H.M., 2006. TRPV1+ sensory neurons control beta cell stress and islet inflammation in autoimmune diabetes, Cell 127 1123–1135). Visceral afferents are heterogeneous with respect to their anatomy, neurochemistry and function. They are also highly plastic in that their cellular environment continuously influences their response properties. This plasticity makes them susceptible to long-term changes that may contribute significantly to the development of persistent pain states such as those associated with irritable bowel syndrome, pancreatitis, and visceral cancers. This review examines recent insights into visceral afferent anatomy and neurochemistry and how neonatal insults can affect the function of these neurons in the adult. New approaches to the treatment of visceral pain, which focus on primary afferents, will also be discussed.

Christianson, Julie A.; Bielefeldt, Klaus; Altier, Christophe; Cenac, Nicolas; Davis, Brian M.; Gebhart, Gerald F.; High, Karin W.; Kollarik, Marian; Randich, Alan; Undem, Brad; Vergnolle, Nathalie



Visceral responses to spinal manipulation.  


While spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain, the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial. This controversy is due in part to the perception that there is no robust neurobiological rationale to justify using a biomechanical treatment of the spine to address a disorder of visceral function. This paper therefore looks at the physiological evidence that spinal manipulation can impact visceral function. A structured search was conducted, using PubMed and the Index to Chiropractic Literature, to construct of corpus of primary data studies in healthy human subjects of the effects of spinal manipulation on visceral function. The corpus of literature is not large, and the greatest number of papers concerns cardiovascular function. Authors often attribute visceral effects of spinal manipulation to somato-autonomic reflexes. While this is not unreasonable, little attention is paid to alternative mechanisms such as somato-humoural pathways. Thus, while the literature confirms that mechanical stimulation of the spine modulates some organ functions in some cohorts, a comprehensive neurobiological rationale for this general phenomenon has yet to appear. PMID:22440554

Bolton, Philip S; Budgell, Brian



Surgical Management of Intractable Epilepsy  

Microsoft Academic Search

Cortical resective surgery (including amygdalohippocampectomy) and corpus callosotomy are the most widely accepted modes of surgical treatment for intractable epilepsy. Between July 1989 and May 1996, 146 surgeries for epilepsy were done at Severance Hospital, Yonsei University. Resective surgery was performed in 126 patients and corpus callosotomy in 20 patients. Of the 126 patients who underwent resective surgery, surgery for

Yong Gou Park



Punctate midline myelotomy: a minimally invasive procedure for the treatment of pain in inextirpable abdominal and pelvic cancer.  


The midline of the dorsal column contains a pathway that may be more important for transmitting visceral nociceptive signals than the spinothalamic tract. Punctate midline myelotomy, a neuroablative operation with the intent of interrupting the midline of the dorsal column, has demonstrated efficacy in the treatment of otherwise intractable abdominal and pelvic cancer pain. The indications, technical procedure, outcomes, and complications of all published clinical studies of punctate midline myelotomy are reviewed. The lesion level of the spinal cord and the depth of the incision are discussed, with the focus on the feasibility of this technique. PMID:17196911

Hong, Dun; Andrén-Sandberg, Ake



Metabolic treatments for intractable epilepsy.  


When a child on anticonvulsant medications continues to have seizures, what other options should be considered? Over the past 100 years, dietary therapies for the treatment of intractable epilepsy have become more widely recognized, and their use has continued to expand throughout the world. An increasing number of studies has shown efficacy of these metabolic treatments in improving seizure control. Currently, 4 types of dietary therapy are available in the clinic: the classic long chain fatty acid "ketogenic" diet, the medium chain triglyceride diet, the modified Atkins diet, and the low glycemic index treatment. These therapies should be considered earlier in the treatment of intractable epilepsy because they offer a different approach to treatment that has proven efficacious, tolerable, and cost-effective. PMID:22062942

Kelley, Sarah A; Hartman, Adam L



Thalamic modulation of visceral nociceptive processing in adult rats with neonatal colon irritation  

Microsoft Academic Search

Visceral pain originates from visceral organs in response to a noxious stimulus which, if prolonged, may lead to chronic changes in the neural network mediating visceral nociception. For instance, colon inflammation enhances the responses of neurons in the thalamus to colorectal distension (CRD), whereas lesion in the dorsal column (DC) reverses this neuronal sensitization, suggesting that the thalamus and the

Carl Y. Saab; Young C. Park; Elie D. Al-Chaer



Interventional management of intractable sympathetically mediated pain by computed tomography-guided catheter implantation for block and neuroablation of the thoracic sympathetic chain: technical approach and review of 322 procedures.  


We retrospectively evaluated the safety and efficacy of computed tomography-guided placement of percutaneous catheters in close proximity to the thoracic sympathetic chain by rating pain intensity and systematically reviewing charts and computed tomography scans. Interventions were performed 322 times in 293 patients of mean (SD) age 59.4 (17.0) years, and male to female ratio 105:188, with postherpetic neuralgia (n = 103, 35.1%), various neuralgias (n = 88, 30.0%), complex regional pain syndrome (n = 69, 23.6%), facial pain (n = 17, 5.8%), ischaemic limb pain (n = 7, 2.4%), phantom limb pain (n = 4, 1.4%), pain following cerebrovascular accident (n = 2, 0.7%), syringomyelia (n = 2, 0.7%) and palmar hyperhidrosis (n = 1, 0.3%). The interventions were associated with a total of 23 adverse events (7.1% of all procedures): catheter dislocation (n = 9, 2.8%); increase in pain intensity (n = 8, 2.5%); pneumothorax (n = 3, 0.9%); local infection (n = 2, 0.6%); and puncture of the spinal cord (n = 1, 0.3%). Continuous infusion of 10 ml.h(-1) ropivacaine 0.2% through the catheters decreased median (IQR [range]) pain scores from 8 (6-9 [2-10]) to 2 (1-3 [0-10]) (p < 0.0001). Chemical neuroablation was necessary in 137 patients (46.8%). We conclude that this procedure leads to a significant reduction of pain intensity in otherwise obstinate burning or stabbing pain and is associated with few hazards. PMID:21564048

Agarwal-Kozlowski, K; Lorke, D E; Habermann, C R; Schulte am Esch, J; Beck, H



Microsurgical junctional drez coagulation for treatment of deafferentation pain syndromes  

Microsoft Academic Search

BACKGROUNDIn the treatment of intractable deafferentation pain, different procedures in the DREZ have proved most effective. For most of the spot-like techniques special equipment is mandatory. In this study the technique and the results of junctional DREZ coagulation for treatment of different pain syndromes with the help of bipolar forceps is presented.METHODSIn 40 patients with intractable deafferentation pain syndromes a

Borut Prestor



Seizure precipitants in children with intractable epilepsy  

Microsoft Academic Search

Purpose: To investigate the seizure precipitants in children with intractable epilepsy, and to determine any distinctive clinical features contributing to seizures in these patients. Methods: A questionnaire and seizure diary prepared by the parents of the patients. Demographic and seizure data were reviewed. Results: Of 120 patients with intractable epilepsy, 74 (62%) had one (n=43), two (n=23), or three seizure

Peng-Cheng Fang; Yung-Jung Chen; Inn-Chi Lee



Therapeutic mechanisms of a mindfulness-based treatment for IBS: effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations.  


Irritable bowel syndrome (IBS) is a prevalent functional disorder characterized by abdominal pain and hypervigilance to gastrointestinal sensations. We hypothesized that mindfulness training (MT), which promotes nonreactive awareness of emotional and sensory experience, may target underlying mechanisms of IBS including affective pain processing and catastrophic appraisals of gastrointestinal sensations. Seventy five female IBS patients were randomly assigned to participate in either 8 weeks of MT or a social support group. A theoretically grounded, multivariate path model tested therapeutic mediators of the effect of MT on IBS severity and quality of life. Results suggest that MT exerts significant therapeutic effects on IBS symptoms by promoting nonreactivity to gut-focused anxiety and catastrophic appraisals of the significance of abdominal sensations coupled with a refocusing of attention onto interoceptive data with less emotional interference. Hence, MT appears to target and ameliorate the underlying pathogenic mechanisms of IBS. PMID:22161025

Garland, Eric L; Gaylord, Susan A; Palsson, Olafur; Faurot, Keturah; Douglas Mann, J; Whitehead, William E



Delivery systems of opioid analgesics for pain relief: a review.  


Chronic pain in patients is usually treated with pharmacological measures using opioids alone or in combination with adjuvant analgesics that play an important role in the treatment of pain not fully responsive to opioids administered alone, especially in neuropathic, bone and visceral colicky pain. The important part of the chronic pain treatment is the appropriate use of non-pharmacological measures along with psychosocial and spiritual support. Opioids may be administered by different routes; the most common and most convenient for majority of treated patients are oral and transdermal. However, in certain circumstances such as inability to swallow, lack of analgesic efficacy and intractable opioid-induced adverse effects parenteral routes (subcutaneous, intravenous) might be more useful. When these routes fail, in some patients intrathecal administration of opioids is required. Recently, more patients have been treated with short-acting opioids for breakthrough pain with sublingual, buccal and intranasal routes of opioid administration that may provide efficacy superior to oral and comparable to intravenous routes. Alternative routes comprise rectal, inhaled and topical administration of opioids. This article discusses various routes of opioid administration. PMID:23489205

Leppert, Wojciech; Krajnik, Malgorzata; Wordliczek, Jerzy



Visceral artery aneurysm rupture  

Microsoft Academic Search

Purpose: Aneurysms of the visceral arteries are infrequently encountered. Many are found incidentally and are thought to have a benign outcome. To better characterize these lesions and their clinical course, we reviewed our experience with visceral artery aneurysms (VAAs) at a single institution. Methods: A retrospective analysis of all VAAs diagnosed at our institution over the past 10 years was

Sandra C. Carr; David M. Mahvi; John R. Hoch; Charles W. Archer; William D. Turnipseed



Examination of intractable recurrent gastric ulcer (III)  

Microsoft Academic Search

Hitherto we examined twice intractable recurrent gastric ulcer from the viewpoint of pancreatic function. Pancreatic function test (similar to the previous one) performed on the patients with so-called \\

M. Abe; S. Oshita; T. Nose; S. Yamaoka; S. Omata; Y. Watanabe



Intractable and rare diseases research in Asia.  


Intractable and rare diseases are an important public health issue and a challenge to medical care. In recent years, much progress has been made in the United States (US), the European Union (EU), and some parts of Asia including Japan, South Korea, and Taiwan, involving specific legislation to encourage discovery and development of orphan drugs, patients' advocacy organizations to provide vast information on intractable and rare diseases and improve patients' access to healthcare, special research programs to strengthen basic and applied research on intractable and rare diseases, and so on. While China is also actively promoting regulation of intractable and rare diseases, but still lags far behind the US, EU, Japan, and other countries and regions with orphan drug legislation. Based on systematic analysis of the current status and future perspectives for intractable and rare diseases in Asia, we recommend that three important aspects of support from government, patients' advocacy organizations and rare disease registry networks, special research programs and global information exchange platform, should be given great attention in promoting the development of intractable and rare diseases research in Asian countries. PMID:22621985

Song, Peipei; Gao, Jianjun; Inagaki, Yoshinori; Kokudo, Norihiro; Tang, Wei



[Pathophysiology of abdominal pain].  


Abdominal pain can be induced by stimulation of visceral nociceptors. Activation of nociceptors usually requires previous sensitization by pathological events, such as inflammation, ischemia or acidosis. Although abdominal pain can obviously be caused by pathology of a visceral structure, clinicians frequently observe that such a pathology explains only part of the pain complaints. Occasionally, there is lack of objective signs of visceral lesions. There is clear evidence that pain states are associated with profound changes of the central processing of the sensory input. The main consequences of such alterations for patients are twofold: 1) a central sensitization, i.e. an increased excitability of the central nervous system; 2) an alteration of the endogenous pain modulation, which under normal conditions inhibits the processing of nociceptive signals in the central nervous system. Both phenomena lead to a spread of pain to other body regions and an amplification of the pain perception. The interactions between visceral pathology and alterations of the central pain processes represent an at least partial explanation for the discrepancy between objective signs of peripheral lesions and severity of the symptoms. Today, both central hypersensitivity and alteration in endogenous pain modulation can be measured in clinical practice. This information can be used to provide the patients with an explanatory model for their pain. Furthermore, first data suggest that alterations in central pain processing may represent negative prognostic factors. A better understanding of the individual pathophysiology may allow in the future the development of individual therapeutic strategies. PMID:21796591

Curatolo, Michele



Viscerosomatic reflexes in referred pain areas evoked by capsaicin stimulation of the human gut  

Microsoft Academic Search

The interaction between visceral pain and the sympathetic nervous system is only sparsely investigated in quantitative human studies. Referred visceral pain can be evoked experimentally by application of substances such as capsaicin (the pungent substance of chilli pepper) to the gut. The aim of the present study was to induce referred visceral pain from the small and large intestine in

Lars Arendt-Nielsen; Klaus-Peter Schipper; Georg Dimcevski; Hiroyuki Sumikura; Anne Lund Krarup; Maria Adele Giamberardino; Asbjørn Mohr Drewes



Acute progression of multiple visceral artery aneurysms  

Microsoft Academic Search

A 62-year-old male with multiple medical problems including a long-standing history of muscular dystrophy presented with recurrent abdominal and back pain of 2-month duration. Two consecutive mesenteric arteriograms were performed 3 weeks apart as part of the work-up and treatment. The latest study revealed a significant progression in the size and number of visceral artery aneurysms. No association between the

Sujit V. Sakpal; Cornelius S. McCarthy; Michael D. Addis; Ronald S. Chamberlain



Visceral artery aneurysms  

Microsoft Academic Search

Optional statement  Visceral artery aneurysms are an uncommon form of vascular disease, yet are important to the practicing vascular surgeon because\\u000a of the potential for rupture or erosion into an adjacent viscus, resulting in life-threatening hemorrhage. Many visceral artery\\u000a aneurysms still present with rupture, which often results in the death of the patient. An aggressive approach to the diagnosis\\u000a and management

Jade S. Hiramoto; Louis M. Messina



The control of severe cancer pain by continuous intrathecal infusion and patient controlled intrathecal analgesia with morphine, bupivacaine and clonidine  

Microsoft Academic Search

The management of severe cancer pain may be problematic in spite of recent advances in pain management. A small percentage of patients with severe intractable pain and\\/or intractable side effects may require more aggressive interventional pain management strategies including the administration of medications continuously by the intrathecal route. A variety of medications, including morphine, bupivacaine, and clonidine, may be used

Paul S Tumber; Dermot R Fitzgibbon



21 CFR 882.5870 - Implanted peripheral nerve stimulator for pain relief.  

Code of Federal Regulations, 2010 CFR

...peripheral nerve stimulator for pain relief. (a) Identification...peripheral nerve stimulator for pain relief is a device that is used...electrically a peripheral nerve in a patient to relieve severe intractable pain. The stimulator...



21 CFR 882.5870 - Implanted peripheral nerve stimulator for pain relief.  

Code of Federal Regulations, 2013 CFR

...peripheral nerve stimulator for pain relief. (a) Identification...peripheral nerve stimulator for pain relief is a device that is used...electrically a peripheral nerve in a patient to relieve severe intractable pain. The stimulator...



21 CFR 882.5870 - Implanted peripheral nerve stimulator for pain relief.  

Code of Federal Regulations, 2010 CFR

...peripheral nerve stimulator for pain relief. (a) Identification...peripheral nerve stimulator for pain relief is a device that is used...electrically a peripheral nerve in a patient to relieve severe intractable pain. The stimulator...



Sequencing Intractable DNA to Close Microbial Genomes  

SciTech Connect

Advancement in high throughput DNA sequencing technologies has supported a rapid proliferation of microbial genome sequencing projects, providing the genetic blueprint for for in-depth studies. Oftentimes, difficult to sequence regions in microbial genomes are ruled intractable resulting in a growing number of genomes with sequence gaps deposited in databases. A procedure was developed to sequence such difficult regions in the non-contiguous finished Desulfovibrio desulfuricans ND132 genome (6 intractable gaps) and the Desulfovibrio africanus genome (1 intractable gap). The polynucleotides surrounding each gap formed GC rich secondary structures making the regions refractory to amplification and sequencing. Strand-displacing DNA polymerases used in concert with a novel ramped PCR extension cycle supported amplification and closure of all gap regions in both genomes. These developed procedures support accurate gene annotation, and provide a step-wise method that reduces the effort required for genome finishing.

Hurt, Jr., Richard Ashley [ORNL; Brown, Steven D [ORNL; Podar, Mircea [ORNL; Palumbo, Anthony Vito [ORNL; Elias, Dwayne A [ORNL



Suprachoroidal implant surgery in intractable glaucoma  

Microsoft Academic Search

Purpose  To report the early results of suprachoroidal silicone implant surgery in intractable glaucoma.\\u000a \\u000a \\u000a \\u000a Materials and methods  A modified silicone implant with no valve was implanted into the suprachoroidal space of 15 eyes with intractable glaucoma.\\u000a \\u000a \\u000a \\u000a Results  The mean age of the patients was 53.0 ± 24.5 (range 7–85) years, the mean follow-up time was 17.1 ± 4.8 (range 10–28) months,\\u000a and the mean preoperative intraocular pressure

Melis Palamar; Halil Ates; Zafer Oztas; Emil Yusifov


The Monoamine Reuptake Inhibitor Milnacipran Does Not Affect Nociception to Acute Visceral Distension in Rats  

Microsoft Academic Search

The role of antidepressants in the treatment of visceral pain has not been extensively examined. Milnacipran, an antidepressant that inhibits monoamine reuptake, is widely used in the treatment of depression and fibromy- algia. In this study, we sought to determine the activity of milnacipran against acute visceral nociception. Female virgin rats were studied 7 days after bilateral ovariec- tomy. For

Sang-Wook Shin; James C. Eisenach; Srinias G. Rao; Chuanyao Tong



Transcranial alternating current stimulation reduces symptoms in intractable idiopathic cervical dystonia: a case study.  


Idiopathic cervical dystonia (ICD) is a movement disorder often resulting in profound disability and pain. Treatment options include oral medications or other invasive procedures, whereas intractable ICD has been shown to respond to invasive (deep) brain stimulation. In the present blinded, placebo-controlled case study, transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) has been applied to a 54-year old patient with intractable ICD. Results showed that 15 Hz tACS had both immediate and cumulative effects in dystonic symptom reduction, with a 54% reduction in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total score, and a 75% in the TWSTRS Pain Scale. These effects were persistent at 30-days follow-up. This is the first report to demonstrate a significant and lasting therapeutic effect of non-invasive electrical brain stimulation in dystonia. PMID:23149130

Angelakis, E; Liouta, E; Andreadis, N; Leonardos, A; Ktonas, P; Stavrinou, L C; Miranda, P C; Mekonnen, A; Sakas, D E



Intractable Diarrhoea due to Congenital Enterocyte Defects  

Microsoft Academic Search

Background: Intractable diarrhoea of infancy represents a severe problem with a high degree of morbidity and mortality. These cases demand dedicated care from both parents and medical staff as there are no easy remedies. The rarity of patients indicates that progress in understanding these disorders requires concerted international efforts to pool resources and patients. Regular reviews of publications in the

Alan D. Phillips



Early Predictors of Intractable Childhood Epilepsy  

Microsoft Academic Search

Introduction : Intractable epilepsies (IE) contribute to a small but significant component of all epilepsies in childhood. There is paucity of data regarding early predictors and magnitude of IE in Indian children. Early identification and intervention will go a long way in improving their outcome. Objectives : (1) To study the clinical profile, aetiopathogenesis and outcome of IE (2) To

Manoj Gulabrao Patil; Sushma Malik; Surekha Joshi; Mona Gajre



Steroid complications and surgery in intractable ulcerative colitis  

Microsoft Academic Search

:   The major operative indication for ulcerative colitis is intractability. Although steroid side effects appear to be closely\\u000a associated with surgical indications for intractable ulcerative colitis, this relationship has yet to be analyzed in detail.\\u000a To elucidate this relationship, we investigated 39 surgical patients with intractable ulcerative colitis, as defined by the\\u000a Research Committee for Intractable Diseases of the Ministry

Masaru Shinozaki; Kimitaka Suzuki; Toshio Sawada; Nelson Tsuno; Yoshiki Higuchi; Tetsuichiro Muto



Visceral Artery Aneurysms  

Microsoft Academic Search

Visceral artery aneurysms (VAA) frequently present as life-threatening emergencies. The purpose of this study was to review our experience with VAA treatment. Between 1988 and April 2002, 31 VAA were treated in 28 patients (14 males, 14 females) with average age of 55?±?15 years. The most common locations were the splenic artery (16) and the hepatic artery (7). Three patients

R. Chiesa; D. Astore; G. Guzzo; S. Frigerio; Y. Tshomba; R. Castellano; M. R. Liberato de Moura; G. Melissano



3. Visceral leishmaniasis  

Microsoft Academic Search

From the early 1900s, visceral leishmaniasis (VL; kala-azar) has been among the most important health problems in Sudan, particularly in the main endemic area in the eastern and central regions. Several major epidemics have occurred, the most recent—in Western Upper Nile province in southern Sudan, detected in 1988 — claiming over 100000 lives. The disease spread to other areas that

E. E. Zijlstra; A. M. El-Hassan



Surgical management of pain.  


This article presents an overview of the neuroanatomical, neurochemical, and neurophysiological substrates of nociception relevant to the neurosurgical treatment of chronic pain. Consideration is given to the various procedures currently employed in the treatment of patients suffering from medically intractable chronic pain of both benign and malignant diseases, including their indications, techniques, and results. Particular attention is given to the modern neuroaugmentative methods, such as electrical stimulation and CNS drug infusion, that are progressively overshadowing the previously developed ablative procedures. PMID:1726524

Goodman, R R



Regional cerebral activation in irritable bowel syndrome and control subjects with painful and nonpainful rectal distention  

Microsoft Academic Search

Background & Aims: Irritable bowel syndrome (IBS) is characterized by visceral hypersensitivity, possibly related to abnormal brain-gut communication. Positron emission tomography imaging has suggested specific central nervous system (CNS) abnormalities in visceral pain processing in IBS. This study aimed to determine (1) if functional magnetic resonance imaging (fMRI) detects CNS activity during painful and nonpainful visceral stimulation; and (2) if

Howard Mertz; Victoria Morgan; Gordon Tanner; David Pickens; Ronald Price; Yu Shyr; Robert Kessler



Asbestos as a possible major cause of malignant lung tumors (including small cell carcinoma, adenocarcinoma & mesothelioma), brain tumors (i.e. astrocytoma & glioblastoma multiforme), many other malignant tumors, intractable pain including fibromyalgia, & some cardio-vascular pathology: Safe & effective methods of reducing asbestos from normal & pathological areas.  


High incidences of Small Cell Carcinoma & Adenocarcinoma of the lung, Astrocytoma & Glioblastoma Multiforme of the brain and Mesothelioma of the lung were found in those who had a high accumulation of Asbestos in the eyes and upper respiratory system (nose, larynx, trachea, etc.). When measured non-invasively using the Bi-Digital O-Ring Test (BDORT), brain tumors had the highest concentration of Asbestos (0.2 approximately 2.1 mg BDORT units). Relatively high levels of Asbestos (0.2 approximately 0.6 mg BDORT units) were found in: Squamous Cell Carcinoma of the lungs & esophagus, Adenocarcinoma of the larynx & breast, myelogenic leukemia, arteries of these cancers, left ventricle of failing heart, myocardial infarction, some of the narrowed arteries, varicose veins, cataracts, balding heads, hot flashes, Alzheimer's Disease and Autism. A small, round or ellipsoidal area, with diameter of 5 mm or less, was found near the center of every cancer tissue with a higher level of Asbestos (1 approximately 3 mg), As, Zn, Cr and Se, than in the rest of the tumor; this small area may be where the cancer initiated. Among areas of intractable pain with frequent recurrence and gradual worsening, about 0.2 approximately 0.5 mg BDORT units (or higher) of Asbestos were found. The author found that in the Astrocytoma and many other cancer patients, the optimal dose of DHEA produced very significant reductions of cancer cell telomere from over 1400 ng in the brain tumors (and over 900 ng in other cancers) to close to or less than 1 yg (=10(-24) g), with circulatory improvement by reduction of TXB2. Unlike the standard, widely used treatment with DHEA 25 approximately 50 mg daily, which is an overdose; we only gave one optimal dose (1.5 approximately 12.5 mg) and the beneficial effects usually lasted anywhere between 3-6 months, unless inhibiting factors were introduced. In addition, once one optimal dose of DHEA was given, the amount of Asbestos from these tumors decreased very significantly (30 approximately 99% reduction) with marked increase in urine Asbestos. One optimal dose of special Cilantro tablet reduced more Asbestos than DHEA or (+) Qi Gong Energy Stored Paper. In addition, the application of (+) Solar Energy Stored Paper often reduces 70 approximately 99% of the Asbestos, while (+) Qi Gong Energy Stored Paper reduces 50 approximately 99% of the Asbestos. PMID:17063831

Omura, Yoshiaki



Gastric Electrical Stimulation in Intractable Symptomatic Gastroparesis  

Microsoft Academic Search

Background: The treatment of gastroparesis remains unsatisfactory despite prokinetic and anti-emetic drugs. Gastric electrical stimulation has been proposed as a therapeutic option. We have assessed the effect of gastric electrical stimulation on symptoms, medical treatment, body weight and gastric emptying in patients with intractable symptomatic gastroparesis in a non-placebo-controlled study. Methods: In this multicenter study, 38 highly symptomatic patients with

Thomas L. Abell; Eric Van Cutsem; Hasse Abrahamsson; Jan D. Huizinga; J. W. Konturek; Jean Paul Galmiche; Guy VoelIer; Ludo Filez; Bernt Everts; William E. Waterfall; W. Domschke; Stanislas Bruley des Varannes; Babajide O. Familoni; Ivan M. Bourgeois; Jozef Janssens; Gervais Tougas



Communication Preliminary to Negotiation in Intractable Conflict  

Microsoft Academic Search

\\u000a Intractable conflict is severely escalated, long-lasting conflict. The hostility that occurs in such conflict tends to block\\u000a association between adversaries and interfere with their communication (Coleman 1957; Sherif and Sherif 1969). For example,\\u000a for years before the Oslo negotiations that established the Palestinian Authority, communication with the Palestinian Liberation\\u000a Organization (PLO) was illegal in Israel and PLO members who made

Dean G. Pruitt


Immunobiology of visceral leishmaniasis  

PubMed Central

Visceral leishmaniasis (VL), commonly known as kala-azar, is caused by Leishmania donovani and Leishmania infantum (Leishmania chagasi in the Americas). These Leishmania species infect macrophages throughout the viscera, and parasites are typically found in the spleen, liver, and bone marrow. Patients with active disease typically exhibit marked immunosuppression, lack reactivity to the Leishmania skin test (LST), a delayed type hypersensitivity test, and their peripheral blood mononuclear cells (PBMC) fail to respond when stimulated with leishmanial antigens in vitro. However, most people infected with visceralizing species of Leishmania never develop disease. Understanding immune failure and the underlying immune mechanism that lead to disease as well as control of infection are key questions for research in this field. In this review, we discuss immunological events described in human and experimental VL and how these can affect the outcome of infection.

Kumar, Rajiv; Nylen, Susanne



Microglia: a newly discovered role in visceral hypersensitivity?  

PubMed Central

Given the growing body of evidence for a role of glia in pain modulation, it is plausible that the exaggerated visceral pain in chronic conditions might be regulated by glial activation. In this study, we have investigated a possible role for microglia in rats with chronic visceral hypersensitivity and previously documented altered neuronal function. Experiments were performed on adult male Sprague-Dawley rats pre-treated with neonatal colon irritation (CI) and on control rats. Effects of fractalkine (FKN, a chemokine involved in neuron-to-microglia signaling) and of minocycline (an inhibitor of microglia) on visceral sensitivity were examined. Visceral sensitivity was assessed by recording the electromyographic (EMG) responses to graded colorectal distension (CRD) in mildly sedated rats. Responses to CRD were recorded before and after injection of FKN, minocycline or vehicle. Somatic thermal hyperalgesia was measured by latency of paw withdrawal to radiant heat. The pattern and intensity of microglial distribution at L6–S2 in the spinal cord was also compared in rats with CI and controls by fluorescence microscopy using OX-42. Results show that: (1) FKN significantly facilitated EMG responses to noxious CRD by >52% in control rats. FKN also induced thermal hyperalgesia in control rats, consistent with previous reports; (2) minocycline significantly inhibited EMG responses to noxious CRD by >70% in rats with CI compared to controls 60 min after injection. The anti-nociceptive effect of minocycline lasted for 180 min in rats with CI, reaching peak values 60 min after injection. Our results show that FKN enhances visceral and somatic nociception, whereas minocycline inhibits visceral hypersensitivity in chronically sensitized rats, which indicates a role for microglia in visceral hypersensitivity.

Saab, Carl Y.; Wang, Jing; Gu, Chunping; Garner, Kirsten N.; Al-Chaer, Elie D.



Gene Therapy for Chronic Pain  

Microsoft Academic Search

\\u000a Gene therapy shows great potential to assist numerous patients with inadequate relief of inflammatory or neuropathic pain,\\u000a or intractable pain associated with advanced cancer. A brief overview is provided of the methods of gene therapy and of preclinical\\u000a findings in animal models of prolonged inflammatory, neuropathic and cancer pain. Preclinical findings demonstrate no efficacy\\u000a of gene therapy on basal thermal

William R. Lariviere; Doris K. Cope


Pain channelopathies  

PubMed Central

Pain remains a major clinical challenge, severely afflicting around 6% of the population at any one time. Channelopathies that underlie monogenic human pain syndromes are of great clinical relevance, as cell surface ion channels are tractable drug targets. The recent discovery that loss-of-function mutations in the sodium channel Nav1.7 underlie a recessive pain-free state in otherwise normal people is particularly significant. Deletion of channel-encoding genes in mice has also provided insights into mammalian pain mechanisms. Ion channels expressed by immune system cells (e.g. P2X7) have been shown to play a pivotal role in changing pain thresholds, whilst channels involved in sensory transduction (e.g. TRPV1), the regulation of neuronal excitability (potassium channels), action potential propagation (sodium channels) and neurotransmitter release (calcium channels) have all been shown to be potentially selective analgesic drug targets in some animal pain models. Migraine and visceral pain have also been associated with voltage-gated ion channel mutations. Insights into such channelopathies thus provide us with a number of potential targets to control pain.

Cregg, Roman; Momin, Aliakmal; Rugiero, Francois; Wood, John N; Zhao, Jing



21 CFR 882.5880 - Implanted spinal cord stimulator for pain relief.  

Code of Federal Regulations, 2010 CFR

...spinal cord stimulator for pain relief is a device that is used to stimulate electrically a patient's spinal cord to relieve severe intractable pain. The stimulator consists...electrodes that are placed on the patient's spinal cord and an...



21 CFR 882.5880 - Implanted spinal cord stimulator for pain relief.  

Code of Federal Regulations, 2013 CFR

...spinal cord stimulator for pain relief is a device that is used to stimulate electrically a patient's spinal cord to relieve severe intractable pain. The stimulator consists...electrodes that are placed on the patient's spinal cord and an...



21 CFR 882.5880 - Implanted spinal cord stimulator for pain relief.  

Code of Federal Regulations, 2010 CFR

...spinal cord stimulator for pain relief is a device that is used to stimulate electrically a patient's spinal cord to relieve severe intractable pain. The stimulator consists...electrodes that are placed on the patient's spinal cord and an...



21 CFR 882.5840 - Implanted intracerebral/subcortical stimulator for pain relief.  

Code of Federal Regulations, 2010 CFR

...subcortical stimulator for pain relief is a device that applies...current to subsurface areas of a patient's brain to treat severe intractable pain. The stimulator consists of...electrodes that are placed within a patient's brain and an external...



21 CFR 882.5840 - Implanted intracerebral/subcortical stimulator for pain relief.  

Code of Federal Regulations, 2010 CFR

...subcortical stimulator for pain relief is a device that applies...current to subsurface areas of a patient's brain to treat severe intractable pain. The stimulator consists of...electrodes that are placed within a patient's brain and an external...



Visceral analgesics: drugs with a great potential in functional disorders??  

PubMed Central

Irritable bowel syndrome remains an incompletely understood, common syndrome with significant unmet medical needs. In IBS patients, abdominal pain is a primary factor related to quality of life impairment, symptom severity and health care utilization, and chronic visceral hyperalgesia has been identified as an important aspect of IBS pathophysiology. However, the development of therapies aimed at reducing this hyperalgesia (visceral analgesics) has been only partially successful despite preclinical evidence supporting the potential usefulness of several preclinical compounds aimed at peripheral as well as central targets.

Bradesi, Sylvie; Herman, Jeremy; Mayer, Emeran A



Activation of ERK signaling in rostral ventromedial medulla is dependent on afferent input from dorsal column pathway and contributes to acetic acid-induced visceral nociception.  


Several lines of evidence from both animal and clinical studies have demonstrated that dorsal column (DC) pathway plays a critical role in visceral pain transmission from the spinal cord to supraspinal center. The descending pain modulation pathway from the rostral ventromedial medulla (RVM) area has been implicated in visceral nociceptive neurotransmission. Previous studies have demonstrated that the multiple protein kinase signaling transduction cascades in the RVM area contribute to the descending facilitation of inflammatory pain and neuropathic pain. However, whether these signaling transduction pathways in the RVM area are triggered by the afferent visceral input from the DC pathway during acute visceral pain remains elusive. Here, we have tested the hypothesis that the afferent visceral stimuli from the DC pathway might induce the activation of extracellular signal-regulated protein kinase (ERK) signaling in the RVM area and contribute to the descending facilitation of neurotransmission in a rat model of visceral pain. Our results showed that acetic acid-induced visceral nociception produced a persistent activation of ERK in the RVM area and a microinjection of a mitogen-activated ERK kinase (MEK) inhibitor, U0126, into the RVM area significantly inhibited the visceral noxious stimulation-induced behaviors in rats. A microinjection of lidocaine into the nucleus gracilis (NG) also inhibited the activation of ERK in the RVM area. The current study indicates that activated ERK signaling pathway in the RVM area is dependent on afferent input from dorsal column pathway and may contribute to acetic acid-induced visceral nociception. PMID:23876632

Kang, Yi; Zhao, Yujie; Guo, Ruijuan; Zhang, Meijuan; Wang, Yue; Mu, Yonggao; Wu, Anshi; Yue, Yun; Wu, Jing; Wang, Yun



Visceral and somatic hypersensitivity in a subset of rats following TNBS-induced colitis  

PubMed Central

Background Chronic abdominal pain is one of the most common gastrointestinal symptoms experienced by patients. Visceral hypersensitivity has been shown to be a biological marker in many patients with chronic visceral pain. We have previously shown that IBS patients with visceral hypersensitivity also have evidence of thermal hyperalgesia of the hand/foot. Objective The objective of the current study was to develop an animal model of chronic visceral and somatic hypersensitivity in rats treated with intracolonic trinitrobenzene sulfonic acid. Design Male Sprague–Dawley rats (200–250 g) were treated with either 20 mg/rat trinitrobenzene sulfonic acid (TNBS, Sigma Chemical Co.) in 50% ethanol (n = 75), an equivalent volume of 50% ethanol (n = 20) or an equivalent volume of saline (n = 20). The agents were delivered with a 24-gauge catheter inserted into the lumen of the colon. Mechanical and thermal behavioral tests were performed using an automated von Frey and Hargreaves device to evaluate somatic hyperalgesia. Colonic distension was performed using an automated distension device to evaluate visceral pain thresholds. All animals were tested 16 weeks after TNBS treatment following complete resolution of the colitis. Results At 16 weeks, 24% of the treated rats (18/75 rats) still exhibited evidence of visceral as well as somatic hypersensitivity compared to saline- and ethanol-treated rats. Conclusion Transient colonic inflammation leads to chronic visceral and somatic hypersensitivity in a subset of rats. These findings are similar to the subset of patients who develop chronic gastrointestinal symptoms following enteric infection.

Zhou, QiQi; Price, Donald D.; Caudle, Robert M.; Verne, G. Nicholas



[Visceral leishmaniasis in an HIV positive patient].  


Background: visceral leishmaniasis is the most serious clinical picture of leishmaniasis or kala azar. In Mexico it is a rare disease, which is a reason why it is diagnosed late concluding with patient's death most of the time. We present a clinical case of an HIV-positive male patient who developed visceral leishmaniasis, with the objective of showing the pathophysiological characteristics as well as the diagnostic approach and treatment. Clinical case: a 45-year-old male, a water utility company worker, presented to the hospital as having chronic bloody diarrhea, abdominal distension, cramping pain, weight loss and fever. On physical examination, he was febrile, with pain localized to the right lower quadrant and hepatosplenomegaly. The ELISA test for HIV was positive and the ultrasound showed a cecal tumor. A tumor biopsy was performed and the pathology report described leishmaniasis. Conclusions: in patients with leishmaniasis and HIV the response to treatment is poor and the mortality rate is high due to lower immune response from the host. Current studies suggest treating these patients with HIV and leishmaniasis with pertinent drugs in combination with miltefosine and liposomal amphotericin B. PMID:23693114

Rossiere-Echazarreta, Natalia Lorena; Rodríguez-Campos, Esther Alicia; Morales-Esponda, Mario; Domínguez-Moreno, Rogelio; Cruz-Ortiz, Margarita; Rodríguez-Guzmán, Leoncio Miguel


[The visceral theory of sleep].  


The review focuses on the studies which were undertaken in order to check our visceral hypothesis of sleep. The review presents also independent studies, results of which are in good agreement with this hypothesis. The visceral hypothesis proposes that during sleep central nervous system including all cortical areas switches from the processing of the exteroceptive information (visual, somatosensory and so on) to the processing of the interoceptive information coming from all visceral systems of an organism. This change of the cortical afferentation during sleep proposes simultaneous change of the directions of the efferent cortical information flows. In wakefulness these flows were directed towards the structures involved in organization of behavior. During sleep they will be redirected towards the structures undertaking visceral regulation. Analysis of the visceral hypothesis of sleep shows that many disorders connected with sleep-wake cycle can be explained by asynchronous switches of the cortical afferent and efferent information flows. PMID:23697225

Pigarev, I N


Untreatable Pain Resulting from Abdominal Cancer: New Hope from Biophysics?  

Microsoft Academic Search

Context Visceral pain characterizing pancreatic cancer is the most difficult symptom of the disease to control and can significantly impair the quality of life which remains and increase the demand for euthanasia. Aim To investigate a possible new method based on biophysical principles (scrambler therapy) to be used in the effective treatment of drug-resistant oncological pain of the visceral\\/neuropathic type.

Giuseppe Marineo



Proinflammatory cytokines and glial cells: Their role in neuropathic pain  

Microsoft Academic Search

\\u000a Neuropathic pain, or chronic pain due to nerve injury, is a prevalent condition for which currently there is no effective\\u000a treatment. These neuropathic pain syndromes include deafferentation pain, diabetic, cancer and ischemic neuropathies, phantom\\u000a limb pain, trigeminal neuralgia, postherpetic neuralgias and nerve injury caused by surgery or trauma [1]. Neuropathic pain is not only chronic and intractable, it is debilitating

Joyce A. DeLeo; Raymond W. Colburn


Chronic pain in torture survivors  

Microsoft Academic Search

According to Amnesty International government-sanctioned torture is verified in one third of the countries in the world. The physical and psychological sequelae are numerous. This study focuses on pain diagnosis, characterising pain types as nociceptive, visceral or neuropathic. Torture victims from the Middle East, treated at the Rehabilitation and Research Centre for Torture Victims (RCT) in Copenhagen, participated in the

Annemarie B Thomsen; Jørgen Eriksen; Knud Smidt-Nielsen



Pathology and Neuroimaging in Pediatric Temporal Lobectomy for Intractable Epilepsy  

Microsoft Academic Search

Objectives: Firstly, to study the pathology at surgery in children undergoing temporal lobectomy for intractable partial epilepsy. Secondly, to compare neuroimaging techniques (CT, MRI) in the preoperative detection of pathology. Lastly, to examine the surgical outcome in children. Methods: Forty-two pediatric patients undergoing temporal lobectomy for intractable epilepsy at the Comprehensive Epilepsy Program at the University of Alberta Hospital between

D. B. Sinclair; M. Wheatley; K. Aronyk; C. Hao; T. Snyder; W. Colmers; J. D. S. McKean



Rethinking Intractable Conflict: The Perspective of Dynamical Systems  

Microsoft Academic Search

Intractable conflicts are demoralizing. Beyond destabilizing the families, communities, or international regions in which they occur, they tend to perpetuate the very conditions of misery and hate that contributed to them in the first place. Although the common factors and processes associated with intractable conflicts have been identified through research, they represent an embarrassment of riches for theory construction. Thus,

Robin R. Vallacher; Peter T. Coleman; Andrzej Nowak; Lan Bui-Wrzosinska



Pain-autonomic interactions.  


There are extensive interactions between the neural structures involved in pain sensation and autonomic control. The insular and anterior cingulate cortices, amygdala, hypothalamus, periaqueductal grey, parabrachial nucleus, nucleus of the solitary tract, ventrolateral medulla and raphe nuclei receive converging nociceptive and visceral inputs from the spinal and trigeminal dorsal horns and initiate arousal, affective, autonomic, motor and pain modulatory responses to painful stimuli. This review will focus on some central pain-autonomic interactions potentially relevant for the pathophysiology of primary headache. PMID:16688616

Benarroch, E E



Microcatheter Embolization of Intractable Idiopathic Epistaxis  

SciTech Connect

Purpose: To assess the efficacy and safety of microcatheter embolization in the treatment of intractable idiopathic epistaxis. Methods: Thirty-seven patients underwent microcatheter embolization in 1991-1998. We evaluated retrospectively the technical and clinical outcome, the number of complications, the duration of embolization in each case, and the number of blood transfusions needed. All embolizations were done with biplane digital subtraction angiography (DSA) equipment. The procedure was carried out under local anesthesia using transfemoral catheterization, except in one case where the translumbar route was used. Tracker 18 or 10 microcatheters were advanced as far as possible to the distal branches of the sphenopalatine artery. Polyvinyl alcohol (PVA) particles were used for embolization in most cases, while platinum coils or a combination of these two materials were occasionally used. The primary outcome was always assessed immediately by angiography. Follow-up data were obtained from patient records, by interviewing patients on the telephone or by postal questionnaires when necessary. The mean follow-up time was 21 months. Results: The embolization was technically successful in all 37 cases. A curative outcome was achieved in 33 cases (89%). The mean duration of the procedure was 110 min. Four patients (8%) had mild transient complications, but no severe or persistent complications were encountered. Twenty-three patients needed a blood transfusion. Slight rebleeding occurred in three patients during the follow-up; all responded to conservative treatment. One patient suffered two episodes of rebleeding within 2 months after primary embolization. Re-embolizations successfully stopped the bleeding. Conclusion: Embolization is the primary invasive modality for treating intractable idiopathic epistaxis. It proved both safe and effective over a relatively long follow-up.

Leppaenen, Martti; Seppaenen, Seppo [Department of Radiology, Tampere University Hospital, P.O. Box 2000, FIN-33521 Tampere (Finland); Laranne, Jussi [Department of Otolaryngology, Tampere University Hospital, P.O. Box 2000, FIN-33521 Tampere (Finland); Kuoppala, Katriina [Department of Neurology, Seinaejoki Central Hospital, Hanneksenrinne 7, FIN-60220 Seinaejoki (Finland)



Clinical Signs of Low Back Pain  

Microsoft Academic Search

Common causes of back pain include mus- culoskeletal injuries, degenerative disease, her- niated nucleus pulposus, and spinal stenosis. Less com- mon causes include metastatic cancer, spinal infections, ankylosing spondylitis, and referred pain from visceral organs. Although the majority of causes of back pain are benign, clinicians must be alert to potential red flags indicating serious pathology. HISTORY A patient's medical

Bernard Karnath


Somatovisceral interactions in visceral perception: Abdominal masking of colonic stimuli  

Microsoft Academic Search

Clinical and experimental evidence on referred pain and spinal-afferent convergence demonstrates a close relationship between\\u000a visceral and somatosensory perception, which is important for current models of symptom perception and central body representation.\\u000a The study uses a psychophysical approach to quantify these interactions at the perceptual level, taking into account problems\\u000a of comparable intermodal scaling and the role of awareness. An

Rupert Hölzl; Andreas Möltner; Claus W. Neidig



Purinergic mechanisms and pain-An update.  


There is a brief summary of the background literature about purinergic signalling. The review then considers purinergic mechanosensory transduction involved in visceral, cutaneous and musculoskeletal nociception and on the roles played by P2X3, P2X2/3, P2X4, P2X7 and P2Y12 receptors in neuropathic and inflammatory pain. Current developments of compounds for the therapeutic treatment of both visceral and neuropathic pain are discussed. PMID:23524093

Burnstock, Geoffrey



Combining ketamine with astrocytic inhibitor as a potential analgesic strategy for neuropathic pain. ketamine, astrocytic inhibitor and pain  

Microsoft Academic Search

BACKGROUND: Neuropathic pain is an intractable clinical problem. Intrathecal ketamine, a noncompetitive N--methyl-D-aspartate receptor (NMDAR) antagonist, is reported to be useful for treating neuropathic pain in clinic by inhibiting the activity of spinal neurons. Nevertheless, emerging studies have disclosed that spinal astrocytes played a critical role in the initiation and maintenance of neuropathic pain. However, the present clinical therapeutics is

Xiao-Peng Mei; Wei Wang; Wen Wang; Chao Zhu; Lei Chen; Ting Zhang; Li-Xian Xu; Sheng-Xi Wu; Yun-Qing Li



[Visceral leishmaniasis: an update].  


During the last decade, visceral leishmaniasis has been reconsidered in its epidemiology and strategies for diagnosis, treatment and prevention. This vectorial disease, responsible for more than 50,000 deaths each year across India, East Africa, South America, the Mediterranean area, Central Asia and China, is currently spreading over new territories. This formerly rural disease has even reached cities in South America. This spreading is caused by environmental changes due to global warming or human activity, and by the movement of workers and refugees. As a consequence, the burden of HIV/Leishmania coinfection is increasing in many developing countries even though effective antiretroviral therapy has led to a marked decrease in its incidence in Europe. The disease is now handled differently than it was 10 years ago: PCR has become the most accurate tool for diagnosis and follow-up in developed countries, and field diagnostic tools have been developed (antigenuria, rK39 dipstick). While resistance to antimoniate has appeared in India and Europe, new therapies have been evaluated such as miltefosine, the first oral therapy, or short treatment with liposomal amphotericin B. In France, liposomal amphotericin B has supplanted antimoniate meglumine because of better tolerance and shorter hospitalization duration. Protecting dogs through immunization or collars impregnated with deltamethrin proved effective to prevent zoonotic leishmaniasis due to Leishmania infantum. PMID:20850210

Faucher, B; Piarroux, R



Painful blind eye: efficacy of enucleation and evisceration in resolving ocular pain  

PubMed Central

AIMS—To assess the effectiveness of enucleation or evisceration in relieving pain from painful blind eyes.?METHODS—24 patients with intractable ocular pain underwent enucleation or evisceration with or without an orbital implant.?RESULTS—Complete pain relief was achieved in all patients at an average time of 3 months (range 1-15 months). Seven patients required further medical or surgical treatment in addition to removal of the globe.?CONCLUSION—Enucleation and evisceration were effective in relieving ocular pain in all patients with a painful blind eye in our study. However, complications of surgery and orbital implants can cause recurrent pain.??

Shah-Desai, S; Tyers, A; Manners, R



Slowed EEG rhythmicity in patients with chronic pancreatitis: evidence of abnormal cerebral pain processing?  

Microsoft Academic Search

BACKGROUND AND AIM: Intractable pain usually dominates the clinical presentation of chronic pancreatitis (CP). Slowing of electroencephalogram (EEG) rhythmicity has been associated with abnormal cortical pain processing in other chronic pain disorders. The aim of this study was to investigate the spectral distribution of EEG rhythmicity in patients with CP. PATIENTS AND METHODS: Thirty-one patients with painful CP (mean age

S. S. Olesen; T. M. Hansen; C. Graversen; K. Steimle; O. H. G. Wilder-Smith; A. M. Drewes



Behavioral, Medical Imaging and Histopathological Features of a New Rat Model of Bone Cancer Pain  

Microsoft Academic Search

Pre-clinical bone cancer pain models mimicking the human condition are required to respond to clinical realities. Breast or prostate cancer patients coping with bone metastases experience intractable pain, which affects their quality of life. Advanced monitoring is thus required to clarify bone cancer pain mechanisms and refine treatments. In our model of rat femoral mammary carcinoma MRMT-1 cell implantation, pain

Louis Doré-Savard; Valérie Otis; Karine Belleville; Myriam Lemire; Mélanie Archambault; Luc Tremblay; Jean-François Beaudoin; Nicolas Beaudet; Roger Lecomte; Martin Lepage; Louis Gendron; Philippe Sarret



Intrathecal bupivacaine for head and neck pain  

PubMed Central

Direct central nervous system (CNS) analgesic delivery is a useful option when more traditional means of dealing with chronic pain fail. Solutions containing local anesthetic have been effective in certain disease states, particularly in patients suffering from intractable head and neck pain. This review discusses historical aspects of CNS drug delivery and the role of intrathecal bupivacaine-containing solutions in refractory head and neck pain patients.

Belverud, Shawn A; Mogilner, Alon Y; Schulder, Michael



Visceral Myopathy Presenting as Acute Appendicitis and Ogilvie Syndrome  

PubMed Central

Background. Visceral myopathy is rare pathological condition of gastrointestinal tract with uncertain clinical presentation and unknown etiology. It often presents with symptoms of chronic intestinal pseudoobstruction of colon. We report a case of visceral myopathy which presented to us as acute appendicitis and Ogilvie syndrome, and we managed it surgically. Method and Result. A case report of 20-year female clinically presented as acute appendicitis and we performed laparoscopic exploration which revealed inflamed appendix with grossly dilated ascending colon. We performed laparoscopic appendectomy and postoperatively managed the patients with IV fluids, antibiotics, neostigmine, and extended length rectal tube for enema and decompression. During postoperative period, she developed abdomen distension and peritonitis, and we ordered abdomen CT which revealed colon pseudo- obstruction. We performed right hemicolectomy with permanent ileostomy, and the histopathology reports of resected colon were visceral myopathy. Conclusion. Visceral myopathy is very rare group of disease and poorly understood condition that may present with chronic or acute intestinal pseudo-obstruction and often mimic other more common gastrointestinal disease. VM should be considered as differential diagnosis whenever the patient presents with acute appendicitis, uncharacteristic abdominal symptoms, recurrent attacks of abdominal distention, and pain with no radiological evidence of intestinal obstruction.

Kharbuja, Punyaram; Thakur, Raghvendra; Suo, Jian



Effects of moxibustion on dynorphin and endomorphin in rats with chronic visceral hyperalgesia  

PubMed Central

AIM: To observe the analgesic effects of moxibustion in rats with chronic visceral hyperalgesia and its influence on the concentration of dynorphin (Dyn) and endomorphin (EM) in spinal cord. METHODS: The rat model of chronic visceral hyperalgesia was established by colorectal distention (CRD). In moxibustion (MX) group, moxibustion was applied once daily for 7 d; in sham moxibustion (SM) group, moxibustion was given to the same acupoints but with the non-smoldered end of the moxa stick. Model control (MC) group and normal control group were also studied. The scoring system of abdominal withdrawal reflex was used to evaluate visceral pain for behavioral assessment. Enzyme linked immunosorbent assay was performed to determine the concentrations of Dyn and EM in spinal cord. RESULTS: Moxibustion significantly decreased visceral pain to CRD in this rat model, and no significant difference was detected between the SM group and the MC group. In MX group, moxibustion also increased the concentrations of Dyn and EM in spinal cord, and no significant difference was found between the SM group and the MC group. CONCLUSION: Moxibustion therapy can significantly enhance the pain threshold of rats with chronic visceral hyperalgesia, and the effect may be closely related to the increased concentration of Dyn and EM in spinal cord.

Liu, Hui-Rong; Qi, Li; Wu, Lu-Yi; Ma, Xiao-Peng; Qin, Xiu-Di; Huang, Wen-Yan; Dong, Ming; Wu, Huan-Gan



Reversal of visceral and somatic hypersensitivity in a subset of hypersensitive rats by intracolonic lidocaine  

PubMed Central

Chronic abdominal pain is a common gastrointestinal symptom experienced by patients. We have previously shown that IBS patients with visceral hypersensitivity also have evidence of thermal hypersensitivity of the hand and foot that is reversed by rectal lidocaine jelly. We have also recently developed an animal model of chronic visceral and somatic hypersensitivity in rats treated with intracolonic trinitrobenzene sulfonic acid (TNBS). The objective of the current study was to determine the effects of intracolonic lidocaine on visceral/somatic hypersensitivity in TNBS-treated rats. A total of 20 hypersensitive rats received either 20 mg intracolonic lidocaine (n = 10) or saline jelly (n = 10). In comparison to saline jelly, intracolonic lidocaine jelly reduced responses to nociceptive visceral/somatic stimuli in hypersensitive rats. The effects were present within 5–30 min after administration of lidocaine and lasted for 6 h. Lidocaine had no effects on recovered rats or control rats that had originally been treated with intracolonic saline instead of TNBS. Local anesthetic blockade of peripheral impulse input from the colon reduces both visceral and somatic hypersensitivity in TNBS-treated rats, similar to results in IBS patients. The results provide further evidence that visceral and secondary somatic hypersensitivity in a subset of TNBS-treated rats reflect central sensitization mechanisms maintained by tonic impulse input from the colon. This study evaluates the reversal of visceral/somatic hypersensitivity in a subset of TNBS-treated rats with intracolonic lidocaine. This animal model may be used in the future to study the mechanisms of local anesthetic agents applied to the gut to reduce visceral pain.

Zhou, QiQi; Price, Donald D.; Verne, G. Nicholas



A New Model of Chronic Visceral Hypersensitivity in Adult Rats Induced by Colon Irritation During Postnatal Development  

Microsoft Academic Search

Background & Aims: The irritable bowel syndrome (IBS) is a common disorder characterized by abdominal pain in the setting of altered perception of viscerosensory stimuli. This so-called visceral hyperalgesia occurs in the absence of detectable organic disease in the peripheral organs and may cause normal or physiologic contractions to be perceived as painful. Although the pathogenesis of IBS remains speculative

Elie D. Al-Chaer; Motohiro Kawasaki; Pankaj J. Pasricha



Visceral leishmaniasis - current therapeutic modalities  

Microsoft Academic Search

Major therapeutic obstacles in the treatment of visceral leishmaniasis (VL) include the alarming increase in antimonial unresponsiveness especially in Bihar, India and relapses in HIV- Leishmania co-infected patients. The therapeutic armamentarium for VL is currently plagued with several limitations as the available drugs are toxic, majority are effective only parenterally and need to be administered for extended periods. The first

Shyam Sundar; Mitali Chatterjee



Laboratory Diagnosis of Visceral Leishmaniasis  

Microsoft Academic Search

The group of diseases known as the leishmaniases are caused by obligate intracellular protozoa of the genus Leish- mania (39). Natural transmission of leishmania is carried out by a certain species of sandfly of the genus Phlebotomus (Old World) or Lutzomyia (New World). These are present in three different forms: (i) visceral leishmaniasis (VL), (ii) cutaneous leishmaniasis, and (iii) mucocutaneous

Shyam Sundar; M. Rai



Electrical stimulation of the trigeminal tract in chronic, intractable facial neuralgia.  


In this paper the treatment of patients with chronic, intractable trigeminal neuralgia by invasive electrical stimulation of the Gasserion ganglion is reviewed. Two different surgical techniques are employed in this treatment. Most frequently, a method similar to the traditional technique for percutaneous glycerol and radiofrequency trigeminal rhizolysis is used: a small percutaneous stimulation electrode is advanced under fluoroscopic control through a thin needle via the foramen ovale to the Gasserian cistern. Some neurosurgeons use an open surgical technique by which the Gasserian ganglion is approached subtemporally and extradurally, and the bipolar pad electrode is sutured to the dura. When percutaneous test stimulation is successful (at least 50% pain relief) the electrode is internalized and connected to a subcutaneous pulse generator or RF-receiver. Data from 8 clinical studies, including 267 patients have been reviewed. Of all 233 patients with medication-resistant atypical trigeminal neuralgia 48% had at least 50% long term pain relief. The result of test stimulation is a good predictor of the long term effect, because 83% of all patients with successful test stimulation had at least 50% long term relief, and 70% had at least 75% long term relief. Patients generally preferred this invasive method over TENS. The success rate in patients with postherpetic trigeminal neuralgia was very low (less than 10%). It is suggested that the likelihood of pain relief by electrical stimulation is inversely related to the degree of sensory loss. It is concluded that invasive stimulation of the Gasserian ganglion is a promising treatment modality for patients with chronic, intractable, atypical trigeminal neuralgia. PMID:11935364

Holsheimer, J



Neuropathological findings in intractable epilepsy: 435 Chinese cases.  


The number of patients with intractable epilepsy undergoing surgical management in China is increasing rapidly. We retrospectively reviewed 435 consecutive cases of intractable epilepsy receiving surgical resection from 2005 to 2008 in our hospital, looking specifically at the neuropathological findings. The three most common causes of intractable epilepsy were focal cortical dysplasia (FCD; 52.9%), scar lesions (22.8%) and brain tumors (11.7%). Hippocampal sclerosis was identified in 74 cases (17.0%), although most of these were accompanied by dual pathology with FCD (especially Palmini type IB), scar lesions or tumors. Among FCD cases, Palmini type I lesions are the most frequently observed abnormality, with a preferred location in the temporal lobe (60.1%) and often accompanied by dual pathology. In contrast, Palmini type II FCD lesions occurred predominantly in the frontal regions and with a lower age of onset. Most tumors were mixed neuronal-glial tumors, mainly ganglioglioma (19 cases) and dysembryoplastic neuroepithelial tumor (10 cases), with a trend toward a temporal location and usually accompanied by cortical dysplasia in the peritumor area. Our data on the neuropathology of intractable epilepsy in China show that glioneuronal lesions are the most prominent cause of intractable epilepsy, and this is consistent with reports from other countries. PMID:20331616

Piao, Yue-Shan; Lu, De-Hong; Chen, Li; Liu, Jing; Wang, Wei; Liu, Lei; Yu, Tao; Wang, Yu-Ping; Li, Yong-Jie



Neurogenic pain relief by repetitive transcranial magnetic cortical stimulation depends on the origin and the site of pain  

Microsoft Academic Search

Objective: Drug resistant neurogenic pain can be relieved by repetitive transcranial magnetic stimulation (rTMS) of the motor cortex. This study was designed to assess the influence of pain origin, pain site, and sensory loss on rTMS efficacy.Patients and methods: Sixty right handed patients were included, suffering from intractable pain secondary to one of the following types of lesion: thalamic stroke,

J-P Lefaucheur; X Drouot; I Menard-Lefaucheur; F Zerah; B Bendib; P Cesaro; Y Keravel; J-P Nguyen



Chronic pain in torture survivors.  


According to Amnesty International government-sanctioned torture is verified in one third of the countries in the world. The physical and psychological sequelae are numerous. This study focuses on pain diagnosis, characterising pain types as nociceptive, visceral or neuropathic. Torture victims from the Middle East, treated at the Rehabilitation and Research Centre for Torture Victims (RCT) in Copenhagen, participated in the study. The patients were referred to a pain specialist for evaluation of unsolved pain problems. Eighteen male torture victims were examined. Twelve patients experienced pain at more than three locations. Nociceptive and neuropathic pain were demonstrated in all patients. Specific neuropathic pain conditions were related to the following four types of physical torture: Palestinian hanging, falanga, beating and kicking of the head, and positional torture. When treating torture victims, it is important to know about torture methods, to think differently than normal on etiological and pathogenetic factors and always consider the presence of neuropathic pain. PMID:10737462

Thomsen, A B; Eriksen, J; Smidt-Nielsen, K



Pain Relief by Electrical Stimulation of the Central Gray Matter in Humans and Its Reversal by Naloxone  

Microsoft Academic Search

Relief of intractable pain was produced in six human patients by stimulation of electrodes permanently implanted in the periventricular and periaqueductal gray matter. The level of stimulation sufficient to induce pain relief seems not to alter the acute pain threshold. Indiscriminate repetitive stimulation produced tolerance to both stimulation-produced pain relief and the analgesic action of narcotic medication; this process could

Yoshio Hosobuchi; John E. Adams; Rita Linchitz



Alum Irrigation for the Treatment of Intractable Haematuria  

PubMed Central

Managing intractable haematuria is a daunting task. One cause of this condition is radiationinduced haemorrhagic cystitis. Several treatments for the condition have been proposed and one non-invasive option is alum irrigation. Here, we report on a 65-year-old woman with intractable haematuria secondary to radiation cystitis who was successfully treated with alum irrigation. Alum irrigation is safe, well tolerated and relatively cheap. A review of the literature and a comprehensive discussion on alum irrigation as treatment for haematuria is discussed here to create an awareness regarding this treatment option.

Ho, Christopher Chee Kong; Md Zainuddin, Zulkifli



Diagnosis of Human Visceral Pentastomiasis  

PubMed Central

Visceral pentastomiasis in humans is caused by the larval stages (nymphs) of the arthropod-related tongue worms Linguatula serrata, Armillifer armillatus, A. moniliformis, A. grandis, and Porocephalus crotali. The majority of cases has been reported from Africa, Malaysia, and the Middle East, where visceral pentastomiasis may be an incidental finding in autopsies, and less often from China and Latin America. In Europe and North America, the disease is only rarely encountered in immigrants and long-term travelers, and the parasitic lesions may be confused with malignancies, leading to a delay in the correct diagnosis. Since clinical symptoms are variable and serological tests are not readily available, the diagnosis often relies on histopathological examinations. This laboratory symposium focuses on the diagnosis of this unusual parasitic disease and presents its risk factors and epidemiology.

Tappe, Dennis; Buttner, Dietrich W.



A selective role for TRPV4 ion channels in visceral sensory pathways  

PubMed Central

Background & Aims Although there are many candidates as molecular mechanotransducers, so far there has been no evidence for molecular specialization of visceral afferents. Here we show that colonic afferents express a specific molecular transducer that underlies their specialized mechanosensory function: the transient receptor potential channel TRPV4. Methods & Results We found TRPV4 mRNA is highly enriched in colonic sensory neurons compared with other visceral and somatic sensory neurons. TRPV4 protein was found in colonic nerve fibers from patients with inflammatory bowel disease, and it colocalized in a subset of fibers with the sensory neuropeptide CGRP in mice. We characterized the responses of eight subtypes of vagal, splanchnic and pelvic mechanoreceptors. Mechanosensory responses of colonic serosal and mesenteric afferents were enhanced by a TRPV4 agonist and dramatically reduced by targeted deletion of TRPV4 or by a TRP antagonist. Other subtypes of vagal and pelvic afferents, by contrast, were unaffected by these interventions. The behavioral responses to noxious colonic distension were also substantially reduced in mice lacking TRPV4. Conclusions These data indicate that TRPV4 contributes to mechanically-evoked visceral pain, with relevance to human disease. In view of its distribution in favor of specific populations of visceral afferents, we propose that TRPV4 may present a selective novel target for the reduction of visceral pain, which is an important opportunity in the absence of current treatments.

Brierley, Stuart M; Page, Amanda J; Hughes, Patrick A; Adam, Birgit; Liebregts, Tobias; Cooper, Nicole J; Holtmann, Gerald; Liedtke, Wolfgang; Blackshaw, L Ashley



Noncardiac Chest Pain  

PubMed Central

Noncardiac chest pain (NCCP) is very common, affecting up to 25% of the adult population in the United States. Treatment for NCCP has markedly evolved in the past decade and is presently focused on gastroesophageal reflux disease (GERD) and visceral hypersensitivity. Aggressive treatment with proton pump inhibitors has become the standard of care for GERD-related NCCP. Pain modulators such as tricyclics, trazodone, and selective serotonin reuptake inhibitors are considered the mainstay of therapy for non-GERD-related NCCP Other therapeutic modalities such as botulinum toxin injections and hypnotherapy have demonstrated promise in small clinical trials.

Schey, Ron; Villarreal, Autumn



Central Processing of Rectal Pain: A Functional MR Imaging Study  

Microsoft Academic Search

BACKGROUND AND PURPOSE: Although the central processing of somatic pain has been dealt with in numerous brain imaging studies, the neural correlates of visceral pain have re- ceived much more limited attention. Our goal was to assess the feasibility of detecting brain activation patterns induced by rectal pain by means of functional MR imaging. We hypothe- sized that the cerebral

Monica V. Baciu; Bruno L. Bonaz; Emmanuel Papillon; Richard A. Bost; Jean-Francois Le Bas; Jacques Fournet; Christoph M. Segebarth


Occipital nerve stimulation in medically intractable, chronic cluster headache. The ICON study: Rationale and protocol of a randomised trial.  


BACKGROUND: About 10% of cluster headache patients have the chronic form. At least 10% of this chronic group is intractable to or cannot tolerate medical treatment. Open pilot studies suggest that occipital nerve stimulation (ONS) might offer effective prevention in these patients. Controlled neuromodulation studies in treatments inducing paraesthesias have a general problem in blinding. We have introduced a new design in pain neuromodulation by which we think we can overcome this problem. METHODS/DESIGN: We propose a prospective, randomised, double-blind, parallel-group international clinical study in medically intractable, chronic cluster headache patients of high- versus low-amplitude ONS. Primary outcome measure is the mean number of attacks over the last four weeks. After a study period of six months there is an open extension phase of six months. Alongside the randomised trial an economic evaluation study is performed. DISCUSSION: The ICON study will show if ONS is an effective preventive therapy for patients suffering medically intractable chronic cluster headache and if there is a difference between high- and low-amplitude stimulation. The innovative design of the study will, for the first time, assess efficacy of ONS in a blinded way. PMID:23720502

Wilbrink, Leopoldine A; Teernstra, Onno Pm; Haan, Joost; van Zwet, Erik W; Evers, Silvia Maa; Spincemaille, Geert H; Veltink, Peter H; Mulleners, Wim; Brand, Ronald; Huygen, Frank Jpm; Jensen, Rigmor H; Paemeleire, Koen; Goadsby, Peter J; Visser-Vandewalle, Veerle; Ferrari, Michel D



Mediastinal germ cell tumor complicated by visceral hemangiomatosis.  


This report describes an extremely rare combination of mediastinal germ cell tumor and visceral hemangiomatosis in a 17-year-old boy who initially presented with chest pain and dyspnea. He was treated with chemotherapy consisting of cisplatin, cyclophosphamide, bleomycin, vinblastine, and dactinomycin followed by surgery. Multiple low-density nodules developed in the spleen three weeks later, suggesting metastases from the primary tumor, but the resected specimen showed cavernous hemangiomas within the splenic parenchyma. The patient died of recurrence of germ cell tumor 19 months after the initial treatment. Postmortem examination disclosed multiple hemangiomas in the lung and liver similar to those in the spleen. PMID:9932638

Sekine, I; Kodama, T; Hasebe, T; Matsumoto, T; Nagai, K; Nishiwaki, Y



Post-injury administration of minocycline: An effective treatment for nerve-injury induced neuropathic pain  

Microsoft Academic Search

Neuropathic pain is an intractable clinical problem, affecting millions of people worldwide. Preemptive administration of minocycline has been confirmed useful for treating neuropathic pain by inhibiting spinal microglia activation and consequently lowering proinflammatory cytokine expression. However, most patients with neuropathic pain have no chance to receive preemptive treatment and it remains unclear whether there is a therapeutic time window for

Xiao-Peng Mei; Hao Xu; Cheng Xie; Jun Ren; Yang Zhou; Hui Zhang; Li-Xian Xu



Outpatient Continuous Interscalene Brachial Plexus Block in Cancer-Related Pain  

Microsoft Academic Search

This case outlines the use of a continuous interscalene brachial plexus block to treat cancer-related pain. Using an elastomeric device, the patient's previously intractable pain was controlled and he was able to return home. Furthermore, the patient developed a pragmatic and effective method of balancing loss of power and sensation against pain control using the flow restrictor. This case illustrates

Deans Buchanan; Emma Brown; Fergus Millar; Fiona Mosgrove; Raj Bhat; Pamela Levack



Endogenous Opioids Inhibit Early Stage Pancreatic Pain in a Mouse Model of Pancreatic Cancer  

PubMed Central

Background & Aims The endogenous opioid system is involved in modulating the experience of pain, the response to stress and the action of analgesic therapies. Recent human imaging studies have demonstrated a significant tonic modulation of visceral pain, raising the question of whether endogenous opioids tonically modulate the pain of visceral cancer. Methods Transgenic mice expressing the first 127 amino acids of simian virus 40 large T antigen, under the control of the rat elastase-1 promoter that spontaneously develop pancreatic cancer were used to investigate the role of endogenous opioids in the modulation of pancreatic cancer pain. Visceral pain behaviors were assessed as degree of hunching and vocalization. Results Whereas, mice with late stage pancreatic cancer displayed spontaneous, morphine-reversible, visceral pain-related behaviors such as hunching and vocalization, these behaviors were absent in mice with early stage pancreatic cancer. Following systemic administration of the central nervous system (CNS) penetrant opioid receptor antagonists naloxone or naltrexone, mice with early stage pancreatic cancer, displayed significant visceral pain-related behaviors, while systemic administration of the CNS non-penetrant opioid antagonist naloxone-methiodide did not induce an increase in visceral pain behaviors. Conclusions Our findings suggest that a CNS opioid-dependent mechanism tonically modulates early and late stage pancreatic cancer pain. Understanding the mechanisms that mask this pain in early stage disease and drive this pain in late stage disease may allow improved diagnosis, treatment, and care of patients with pancreatic cancer.

Sevcik, Molly A.; Jonas, Beth M.; Lindsay, Theodore H.; Halvorson, Kyle G.; Ghilardi, Joseph R.; Kuskowski, Michael A.; Mukherjee, Pinku; Maggio, John E.; Mantyh, Patrick W.



Deep brain stimulation for neuropathic pain  

Microsoft Academic Search

Deep brain stimulation (DBS) for pain was one of the earliest indications for the therapy. This study reports the outcome\\u000a of DBS of the sensory thalamus and the periventricular and peri-aqueductal grey area (PVG=PAG) complex for different intractable\\u000a neuropathic pain syndromes. Forty-seven patients (30 males and 17 females) were selected for surgery; they were suffering\\u000a from any of the following

S. L. F. Owen; A. L. Green; D. D. Nandi; R. G. Bittar; S. Wang; Tipu Z. Aziz


Successful monotherapy of severe and intractable atopic dermatitis by photopheresis  

Microsoft Academic Search

Background: Patients with chronic atopic dermatitis can become unresponsive to standard immunosuppressive therapy and thus pose a serious therapeutic problem. Objective: Our purpose was to evaluate the therapeutic effectiveness of photopheresis in the management of patients with severe and intractable atopic dermatitis. Methods: Photopheresis was used as monotherapy in patients (n = 3) who previously did not respond to treatment

Heike I. Richter; Claudia Billmann-Eberwein; Markus Grewe; Helger Stege; Mark Berneburg; Thomas Ruzicka; Jean Krutmann



Penile Implant for Intractable Priapism Associated With Sickle Cell Disease  

Microsoft Academic Search

Intractable, therapy-resistant priapism in a patient with sickle cell disease is presented. The patient was managed with insertion of an inflatable penile prosthesis. He consequently maintained potency and remains free of priapitic episodes. To our knowledge, immediate penile prosthesis insertion for management of priapism has not been reported. We discuss the indications and advantages of this approach and review the

Jyoti Upadhyay; Bijan Shekarriz; C. B Dhabuwala



Vagus Nerve Stimulation for Control of Intractable Seizures in Childhood  

Microsoft Academic Search

Vagus nerve stimulation (VNS) is gaining increasing popularity and credibility as a treatment option for children with intractable epilepsy. VNS offers several advantages over extant treatments. Its efficacy is maintained during prolonged stimulation, and seizure control actually improves with time. There is no associated cognitive impairment and no adverse drug interactions. Unlike cerebral surgery, VNS is a potentially reversible form

Arun Paul Amar; Michael L. Levy; J. Gordon McComb; Michael L. J. Apuzzo



Intractable frontal lobe epilepsy: Pathological and MRI features  

Microsoft Academic Search

The clinical, pathological, and at least one year follow-up of 48 patients with intractable frontal lobe partial epilepsy who underwent surgical treatment for their seizure disorder were reviewed. The group consisted of 27 males and 21 females. Preoperative magnetic resonance imaging (MRI) was normal (26 patients), demonstrated focal frontal lobe (16 patients) or multilobar signal abnormalities (6 patients). Postoperatively patients

Nicholas Y. Lorenzo; Joseph E. Parisi; Gregory D. Cascino; Clifford R. Jack; W. Richard Marsh; Kathryn A. Hirschorn



From Intractable Conflict Through Conflict Resolution To Reconciliation: Psychological Analysis  

Microsoft Academic Search

Intractable intergroup conflicts require the formation of a conflictive ethos that enables a society to adapt to the conflict situation, survive the stressful period, and struggle successfully with the adversary. The formal termination of such a conflict begins with the elimination of the perceived incompatibility between the opposing parties through negotiation by their representatives—that is, a conflict resolution process. But

Daniel Bar-Tal



Stent graft repair of visceral artery aneurysms  

Microsoft Academic Search

Endovascular techniques with coil embolization have been used in certain visceral aneurysm cases, often resulting in sacrifice of the involved visceral vessel and end-organ thrombosis. We describe two cases in which stent grafts were used to treat these aneurysms, allowing preservation of visceral artery and end-organ flow while completely excluding the aneurysm. Case 1 was a 50-year-old morbidly obese woman

Robert A. Larson; Jeffrey Solomon; Jeffrey P. Carpenter



Imipramine decreases oesophageal pain perception in human male volunteers  

PubMed Central

Department of Medicine, Suite 501, Pepper Pavilion, Allegheny University Hospitals, Graduate, One Graduate Plaza, 1800 Lombard Street, Philadelphia, Pennsylvania 19146, USA Correspondence to: Dr D O Castell. Accepted for publication 19 January 1998 Background—Visceral hyperalgesia is a hallmark of functional gastrointestinal disorders. Antidepressants improve symptoms in these patients, although their mode of action is unclear. Antidepressant, anticholinergic, and analgesic mechanisms have been proposed. ?Aims—To investigate whether imipramine, which has a visceral analgesic effect, increases pain thresholds to experimental visceral pain. ?Methods—Visceral perception for first sensation and pain was measured with intraoesophageal balloon distension in 15 male volunteers. The effect of imipramine was studied in a double blind, placebo controlled, crossover study. Imipramine was given in ascending doses for 12 days (25 mg days 1-3, 50 mg days 4-6, 75 mg days 7-12), with oesophageal perception studied on day 13. ?Results—Inflation volumes and intraballoon pressures at first sensation were not different between placebo and imipramine. Balloon inflation volume at pain threshold was higher on imipramine (p=0.015). Median intraballoon pressures were not different at pain threshold for placebo and imipramine. Oesophageal wall compliance was not affected by imipramine. ?Conclusion—Increased pain thresholds on imipramine in this group of normal male volunteers in the absence of changes in oesophageal tone imply the presence of a visceral analgesic effect. ?(GUT 1998;:807-813)? Keywords: antidepressants;  imipramine;  visceral hyperalgesia;  oesophageal balloon;  distension;  functional bowel syndromes

Peghini, P; Katz, P; Castell, D



Is the pain in chronic pancreatitis of neuropathic origin? Support from EEG studies during experimental pain  

Microsoft Academic Search

AIM: To prove the hypothesis that patients with chronic pancreatitis would show increased theta activity during painful visceral stimulation. METHODS: Eight patients and 12 healthy controls underwent an experiment where the esophagus was electrically stimulated at the pain threshold using a nasal endoscope. The electroencephalogram (EEG) was recorded from 64 surface electrodes and \\

Asbjørn M Drewes; Maciej Gratkowski; Saber AK Sami; Georg Dimcevski; Peter Funch-Jensen; Lars Arendt-Nielsen



Visceral adiposity in gastrointestinal and hepatic carcinogenesis.  


There is emerging evidence that the association between obesity and cancer is mediated by visceral rather than generalised body fat. Visceral fat has been directly implicated in the risk and progression of several gastrointestinal cancers including colorectal, oesophageal, pancreatic and hepatocellular carcinomas. Excess visceral adipose tissue induces a state of chronic systemic inflammation and altered metabolic activity that promotes a pro-oncogenic environment. This review examines the evidence linking visceral fat in gastrointestinal and hepatic carcinogenesis and explores our current understanding of the mechanisms underlying this relationship. PMID:23201597

Vongsuvanh, Roslyn; George, Jacob; Qiao, Liang; van der Poorten, David



Pathogenesis and mechanisms of phantom pain  

Microsoft Academic Search

Although phantom limb pain is a well-known syndrome, phantom sensation or pain may affect virtually any part of the body (somatic\\u000a or visceral) that is accessible to sensory perception. This review begins with a novel classification system of this diverse\\u000a group of clinical conditions. Attention is then devoted to the mechanisms responsible for the pathogenesis of phantom pain,\\u000a notably, deafferentation

Edward M. Lee



A comparative study of oxycodone and morphine in a multi-modal, tissue-differentiated experimental pain model  

Microsoft Academic Search

Visceral pain can be difficult to treat with classical ?-opioid agonists and it has been suggested to use opioids with distinct pharmacological profiles. In animal experiments, oxycodone has shown different effects compared to morphine, and clinical observations have shown that oxycodone may occasionally be superior to, e.g., morphine in the treatment of visceral pain. In the current study, we randomised

Camilla Staahl; Lona Louring Christrup; Søren Due Andersen; Lars Arendt-Nielsen; Asbjørn Mohr Drewes



[Current topics in prevention, diagnosis and treatment of neuropathic pain from different causes: preface and comments].  


Neuropathic pain, as a chronic intractable pain, is well known to be difficult in prevention, diagnosis and treatment. Especially, neuropathic pain from different causes has each characteristics for prevention, diagnosis and treatment. These include post-herpetic pain, persistent chronic pain following traffic accident, pain after peripheral nerve injury in venipuncture, phantom limb pain originating from dysfunction of the primary motor cortex, pain from failed back surgery syndrome, and diabetic neuropathy, and are helpful for understanding prevention, diagnosis and treatment of neuropathic pain. PMID:21077299

Hanaoka, Kazuo



Role of differential neuroaxial blockade in the evaluation and management of pain in chronic pancreatitis  

Microsoft Academic Search

OBJECTIVES:Chronic pancreatic pain is difficult to treat. Surgical and medical therapies directed at reducing pain have met with little long-term success. In addition, there are no reliable predictors of response including pancreatic duct diameter. A differential neuroaxial blockade allows characterization of chronic abdominal pain into visceral and nonvisceral pain origins and may be useful as a guide to the treatment.

Darwin L. Conwell; John J. Vargo; Gregory Zuccaro; Teresa E. Dews; Nagy Mekhail; Judith Scheman; R. Matthew Walsh; Sharon F. Grundfest-Broniatowski; John A. Dumot; Steven S. Shay



Altered rectal sensory response induced by balloon distention in patients with functional abdominal pain syndrome  

Microsoft Academic Search

BACKGROUND: Functional abdominal pain syndrome (FAPS) has chronic unexplained abdominal pain and is similar to the psychiatric diagnosis of somatoform pain disorder. A patient with irritable bowel syndrome (IBS) also has chronic unexplained abdominal pain, and rectal hypersensitivity is observed in a majority of the patients. However, no reports have evaluated the visceral sensory function of FAPS precisely. We aimed

Tsukasa Nozu; Miwako Kudaira



The Role of Chemical Neurolysis in Cancer Pain  

Microsoft Academic Search

Pain continues to be a significant symptom burden in cancer patients, with prevalence in 53% of patients at all stages of\\u000a cancer and as high as 58% to 69% in those with advanced cancer. Neurolytic blocks are a mainstay in the armamentarium of cancer\\u000a pain management, more so in intractable pain from advanced cancer. There is no clear consensus on

Dhanalakshmi Koyyalagunta; Allen W. Burton



Spinal Cord Stimulation for Neuropathic Pain  

PubMed Central

Executive Summary Objective The objective of this health technology policy assessment was to determine the effectiveness of spinal cord stimulation (SCS) to manage chronic intractable neuropathic pain and to evaluate the adverse events and Ontario-specific economic profile of this technology. Clinical Need SCS is a reversible pain therapy that uses low-voltage electrical pulses to manage chronic, intractable neuropathic pain of the trunk or limbs. Neuropathic pain begins or is caused by damage or dysfunction to the nervous system and can be difficult to manage. The prevalence of neuropathic pain has been estimated at about 1.5% of the population in the United States and 1% of the population in the United Kingdom. These prevalence rates are generalizable to Canada. Neuropathic pain is extremely difficult to manage. People with symptoms that persist for at least 6 months or who have symptoms that last longer than expected for tissue healing or resolution of an underlying disease are considered to have chronic pain. Chronic pain is an emotional, social, and economic burden for those living with it. Depression, reduced quality of life (QOL), absenteeism from work, and a lower household income are positively correlated with chronic pain. Although the actual number is unknown, a proportion of people with chronic neuropathic pain fail to obtain pain relief from pharmacological therapies despite adequate and reasonable efforts to use them. These people are said to have intractable neuropathic pain, and they are the target population for SCS. The most common indication for SCS in North America is chronic intractable neuropathic pain due to failed back surgery syndrome (FBSS), a term that describes persistent leg or back and leg pain in patients who have had back or spine surgery. Neuropathic pain due to complex regional pain syndrome (CRPS), which can develop in the distal aspect of a limb a minor injury, is another common indication. To a lesser extent, chronic intractable pain of postherpetic neuralgia, which is a persistent burning pain and hyperesthesia along the distribution of a cutaneous nerve after an attack of herpes zoster, is also managed with SCS. For each condition, SCS is considered as a pain management therapy only after conventional pain therapies, including pharmacological, nonpharmacological, and surgical treatments, if applicable, have been attempted and have failed. The Technology The SCS technology consists of 3 implantable components: a pulse generator, an extension cable, and a lead (a small wire). The pulse generator is the power source for the spinal cord stimulator. It generates low-voltage electrical pulses. The extension cable connects the pulse generator to the lead. The lead is a small, insulated wire that has a set of electrodes at one end. The lead is placed into the epidural space on the posterior aspect of the spinal cord, and the electrodes are positioned at the level of the nerve roots innervating the painful area. An electrical current from the electrodes induces a paresthesia, or a tingling sensation that masks the pain. Before SCS is initiated, candidates must have psychological testing to rule out major psychological illness, drug habituation, and issues of secondary gain that can negatively influence the success of the therapy. Successful candidates will have a SCS test stimulation period (trial period) to assess their responsiveness to SCS. The test stimulation takes about 1 week to complete, and candidates who obtain at least 50% pain relief during this period are deemed suitable to receive a permanent implantation of a spinal cord stimulator Review Strategy The Medical Advisory Secretariat (MAS) reviewed all published health technology assessments of spinal cord stimulation. Following this, a literature search was conducted from 2000 to January, 2005 and a systematic review of the literature was completed. The primary outcome for the systematic review was pain relief. Secondary outcomes included functional status and quality of life. After applying the predetermined inclusion and exclus



[Visceral field of the rat insular cortex].  


Structural-functional organisation of the cortical insular area relating to processes of the visceral functions control, was analysed. Representation of gastrointestinal, respiratory, and cardiovascular systems in the area, is given. Sites of respective neuronal groups and specifics of their spatial organisation within the area, were found. The data obtained suggest a scheme of the rat insular cortex's visceral field. PMID:11195217

Bagaev, V A; Aleksandrov, V G



Intractable epilepsy in hemimegalencephaly and tuberous sclerosis complex.  


Hemimegalencephaly is a rare brain malformation consisting of the enlargement of 1 hemisphere, often associated with abnormal cortical gyration, thick cortex, large neurons, and increased astrocytes. Cranial asymmetry is the first clinical sign usually present at birth; in the most severe cases, hemimegalencephaly may be evident during pregnancy. Hemiparesis, intractable epilepsy, and developmental delay are the typical clinical manifestations. Tuberous Sclerosis Complex is an autosomal dominant disorder affecting about 1 in 6000 live births; the number of spontaneous mutations is remarkable. It is characterized by the development of hamartias, or nongrowing lesions, and hamartomas, which grow as benign tumors and rarely progress to malignancy. These lesions most frequently involve the brain, skin, kidneys, eyes, and heart. The rare association of hemimegalencephaly and tuberous sclerosis complex has been reported in a few cases. The authors report the case of a 4-year-old boy with left hemimegalencephaly, tuberous sclerosis complex genetically confirmed, and intractable epilepsy originating from the nonhemimegalencephalic hemisphere. PMID:17608312

Guerra, Maria P; Cavalleri, Francesca; Migone, Nicola; Lugli, Licia; Delalande, Olivier; Cavazzuti, Giovanni B; Ferrari, Fabrizio



Early onset intractable seizures: nonverbal communication after hemispherectomy.  


The nonverbal communication skills of 10 children (mean age = 44.2 months) who underwent hemispherectomy for early onset intractable seizures were tested before and after surgery. A within-group analysis suggests that the 10 seizure-free children used more nonverbal communication after a mean follow-up period of 11.2 months than before surgery. Young normal language age matches were available for the 4 older and higher functioning subjects in the sample. Before surgery, the surgical subjects used less requesting gestures than did the normal children. After surgery, these differences were no longer apparent. The patients also employed more gestures to focus an adult's attention on objects and events than language-age-matched normal children. The children who underwent left or right hemispherectomy used similar nonverbal communication behaviors. The study's findings suggest that children with early onset intractable seizures have impaired early social communication that improves to some extent after hemispherectomy. PMID:1401119

Caplan, R; Guthrie, D; Shields, W D; Sigman, M; Mundy, P; Sherman, T; Vinters, H V



Widespread hyperalgesia in irritable bowel syndrome is dynamically maintained by tonic visceral impulse input and placebo/nocebo factors: Evidence from human psychophysics, animal models, and neuroimaging  

PubMed Central

Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder that is often accompanied by both visceral and somatic hyperalgesia (enhanced pain from colorectal and somatic stimuli). Neural mechanisms of both types of hyperalgesia have been analyzed by neuroimaging studies of IBS patients and animal analog studies of “IBS-like” rats with delayed rectal and somatic hypersensitivity. Results from these studies suggest that pains associated with both visceral and widespread secondary cutaneous hyperalgesia are dynamically maintained by tonic impulse input from the non-inflamed colon and/or rectum and by brain-to-spinal cord facilitation. Enhanced visceral and somatic pains are accompanied by enhanced pain-related brain activity in IBS patients as compared to normal control subjects; placebos can normalize both their hyperalgesia and enhanced brain activity. That pain in IBS which is likely to be at least partly maintained by peripheral impulse input from the colon/rectum is supported by results showing that local rectal–colonic anesthesia normalizes visceral and somatic hyperalgesia in IBS patients and visceral and somatic hypersensitivity in “IBS-like” rats. Yet these forms of hyperalgesia are also highly modifiable by placebo and nocebo factors (e.g., expectations of relief or distress, respectively). Our working hypothesis is that synergistic interactions occur between placebo/nocebo factors and enhanced afferent processing so as to enhance, maintain, or reduce hyperalgesia in IBS. This explanatory model may be relevant to other persistent pain conditions.

Price, Donald D.; Craggs, Jason G.; Zhou, QiQi; Verne, G. Nicholas; Perlstein, William M.; Robinson, Michael E.



A Team Approach to the Management of Intractable Leg Ulcers  

PubMed Central

Objectives: The management of intractable leg ulcers requires a team approach which includes vascular surgeons and plastic surgeons. We retrospectively reviewed the results of the management of intractable leg ulcers by plastic surgeons. Patients and Methods: A total of 73 patients with intractable leg ulcers, (79 limbs) were treated at the Department of Plastic Surgery at our institution. Skin perfusion pressure (SPP) around the ulcer on the limb was measured before and after arterial reconstructive procedures. Local ulcer management involved intra-wound continuous negative pressure and irrigation therapy or negative pressure wound therapy. We examined the rates of wound healing and associated prognostic factors. Results: There were 21 limbs without ischemia (non-peripheral arterial disease [Non-PAD] group) and 58 limbs with ischemia (PAD group). The healing rates were 66% in the PAD group and 81% in the Non-PAD group, but the difference between the groups was not significant. A total of 41 limbs in the PAD group underwent revascularization, which involved bypass surgery in 18 limbs and endovascular therapy in 23 limbs. The salvage rate of the revascularized limbs was 83% at 1 year. The primary patency rates at 1 year were 87% for bypass surgery and 58% for endovascular therapy. The healing rate of the revascularized limbs was 66%, and the presence of concomitant hemodialysis, infected ulcers, and limbs without improved SPP were shown to be poor prognostic factors. Limbs treated with bypass surgery had a better healing rate than limbs treated with endovascular therapy, but the difference was not significant. Conclusion: Good ulcer-healing rates were achieved by effective revascularization and aggressive local management. These results suggest that a team approach is useful for the management of intractable leg ulcers. (English translation of Jpn J Vasc Surg 2011; 20: 913-920)

Kiyokawa, Kensuke; Akaiwa, Keiichi; Ishida, Masaru; Furuyama, Tadashi; Onohara, Toshihiro



Seizure outcome of intractable partial epilepsy in children  

Microsoft Academic Search

The intractable partial epilepsy outcome information is important in determining not only when epilepsy surgery evaluation should begin but also in deciding who would benefit and what is the likelihood of any benefit from surgery. Medical records of 50 children diagnosed with nontumor-related partial seizures, confirmed by video-electroencephalography (video-EEG), had at least one seizure per week and were followed for

Lan S Chen; Nina Wang; Meei-Ing Lin



Treatment of cyclophosphamide-induced intractable hemorrhagic cystitis.  


We report the successful use of prostaglandin F2 alpha continous bladder irrigation in two patients for the treatment of intractable cyclophosphamide-induced hemorrhagic cystitis which was resistant to conventional therapy in two patients. A 0.7 mg% solution of prostaglandin F2 alpha was used for continuous bladder irrigation at a rate of 150 to 200 cc/hr for four days. The response was complete in both patients and no side effects were noted. PMID:17589053

Bazarbashi, M S; Shurafa, M S; Karanes, C



Complications of invasive monitoring used in intractable pediatric epilepsy.  


Invasive monitoring for intractable epilepsy is useful when the epileptogenic focus is in question even after an extensive noninvasive presurgical evaluation, or when the epileptogenic focus is located in or near eloquent cortex. From June 1989 to June 2001 at the Children's Hospital of Philadelphia, 64 children with intractable epilepsy underwent 67 invasive monitoring procedures as part of their presurgical evaluation. The average age at implantation was 10 years. In all but two cases, subdural strips and grids were used. Depth electrodes, when used, were placed stereotactically or under direct vision. The average duration of the monitoring period was 5.87 days. Every patient had intradural cultures sent during removal of the electrodes, and lumbar punctures were performed in 15 patients. Twenty-one patients had at least one episode of a CSF leak. Of the 67 patients, 10 had positive intradural cultures, only 1 of whom had a positive lumbar puncture and none of whom developed clinically significant meningitis. No clinically relevant hemorrhages occurred as a result of the invasive monitoring. One patient did have a transient visual field loss after placement of an occipital grid. While CSF leaks are common after invasive monitoring despite precautions, clinically significant CSF infections are uncommon and appear to be unrelated to the duration of monitoring, the occurrence of a CSF leak or the length of time the patient is on perioperative antibiotics. We conclude that invasive monitoring for intractable epilepsy is generally safe. PMID:12476027

Simon, Scott L; Telfeian, Albert; Duhaime, Ann-Christine



Intractable sneezing due to IgE-mediated triethanolamine sensitivity.  


Sneezing has been commonly recognized as part of the nasal allergic reaction in response to pollen and inhalant allergens; isolated intractable sneezing is an unusual presentation in allergic patients. An 8-yr-old white girl developed intractable sneezing in the fall while walking past an area where fresh roofing tar was being prepared. Her personal and family histories were negative for allergic disease or symptoms. Positive physical findings were boggy nasal mucosa; pollen and inhalant skin tests were negative. Response to topical cromolyn and beclomethasone administered intranasally was only partial; antihistamines were little help. Upon careful review of history, exposure to clothes washed in Miracle White Laundry Soil and Stain Remover correlated to symptoms; removal from clothing by extensive washing relieved the sneezing, which recurred upon exposure. Prick test was positive to triethanolamine at 10(7)M to 10(-4)M and not to other ingredients of this product. Investigation demonstrated dose-dependent leukocyte histamine release (25% to 27% specific release) to triethanolamine (10(-4)M to 10(-7)M); this release (50% at 10(-5)M) was inhibited by preincubation with cromolyn sodium (5 X 10(-6)M). Passive cutaneous anaphylaxis was demonstrated to triethanolamine (10(-7)M to 10(-4)M); specific IgE to triethanolamine was demonstrated by polystyrene tube radioimmunoassay. Controls had no histamine release or specific IgE. Thus exposure to triethanolamine caused IgE-mediated intractable sneezing. PMID:6186715

Herman, J J



Modified Atkins diet vs classic ketogenic formula in intractable epilepsy.  


OBJECTIVES: The study was designed to evaluate the efficacy, safety, and tolerability of the ketogenic diet (KD) whether classic 4:1 formula or the modified Atkins diet (MAD) in intractable childhood epilepsy. PATIENTS AND METHODS: Anthropometric measurements and serum lipid profile were measured upon enrollment and after 3 and 6 months in 40 patients with symptomatic intractable epilepsy. Fifteen were given MAD diet, ten were kept on classic 4:1 ketogenic liquid formula, and the rest were allowed to eat as desired. RESULTS: The liquid ketogenic formula group showed significantly higher body mass index compared with those who did not receive KD after 6 months. The lipid profile of KD patients was within normal limits for age and sex during the study period. The rate of change of frequency and severity of seizures showed best improvement in ketogenic liquid formula patients followed by the MAD group than the patients on anti-epileptic medications alone. CONCLUSION: The KD whether classic 4:1 or MAD is a tolerable, safe, and effective adjuvant therapy for intractable symptomatic childhood epilepsy with limited adverse effects on the growth parameters and accepted changes in the lipid profile. The liquid ketogenic formula patients showed better growth pattern and significantly more seizure control. PMID:23679058

El-Rashidy, O F; Nassar, M F; Abdel-Hamid, I A; Shatla, R H; Abdel-Hamid, M H; Gabr, S S; Mohamed, S G; El-Sayed, W S; Shaaban, S Y



Chronic neck pain: how to approach treatment.  


Chronic neck pain is a common patient complaint. Despite its frequency as a clinical problem, there are few evidence-based studies that document efficacy of therapies for neck pain. The treatment of this symptom is based primarily on clinical experience. Preventing the development of chronic neck pain can be achieved by modification of the work environment with chairs that encourage proper musculoskeletal movement. The use of neck supports for sleep and active neck exercises together can improve neck pain. Passive therapies, including massage, acupuncture, mechanical traction, and electrotherapy, have limited benefit when measured by clinical trial results. NSAIDs, muscle relaxants, and pure analgesics are the mainstays of therapy. Local injections of anesthetics with or without soluble corticosteroid preparations offer additional pain relief. The purpose of these agents is to diminish pain to facilitate normal neck movement. Surgical therapy with cervical spine fusion is indicated for the rare patient with intractable neck pain resistant to all nonsurgical therapies. PMID:18173978

Borenstein, David G



Long-term experience with implanted intrathecal drug administration systems for failed back syndrome and chronic mechanical low back pain  

Microsoft Academic Search

BACKGROUND: Continuous intrathecal drug delivery has been shown in open studies to improve pain and quality of life in those with intractable back pain who have had spinal surgery. There is limited data on long term effects and and even less for patients with mechanical back pain without prior spinal surgery. METHODS: We have investigated spinal drug administration systems for

JH Raphael; JL Southall; TV Gnanadurai; GJ Treharne; GD Kitas



Homeoprotein Phox2b commands a somatic-to-visceral switch in cranial sensory pathways  

PubMed Central

Taste and most sensory inputs required for the feedback regulation of digestive, respiratory, and cardiovascular organs are conveyed to the central nervous system by so-called “visceral” sensory neurons located in three cranial ganglia (geniculate, petrosal, and nodose) and integrated in the hindbrain by relay sensory neurons located in the nucleus of the solitary tract. Visceral sensory ganglia and the nucleus of the solitary tract all depend for their formation on the pan-visceral homeodomain transcription factor Phox2b, also required in efferent neurons to the viscera. We show here, by genetically tracing Phox2b+ cells, that in the absence of the protein, many visceral sensory neurons (first- and second-order) survive. However, they adopt a fate—including molecular signature, cell positions, and axonal projections—akin to that of somatic sensory neurons (first- and second-order), located in the trigeminal, superior, and jugular ganglia and the trigeminal sensory nuclei, that convey touch and pain sensation from the oro-facial region. Thus, the cranial sensory pathways, somatic and visceral, are related, and Phox2b serves as a developmental switch from the former to the latter.

D'Autreaux, Fabien; Coppola, Eva; Hirsch, Marie-Rose; Birchmeier, Carmen; Brunet, Jean-Francois



Acute Abdomen and Perforated Bowel with a Rare Pathology: Nonfamilial Visceral Myopathy  

PubMed Central

Visceral myopathy is a rare chronic disease affecting the peristalsis of the bowel causing intermittent pseudoobstruction. We report an atypical case of an eighty-nine-year-old woman with no prior history of abdominal illness who was admitted to our hospital with 2 days of increasing nausea, abdominal distension, and abdominal pain. On arrival at the hospital, she was critically ill. Abdominal X-ray showed distended loops of the colon and liquid levels resembling colonic obstruction. A subsequent abdominal CT scan confirmed the colonic obstruction. A suspicion of sigmoid volvulus was raised, that is why a barium enema was performed but no lower colonic obstruction could be confirmed. Acute laparotomy showed perforated cecum without intestinal obstruction. Postoperatively, the patient became septic which was fatal for the patient. Pathology gave the diagnosis visceral myopathy. It is very difficult to make the diagnosis clinically and radiologically since visceral myopathy mimics other more common gastrointestinal diseases. It is important to consider visceral myopathy as a possible diagnosis in cases with recurrent episodes of abdominal pain, vomiting, and abdominal distension, but without actual intestinal obstruction.

Burcharth, Jakob; Olsen, Caroline; Rosenberg, Jacob



Brainstem facilitations and descending serotonergic controls contribute to visceral nociception but not pregabalin analgesia in rats  

PubMed Central

Pro-nociceptive ON-cells in the rostral ventromedial medulla (RVM) facilitate nociceptive processing and contribute to descending serotonergic controls. We use RVM injections of neurotoxic dermorphin-saporin (Derm-SAP) in rats to evaluate the role of putative ON-cells, or ?-opioid receptor-expressing (MOR) neurones, in visceral pain processing. Our immunohistochemistry shows that intra-RVM Derm-SAP locally ablates a substantial proportion of MOR and serotonergic cells. Given the co-localization of these neuronal markers, some RVM ON-cells are serotonergic. We measure visceromotor responses in the colorectal distension (CRD) model in control and Derm-SAP rats, and using the 5-HT3 receptor antagonist ondansetron, we demonstrate pro-nociceptive serotonergic modulation of visceral nociception and a facilitatory drive from RVM MOR cells. The ?2? calcium channel ligand pregabalin produces state-dependent analgesia in neuropathy and osteoarthritis models relating to injury-specific interactions with serotonergic facilitations from RVM MOR cells. Although RVM MOR cells mediate noxious mechanical visceral input, we show that their presence is not a permissive factor for pregabalin analgesia in acute visceral pain.

Sikandar, Shafaq; Bannister, Kirsty; Dickenson, Anthony H.



Perceived success and failure of intrathecal infusion pump implantation in chronic pain patients.  


Objectives.? Over the past few years, there has been an increased reliance on the intrathecal delivery of drugs for patients suffering from intractable pain. We sought to demonstrate the effectiveness of the intrathecal pain pump by examining self-reported pre- and postimplantation pain levels. Methods.? Eighty-four patients who had elected to implant a Medtronic SynchroMed 1 or 2 system in order to control their pain were asked to complete a survey. The survey consisted of pain ratings before implantation, pain ratings postimplantation, medications used before and after implantation, and patient satisfaction with the procedure. Results.? Perceived success rate for implantation is 68%, when measured by the ability to reduce reliance on oral medication. When measured by willingness to undergo the procedure again, the success rate is 86%. Conclusions.? Overall, the implantation of an intrathecal pain pump is an effective way for most people to manage their intractable pain and reduce reliance on oral medications. PMID:22151041

Corrado, Philip; Alperson, Burton; Wright, Michelle



Pain Acceptance Moderates the Relation Between Pain and Negative Affect in Osteoarthritis and Fibromyalgia Patients  

PubMed Central

Background Chronic pain is often intractable despite advanced medical and psychotherapeutic treatments. Pain acceptance is emerging as a promising complement to control-based pain management strategies and a likely approach to maintaining quality of life for chronic pain patients. Purpose This theoretically-based analysis of an existing database examined the extent to which pain acceptance predicted weekly reports of positive affect (PA) and negative affect (NA), and the relations of pain severity to both PA and NA. Methods Participants were women, 35 with osteoarthritis and 75 with fibromylagia, who completed an initial assessment for demographics, pain catastrophizing, and pain acceptance, and 8?12 weekly assessments of pain severity, PA, and NA. Results Multilevel modeling analyses indicated that pain acceptance was related to higher levels of PA but was unrelated to NA. Furthermore, pain acceptance moderated the relation of NA and pain severity, such that expected increases in NA during pain exacerbations were buffered by higher levels of pain acceptance. Conclusions These findings suggest that pain patients with greater capacity to accept pain may be emotionally resilient in managing their condition.

Kratz, Anna L.; Davis, Mary C.; Zautra, Alex J.



Deep brain stimulation for the alleviation of post-stroke neuropathic pain  

Microsoft Academic Search

Our aim was to asses the efficacy of deep brain stimulation in post-stroke neuropathic pain. Since 2000, 15 patients with post-stroke intractable neuropathic pain were treated with deep brain stimulation of the periventricular gray area (PVG), sensory thalamus (Ventroposterolateral nucleus-VPL) or both. Pain was assessed using both a visual analogue scale and the McGill's pain questionnaire. VAS scores show a

Sarah L. F. Owen; Alexander L. Green; John F. Stein; Tipu Z. Aziz



Descending modulation of visceral nociceptive transmission from the locus coeruleus\\/subcoeruleus in the rat  

Microsoft Academic Search

The purpose of the present investigation was to examine whether electrical stimulation in the locus coeruleus\\/subcoeruleus (LC\\/SC) could modulate visceral pain evoked by noxious colorectal distention (CRD). Experiments were performed on 40 pentobarbital anesthetized male Sprague–Dawley rats. Extracellular potentials of single L6–S2 spinal neuron were recorded with a carbon filament electrode. CRD (80mmHg) was produced by inflating a balloon inside

Limin Liu; Masayoshi Tsuruoka; Masako Maeda; Bunsho Hayashi; Xiaomin Wang; Tomio Inoue



Sex Differences in Functional Brain Activation during Noxious Visceral Stimulation in Rats  

PubMed Central

Studies in healthy human subjects and patients with irritable bowel syndrome suggest sex differences in cerebral nociceptive processing. Here we examine sex differences in functional brain activation in the rat during colorectal distention (CRD), a preclinical model of acute visceral pain. [14C]-iodoantipyrine was injected intravenously in awake, nonrestrained female rats during 60-mmHg or 0-mmHg CRD while electromyographic abdominal activity (EMG) and pain behavior were recorded. Regional cerebral blood flow related tissue radioactivity was analyzed by statistical parametric mapping from autoradiographic images of 3-dimensionally reconstructed brains. Sex differences were addressed by comparing current data with our previously published data collected from male rats. While sex differences in EMG and pain scores were modest, significant differences were noted in functional brain activation. Females showed widespread changes in limbic (amygdala, hypothalamus) and paralimbic structures (ventral striatum, nucleus accumbens, raphe), while males demonstrated broad cortical changes. Sex differences were apparent in the homeostatic afferent network (parabrachial nucleus, thalamus, insular and dorsal anterior cingulate cortices), in an emotional-arousal network (amygdala, locus coeruleus complex), and in cortical areas modulating these networks (prefrontal cortex). Greater activation of the ventromedial prefrontal cortex and broader limbic/paralimbic changes in females suggest greater engagement of affective mechanisms during visceral pain. Greater cortical activation in males is consistent with the concept of greater cortical inhibitory effects on limbic structures in males, which may relate to differences in attentional and cognitive attribution to visceral stimuli. These findings show remarkable similarities to reported sex differences in brain responses to visceral stimuli in humans.

Bradesi, Sylvie; Labus, Jennifer S.; Maarek, Jean-Michel I.; Lee, Kevin; Winchester, Wendy J.; Mayer, Emeran A.; Holschneider, Daniel P.



Role of Neurogenic Inflammation in Pancreatitis and Pancreatic Pain  

PubMed Central

Pain arising from pancreatic diseases can become chronic and difficult to treat. There is a paucity of knowledge regarding the mechanisms that sensitize neural pathways that transmit noxious information from visceral organs. In this review, neurogenic inflammation is presented as a possible amplifier of the noxious signal from peripheral organs including the pancreas. The nerve pathways that transmit pancreatic pain are also reviewed as a conduit of the amplified signals. It is likely that components of these visceral pain pathways can also be sensitized after neurogenic inflammation.

Vera-Portocarrero, Louis; Westlund, Karin N.



Progesterone therapy in women with intractable catamenial epilepsy  

PubMed Central

Background: Catamenial epilepsy is a kind of epilepsy, known in this name, when the periodicity of the exacerbation of the seizure is in association with menstural cycle. The present study examined the progesterone effectiveness as a complementary treatment in women with intractable catamenial epilepsy. Materials and Methods: The present study was conducted as a double-blind randomized controlled trial on 38 women with intractable catamenial epilepsy. Patients were assessed in two groups: The case group received in addition to AEDs, two (Mejestrol) 40 mg progesterone tablets in the second half of the cycle from 15th to 25th day. And the control group received in addition to AEDs, two placebo tablets daily. Age, BMI, epilepsy duration, types of the drugs used, progesterone level, and the number of the seizures in 3 months before and after the study were compared. Results: Based on the results of which there was no statistically significant difference in regard to age, BMI, epilepsy duration, types of the drugs used, progesterone level between the case and the control groups (P-value > 0.05). The number of the seizures after treatment has significantly decreased compared to before-treatment state. The degree of decreasing in the case group receiving the progesterone was higher than in the control group receiving the placebo. The difference, thus, is significant, based on statistical tests (P-value = 0.024). Conclusion: Based on the findings of this study using progesterone in women with intractable catamenial epilepsy has a significant effect on the degree of decreasing in the number of the seizures.

Najafi, Mohammadreza; Sadeghi, Maedeh Mirmohamad; Mehvari, Jafar; Zare, Mohammad; Akbari, Mojtaba



Biofeedback and Visceral Learning: Clinical Applications.  

National Technical Information Service (NTIS)

Basic research in animals and man indicates that visceral and neural processes can be modified by biofeedback and operant conditioning techniques. This research has suggested that the techniques may be useful in alleviating symptoms of psychosomatic and o...

D. Shapiro G. E. Schwartz



Efficacy of the Atkins diet as therapy for intractable epilepsy.  


The ketogenic diet is effective for treating seizures in children with epilepsy. The Atkins diet can also induce a ketotic state, but has fewer protein and caloric restrictions, and has been used safely by millions of people worldwide for weight reduction. Six patients, aged 7 to 52 years, were started on the Atkins diet for the treatment of intractable focal and multifocal epilepsy. Five patients maintained moderate to large ketosis for periods of 6 weeks to 24 months; three patients had seizure reduction and were able to reduce antiepileptic medications. This provides preliminary evidence that the Atkins diet may have a role as therapy for patients with medically resistant epilepsy. PMID:14694049

Kossoff, Eric H; Krauss, Gregory L; McGrogan, Jane R; Freeman, John M



Adult rumination syndrome: Differentiation from psychogenic intractable vomiting  

PubMed Central

Rumination syndrome is known to exist in infants and mentally retarded adults since long time. In past few years, some reports appeared that showed its existence in adult patients also. It is frequently confused with the intractable vomiting in adults and misdiagnosis leads to delay in appropriate management. We are here describing the case of a female patient with rumination syndrome where specific points in the history delineated the presence of this illness and helped in appropriate management. The patient became symptom free soon after the diagnosis was reached.

Gupta, Ravi; Kalla, Mukesh; Gupta, Jugal Behari



Propranolol for intractable hemolysis after open heart operation.  


Postoperative intravascular hemolysis occurring in 2 patients was alleviated by propranolol. One patient underwent mitral valve replacement and had development of intractable hemolysis due to a paravalvular leak. The other patient underwent ventricular septal defect closure and had hemolysis caused by the Dacron patch. Both patients were given oral propranolol, and the degree of hemolysis decreased substantially. Although the exact mechanism of the propranolol effect on mechanical intravascular hemolysis is unclear, propranolol is thought to reduce the shearing stress between erythrocytes and the foreign material by slowing the velocity of the circulation. PMID:1953141

Okita, Y; Miki, S; Kusuhara, K; Ueda, Y; Tahata, T; Yamanaka, K



Visceral perception in irritable bowel syndrome  

Microsoft Academic Search

We wished to determine if visceral perception in the rectum and stomach is altered in patients with irritable bowel syndrome and to evaluate the effects on visceral sensation of 5-HT3 receptor blockade. Twelve community patients with diarrhea-predominant irritable bowel syndrome and 10 healthy controls were studied in a double-blind, randomized, placebo-controlled study. Using two barostats, the stomach and rectum were

Jaime Zighelboim; Nicholas J. Talley; Sidney F. Phillips; William S. Harmsen; Alan R. Zinsmeister



Eosinophilic meningitis: cause of a chronic pain syndrome.  

PubMed Central

Three tourists developed eosinophilic meningitis after visiting the Fijian Islands. Two had a severe and long lasting illness with chronic intractable pain. In one patient electrophysiological studies and MRI scan of the brain were abnormal and provided evidence of both radicular and cerebral parenchymal involvement by the most likely causative agent, Angiostrongylus cantonensis. Images

Clouston, P D; Corbett, A J; Pryor, D S; Garrick, R



Central lateral thalamic neurons receive noxious visceral mechanical and chemical input in rats.  


Thalamic intralaminar and medial nuclei participate mainly in affective and motivational aspects of pain processing. Unique to the present study were identification and characterization of spontaneously active neurons in the central lateral nucleus (CL) of the intralaminar thalamus, which were found to respond only to viscerally evoked noxious stimuli in animals under pentobarbital anesthesia. Responses to noxious colorectal distention, intrapancreatic bradykinin, intraperitoneal dilute acetic acid, and greater splanchnic nerve electrical stimulation were characterized. Electrophysiological recordings revealed activity in most CL neurons (93%) was excited (69%) or inhibited (31%) in response to noxious visceral stimulation of visceral nerves. Expression of c-Fos observed in CL nucleus after intensive visceral stimulation confirmed the activation. However, excited CL neurons did not have somatic fields, except in 3 of 43 (7%) CL neurons tested for responses to somatic stimulation (innocuous brush and noxious pinch). Intrathecal administration of morphine significantly reduced the increased responses of CL neurons to colorectal and pancreatic stimuli and was naloxone reversible. High-level thoracic midline dorsal column (DC) myelotomy also dramatically reduced responses, identifying the DC as a major route of travel from the spinal cord for CL input, in addition to input traveling ventromedially in the spinothalamic tract identified anatomically in a previous study. Spinal cord and lower brain stem cells providing input to medial thalamus were mapped after stereotaxic injections of a retrograde dye. These data combined with our previous data suggest that the CL nucleus is an important component of a medial visceral nociceptive system that may mediate attentional, affective, endocrine, motor, and autonomic responses to noxious visceral stimuli. PMID:19369360

Ren, Yong; Zhang, Liping; Lu, Ying; Yang, Hong; Westlund, Karin N



Therapeutic options for intractable hematuria in advanced bladder cancer.  


Intractable hematuria is a common and severe complication in patients with inoperable bladder carcinoma. The aim was to provide an overview of therapeutic options for such cases, and analyze their effectiveness and risk profile, so a systematic literature search of peer-reviewed papers published up to September 2012 was carried out. Various options are available to treat hematuria in patients with inoperable bladder cancer; these include orally administered epsilon-aminocaproic acid, intravesical formalin, alum or prostaglandin irrigation, hydrostatic pressure, urinary diversion, radiotherapy, embolization and intraarterial mitoxantrone perfusion. These treatment options are associated with different prospects of success, risks and side-effects. Well-designed and large studies comparing options are completely lacking. Despite various treatment options, management of intractable hematuria in patients with inoperable bladder cancer remains a challenge, and most of the reported methods should be seen as experimental. Interventional radiology and alum instillation seem to be suitable alternative options for patients who, after critical consideration, cannot be treated by irrigation, transurethral resection or palliative cystectomy. PMID:23387805

Abt, Dominik; Bywater, Mirjam; Engeler, Daniel Stephan; Schmid, Hans-Peter



The effects of duration of intractable epilepsy on memory function.  


We assessed whether duration (time since diagnosis) of intractable epilepsy is associated with progressive memory loss in 250 individuals with left or right temporal lobe epilepsy and those diagnosed with psychogenic nonepileptic seizures. Verbal and nonverbal memory function was assessed using several memory assessment measures administered to all individuals as part of a larger neuropsychological assessment. Multivariate multiple regression analyses demonstrated that duration of temporal lobe epilepsy and age of seizure onset are significantly related to verbal memory deficits in patients with epilepsy. The interaction between duration of epilepsy and diagnostic group was nonsignificant, as was the interaction between age at spell onset and diagnostic group. As measured by several neuropsychological memory tests, duration of disease adversely affects verbal memory performance in patients diagnosed with temporal lobe epilepsy. Our study also supports the notion that age at seizure onset significantly affects verbal memory performance in this population. These results have implications for the strategy of treatment and counseling of patients with intractable temporal lobe epilepsy. PMID:16931163

Kent, Glenn P; Schefft, Bruce K; Howe, Steven R; Szaflarski, Jerzy P; Yeh, Hwa-Shain; Privitera, Michael D



The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis  

PubMed Central

As a result of the rising epidemic of obesity, understanding body fat distribution and its clinical implications is critical to timely treatment. Visceral adipose tissue is a hormonally active component of total body fat, which possesses unique biochemical characteristics that influence several normal and pathological processes in the human body. Abnormally high deposition of visceral adipose tissue is known as visceral obesity. This body composition phenotype is associated with medical disorders such as metabolic syndrome, cardiovascular disease and several malignancies including prostate, breast and colorectal cancers. Quantitative assessment of visceral obesity is important for evaluating the potential risk of development of these pathologies, as well as providing an accurate prognosis. This review aims to compare different methods of measuring visceral adiposity with emphasis on their advantages and drawbacks in clinical practice.

Shuster, A; Patlas, M; Pinthus, J H; Mourtzakis, M



The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis.  


As a result of the rising epidemic of obesity, understanding body fat distribution and its clinical implications is critical to timely treatment. Visceral adipose tissue is a hormonally active component of total body fat, which possesses unique biochemical characteristics that influence several normal and pathological processes in the human body. Abnormally high deposition of visceral adipose tissue is known as visceral obesity. This body composition phenotype is associated with medical disorders such as metabolic syndrome, cardiovascular disease and several malignancies including prostate, breast and colorectal cancers. Quantitative assessment of visceral obesity is important for evaluating the potential risk of development of these pathologies, as well as providing an accurate prognosis. This review aims to compare different methods of measuring visceral adiposity with emphasis on their advantages and drawbacks in clinical practice. PMID:21937614

Shuster, A; Patlas, M; Pinthus, J H; Mourtzakis, M



Gut pain and hyperalgesia induced by capsaicin: a human experimental model  

Microsoft Academic Search

Human experimental visceral pain models using chemical stimulation are needed for the study of visceral hyperexcitability. Our aim was to stimulate the human gut with chemical activators (capsaicin, glycerol) and measure quantitatively the induced hyperexcitability to painful mechanical gut distension. Ten otherwise healthy subjects with an ileostoma participated. Increasing volumes of capsaicin 50 ?g\\/ml (0.25, 0.5, 0.75, 1.0, 1.5, 2.0,

Asbjørn Mohr Drewes; Klaus-Peter Schipper; Georg Dimcevski; Poul Petersen; Hans Gregersen; Peter Funch-Jensen; Lars Arendt-Nielsen



Occipital nerve stimulation for the treatment of intractable chronic migraine headache: ONSTIM feasibility study  

PubMed Central

Background: Medically intractable chronic migraine (CM) is a disabling illness characterized by headache ?15 days per month. Methods: A multicenter, randomized, blinded, controlled feasibility study was conducted to obtain preliminary safety and efficacy data on occipital nerve stimulation (ONS) in CM. Eligible subjects received an occipital nerve block, and responders were randomized to adjustable stimulation (AS), preset stimulation (PS) or medical management (MM) groups. Results: Seventy-five of 110 subjects were assigned to a treatment group; complete diary data were available for 66. A responder was defined as a subject who achieved a 50% or greater reduction in number of headache days per month or a three-point or greater reduction in average overall pain intensity compared with baseline. Three-month responder rates were 39% for AS, 6% for PS and 0% for MM. No unanticipated adverse device events occurred. Lead migration occurred in 12 of 51 (24%) subjects. Conclusion: The results of this feasibility study offer promise and should prompt further controlled studies of ONS in CM.

Saper, Joel R; Dodick, David W; Silberstein, Stephen D; McCarville, Sally; Sun, Mark; Goadsby, Peter J



Peace Education in Societies Involved in Intractable Conflicts: Direct and Indirect Models  

ERIC Educational Resources Information Center

The present article deals with the crucial question: Can peace education facilitate change in the sociopsychological infrastructure that feeds continued intractable conflict and then how the change can be carried? Intractable conflicts still rage in various parts of the globe, and they not only cause local misery and suffering but also threaten…

Bar-Tal, Daniel; Rosen, Yigal



Psychological Dynamics of Intractable Ethnonational Conflicts: The Israeli–Palestinian Case  

Microsoft Academic Search

In this article, the authors use the Israeli–Palestinian conflict as an example of ostensibly intractable ethnonational conflict and examine the psychological dynamics that contribute to its intractability. They review the unique characteristics of this conflict and the clash of narratives. They argue that some ethnonational conflicts have characteristics that increase their resistance to change and that societies in such conflicts

Nadim N. Rouhana; Daniel Bar-Tal



Various indications for a modified Atkins diet in intractable childhood epilepsy  

Microsoft Academic Search

Purpose: We reviewed retrospectively our experiences with children with intractable epilepsy who were indicated for a modified Atkins diet (MAD). Methods: Twenty children (8 female, 12 male) who were aged 2–17years with intractable epilepsy and tried the MAD between September 2008 and December 2010 were enrolled. Outcome measures included seizure frequency, adverse reactions and tolerability of the diet. Results: Finally

Yoon Mi Kim; Varsha Viranchi Vaidya; Timur Khusainov; Heung Dong Kim; Shin-Hye Kim; Eun Joo Lee; Young Mock Lee; Joon Soo Lee; Hoon-Chul Kang


Regional brain activation in conscious, nonrestrained rats in response to noxious visceral stimulation.  


Preclinical drug development for visceral pain has largely relied on quantifying pseudoaffective responses to colorectal distension (CRD) in restrained rodents. However, the predictive value of changes in simple reflex responses in rodents for the complex human pain experience is not known. Male rats were implanted with venous cannulas and with telemetry transmitters for abdominal electromyographic (EMG) recordings. [(14)C]-iodoantipyrine was injected during noxious CRD (60 mmHg) in the awake, nonrestrained animal. Regional cerebral blood flow (rCBF)-related tissue radioactivity was quantified by autoradiography and analyzed in the three-dimensionally reconstructed brain by statistical parametric mapping. 60-mmHg CRD, compared with controls (0 mmHg) evoked significant increases in EMG activity (267+/-24% vs. 103+/-8%), as well as in behavioral pain score (77+/-6% vs. 3+/-3%). CRD elicited significant increases in rCBF as expected in sensory (insula, somatosensory cortex), and limbic and paralimbic regions (including anterior cingulate cortex and amygdala). Significant decreases in rCBF were seen in the thalamus, parabrachial nucleus, periaqueductal gray, hypothalamus and pons. Correlations of rCBF with EMG and with behavioral pain score were noted in the cingulate, insula, lateral amygdala, dorsal striatum, somatosensory and motor regions. Our findings support the validity of measurements of cerebral perfusion during CRD in the freely moving rat as a model of functional brain changes in human visceral pain. However, not all regions demonstrating significant group differences correlated with EMG or behavioral measures. This suggests that functional brain imaging captures more extensive responses of the central nervous system to noxious visceral distension than those identified by traditional measures. PMID:18538929

Wang, Zhuo; Bradesi, Sylvie; Maarek, Jean-Michel I; Lee, Kevin; Winchester, Wendy J; Mayer, Emeran A; Holschneider, Daniel P



Epidemiology and treatment of pain in multiple sclerosis subjects  

Microsoft Academic Search

Symptom management in multiple sclerosis (MS) represents a primary focus for neurologists, data available in the literature\\u000a on pain are lacking. There are no double-blind, parallel-arm, placebo-controlled trials and the majority of therapeutic approaches\\u000a are taken from clinical experience. Pain syndromes can be classified as nociceptive somatic\\/visceral, neuropathic and psycogenic\\u000a pain. Several studies has been recently pubblished addressing the prevalence

C. Solaro



Percutaneous destructive pain procedures on the upper spinal cord and brain stem in cancer pain: CT-guided techniques, indications and results.  


In the century of science and technology, the average life span has increased, bringing with it an increase in the incidence of degenerative and cancer disease. Intractable pain is usually the main symptom of cancer. With the advancement in technology, there is a large group of patients with intractable pain problems who can benefit from special help medically or surgically. Destructive pain procedures are necessary to control the cancer pain and are based on the lesioning of the pain conducting pathways. Percutaneous cordotomy, trigeminal tractotomy and extralemniscal myelotomy are special methods based on lesioning of the pain conducting pathways. The procedure consists of obtaining direct morphological appearance of the upper spinal cord and surrounding structures by computed tomography (CT). The next step is functional evaluation of the target and its environment by impedance measurement and stimulation. The final step is terminated with controlled lesioning obtained by a radiofrequency system (generator, needles, electrode system). In the last two decades, CT-guided destructive procedures were used as minimally invasive procedures as follows: percutaneous cordotomy (207 patients), trigeminal tractotomy-nucleotomy (65 patients), and extralemniscal myelotomy (16 patients). Most of these patients had cancer pain. Minimally invasive CT-guided destructive pain procedures are still safe and effective operations for relieving intractable cancer pain in selected cases. PMID:17907477

Kanpolat, Y



Scrambler Therapy for Patients with Cancer Pain - Case Series -  

PubMed Central

More than 80% of cancer patients experience cancer pain. Among them, more than 50% experience moderate to severe pain. To control cancer pain, a variety of methods have been used, including medications and nerve blocks. In some patients, however, it is impossible to perform nerve blocks due to caner metastasis into the epidural space, while in other patients, opioid dose escalation is impossible due to opioid side effects; thus, cancer pain management is difficult. Scrambler therapy is a novel approach for pain control that uses EKG-like pads, which are applied above and below the site of pain. Scrambler therapy synthesizes 16 different types of nerve action potentials that provide "non-pain" information via cutaneous nerves. The advantages of this treatment are that it is non-invasive and safe and has no significant side effects. In this case series, we report the treatment results of using scrambler therapy in three cancer patients with intractable pain.

Park, Hong Sik; Sin, Woo Kyung; Kim, Hye Young; Park, Soo Young; Kim, Yong Chul; Lee, Sang Chul



Scrambler therapy for patients with cancer pain - case series -.  


More than 80% of cancer patients experience cancer pain. Among them, more than 50% experience moderate to severe pain. To control cancer pain, a variety of methods have been used, including medications and nerve blocks. In some patients, however, it is impossible to perform nerve blocks due to caner metastasis into the epidural space, while in other patients, opioid dose escalation is impossible due to opioid side effects; thus, cancer pain management is difficult. Scrambler therapy is a novel approach for pain control that uses EKG-like pads, which are applied above and below the site of pain. Scrambler therapy synthesizes 16 different types of nerve action potentials that provide "non-pain" information via cutaneous nerves. The advantages of this treatment are that it is non-invasive and safe and has no significant side effects. In this case series, we report the treatment results of using scrambler therapy in three cancer patients with intractable pain. PMID:23342211

Park, Hong Sik; Sin, Woo Kyung; Kim, Hye Young; Moon, Jee Youn; Park, Soo Young; Kim, Yong Chul; Lee, Sang Chul



Total lymphoid irradiation for treatment of intractable cardiac allograft rejection  

SciTech Connect

The ability of postoperative total lymphoid irradiation to reverse otherwise intractable cardiac allograft rejection was examined in a group of 10 patients in whom conventional rejection therapy (including pulsed steroids and monoclonal or polyclonal anti-T-cell antibody therapy) had failed to provide sustained freedom from rejection. Follow-up periods range from 73 to 1119 days since the start of total lymphoid irradiation. No patient died or sustained serious morbidity because of the irradiation. Three patients have had no further rejection (follow-up periods, 105 to 365 days). Two patients died--one in cardiogenic shock during the course of total lymphoid irradiation, the other with recurrent rejection caused by noncompliance with his medical regimen. Total lymphoid irradiation appears to be a safe and a moderately effective immunosuppressive modality for 'salvage' therapy of cardiac allograft rejection unresponsive to conventional therapy.

Hunt, S.A.; Strober, S.; Hoppe, R.T.; Stinson, E.B. (Stanford Univ.Medical Center, CA (USA))



An acute postoperative intractable hyperventilation after an endoscopic third ventriculostomy.  


This report describes a rare case of postoperative hyperventilation attack after an endoscopic third ventriculostomy in a 46-year-old woman. About 60 min after the termination of the operation, an intractable hyperventilation started with respiratory rate of 65 breaths/min and EtCO(2), 16.3 mm Hg. Sedation with benzodiazepine, thiopental sodium, fentanyl, and propofol/remifentanil infusion was tried under a rebreathing mask at a 4 L/min of oxygen. With aggressive sedative challenges, ventilation pattern was gradually returned to normal during the 22 hrs of time after the surgery. A central neurogenic hyperventilation was suspected due to the stimulating central respiratory center by cold acidic irrigation solution during the neuroendoscopic procedure. PMID:22639718

Lee, Hae Mi; Shin, Kyung Bae; Kim, Seong Ho; Jee, Dae Lim



Surgical outcomes for intractable epilepsy in children with epileptic spasms.  


Epileptic spasms, or seizures marked by flexor, extensor, or flexor-extensor spasms, are not always responsive to medical management. The purpose of our study was to evaluate the outcome of epilepsy surgery in children with medically intractable epileptic spasms. We identified 11 children with epileptic spasms who underwent lesionectomy (36%), lobectomy (27%), multi-lobectomy (9%), hemispherectomy (18%), or corpus callosotomy (9%). At the time of surgery, 6 children had developed other concurrent seizure type(s), including simple partial (9%), complex partial (27%), partial undifferentiated (9%), primary generalized tonic clonic (9%), tonic (9%), atonic (27%), and myoclonic (9%) seizures. Six children (55%) were seizure free at last follow-up from initial surgery. Predictors of favorable outcome included lack of focal slowing and the presence of less than 2 interictal epileptiform abnormalities on postoperative electroencephalogram (P = .035 and .035, respectively). Favorable outcome was significantly associated with parent/caregiver report of improved postoperative developmental outcomes (P = .026). PMID:22123426

Moseley, Brian D; Nickels, Katherine; Wirrell, Elaine C



An Acute Postoperative Intractable Hyperventilation after an Endoscopic Third Ventriculostomy  

PubMed Central

This report describes a rare case of postoperative hyperventilation attack after an endoscopic third ventriculostomy in a 46-year-old woman. About 60 min after the termination of the operation, an intractable hyperventilation started with respiratory rate of 65 breaths/min and EtCO2, 16.3 mm Hg. Sedation with benzodiazepine, thiopental sodium, fentanyl, and propofol/remifentanil infusion was tried under a rebreathing mask at a 4 L/min of oxygen. With aggressive sedative challenges, ventilation pattern was gradually returned to normal during the 22 hrs of time after the surgery. A central neurogenic hyperventilation was suspected due to the stimulating central respiratory center by cold acidic irrigation solution during the neuroendoscopic procedure.

Lee, Hae Mi; Shin, Kyung Bae; Kim, Seong Ho



Intractable pneumothorax with empyema in a patient with interstitial pneumonia.  


Secondary pneumothorax occurring in interstitial lung disease cases is a refractory and life-threatening condition, because of compromised lung function. A 70-year-old woman with interstitial pneumonia was referred to our hospital after treatment failure for pneumothorax associated with empyema. An open window thoracostomy was created, and mechanical irrigation and dressing changes of the pleural cavity were performed. Then, the lung was widely covered with the latissimus dorsi and serratus anterior muscles because there were multiple fistulae on the lung surface. After the covering muscles were completely adhered to the lung surface and stopped air leaking, the chest was successfully closed. The wide covering technique of the lung with chest wall muscles is effective for intractable pneumothorax with multiple fistulae. PMID:23054619

Miyoshi, Shinichiro; Tamura, Motohiko; Araki, Osamu; Ikeda, Yasunori; Chida, Masayuki



Nurse management of intractable functional constipation: a randomised controlled trial  

PubMed Central

Aims: To evaluate the effectiveness of a nurse led clinic (NLC) compared with a consultant led paediatric gastroenterology clinic (PGC) in the management of chronic constipation. Methods: Children (age 1–15 years) with functional constipation were randomised following a detailed medical assessment to follow up in either the NLC or PGC. An escalating algorithm of treatment was used as the basis of management in both the NLC and PGC. Main outcome measures were: time to cure at last visit or later confirmed by telephone; time to cure at last visit; and time to prematurely leaving the study. Results: A total of 102 children were recruited, of whom 52 were randomly assigned to NLC and 50 to PGC. Outcome assessment showed that 34 children in the NLC and 25 children in the PGC were confirmed cured at their last visit or later confirmed by telephone. The median time to cure was 18.0 months in the NLC and 23.2 months in the PGC. The probability of being cured was estimated as 33% higher in the NLC compared to PGC (hazard ratio 1.33). Attending the NLC hastened time to cure by an estimated 18.4%. Conclusion: Children who attend an NLC are equally as, if not more likely to be cured of intractable constipation, than those attending a PGC and on average their cure will occur sooner. Results suggest that an NLC can significantly improve follow up for children with intractable constipation and highlight the important role for clinic nurse specialists in management of children with gastrointestinal disease.

Burnett, C; Juszczak, E; Sullivan, P



Monoclonal gammopathy after visceral leishmaniasis: just a coincidence?  


The authors describe a case of monoclonal gammopathy occurring about six months after a visceral leishmaniasis. A literature survey suggests that strong antigenic stimulation caused by visceral leishmaniasis can induce monoclonal gammopathy in a predisposed subject. PMID:18843217

Rombola, F; Spinoso, A; Bertuccio, S N



Midazolam for the treatment of phantom limb pain exacerbation: preliminary reports.  


Phantom pain is one of the most difficult intractable pains to manage. The pain may result from the imbalance of self-sustaining neural activity that exceeds the inhibitory control. The management of acute severe exacerbation of phantom pain is extremely difficult. Midazolam acts by potentiation of gamma aminobutyric acid (GABA) and enhance the inhibitory action of glycine receptor at spinal neurons. We describe two preliminary reports of complete pain relief of severe phantom pain exacerbation by intravenous midazolam 3-5 mg. PMID:11336093

Vichitrananda, C; Pausawasdi, S



Canine visceral leishmaniasis in Sicily.  


The Sicilian province of Catania is an active foci for human visceral leishmaniasis (VL) in the Mediterranean area. Approximately 10 to 15 cases of VL are diagnosed via hospital admissions each year in this community. Recently, an increase in VL case reporting by Sicilian physicians was noted, with 38 and 37 VL cases in 1996 and 1997, respectively. Before 1995, there were no reported VL cases among U.S. military personnel or their family members living in Sicily. However, since 1996, there have been four cases referred to Walter Reed Army Medical Center for diagnosis and treatment, all involving the children of personnel assigned to Naval Air Station Sigonella. Exposure histories for all infected individuals excluded exposure to Leishmania parasites outside of Sicily. All patients lived in areas where vectoring sandflies are present. All had dogs as family pets. To evaluate the level of infection among dogs owned by Navy personnel and their families, U.S. Navy Environmental and Preventive Medicine Unit 7, in a collaborative study with the U.S. Army Veterinary Clinic, Naval Air Station Sigonella, and the Walter Reed Army Institute of Research, performed clinical evaluation and serological testing of 50 dogs residing with U.S. personnel assigned to Naval Air Station Sigonella. The data indicate a high exposure rate to Leishmania (60% of the animals tested had elevated immunoglobulin M antibody levels) in the study population, suggesting that they were infected with Leishmania infantum. Distribution of seropositive dogs by sex was equal. Most of the dogs studied appeared to be in good health. However, inapparent infection of dogs, seen by Italian veterinarians, has been observed throughout all areas of Catania. Sandflies responsible for vectoring L. infantum were trapped in the same locations as the dogs sampled in this study. The level of subclinical infection was 75% among seropositive dogs. The overall level of canine infection observed was higher than expected. This study demonstrates an increased risk to military working dogs and companion dogs of U.S. personnel for infection with L. infantum during a 2- to 3-year tour in Sicily. PMID:10658425

Orndorff, G R; Cooper, B A; Smith, W; Ryan, J R



Separate revascularization of the visceral arteries in thoracoabdominal aneurysm repair  

Microsoft Academic Search

We successfully repaired a ruptured aortic patch containing the visceral arteries after thoracoabdominal aneurysm repair in a young patient with Marfan syndrome. This unexpected and tricky situation was treated by separate revascularization of each visceral artery using small-caliber prosthetic grafts as interposition between the aortic prosthesis and the ostia of the visceral arteries.

Thierry P Carrel; Christoph Signer



Cortical Processing of Human Somatic and Visceral Sensation  

Microsoft Academic Search

Somatic sensation can be localized precisely, whereas local- ization of visceral sensation is vague, possibly reflecting differ- ences in the pattern of somatic and visceral input to the cere- bral cortex. We used functional magnetic resonance imaging to study the cortical processing of sensation arising from the proximal (somatic) and distal (visceral) esophagus in six healthy male subjects. Esophageal stimulation

Q. Aziz; D. G. Thompson; V. W. K. Ng; S. Hamdy; S. Sarkar; M. J. Brammer; E. T. Bullmore; A. Hobson; I. Tracey; L. Gregory; A. Simmons; S. C. R. Williams



Pain caused by a dental implant impinging on an accessory inferior alveolar canal: a case report.  


This report presents a case history of intractable facial pain following the placement of a posterior mandibular implant. The pain was resistant to all medical management, but a cone beam computed tomography (CBCT) scan showed that the implant impinged on an unusual accessory inferior alveolar nerve. The decision to remove the implant led to significant pain reduction. This clinical example underscores the need for scrupulous imaging prior to implant placement. PMID:23476904

Maqbool, Arman; Sultan, Ahmed Ali; Bottini, Gian Battista; Hopper, Colin


Preoperative affective distress and somatic complaints predict persistent pain after postmastectomy breast reconstruction  

Microsoft Academic Search

Persistent pain is a common but undesirable outcome of breast cancer surgery. With the increasing popularity of breast reconstruction\\u000a after mastectomy for breast cancer, researchers have recently directed attention to the prevalence of intractable pain due\\u000a to reconstructive surgery. However, available studies that examine factors associated with the development of postreconstruction\\u000a pain are limited to clinical investigations that have been

R. S. Roth; J. C. Lowery; J. Davis; E. G. Wilkins



Sequential multiple visceral arteries dissections without aortic involvement.  


Isolated dissection of visceral arteries without associated aortic pathology is very rare. Risk factors, etiology, and natural history of this pathology continue to be unclear, and the guidelines for clinical management remain to be defined. We present a case not described previously, with sequential dissections of the celiac trunk, superior mesenteric artery, and renal arteries without aortic involvement. The patient presented with severe back thoracic and abdominal pain and without evidence of peritonitis. An abdominal angio-CT scan showed dissection of the superior mesenteric artery (SMA), with partial thrombosis of the false lumen and subsequent stenosis of around 60%. Conservative treatment with anticoagulants seemed to be appropriate in the beginning, because the patient became asymptomatic spontaneously within a few hours and angio-CT showed dissection but no ischemic lesions. On day 10 after onset, however, he again indicated severe back thoracic and abdominal pain. Emergent CT was performed. The prior SMA dissection appeared to be worse due to increased size of the false lumen, followed by SMA stenosis (about 75?80%). In addition, dissection of the celiac artery and both renal arteries could be seen. The patient underwent angiography and stenting of the main trunk of the SMA, with good clinical and radiologic outcome. Double oral antiplatelet therapy was then introduced. An angio-MRI scan 6 months later showed stability of the multiple dissections. PMID:23522441

Bonardelli, Stefano; Battaglia, Giuseppe; Zanotti, Camilla; Cervi, Edoardo; Guadrini, Cristina; Giulini, Stefano M



Low cost continuous femoral nerve block for relief of acute severe cancer related pain due to pathological fracture femur.  


Pathological fractures in cancer patient cause severe pain that is difficult to control pharmacologically. Even with good pain relief at rest, breakthrough and incident pain can be unmanageable. Continuous regional nerve blocks have a definite role in controlling such intractable pain. We describe two such cases where severe pain was adequately relieved in the acute phase. Continuous femoral nerve block was used as an efficient, cheap and safe method of pain relief for two of our patients with pathological fracture femur. This method was proved to be quite efficient in decreasing the fracture-related pain and improving the level of well being. PMID:21218010

Koshy, Rachel Cherian; Padmakumar, G; Rajasree, O



[Aneurysm of the unpaired visceral aortal branches].  


Clinical signs, data of additional methods of examination, results of surgical treatment of patients for aneurysm of unpaired visceral aortal branches were analyzed. Specific complaints and clinical signs are absent. Most informative and trustworthy method of investigation is a computer tomography. In the sizes of aneurysm more than 2 cm surgical treatment is indicated. PMID:23987031

Nikonenko, A A; Nikul'nikov, P I; Furkalo, S N



Visceral artery aneurysms in Von Recklinghausen's neurofibromatosis  

Microsoft Academic Search

We report the case of a patient with Von Recklinghausen's neurofibromatosis in whom two visceral artery aneurysms were diagnosed: a 4 cm aneurysm originating from the common hepatic artery and a smaller aneurysm originating from the superior mesenteric artery. The hepatic artery aneurysm underwent successful embolization. Because of the patient's poor general condition, the superior mesenteric aneurysm was considered inoperable

Réda Hassen-Khodja; Serge Declemy; Michel Batt; Jérôme Castanet; Christophe Perrin; Jean-Paul Ortonne; Pierre Le Bas



Visceral leishmaniasis (kala-azar) and pregnancy.  

PubMed Central

OBJECTIVE: The aim of the present review was to close the gap in the approach to pregnant women with visceral leishmaniasis (kala-azar) by providing up-to-date information to obstetricians about physiopathology, epidemiology, vertical transmission, drugs and treatment during pregnancy. BACKGROUND: Infection with Leishmania chagasi during pregnancy is rare and deserves special attention since little information is available regarding the occurrence of visceral leishmaniasis during gestational period and the real possibility of vertical transmission of this disease. Because specific areas in the world are endemic for the disease and considering the continuous growth of the population, cases of pregnant women with visceral leishmaniasis are becoming more frequent. Unfortunately, textbooks on infectious diseases do not include this specific group of patients, and studies in the literature on aspects related to pregnancy and visceral leishmaniasis are scarce. CONCLUSIONS: Vertical transmission of leishmaniasis is possible and the institution of treatment is imperative in cases of pregnant women with kala-azar. Amphotericin B is strongly recommended as the first choice drug due to its fewer maternal-fetal adverse effects.

Figueiro-Filho, Ernesto Antonio; Duarte, Geraldo; El-Beitune, Patricia; Quintana, Silvana Maria; Maia, Tamara Lemos



Cerebral cortical registration of subliminal visceral stimulation  

Microsoft Academic Search

Background & Aims:Although brain registration of subliminal somatic stimulations such as masked visual stimuli and their influence on electrical and hemodynamic measures of cerebral activity have been reported previously, there have been no reports on cerebral cortical registration of subliminal visceral stimulation. Because studies evaluating the consequences of subliminal somatic stimulation have shown that subliminal stimulation can effect behavior, it

Mark K. Kern; Reza Shaker



Noninvasive Molecular Diagnosis of Human Visceral Leishmaniasis?  

PubMed Central

Previously developed methods for noninvasive PCR diagnosis of visceral leishmaniasis (VL) have significant limitations. Diagnosis of VL using PCR and buccal swabs was evaluated in 307 subjects, including 148 patients confirmed to have VL. This method is simple and well tolerated and has good potential for development, showing 83% sensitivity with 90.56% specificity in control groups.

Vaish, Manisha; Mehrotra, Sanjana; Chakravarty, Jaya; Sundar, Shyam



Mechanical behavior of excised canine visceral pleura.  


A computer-controlled optical electromechanical biaxial test system was employed to study the mechanical response of excised sheets of canine visceral pleura. Three classes of tests were performed: uniform biaxial stretching tests and tests in which the specimen was cyclically stretched along one axis while either the load or dimension was maintained at a prescribed level in the orthogonal direction. The tests were defined completely within the software. Strain was inferred from tracking four particles affixed to the central region of the specimen surface. The visceral pleura was found to behave similarly to other biological soft tissues and required preconditioning to yield repeatable responses. In addition, the visceral pleura appeared to possess in-plane transverse isotropic material symmetry and to exhibit strong in-plane mechanical coupling at lower loads. The data presented herein is sufficient for determination of certain three-dimensional constitutive laws which are essential for further biomechanical analyses of the visceral pleura's role in lung response. PMID:3789490

Humphrey, J D; Vawter, D L; Vito, R P



Central poststroke pain: An abstruse outcome  

PubMed Central

Central poststroke pain (CPSP), formerly known as thalamic pain syndrome of Déjerine and Roussy, is a central neuropathic pain occurring in patients affected by stroke. It is one manifestation of central pain, which is broadly defined as central neuropathic pain caused by lesions or dysfunction in the central nervous system. Thalamic pain was first described 100 years ago by Déjerine and Roussy and has been described as “among the most spectacular, distressing, and intractable of pain syndromes”. CPSP is characterized by constant or intermittent pain and is associated with sensory abnormalities, particularly of thermal sensation. While the pain is frequently described as burning, scalding, or burning and freezing, other symptoms are usually vague and hard to characterize, making an early diagnosis particularly difficult. In fact, those who develop CPSP may no longer be under the care of health care professionals when their symptoms begin to manifest, resulting in misdiagnosis or a significant delay before treatment begins. Diagnosis is further complicated by cognitive and speech limitations that may occur following stroke, as well as by depression, anxiety and sleep disturbances. Patients may also exhibit spontaneous dysesthesia and the stimulus-evoked sensory disturbances of dysesthesia, allodynia and hyperalgesia. The present study offers a historical reference point for future clinical and basic research into this elusive type of debilitating pain.

Henry, James L; Lalloo, Chitra; Yashpal, Kiran



Central poststroke pain: an abstruse outcome.  


Central poststroke pain (CPSP), formerly known as thalamic pain syndrome of Déjerine and Roussy, is a central neuropathic pain occurring in patients affected by stroke. It is one manifestation of central pain, which is broadly defined as central neuropathic pain caused by lesions or dysfunction in the central nervous system. Thalamic pain was first described 100 years ago by Déjerine and Roussy and has been described as "among the most spectacular, distressing, and intractable of pain syndromes". CPSP is characterized by constant or intermittent pain and is associated with sensory abnormalities, particularly of thermal sensation. While the pain is frequently described as burning, scalding, or burning and freezing, other symptoms are usually vague and hard to characterize, making an early diagnosis particularly difficult. In fact, those who develop CPSP may no longer be under the care of health care professionals when their symptoms begin to manifest, resulting in misdiagnosis or a significant delay before treatment begins. Diagnosis is further complicated by cognitive and speech limitations that may occur following stroke, as well as by depression, anxiety and sleep disturbances. Patients may also exhibit spontaneous dysesthesia and the stimulus-evoked sensory disturbances of dysesthesia, allodynia and hyperalgesia. The present study offers a historical reference point for future clinical and basic research into this elusive type of debilitating pain. PMID:18301815

Henry, James L; Lalloo, Chitra; Yashpal, Kiran


Activation of Colonic Mucosal 5-HT4 Receptors Accelerates Propulsive Motility and Inhibits Visceral Hypersensitivity  

PubMed Central

BACKGROUND & AIMS 5-hydroxytryptamine receptor (5-HT4R) agonists promote gastrointestinal motility and attenuate visceral pain, but concerns about adverse reactions have restricted their availability. We tested the hypotheses that 5-HT4 receptors are expressed in the colonic epithelium and that 5-HT4R agonists can act intraluminally to increase motility and reduce visceral hypersensitivity. METHODS Mucosal expression of the 5-HT4R was evaluated by reverse-transcriptase polymerase chain reaction and immunohistochemical analysis of tissues from 5-HT4R(BAC)-enhanced green fluorescent protein mice. Amperometry, histology, and short-circuit current measurements were used to study 5-HT, mucus, and Cl? secretion, respectively. Propulsive motility was measured in guinea pig distal colon, and visceromotor responses were recorded in a rat model of colonic hypersensitivity. 5-HT4R compounds included cisapride, tegaserod, naronapride, SB204070, and GR113808. RESULTS Mucosal 5-HT4 receptors were present in the small and large intestines. In the distal colon, 5-HT4 receptors were expressed by most epithelial cells, including enterochromaffin and goblet cells. Stimulation of 5-HT4Rs evoked mucosal 5-HT release, goblet cell degranulation, and Cl? secretion. Luminal administration of 5-HT4R agonists accelerated propulsive motility; a 5-HT4R antagonist blocked this effect. Bath application of 5-HT4R agonists did not affect motility. Oral or intracolonic administration of 5-HT4R agonists attenuated visceral hypersensitivity. Intracolonic administration was more potent than oral administration, and was inhibited by a 5-HT4R antagonist. CONCLUSIONS Mucosal 5-HT4 receptor activation can mediate the prokinetic and antinociceptive actions of 5-HT4R agonists. Colon-targeted, intraluminal delivery of 5-HT4R agonists might be used to promote motility and alleviate visceral pain, while restricting systemic bioavailability and resulting adverse side effects.




Retinectomy for treatment of intractable glaucoma: long term results  

PubMed Central

Aim: To report long term efficacy and complications of retinectomy as an intraocular pressure lowering procedure for intractable glaucoma. Methods: This was a consecutive interventional case series. In 44 consecutive eyes (39 patients, 22 men and 17 women) retinectomy was performed to lower the intraocular pressure (IOP) in patients with uncontrolled IOP (>35 mm Hg for more than 4 months) despite conventional filtering surgery and drug treatment. Pars plana vitrectomy was performed and the peripheral retina was surgically excised to various degrees. The procedure was concluded by an intraocular gas tamponade of 20% C3F8. Included were patients with neovascular glaucoma (12 eyes), infantile and juvenile glaucoma (three eyes), secondary glaucoma due to aphakia (13 eyes), severe ocular trauma (seven eyes), uveitis (seven eyes), and glaucoma in Ehlers-Danlos syndrome (two). Results: All patients underwent successful surgical retinectomy. All patients were followed for 5 years. Mean postoperative IOP after 4 years was 15.7 (SD 9.4) mm Hg, representing a decrease of IOP by 61% compared to the preoperative level (41.2 (9.4) mm Hg). In 52.3% of eyes long term regulation of IOP could be achieved without complications. Retinectomy was least effective in neovascular glaucoma because of central retinal vein occlusion (CRVO). Eyes with glaucoma secondary to uveitis showed a tendency towards low IOP levels with subsequent phthisis bulbi. The initial visual acuity of all patients was lower than 20/50 (mean 1.8 (0.8) logMAR) in the treated eye. Final visual acuity was 2.3 (0.6) logMAR. 21 out of 44 cases developed retinal complications (retinal detachment or proliferative vitreoretinopathy (PVR)) after surgery, requiring silicone tamponade in 11 eyes (52%) either for persistent low IOP or for PVR. Nine eyes developed phthisis, seven of which were enucleated during the follow up. Conclusions: Long term results after retinectomy demonstrate its efficacy in otherwise intractable glaucoma. Efficacy and safety of retinectomy are dependent on the underlying disease.

Joussen, A M; Walter, P; Jonescu-Cuypers, C P; Koizumi, K; Poulaki, V; Bartz-Schmidt, K U; Krieglstein, G K; Kirchhof, B



Responsive neurostimulation for the treatment of medically intractable epilepsy.  


With an annual incidence of 50/100,000 people, nearly 1% of the population suffers from epilepsy. Treatment with antiepileptic medication fails to achieve seizure remission in 20-30% of patients. One treatment option for refractory epilepsy patients who would not otherwise be surgical candidates is electrical stimulation of the brain, which is a rapidly evolving and reversible adjunctive therapy. Therapeutic stimulation can involve direct stimulation of the brain nuclei or indirect stimulation of peripheral nerves. There are three stimulation modalities that have class I evidence supporting their uses: vagus nerve stimulation (VNS), stimulation of the anterior nuclei of the thalamus (ANT), and, the most recently developed, responsive neurostimulation (RNS). While the other treatment modalities outlined deliver stimulation regardless of neuronal activity, the RNS administers stimulation only if triggered by seizure activity. The lower doses of stimulation provided by such responsive devices can not only reduce power consumption, but also prevent adverse reactions caused by continuous stimulation, which include the possibility of habituation to long-term stimulation. RNS, as an investigational treatment for medically refractory epilepsy, is currently under review by the FDA. Eventually systems may be developed to enable activation by neurochemical triggers or to wirelessly transmit any information gathered. We review the mechanisms, the current status, the target options, and the prospects of RNS for the treatment of medically intractable epilepsy. PMID:23735806

Liu, Chong; Wen, Xiong-Wei; Ge, Yan; Chen, Ning; Hu, Wen-Han; Zhang, Tan; Zhang, Jian-Guo; Meng, Fan-Gang



[Intractable vasculitis: general consideration-concept and classification: pathological aspects].  


Vasculitis may be defined as an inflammatory process, primarily affecting the vascular wall which possesses an architecture, such as organ or tissue, and accordingly may not include the capillary. Since the walls are destroyed, secondary circulatory disturbances may be associated and produce vasculitic symptoms, which are nonspecific in most instances. Although the pathogenesis of most vasculitides is well understood, the lack of knowledge of the etiology makes it difficult to establish a satisfactory classification of vasculitis. The inflammatory lesions tend to be distributed along the course of the vessels throughout the body in most systemic vasculitic syndromes but long segments are frequently affected in the arteritides of large arteries. In recent years, a classification, useful for understanding the clinical manifestations of these vasculitic disorders, is based on the predominant size of the involved vessels, which may be categorized into large arteries (aorta and its primary branches), medium-sized to small muscular arteries and small vessels (arterioles and venules). Certain vasculitides may occur as a primary disease process, whereas others may be associated with other primary disorders. In general, idiopathic primary vasculitides have an extremely poor prognosis and are intractable. However, recent advances of drug therapies in the early stage of the systemic necrotizing vasculitides, such as Wegener's granulomatosis, has bettered prognosis. In the patients with Takayasu's arteritis, life has been prolonged over more than ten years. As a result, additional problems, such as luminal stenosis or dilatation of the involved vessels, have occurred. PMID:7933570

Hotchi, M



Treatment of intractable rheumatoid arthritis with total lymphoid irradiation  

SciTech Connect

Eleven patients with intractable rheumatoid arthritis were treated with total lymphoid irradiation (total dose, 2000 rad) in an uncontrolled feasibility study, as an alternative to long-term therapy with cytotoxic drugs such as cyclophosphamide and azathioprine. During a follow-up period of five to 18 months after total lymphoid irradiation, there was a profound and sustained suppression of the absolute lymphocyte count and in vitro lymphocyte function, as well as an increase in the ratio of Leu-2 (suppressor/cytotoxic) to Leu-3 (helper) T cells in the blood. Persistent circulating suppressor cells of the mixed leukocyte response and of pokeweed mitogen-induced immunoglobulin secretion developed in most patients. In nine of the 11 patients, these changes in immune status were associated with relief of joint tenderness and swelling and with improvement in function scores. Maximum improvement occurred approximately six months after irradiation and continued for the remainder of the observation period. Few severe or chronic side effects were associated with the radiotherapy.

Kotzin, B.L.; Strober, S.; Engleman, E.G.; Calin, A.; Hoppe, R.T.; Kansas, G.S.; Terrell, C.P.; Kaplan, H.S.



Treatment of intractable rheumatoid arthritis with total lymphoid irradiation  

SciTech Connect

Eleven patients with intractable rheumatoid arthritis were treated with total lymphoid irradiation (total dose, 2000 rad) in an uncontrolled feasibility study, as an alternative to long-term therapy with cytotoxic drugs such as cyclophosphamide and azathioprine. During a follow-up period of five to 18 months after total lymphoid irradiation, there was a profound and sustained suppression of the absolute lymphocyte count and in vitro lymphocyte function, as well as an increase in the ratio of Leu-2 (suppressor/cytotoxic) to Leu-3 (helper) T cells in the blood. Persistent circulating suppressor cells of the mixed leukocyte response and of pokeweek mitogen-induced immunoglobulin secretion developed in most patients. In nine of the 11 patients, these changes in immune status were associated with relief of joint tenderness and swelling and with improvement in function scores. Maximum improvement occurred approximately six months after irradiation and continued for the remainder of the observation period. Few severe or chronic side effects were associated with the radiotherapy.

Kotzin, B.L.; Strober, S.; Engleman, E.G.; Calin, A.; Hoppe, R.T.; Kansas, G.S.; Terrell, C.P.; Kaplan, H.S.



Sustained improvement of intractable rheumatoid arthritis after total lymphoid irradiation  

SciTech Connect

Total lymphoid irradiation (TLI) was administered to 11 patients who had intractable rheumatoid arthritis that was unresponsive to conventional medical therapy, including aspirin, multiple nonsteroidal antiinflammatory drugs, gold salts, and D-penicillamine. Total lymphoid irradiation was given as an alternative to cytotoxic drugs such as azathioprine and cyclophosphamide. After radiotherapy, 9 of the 11 patients showed a marked improvement in clinical disease activity as measured by morning stiffness, joint tenderness, joint swelling, and overall functional abilities. The mean improvement of disease activity in all patients ranged from 40-70 percent and has persisted throughout a 13-28 month followup period. This improvement permitted the mean daily steroid dose to be reduced by 54%. Complications included severe fatigue and other constitutional symptoms during radiotherapy, development of Felty's syndrome in 1 patient, and an exacerbation of rheumatoid lung disease in another. After therapy, all patients exhibited a profound T lymphocytopenia, and a reversal in their T suppressor/cytotoxic cell to helper cell ratio. The proliferative responses of peripheral blood mononuclear cells to phytohemagglutinin, concanavalin A, and allogeneic leukocytes (mixed leukocyte reaction) were markedly reduced, as was in vitro immunoglobulin synthesis after stimulation with pokeweed mitogen. Alterations in T cell numbers and function persisted during the entire followup period, except that the mixed leukocyte reaction showed a tendency to return to normal values.

Field, E.H.; Strober, S.; Hoppe, R.T.; Calin, A.; Engleman, E.G.; Kotzin, B.L.; Tanay, A.S.; Calin, H.J.; Terrell, C.P.; Kaplan, H.S.



The Effects of Surgical Treatment for Focal Epilepsy. Impairment and Rehabilitation of Medically Intractable Epileptics.  

National Technical Information Service (NTIS)

The report discusses two groups of epileptic patients. One treated surgically (37 cases) and one treated medically (31 cases), were studied to ascertain factors of importance to their rehabilitation. Patients with chronic intractable epilepsy can be consi...

A. E. Walker D. Blumer



Posttraumatic Oxytocin Dysregulation: Is It a Link Among Posttraumatic Self Disorders, Posttraumatic Stress Disorder, and Pelvic Visceral Dysregulation Conditions in Women?  

Microsoft Academic Search

This article explicates a theory that oxytocin, a sexually dimorphic neurotransmitter and paracrine hormone, is a plausible mechanism linking early relational trauma with posttraumatic self disorders (e.g., dissociation, somatization, and interpersonal sensitivity), posttraumatic stress disorder, and pelvic visceral dysregulation disorders (e.g., irritable bowel syndrome, chronic pelvic pain, interstitial cystitis, and hyperemesis gravidarum). This posttraumatic oxytocin dysregulation disorders theory is consistent

Julia S. Seng



Pediatric intractable epilepsy: the role of presurgical evaluation and seizure outcome  

Microsoft Academic Search

Surgical experience with long-term follow-up is limited in childhood intractable epilepsy, compared with adult epilepsy. To\\u000a assess the role of each presurgical evaluation modality and to identify prognostic factors for favorable seizure control after\\u000a epilepsy surgery, 38 children with intractable epilepsy who underwent surgery were retrospectively reviewed. Among the available\\u000a preoperative evaluation modalities, PET and neuropsychological testing showed the highest

Seung-Ki Kim; Kyu-Chang Wang; Yong-Seung Hwang; Ki Joong Kim; Dong Soo Lee; Yungnahn Yi; Byung-Kyu Cho



[Home nervous intractable diseases patient support system in our hospital-planned respite inpatient system].  


The current situation for patients with nervous intractable diseases is that there are few places where they can be hospitalized for a long term,and their family members bear a heavy burden for caring for them. In order to support home care,our hospital is formulating a system in which regular respite hospitalization is possible,and we are supporting home care of many patients with nervous intractable diseases. PMID:23268923

Harada, Yukiko; Fukagawa, Chie



Outpatient continuous interscalene brachial plexus block in cancer-related pain.  


This case outlines the use of a continuous interscalene brachial plexus block to treat cancer-related pain. Using an elastomeric device, the patient's previously intractable pain was controlled and he was able to return home. Furthermore, the patient developed a pragmatic and effective method of balancing loss of power and sensation against pain control using the flow restrictor. This case illustrates the potential of an integrated approach to cancer pain management to obtain rapid pain relief in the acute hospital setting. PMID:19822278

Buchanan, Deans; Brown, Emma; Millar, Fergus; Mosgrove, Fiona; Bhat, Raj; Levack, Pamela



American visceral leishmaniasis in Chiapas, Mexico.  


We report the results of a study conducted during 1990-2006 with 89 cases of American visceral leishmaniasis in Chiapas State in southeastern Mexico and a seroprevalence study performed with 726 persons and 224 dogs that lived near cases of American visceral leishmaniasis. Clinical aspects, epidemiologic profiles, and risk factors are described. Most cases were in children ? 5 years of age, the prevalence of seropositive persons was 77%. The main risk factors associated with this disease were having 1-3 rooms in a house compared with ? 4 rooms, having a roof that was not made of cement, and having domestic animals. In contrast, only 19% of dogs were seropositive, suggesting that this species is not important in the transmission cycle of Leishmania. These data indicate that active transmission is taking place in the central valley of Chiapas State, Mexico, in communities located < 1,000 meters above sea level near the Grijalva River. PMID:22232459

Pastor-Santiago, Jorge A; Chávez-López, Susana; Guzmán-Bracho, Carmen; Flisser, Ana; Olivo-Díaz, Angélica



Visceral brain-body information transfer.  


Organisms interact with their environments through various afferent (sensory) and efferent (motor) mechanisms. While the usual environment of interest has been external to the organism, the internal environment is also of fundamental importance. This article briefly reviews many of the interactive mechanisms between the brain and the visceral environment, along with identification of relevant brain structures and linkages related to these peripheral functions (particularly the hypothalamus). Afferent and efferent neural (autonomic nervous system) and chemical (endocrine, immune, and blood-brain barrier and circumventricular organs) pathways are described, and potential unifying principles (emotion and, especially, homeostasis, including allostasis and stress) are identified. The importance of bidirectional (afferent, efferent) communication is emphasized. These systems of visceral brain-body information transfer are major connections between the central nervous system and the body through which and by which many psychosomatic processes occur. PMID:19446643

Cameron, Oliver G



Elbow Pain  


... find it difficult to describe what exactly brings on the pain. Causes Most elbow pain results from overuse injuries. Many sports, hobbies and jobs require repetitive hand, wrist or arm movements. Elbow pain may occasionally ...


Neuropathic Pain  


... in Cart : 0 Resource Guide to Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going to the ER Communication Tools Pain Management Programs Videos Resources Glossary FAQs ...


Chronic Pain  


... cause. Problems that cause chronic pain include Headache Low back strain Cancer Arthritis Pain from nerve damage Chronic pain usually cannot be cured. But treatments can help. They include medicines, acupuncture, electrical stimulation and surgery. Other treatments include psychotherapy, ...


Acute extensive necrosis of the visceral organs after repair of a ruptured thoracic aortic aneurysm.  


A 47-year-old woman was admitted to our hospital for repair of a ruptured thoracic aortic aneurysm. Her post-operative course was uneventful, but she had persistent complaints of anorexia and general fatigue that failed to improve. Thirty-one days after surgery, she complained of severe abdominal pain. Abdominal computed tomography (CT) and X-ray revealed extensive necrosis of the visceral organs. She underwent emergency abdominal exploration and was found to have necrosis of the liver, gallbladder, stomach, entire small bowel and colon. The extensive necrosis made resection of the involved organs unfeasible. The patient died one day after exploratory laparotomy. PMID:8227110

Sugita, T; Mori, A; Watarida, S; Onoe, M; Shiraishi, S; Nojima, T; Nakajima, Y; Tabata, R; Matsuno, S



How many kinds of visceral afferents?  

PubMed Central

Most afferent signals from the viscera do not give rise to conscious experience and yet they participate in the complex neural control of visceral functions. Surprisingly little information is available on the origin, morphology, and receptor functional characteristics of the nerve endings of most primary afferent neurones to the digestive tract. This review deals with the morphological nature of the afferent neurones that supply the gastrointestinal tract specifically.

Costa, M; Brookes, S; Zagorodnyuk, V



Mechanical behavior of excised canine visceral pleura  

Microsoft Academic Search

A computer-controlled optical electromechanical biaxial test system was employed to study the mechanical response of excised\\u000a sheets of canine visceral pleura. Three classes of tests were performed: uniform biaxial stretching tests and tests in which\\u000a the specimen was cyclically stretched along one axis while either the load or dimension was maintained at a prescribed level\\u000a in the orthogonal direction. The

J. D. Humphrey; D. L. Vawter; R. P. Vitoi



Toxocariasis of the liver: visceral larva migrans  

Microsoft Academic Search

Toxocariasis is caused by dog ascarid, Toxocara canis, forming eosinophilic inflammation such as eosinophilic abscess or granuloma in the liver and lungs. The lesions move slowly\\u000a and thus the disease is called as visceral larva migrans. On CT or MR imaging, hepatic lesions are seen as multiple, ill-defined,\\u000a oval lesions that measure 1.0–1.5 cm in diameter. Sometimes, the lesion may be

Jae Hoon Lim



Neurosurgical advances in cancer pain management.  


Neurosurgical procedures to treat pain are mainly destructive and involve the spinal cord and occasionally the brain. Targets include the spinothalamic tract, the trigeminal tract nucleus, the midline ascending visceral pain pathway, the brainstem spinal lemniscus, the thalamus, and the cingulate gyrus. Since the introduction of intrathecal opioids, the need for neurosurgical destructive procedures has been in decline. In recent years, cordotomy, trigeminal tractotomy, and dorsal root entry zone (DREZ) operations are the neurosurgical procedures most often utilized to treat cancer pain. The addition of CT guidance to spinal cord pain pathway ablation was a major addition and refinement to the procedure. Here the authors review the latest techniques and recently published results for CT-guided cordotomy, CT-guided trigeminal tractotomy, and DREZ operations utilized to treat cancer pain. PMID:20665249

Raslan, Ahmed M; Burchiel, Kim J



Depression, Pain, and Pain Behavior.  

ERIC Educational Resources Information Center

Examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory was administered to 207 low back pain patients. Depression and physical findings were the most important predictors of pain and pain behavior. Depression proved significant even after controlling for important demographic and medical status…

Keefe, Francis J.; And Others



Depression, Pain, and Pain Behavior  

Microsoft Academic Search

This study examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory (BDI) was administered to 207 low back pain patients. Observations of pain behaviors during physical examination, ratings of pain, and measures of activity level and medication intake were taken on each patient. Regression analyses revealed that depression and physical findings were the most

Francis J. Keefe; Robert H. Wilkins; Wesley A. Cook; James E. Crisson; Lawrence H. Muhlbaier



Follow-up 26 years after dorsal root entry zone thermocoagulation for brachial plexus avulsion and phantom limb pain.  


Brachial plexus avulsion and limb amputation are often associated with intractable chronic pain. Dorsal root entry zone (DREZ) thermocoagulation is an effective surgical treatment for upper-extremity deafferentation pain. The authors describe the clinical follow-up and imaging in a patient who underwent DREZ thermocoagulation 26 years ago for postamputation phantom limb syndrome with associated brachial plexus avulsion. This patient continues to have successful pain control without phantom limb sensation and has never experienced a recurrence of his left upper-extremity pain syndrome. This report lends credibility to the notion that, among ablative neurosurgical pain operations, DREZ thermocoagulation may provide the greatest durability of pain control. PMID:20509732

Tomycz, Nestor D; Moossy, John J



Adrenergic Stimulation Mediates Visceral Hypersensitivity to Colorectal Distension following Heterotypic Chronic Stress  

PubMed Central

Background & Aims Chronic stress exacerbates or causes relapse of symptoms such as abdominal pain and cramping in patients with irritable bowel syndrome (IBS). We investigated whether chronic stress increases plasma norepinephrine and sensitizes colon-specific dorsal root ganglion (DRG) neurons by increasing the expression of nerve growth factor (NGF) in the colon wall. Methods Heterotypic chronic stress (HeCS) was induced in male Wistar rats and neurologic and molecular responses were analyzed. Tissues were analyzed for NGF expression. Results HeCS significantly increased the visceromoter response to colorectal distension; expression of NGF increased in colonic muscularis externa and mucosa/submucosa. Rheobase decreased, resting membrane potential was depolarized, and electrogenesis of action potentials increased in colon-specific thoracolumbar DRG neurons. Luminal administration of resiniferatoxin in distal colon, systemic administration of anti-NGF antibody, or inhibition of the NGF receptor TrkA by k252A or antisense oligonucleotides in thoracolumbar DRG blocked the chronic stress-induced visceral hypersensitivity to colorectal distension. Blockade of ?1/?2- and ?1/?2-adrenergic receptors prevented the stress-induced visceral hypersensitivity and increased expression of NGF in the colon wall. HeCS did not induce any inflammatory response in the colon wall. Conclusion The peripheral stress mediator norepinephrine induces visceral hypersensitivity to colorectal distension in response to HeCS by increasing the expression of NGF in the colon wall, which sensitizes primary afferents in the absence of an inflammatory response.

Winston, John H.; Xu, Guang-Yin; Sarna, Sushil K.



Central processing of rectal pain in patients with irritable bowel syndrome: an fMRI study  

Microsoft Academic Search

OBJECTIVES:In healthy subjects, the neural correlates of visceral pain bear much similarity with the correlates of somatic pain. In patients with irritable bowel syndrome, the central nervous system is believed to play a strong modulatory or etiological role in the pathophysiology of the disease. We hypothesize that this role must be reflected in aberrations of central functional responses to noxious

B. Bonaz; M. Baciu; E. Papillon; R. Bost; N. Gueddah; J.-F. Le Bas; J. Fournet; C. Segebarth



Short-term restoration of facial sensory loss by motor cortex stimulation in peripheral post-traumatic neuropathic pain  

Microsoft Academic Search

We report a case in which motor cortex stimulation (MCS) improved neuropathic facial pain due to peripheral nerve injury and\\u000a restored tactile and thermal sensory loss. A 66-year-old man developed intractable trigeminal neuropathic pain after trauma\\u000a of the supraorbital branch of the Vth nerve, associated with tactile and thermal sensory loss in the painful area. MCS was\\u000a performed using neuronavigation

Denys Fontaine; Jean Louis Bruneto; Hasna El Fakir; Philippe Paquis; Michel Lanteri-Minet



Radical Distal Pancreatectomy with En Bloc Resection of the Celiac Artery, Plexus, and Ganglions for Advanced Cancer of the Pancreatic Body: A Preliminary Report on Perfect Pain Relief  

Microsoft Academic Search

Objective The purpose of this study was to report the effect of radical distal pancreatectomy with en bloc resection of the celiac artery, plexus, and ganglions for locally advanced cancer of the pancreatic body on intractable abdominal and\\/or back pain and to explore the histopathologic mechanism of this pain. Patients Five patients with pancreatic body cancer involving the celiac and\\/or

Satoshi Kondo; Hiroyuki Katoh; Makoto Omi; Satoshi Hirano; Yoshiyasu Ambo; Eiichi Tanaka; Shunichi Okushiba; Toshiaki Morikawa; Michio Kanai; Takashi Yano



[A chance finding in a woman with abdominal pain].  


A 73-year-old woman was presented to the emergency department with severe abdominal pain. A CT-scan of the abdomen showed coprostasis and a visceral abdominal aneurysm of the splenic artery. Subsequently, the aneurysm was treated with endovascular coiling. PMID:23446152

van den Heijkant, A C Teun; Ponten, Jeroen E H; Willigendael, Edith M



Postdural Puncture Headache with Abdominal Pain and Diarrhea  

Microsoft Academic Search

Dural puncture or a rent in the dura with prolonged cere- brospinal fluid leakage may cause noninfectious arach- noiditis and may be associated with urinary and fecal in- continence. Visceral dysfunction is common for patients withnoninfectiousarachnoiditisofthelumbosacralnerve roots after dural puncture. We report a case of postdural puncture headache associated with abdominal pain and diarrhea.Anepiduralbloodpatchwasperformed,andall symptoms resolved after 5 days. After

Chih-Ping Yang; Chian-Her Lee; Cecil O. Borel; Chun-Chang Yeh; Chueng-He Lu; Chih-Shung Wong; Ching-Tang Wu



Thermally potentiated responses to algesic substances of visceral nociceptors.  


Using spermatic nerve preparations from testis superior, the effects of temperature rise on chemical responses were studied in vitro, within both subthreshold and suprathreshold ranges for testicular polymodal receptors, one type of visceral nociceptor. In the range of temperature subthreshold for polymodal receptors, the responses to algesic substances tested were greater at higher temperatures. The mean discharge rates induced by various concentrations of bradykinin (BK, 9 X 10(-9)-9 X 10(-6) M), were significantly greater at 36 degrees C than at 30 degrees C. Responses to hypertonic saline, tested in the temperature range, 34-43 degrees C, showed similar temperature-dependent increases, and Q10 values between 2.3 and 4.2. In the units exhibiting 'heat sensitization' with repeated testing of suprathreshold temperature rises, the response to hypertonic saline (616 mM) at 34 degrees C also increased. Although calor in the inflamed tissues is in itself not high enough to cause excitation of 'pain receptors,' temperature-dependent augmentation of chemical responses of the polymodal receptor might partly explain peripheral hyperalgesic behaviour observable in inflamed tissue on the basis of sensory receptor activity. PMID:3547256

Kumazawa, T; Mizumura, K; Sato, J



Psychophysiological responses to pain identify reproducible human clusters.  


Pain is a ubiquitous yet highly variable experience. The psychophysiological and genetic factors responsible for this variability remain unresolved. We hypothesised the existence of distinct human pain clusters (PCs) composed of distinct psychophysiological and genetic profiles coupled with differences in the perception and the brain processing of pain. We studied 120 healthy subjects in whom the baseline personality and anxiety traits and the serotonin transporter-linked polymorphic region (5-HTTLPR) genotype were measured. Real-time autonomic nervous system parameters and serum cortisol were measured at baseline and after standardised visceral and somatic pain stimuli. Brain processing reactions to visceral pain were studied in 29 subjects using functional magnetic resonance imaging (fMRI). The reproducibility of the psychophysiological responses to pain was assessed at 1year. In group analysis, visceral and somatic pain caused an expected increase in sympathetic and cortisol responses and activated the pain matrix according to fMRI studies. However, using cluster analysis, we found 2 reproducible PCs: at baseline, PC1 had higher neuroticism/anxiety scores (P?0.01); greater sympathetic tone (P<0.05); and higher cortisol levels (P?0.001). During pain, less stimulus was tolerated (P?0.01), and there was an increase in parasympathetic tone (P?0.05). The 5-HTTLPR short allele was over-represented (P?0.005). PC2 had the converse profile at baseline and during pain. Brain activity differed (P?0.001); greater activity occurred in the left frontal cortex in PC1, whereas PC2 showed greater activity in the right medial/frontal cortex and right anterior insula. In health, 2 distinct reproducible PCs exist in humans. In the future, PC characterization may help to identify subjects at risk for developing chronic pain and may reduce variability in brain imaging studies. PMID:23714265

Farmer, Adam D; Coen, Steven J; Kano, Michiko; Paine, Peter A; Shwahdi, Mustafa; Jafari, Jafar; Kishor, Jessin; Worthen, Sian F; Rossiter, Holly E; Kumari, Veena; Williams, Steven C R; Brammer, Michael; Giampietro, Vincent P; Droney, Joanne; Riley, Julia; Furlong, Paul L; Knowles, Charles H; Lightman, Stafford L; Aziz, Qasim



Adolescent chronic pain: the ability to cope.  


The study investigated differences in mother-child interaction, child personality, and family characteristics between adolescents who were coping with chronic benign intractable pain and adolescents who were not. Both groups experienced a similar amount and intensity of pain. Behavioural observations indicated that non-copers engaged in significantly more negative behaviour than the copers. In addition, non-copers tended to express more pain and were on-task less often than the copers. Mothers of non-copers more frequently discouraged coping behaviour. No differences between the two groups were evident on the family or personality measures. The data are consistent with clinical impressions that parental behaviour interacts with child coping. PMID:3737229

Dunn-Geier, B J; McGrath, P J; Rourke, B P; Latter, J; D'Astous, J



Mast cell degranulation distinctly activates trigemino-cervical and lumbosacral pain pathways and elicits widespread tactile pain hypersensitivity  

PubMed Central

Mast cells (MCs) are tissue resident immune cells that participate in a variety of allergic and other inflammatory conditions. In most tissues, MCs are found in close proximity to nerve endings of primary afferent neurons that signal pain (i.e. nociceptors). Activation of MCs causes the release of a plethora of mediators that can activate these nociceptors and promote pain. Although MCs are ubiquitous, conditions associated with systemic MC activation give rise primarily to two major types of pain, headache and visceral pain. In this study we therefore examined the extent to which systemic MC degranulation induced by intraperitoneal administration of the MC secretagogue compound 48/80 activates pain pathways that originate in different parts of the body and studied whether this action can lead to development of behavioral pain hypersensitivity. Using c-fos expression as a marker of central nervous system neural activation, we found that intraperitoneal administration of 48/80 leads to the activation of dorsal horn neurons at two specific levels of the spinal cord; one responsible for processing cranial pain, at the medullary/C2 level, and one that processes pelvic visceral pain, at the caudal lumbar/rostral sacral level (L6-S2). Using behavioral sensory testing, we found that this nociceptive activation is associated with development of widespread tactile pain hypersensitivity within and outside the body regions corresponding to the activated spinal levels. Our data provide a neural basis for understanding the primacy of headache and visceral pain in conditions that involve systemic MC degranulation. Our data further suggest that MC activation may lead to widespread tactile pain hypersensitivity.

Levy, Dan; Kainz, Vanessa; Burstein, Rami; Strassman, Andrew M.



Cancer Pain  

Microsoft Academic Search

Cancer pain remains undertreated. Pain occurs in over three-quarters of cancer patients and remains one of the most feared\\u000a aspects of this illness despite the excellent therapies that are available. Cancer pain commonly results from tumor compressing\\u000a or invading soft tissue, bone, or nerves or from diagnostic or therapeutic endeavors. Optimal pain management involves determining\\u000a pain intensity, evaluating the etiology

Suzanne A. Nesbit


Analysis of Breakthrough Pain in 50 Patients Treated with Intrathecal Morphine Infusion Therapy  

Microsoft Academic Search

Fifty patients with intractable benign pain were treated with intrathecal morphine (IT-MS) infusion therapy. Median follow-up was 39 months (range 5–70). Breakthrough pain was reported in 45 (90%) patients 75 outpatient clinic events. A diagnostic algorithm was developed to evaluate and efficiently treat these patients. A programmed bolus (50% of daily dose) identified that 50 (67%) breakthrough events where due

Steve Bloomfield; Jeff Hogg; Orlando Ortiz; Richard Gross



Ancient origin of somatic and visceral neurons  

PubMed Central

Background A key to understanding the evolution of the nervous system on a large phylogenetic scale is the identification of homologous neuronal types. Here, we focus this search on the sensory and motor neurons of bilaterians, exploiting their well-defined molecular signatures in vertebrates. Sensorimotor circuits in vertebrates are of two types: somatic (that sense the environment and respond by shaping bodily motions) and visceral (that sense the interior milieu and respond by regulating vital functions). These circuits differ by a small set of largely dedicated transcriptional determinants: Brn3 is expressed in many somatic sensory neurons, first and second order (among which mechanoreceptors are uniquely marked by the Brn3+/Islet1+/Drgx+ signature), somatic motoneurons uniquely co-express Lhx3/4 and Mnx1, while the vast majority of neurons, sensory and motor, involved in respiration, blood circulation or digestion are molecularly defined by their expression and dependence on the pan-visceral determinant Phox2b. Results We explore the status of the sensorimotor transcriptional code of vertebrates in mollusks, a lophotrochozoa clade that provides a rich repertoire of physiologically identified neurons. In the gastropods Lymnaea stagnalis and Aplysia californica, we show that homologues of Brn3, Drgx, Islet1, Mnx1, Lhx3/4 and Phox2b differentially mark neurons with mechanoreceptive, locomotory and cardiorespiratory functions. Moreover, in the cephalopod Sepia officinalis, we show that Phox2 marks the stellate ganglion (in line with the respiratory — that is, visceral— ancestral role of the mantle, its target organ), while the anterior pedal ganglion, which controls the prehensile and locomotory arms, expresses Mnx. Conclusions Despite considerable divergence in overall neural architecture, a molecular underpinning for the functional allocation of neurons to interactions with the environment or to homeostasis was inherited from the urbilaterian ancestor by contemporary protostomes and deuterostomes.



Minocycline markedly reduces acute visceral nociception via inhibiting neuronal ERK phosphorylation  

PubMed Central

Background Minocycline prevents the development of neuropathic and inflammatory pain by inhibiting microglial activation and postsynaptic currents. But, how minocycline obviates acute visceral pain is unclear. The present study investigated whether minocycline had an any antinociceptive effect on acetic acid-induced acute abdominal pain after intraperitoneal (i.p.) administration of saline or minocycline 1 hour before acetic acid injection (1.0%, 250 ?l, i.p.). Results Minocycline (4, 10, or 40 mg/kg) significantly decreased acetic acid-induced nociception (0-60 minutes post-injection) and the enhancement in the number of c-Fos positive cells in the T5-L2 spinal cord induced by acetic acid injection. Also, the expression of spinal phosphorylated extracellular signal-regulated kinase (p-ERK) induced by acetic acid was reduced by minocycline pre-administration. Interestingly, intrathecal introduction of PD98059, an ERK upstream kinase inhibitor, markedly blocked the acetic acid-stimulated pain responses. Conclusions These results demonstrate that minocycline effectively inhibits acetic acid-induced acute abdominal nociception via the inhibition of neuronal p-ERK expression in the spinal cord, and that minocycline may have therapeutic potential in suppressing acute abdominal pain.



Repair of acute descending aortic dissection complicated by visceral ischemia.  


Visceral ischemia is a rare but lethal complication of type III aortic dissection. We report a Marfan patient with such a complication who had a complete resolution of profound visceral ischemia despite a delay in repair of over 48 hours. PMID:10510012

Wang, N; Wong, D T; Rivera, J L; Bansal, R C; Gundry, S R



Visceral and Somatic Hypersensitivity in TNBS induced Colitis in Rats  

PubMed Central

Inflammation of visceral structures in rats has been shown to produce visceral/somatic hyperalgesia. Our objectives were to determine if trinitrobenzene sulfonic acid (TNBS) induced colitis in rats leads to visceral/somatic hypersensitivity. Male Sprague-Dawley rats (200g–250g) were treated with 20 mg of TNBS in 50% ethanol (n=40) or an equivalent volume of ethanol (n=40) or saline (n=25) via the colon. Colonic distension, Von-Frey, Hargreaves, and tail reflex test were used to evaluate for visceral, mechanical, and thermal sensitivity. The rats demonstrated visceral hypersensitivity at 2–28 days following TNBS (p<0.0001). The ethanol treated rats also demonstrated visceral hypersensitivity that resolved after day 14. TNBS treated rats demonstrated somatic hypersensitivity at days 14–28 (p<0.0001) in response to somatic stimuli of the hind-paw. TNBS colitis is associated with visceral and somatic hypersensitivity in areas of somatotopic overlap. This model of colitis should allow further investigation into the mechanisms of visceral and somatic hypersensitivity.

Zhou, QiQi; Price, Donald D.; Caudle, Robert M.; Verne, G. Nicholas



Visceral drives in retrospect: Explanations about the inaccessible past  

Microsoft Academic Search

The present research demonstrates that the extent to which people appreciate the influence past vis- ceral states have had on behavior (e.g., the influence hunger has had on food choice) depends largely on their current visceral state. Specifically, we found that when people were in a hot state (e.g., fatigued), they attributed behavior primarily to visceral influences, whereas when people

Loran F. Nordgren; Joop van der Pligt; Frenk van Harreveld



Visceral gendering and a politics of connectivity in science  

Microsoft Academic Search

This article contributes to tackling the limited impact of existing gender equality policies in science and their widespread dismissal in countries such as the Czech Republic by conceptualizing and addressing visceral gendering practices by which gender differences are produced and rendered (in)visible. Based on research at a Czech research institution and on theories of viscerality and the co-constitution of gender

Dagmar Lorenz-Meyer



Visceral leishmaniasis control in Thi Qar Governorate, Iraq, 2003  

Microsoft Academic Search

Since 1991, visceral leishmaniasis has extended to new areas rarely affected before in Iraq, such as the southern governorates. In 2003, in the aftermath of the invasion of the Coalition Forces, Thi Qar Governorate was at high risk for an outbreak of visceral leishmaniasis. This paper de- scribes the cooperation of an international nongovernmental organization and a district primary health

A. K. Jassim; R. Maktoof; H. Ali; K. Campbell


[Malignant pleural mesothelioma in general practice; complex pain problems].  


In three patients, men aged 67, 57 and 69 years, malignant pleural mesothelioma was diagnosed. All three had worked as coal miners and were presented with thoracic pain. They were among seven cases of malignant pleural mesothelioma diagnosed in a period of five years in one suburban general practice (adherence: 5600 patients) in the former mining area in the province of Limburg. The terminal phase of the disease was characterized by intractable pain. High doses of opioids and adjuvants were necessary to achieve acceptable pain relief. It is suggested that step one of the 'analgesic ladder for cancer pain management' of the WHO (non-opioids) should be followed soon by step three (strong opioids). Because the incidence of pleural mesothelioma is not yet decreasing, it is important to know that pain management remains a serious problem. PMID:9380133

Leclercq, R M; Jongmans-Liedekerken, A W



Animal reservoirs of visceral leishmaniasis in India.  


Visceral leishmaniasis (VL) is a disease that has both zoonotic and anthroponotic etiologies. In India, VL is endemic, considered to be anthroponotic, and caused by Leishmania donovani . Anthroponotic diseases are maintained by transmission from human to human and to a lesser extent from human to animals. Serum samples from 1,220 animals from 7 human VL endemic districts of Bihar, India, were tested for antibodies to a recombinant kinetoplast antigen (rK39 antigen) present in amastigotes of visceralizing Leishmania species, i.e., L. donovani complex. Additionally, PCR was used to examine samples positive by rK39 antigen serology. Antibodies to rK39 indicative of VL were detected in 33 of 1,220 animals. Thirty-one of 867 goats (Capra hircus), 1 of 161 cattle (Bos indicus), and 1 of 54 wild rats (Rattus sp.) were positive by rK39 serology. None of 106 chickens (Gallus domesticus), 26 sheep (Ovis aries), 3 water buffaloes (Bubalus bubalus), or 3 dogs (Canis familiaris) was positive by rK39 serology. Leishmania donovani DNA was detected by PCR in 20 rK39 positive blood samples from goats and 1 sample from a cow. The present study indicates that goats are potential animal reservoirs of human VL in India. PMID:22765517

Singh, Niti; Mishra, Jyotsna; Singh, Ram; Singh, Sarman



Diagnosis of systemic or visceral candidosis.  

PubMed Central

Although systemic or visceral candidosis can be diagnosed during life, it is usually discovered at autopsy. Early diagnosis is important since treatment with specific antifungal drugs is effective. The diagnosis should rest on all available clinical and laboratory evidence. Mucocutaneous lesions and chorioretinitis are important clinical findings in the presence of predisposing illness and iatrogenic factors. Repeatedly positive blood cultures for Candida in the absence of an indwelling intravenous line and Candida colony counts of 10 000/ml or greater in urine freshly obtained by catheter in the absence of an indwelling Foley catheter are very significant. Similarly significant is recovery of Candida from closed spaces (pleural, peritoneal, joint or subarachnoid). The agar gel diffusion test for Candida antibodies has a sensitivity and specificity of 85% or greater and can confirm the diagnosis in otherwise doubtful cases. The various antibody tests for Candida are not suitable for random screening because of the low prevalence of visceral or systemic candidosis in the general population. Images FIG. 1

Kozinn, P. J.; Taschdjian, C. L.; Kodsi, B. E.; Wise, G. J.; Seelig, M. S.; Goldberg, P. K.



Endemic transmission of visceral leishmaniasis in Bhutan.  


Visceral leishmaniasis was first reported in Bhutan in 2006. We conducted studies of the parasite, possible vectors and reservoirs, and leishmanin skin test and risk factor surveys in three villages. Nineteen cases were reported from seven districts. Parasite typing yielded two novel microsatellite sequences, both related to Indian L. donovani. In one case village, 40 (18.5%) of 216 participants had positive leishmanin skin test results, compared with 3 (4.2%) of 72 in the other case village and 0 of 108 in the control village. Positive results were strongly associated with the village and increasing age. None of the tested dogs were infected. Eighteen sand flies were collected, 13 Phlebotomus species and 5 Sergentomyia species; polymerase chain reaction for leishmanial DNA was negative. This assessment suggests that endemic visceral leishmaniasis transmission has occurred in diverse locations in Bhutan. Surveillance, case investigations, and further parasite, vector, and reservoir studies are needed. The potential protective impact of bed nets should be evaluated. PMID:23091191

Yangzom, Thinley; Cruz, Israel; Bern, Caryn; Argaw, Daniel; den Boer, Margriet; Vélez, Iván Dario; Bhattacharya, Sujit K; Molina, Ricardo; Alvar, Jorge



Gene Therapy for Pain: Results of a Phase I Clinical Trial  

PubMed Central

Objective Preclinical evidence indicates that gene transfer to the dorsal root ganglion (DRG) using replication defective herpes simplex virus (HSV)-based vectors can reduce pain-related behavior in animal models of pain. This clinical trial was carried out to assess the safety and explore the potential efficacy of this approach in humans. Methods We conducted a multicenter, dose-escalation, Phase I clinical trial of NP2, a replication defective HSV-based vector expressing human preproenkephalin (PENK) in subjects with intractable focal pain caused by cancer. NP2 was injected intradermally into the dermatome(s) corresponding to the radicular distribution of pain. The primary outcome was safety. As secondary measures, efficacy of pain relief was assessed using a numeric rating scale (NRS), the Short Form McGill Pain Questionnaire (SF-MPQ) and concurrent opiate usage. Results Ten subjects with moderate to severe intractable pain despite treatment with more than 200 mg/day of morphine (or equivalent) were enrolled into the study. Treatment was well tolerated with no study agent-related serious adverse events (SAE) observed at any point in the study. Subjects receiving the low dose of NP2 reported no substantive change in pain. Subjects in the middle and high dose cohorts reported pain relief as assessed by NRS and SF-MPQ. Interpretation Treatment of intractable pain with NP2 was well tolerated. There were no placebo controls in this relatively small study, but the dose-responsive analgesic effects suggest that NP2 may be effective in reducing pain and warrants further clinical investigation.

Fink, David J.; Wechuck, James; Mata, Marina; Glorioso, Joseph C.; Goss, James; Krisky, David; Wolfe, Darren



Nerve growth factor-mediated neuronal plasticity in spinal cord contributes to neonatal maternal separation-induced visceral hypersensitivity in rats.  


Visceral hyperalgesia is a multifactorial gastrointestinal disorder which featured with alterations of abdominal motility and/or gut sensitivity, and is believed to be triggered by environmental stressor or psychological factors. However, its etiology remains incompletely understood. In this study, we aimed to investigate whether nerve growth factor (NGF)-mediated neuronal plasticity is involved in neonatal maternal separation (NMS)-induced visceral hypersensitivity in adult rats, and whether NGF antagonist can attenuate or block such development. In our experiments, animals subjected to NMS were developed with visceral hyperalgesia at age of 8 weeks. The threshold for visceral pain among these NMS rats was remarkably lowered than that of the normal handling (NH) rats; however, the expression levels of NGF, c-fos, calcitonin gene-related peptide (CGRP), Substance P, and tyrosine kinases A (TrkA) were notably elevated in lumbosacral spinal cord and/or dorsal root ganglion (DRG) when comparing to those of the NH rats. Further, as intra-peritoneal administration of NGF (10??l at 1??g/kg/day) was given to NH rats during neonatal period, effects that comparable to NMS induction were observed in the adulthood. In contrast, when NMS rats were treated with NGF antagonist K252a (10??l/day from postnatal days 2-14), which acts against tyrosine kinases, the neonatal stress-induced down-shifted visceral pain threshold was restored and neuronal activation, specifically NGF and neuropeptide production, was attenuated. In conclusion, our data strongly suggest that NGF triggers neuronal plasticity and plays a crucial role in NMS-induced visceral hypersensitivity in which NGF antagonism provides positive inhibition via blocking the tyrosine phosphorylation of TrkA. PMID:22396076

Tsang, S W; Zhao, M; Wu, J; Sung, J J Y; Bian, Z-X



Predictors of outcome and pathological considerations in the surgical treatment of intractable epilepsy associated with temporal lobe lesions  

Microsoft Academic Search

OBJECTIVESTo evaluate the influence of clinical, investigative, and pathological factors on seizure remission after temporal lobectomy for medically intractable epilepsy associated with focal lesions other than hippocampal sclerosis.METHODSFrom a series of 234 consecutive “en bloc” temporal resections for medically intractable epilepsy performed between 1976 and 1995, neuropathological examination disclosed a focal lesion in 80. The preoperative clinical, neuropsychological, interictal EEG,

M J Hennessy; R D C Elwes; M Honavar; S Rabe-Hesketh; C D Binnie; C E Polkey



Orofacial Pain  


... Neck, shoulder or back pain Dizziness ?xml:namespace> Sleep disorders ; If you have gone through treatment and still experience orofacial pain, you may have a sleep disorder, such as bruxism, or a sleep-related breathing ...


Back Pain  


... Oh, my aching back!", you are not alone. Back pain is one of the most common medical problems, ... 10 people at some point during their lives. Back pain can range from a dull, constant ache to ...


Hip Pain  


... 0/1807/0.html. Accessed May 13, 2013. Anderson BC. Evaluation of the adult with hip pain. ... Accessed May 13, 2013. Anderson BC. Patient information: Hip pain (Beyond the basics). ...


Neck Pain  


... over-the counter medicine, such as acetaminophen or ibuprofen, to relieve pain, and apply heat to the ... an injury. Use anti-inflammatory medicines, such as ibuprofen and aspirin, to relieve pain and discomfort, and ...


Viscero-somatic reflexes in referred pain areas evoked by capsaicin stimulation of the human gut.  


The interaction between visceral pain and the sympathetic nervous system is only sparsely investigated in quantitative human studies. Referred visceral pain can be evoked experimentally by application of substances such as capsaicin (the pungent substance of chilli pepper) to the gut. The aim of the present study was to induce referred visceral pain from the small and large intestine in 32 volunteers via the stomal opening in patients with ileo- or colostomy and quantify the viscero-somatic reflex responses in these referred pain areas by thermography and laser doppler flowmetry. Capsaicin evoked pain and referred pain areas in all subjects. In the referred pain area, the temperature increased by approximately 0.6 degrees C (P<0.001) and the blood flow by approximately 35AU (P<0.001). Saline was used in a control experiment, and no temperature and blood flow changes were found. The present quantitative human study of viscero-somatic reflexes showed dramatic sympathetic responses in the referred pain areas after experimentally induced gut pain. PMID:17977761

Arendt-Nielsen, Lars; Schipper, Klaus-Peter; Dimcevski, Georg; Sumikura, Hiroyuki; Krarup, Anne Lund; Giamberardino, Maria Adele; Drewes, Asbjørn Mohr



Lymphoid irradiation in intractable rheumatoid arthritis. Long-term followup of patients treated with 750 rads or 2,000 rads  

SciTech Connect

Twenty patients with intractable rheumatoid arthritis were randomized to receive 750 or 2,000 rads of lymphoid irradiation (LI) in a double-blind comparative study, and were followed for a maximum of 48 months (mean 40 months) after treatment. During followup, sustained immunomodulation (including lymphopenia, particularly of the T helper cell subset; reduced ratio of helper cells to suppressor cells; and impaired in vitro lymphocyte proliferation in response to phytohemagglutinin and pokeweed mitogen) was observed. Significant improvements in early morning stiffness, Ritchie articular index, pain score, grip strength, and 15-meter walk time were observed in both treatment groups, but these were not sustained through the followup period. Progressive joint damage was observed radiologically in both groups during followup. Thus, LI induced sustained immunosuppression, but resulted in only short-lived clinical improvement and was associated with progressive joint erosion in these patients.

Soden, M.; Hassan, J.; Scott, D.L.; Hanly, J.G.; Moriarty, M.; Whelan, A.; Feighery, C.; Bresnihan, B.



Cancer Pain  

Microsoft Academic Search

Pain is a significant problem in cancer and there are many barriers to adequate pain control. Cancer-related pain is common\\u000a and has a destructive impact on a patient’s quality of life. Physicians need to understand better the appropriate use of opioid\\u000a and nonopioid analgesics and to consider other therapeutic options when appropriate. This chapter discusses the mechanisms\\u000a of pain underlying

Sebastiano Mercadante


Intrathecal baclofen therapy in children with intractable spastic cerebral palsy: a cost-effectiveness analysis  

Microsoft Academic Search

In a Dutch national study, we recently established the effectiveness and safety of continuous intrathecal baclofen infusion (CITB) in children with intractable spastic cerebral palsy (CP). Because prospective studies on the cost-effectiveness of CITB in children with spastic CP are lacking, we conducted a cost-effectiveness analysis alongside our prospective national study. We compared the costs and health effects of CITB

M. A. Hoving; S M A A Evers; A J H A Ament; E P M van Raak; J. S. H. Vles; J. G. Becher; R. Vermeulen; O. F. Brouwer; C. G. Maathuis; C. E. Catsman-Berrevoets; J. Gerritsen; M. J. Geerts; P. H. Jongerius; O. F. Nieuwenhuizen; J. J. Rotteveel; L. A. Speth; H. Stroink; E. G. van der Ziel



Conflict, Complexity, and Change: A Meta-Framework for Addressing Protracted, Intractable Conflicts—III  

Microsoft Academic Search

Conflicts that endure despite repeated good faith attempts to resolve them are considered intractable. Such conflicts can exist at the family, organizational, community, and international levels and present conflict resolution practitioners with extraordinarily difficult challenges. Over time, they can become highly complex, mercurial, and malignant, and render standard methods of conflict resolution such as negotiation and mediation less effective. This

Peter T. Coleman



Developing Agency through Peacebuilding in the Midst of Intractable Conflict: The Case of Israel and Palestine  

ERIC Educational Resources Information Center

This paper discusses the presence of "peacebuilding islands" within civil society as potential agents of transformation in the midst of intractable conflict. Focusing on the particular case of the Israeli-Palestinian conflict, the argument stems from a deconstruction of the legacy of national myopia perpetuated through social and political…

Plonski, Sharri



[Principle of double effect and sedation for intractable distress: reflexion on survival in sedated patients].  


The effect of sedation for intractable distress on survival in terminally ill patients is a debated question. For certain people, this would limit the physician's intervention to the detriment of symptom alleviation for patients. The principle of double effect is traditionally used to overcome this ethical conflict. Studies conducted between 1990 and 2009 fail to show that the death of patients undergoing sedation for intractable distress is hastened. Some authors conclude that sedation does not hasten death and claim that principle of double effect is unnecessary in this debate. In our view, caution is required in the interpretation of studies results and absence of evidence of sedation effects on survival cannot be considered as an evidence of absence of sedation effects on survival. Furthermore, we consider obtaining a definitive answer as impossible in the future, as the required cannot be conducted for ethical reasons. Caution, we think, is necessary, especially as sedation is sometimes used with explicit intention of hastening the end of life. Physician's intention, key point of the principle of double effect, comes back into the foreground of ethical debate on sedation for intractable distress. Far from limiting the physician's action, the principle of double effect, which requires us to clarify our intentions, should allow us to make the distinction between sedation for intractable distress and euthanasia. PMID:22341946

Leheup, Benoît F; Piot, Elise; Ducrocq, Xavier; Wary, Bernard



Clinical application of continent anal plug in bedridden patients with intractable diarrhea  

Microsoft Academic Search

PURPOSE: Some patients bedridden from various causes such as stroke or spinal cord injury experience poor control of bowel movement. This causes fecal leakage and diarrhea, increases the risk of perianal excoriation and bed sores, and is a burden on caregivers. To evaluate the efficacy of fecal evacuation and the prevention and treatment of skin complications in intractable diarrhea patients

Jaehwang Kim; Min-Chul Shim; Byung-Yon Choi; Sang-Ho Ahn; Sung-Ho Jang; Hyoun-Jin Shin



An Analysis of Intractable Nightmares in a Two-Year Old Boy.  

ERIC Educational Resources Information Center

|This paper discusses a case study of therapeutic intervention with a 2-year-old boy. The child's major presenting symptom is intractable insomnia caused by nightmares, but his problems are linked to general patterns resulting from early paternal loss. The report analyzes the first 30 sessions of treatment. Discussion focuses on the unusual…

Feinberg, Daniel


Management of intractable epistaxis in patients who received radiation therapy for nasopharyngeal carcinoma.  


To report clinical manifestations, bleeding point localization, and outcomes of management in 16 patients with 16 instances of intractable epistaxis after radiation therapy for nasopharyngeal carcinoma. Retrospective chart review of 16 patients with nasopharyngeal carcinoma (mean age 52.06 ± 14.37 years) with 16 instances of intractable epistaxis during the past 5 years, whose diagnosis was confirmed by angiography (n = 10) or MRI/CT imaging studies and clinical manifestations (n = 6). The mean radiation dose to the affected carotid artery was 101.37 ± 34.85 Gy. Bleeding points were detected in the internal carotid artery (n = 8) or external carotid artery (n = 8). Detachable balloons were used in one affected artery for vascular occlusion; six were treated using an absorbable gelatin sponge (n = 4) or microcoils (diameter 1 mm) (n = 2). Endovascular embolization was successful in seven radiation carotid blowout syndromes with cessation of hemorrhage. One patient underwent external carotid artery ligation and one patient recovered without treatment. The clinical follow-up was 3 months. Therapeutic endovascular embolization of intractable epistaxis is both efficient and safe. It should be considered as the primary treatment modality in intractable epistaxis of nasopharyngeal carcinoma. PMID:23846664

He, Cheng-Cheng; Si, Yong-Feng; Xie, Yu-An; Yu, Lei



The perceived characteristics of irresolvable, resolvable and resolved intimate conflicts : Is there evidence of intractability?  

Microsoft Academic Search

Purpose – The paper seeks to investigate the characteristics of irresolvable interpersonal conflicts by comparing irresolvable conflicts to resolvable and resolved conflicts on each of Coleman's common social psychological factors associated with intractable conflicts. Design\\/methodology\\/approach – Undergraduate students were randomly assigned to complete questionnaires about an irresolvable conflict, a resolvable conflict, or a resolved conflict. Participants reported on conflicts in

Courtney Waite Miller; Michael E. Roloff



Modified Atkins diet to children and adolescents with medical intractable epilepsy  

Microsoft Academic Search

The aim of the present study was to evaluate the tolerability and efficacy of the modified Atkins diet given to children and adolescents with antiepileptic drug (AED) treatment resistant epilepsy.15 children with medically intractable epilepsy were enrolled in the study. Inclusion criteria were at least one seizure a week and a trial of at least two AEDs without obtaining seizure

Susanne Weber; Christian Mølgaard; KarenTaudorf; Peter Uldall



A Modified Atkins Diet Is Effective for the Treatment of Intractable Pediatric Epilepsy  

Microsoft Academic Search

Summary: Purpose: The Atkins diet may induce ketosis as does the ketogenic diet, without restrictions on calories, fluids, protein, or need for an inpatient fast and admission. Our objective was to evaluate the efficacy and tolerability of a modified Atkins diet for intractable childhood epilepsy. Methods: Twenty children were treated prospectively in a hospital-based ambulatory clinic from September 2003 to

Eric H. Kossoff; Jane R. McGrogan; Renee M. Bluml; Diana J. Pillas; James E. Rubenstein; Eileen P. Vining



Neuropathologic findings in cortical resections (including hemispherectomies) performed for the treatment of intractable childhood epilepsy  

Microsoft Academic Search

Despitè the use of hemispherectomy in the treatment of medically refractory seizures since the early 1950's, few studies published have documented neuropathologic findings in the resected specimens. This report describes the neuropathologic findings in 38 children who underwent either hemispherectomy or multilobar cortical resection as treatment for medically intractable epilepsy between 1986 and 1990. Examination of the resected specimens revealed

M. A. Farrell; M. J. DeRosa; J. G. Curran; D. Lenard Secor; M. E. Cornford; Y. G. Comair; W. J. Peacock; W. D. Shields; H. V. Vinters



Recombinant activated factor VII (rFVIIa) as salvage treatment for intractable hemorrhage  

Microsoft Academic Search

BACKGROUND: Recently, there has been an increased use of recombinant activated factor VII (rFVIIa) to promote hemostasis in various hemorrhagic conditions. The objective of this study was to determine the outcome of patients treated with rFVIIa who had intractable bleeding associated with cardiac surgery (CSP) or as a result of other causes (OBP). METHODS: The medical records of 40 consecutive

Anita Aggarwal; Vera Malkovska; Joseph P Catlett; Kirsten Alcorn



Intractable hiccup as the initial presenting feature of systemic lupus erythematosus.  


An infarctus of medulla oblongata was discovered in a 44-year old man with an intractable hiccup and 10, 11th and 12th right cranial nerves palsies. Systemic lupus erythematosus (SLE) with antiphospholipid syndrome was subsequently diagnosed. Hiccup has withdrew with corticosteroid therapy and low-dose aspirin. The other cases of literature and pathophysiologic hypotheses are briefly reported. PMID:15934443

Delèvaux, I; André, M; Marroun, I; Lamaison, D; Piette, J C; Aumaître, O



Cognitive Skills in Children with Intractable Epilepsy: Comparison of Surgical and Nonsurgical Candidates  

Microsoft Academic Search

Summary: Purpose: To compare neuropsychological perfor- mance of two groups of children with intractable epilepsy: those who are surgical candidates, and those who are not. Methods: Intelligence, verbal memory, visual memory, aca- demic skills, and sustained attention were measured in children aged 6-18 years. The effects of number of antiepileptic drugs (AEDs), seizure frequency, age at seizure onset, and duration

Lucyna Lach



Growth Failure in Children with Intractable Epilepsy Is Not Due to Increased Resting Energy Expenditure  

ERIC Educational Resources Information Center

|The aim of this study was to evaluate the resting energy expenditure (REE) of children with intractable epilepsy (IE) compared with healthy children, and to determine factors that contribute to the pattern of REE. REE, growth status, and body composition were assessed in 25 prepubertal children with IE (15 males, 10 females; mean age 5y 5mo [SD…

Bergqvist, A. G. Christina; Trabulsi, Jillian; Schall, Joan I.; Stallings, Virginia A.



A versatile MCMC strategy for sampling posterior distributions of analytically intractable models  

Microsoft Academic Search

This paper proposes a new versatile strategy for sampling posterior distributions for analytically intractable models. Building such samplers using Markov Chain Monte Carlo methodology usually leads to algorithms which are rather expensive from a computational point of view, hence hav- ing very few chances to be used for practical applications. The strategy we propose overcomes this drawback and is easy

R. S. Stoica; Villeneuve d'Ascq; P. Gregori; J. Mateu



Peritoneovenous shunt for intractable ascites due to hepatic lymphorrhea after hepatectomy  

PubMed Central

A peritoneovenous shunt has become one of the most efficient procedures for intractable ascites due to liver cirrhosis. A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular carcinoma that was successfully treated by the placement of a peritoneovenous shunt is presented. A 72-year-old Japanese man underwent partial resection of the liver for hepatocellular carcinoma associated with hepatitis C viral infection. After hepatectomy, a considerable amount of ascites ranging from 800-4600 mL per day persisted despite conservative therapy, including numerous infusions of albumin and plasma protein fraction and administration of diuretics. Since the patient’s general condition deteriorated, based on the diagnosis of intractable hepatic lymphorrhea, a subcutaneous peritoneovenous shunt was inserted. The patient’s postoperative course was uneventful and the ascites decreased rapidly, with serum total protein and albumin levels and hepatic function improving accordingly. For intractable ascites due to hepatic lymphorrhea after hepatectomy, we recommend the placement of a peritoneovenous shunt as a procedure that can provide immediate effectiveness without increased surgical risk.

Inoue, Yoshihiro; Hayashi, Michihiro; Hirokawa, Fumitoshi; Takeshita, Atsushi; Tanigawa, Nobuhiko



Paradigmatic Framing of Protracted, Intractable Conflict: Toward the Development of a Meta-framework-II  

Microsoft Academic Search

Protracted, intractable conflicts are a form of human interaction that may very well determine our capacity to survive as a species. Their high degree of malignancy, complexity, and mercurial natures present severe challenges to our human abilities to perceive, comprehend, and intervene accurately and effectively. The applied literature in this area presents a wide variety of approaches for intervention. Each

Peter T. Coleman



Spinal cord stimulation in chronic intractable angina pectoris: A randomized, controlled efficacy study  

Microsoft Academic Search

Background Spinal cord stimulation is known to be a successful treatment for chronic intractable angina pectoris. Its effect may be anti-ischemic. It is uncertain if the clinical effect is partly caused by a placebo effect of surgery for implantation of a stimulator. In this study, clinical efficacy is investigated, together with a possible placebo effect. Methods and Results Efficacy of

Raymond W. M. Hautvast; Mike J. L. DeJongste; Michiel J. Staal; Wiek H. van Gilst; K. I. Lie



Management of chronic severe pain: spinal neuromodulatory and neuroablative approaches.  


The spinal cord is the target of many neurosurgical procedures used to treat pain. Compactness and well-defined tract separation in addition to well understood dermatomal cord organization make the spinal cord an ideal target for pain procedures. Moreover, the presence of opioid and other receptors involved in pain modulation at the level of the dorsal horn increases the suitability of the spinal cord. Neuromodulative approaches of the spinal cord are either electrical or pharmacological. Electrical spinal cord modulation is used on a large scale for various pain syndromes including; failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), neuropathic pain, angina, and ischemic limb pain. Intraspinal delivery of medications e.g. opioids is used to treat nociceptive and neuropathic pains due to malignant and cancer pain etiologies. Neuroablation of the spinal cord pain pathway is mainly used to treat cancer pain. Targets involved include; the spinothalamic tract, the midline dorsal column visceral pain pathway and the trigeminal tract in the upper spinal cord. Spinal neuroablation can also involve cellular elements such as with trigeminal nucleotomy and the dorsal root entry zone (DREZ) operation. The DREZ operation is indicated for phantom type pain and root avulsion injuries. Due to its reversible nature spinal neuromodulation prevails, and spinal neuroablation is performed in a few select cases. PMID:17691354

Raslan, A M; McCartney, S; Burchiel, K J



Urban parasitology: visceral leishmaniasis in Brazil.  


Since the early 1980s, visceral leishmaniasis (VL) which is, in general, a rural zoonotic disease, has spread to the urban centers of the north, and now the south and west of Brazil. The principal drivers differ between cities, though human migration, large urban canid populations (animal reservoir), and a decidedly peripatetic and adaptable sand fly vector are the primary forces. The exact number of urban cases remains unclear as a result of challenges with surveillance. However, the number of urban cases registered continues to increase annually. Most control initiatives (e.g. culling infected dogs and household spraying to kill the sand fly) could be effective, but have proven hard to maintain at large scales due to logistical, financial and other reasons. In this article, the urbanization of VL in Brazil is reviewed, touching on these and other topics related to controlling VL within and outside Brazil. PMID:21596622

Harhay, Michael O; Olliaro, Piero L; Costa, Dorcas Lamounier; Costa, Carlos Henrique Nery



Disseminated visceral coccidiosis in sandhill cranes  

USGS Publications Warehouse

Disseminated visceral coccidiosis (DVC) caused by Eimeria spp was first recognized as a disease entity in captive sandhill cranes (Grus canadensis) and whooping cranes (G americana) at the Patuxent Wildlife Research Center. Because cranes produced at the Center are reintroduced to the wild to augment wild populations, studies involving both experimentally induced and natural infections were initiated to determine the potential or actual occurrence of DVC in wild Gruidae. Nine sandhill cranes dosed orally with eimerian oocysts of wild origin developed lesions characteristic of DVC. Extraintestinal granulomas associated with developing schizonts were found in 6 birds. Similar lesions were observed in wild sandhill cranes throughout parts of midwestern United States, Alaska, and Saskatchewan. These studies revealed the wide geographic distribution and the high frequency of occurrence of DVC in wild cranes.

Carpenter, J.W.; Novilla, M.N.; Fayer, R.; Iverson, G.C.



Visceral obesity, metabolic syndrome, insulin resistance and cancer.  


This paper presents emerging evidence linking visceral adiposity and the metabolic syndrome (MetSyn) with carcinogenesis. The link between obesity and cancer has been clearly identified in a multitude of robust epidemiological studies. Research is now focusing on the role of visceral adipose tissue in carcinogenesis; as it is recognised as an important metabolic tissue that secretes factors that systemically alter the immunological, metabolic and endocrine milieu. Excess visceral adipose tissue gives rise to a state of chronic systemic inflammation with associated insulin resistance and dysmetabolism, collectively known as the MetSyn. Prospective cohort studies have shown associations between visceral adiposity, the MetSyn and increased risk of breast cancer, colorectal cancer and oesophageal adenocarcinoma. Furthermore, visceral adiposity and the MetSyn have been associated with increased tumour progression and reduced survival. The mechanisms by which visceral adiposity and the MetSyn are thought to promote tumorigenesis are manifold. These include alterations in adipokine secretion and cell signalling pathways. In addition, hyperinsulinaemia, subsequent insulin resistance and stimulation of the insulin-like growth factor-1 axis have all been linked with visceral adiposity and promote tumour progression. Furthermore, the abundance of inflammatory cells in visceral adipose tissue, including macrophages and T-cells, create systemic inflammation and a pro-tumorigenic environment. It is clear from current research that excess visceral adiposity and associated dysmetabolism play a central role in the pathogenesis of certain cancer types. Further research is required to elucidate the exact mechanisms at play and identify potential targets for intervention. PMID:22051112

Doyle, Suzanne L; Donohoe, Claire L; Lysaght, Joanne; Reynolds, John V



Quantitative sensory testing in gynaecology: improving preoperative and postoperative pain diagnosis.  


Chronic pelvic pain presents difficulties for women suffering its complex presentation. It also presents difficulties for clinicians involved in diagnosing and managing the problem. We review here clinically relevant information related to visceral pathology and its association with peripheral and central aspects of pain hypersensitivity. We address why surgery appears to be successful in some cases but less than successful in others, and what cautionary indicators should be taken into account. A categorization of chronic pelvic pain based on our understanding of pain physiology and mechanisms involved is proposed. The benefits of multidimensional sensory and pain testing in gynaecological care are reviewed. PMID:23870777

Jarrell, John; Arendt-Nielsen, Lars



Deep brain stimulation for pain relief: a meta-analysis.  


Deep brain stimulation (DBS) has been used to treat intractable pain for over 50 years. Variations in targets and surgical technique complicate the interpretation of many studies. To better understand its efficacy, we performed a meta-analysis of DBS for pain relief. MEDLINE (1966 to February 2003) and EMBASE (1980 to January 2003) databases were searched using key words deep brain stimulation, sensory thalamus, periventricular gray and pain. Inclusion criteria were based on patient characteristics and protocol clarity. Six studies (between 1977-1997) fitting the criteria were identified. Stimulation sites included the periventricular/periaqueductal grey matter (PVG/PAG), internal capsule (IC), and sensory thalamus (ST). The long-term pain alleviation rate was highest with DBS of the PVG/PAG (79%), or the PVG/PAG plus sensory thalamus/internal capsule (87%). Stimulation of the sensory thalamus alone was less effective (58% long-term success) (p < 0.05). DBS was more effective for nociceptive than deafferentation pain (63% vs 47% long-term success; p < 0.01). Long-term success was attained in over 80% of patients with intractable low back pain (failed back surgery) following successful trial stimulation. Trial stimulation was successful in approximately 50% of those with post-stroke pain, and 58% of patients permanently implanted achieved ongoing pain relief. Higher rates of success were seen with phantom limb pain and neuropathies. We conclude that DBS is frequently effective when used in well-selected patients. Neuroimaging and neuromodulation technology advances complicate the application of these results to modern practice. Ongoing investigations should shed further light on this complex clinical conundrum. PMID:15993077

Bittar, Richard G; Kar-Purkayastha, Ishani; Owen, Sarah L; Bear, Renee E; Green, Alex; Wang, ShouYan; Aziz, Tipu Z



Pain Genes  

PubMed Central

Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors) signal the existence of tissue damage to the central nervous system (CNS), where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating pain pathways using model organisms have identified the molecular nature of the transducers, regulatory mechanisms involved in changing neuronal activity, as well as the critical role of immune system cells in driving pain pathways. In man, mapping of human pain mutants as well as twin studies and association studies of altered pain behaviour have identified important regulators of the pain system. In turn, new drug targets for chronic pain treatment have been validated in transgenic mouse studies. Thus, genetic studies of pain pathways have complemented the traditional neuroscience approaches of electrophysiology and pharmacology to give us fresh insights into the molecular basis of pain perception.

Foulkes, Tom; Wood, John N.



Vulnerability in Clinical Research with Patients in Pain  

PubMed Central

Some have characterized patients living with intractable pain as a vulnerable population in both clinical and research settings. Labeling the population as vulnerable, however, does not provide clarity regarding the potential risks that they face when they participate in research. Instead, research vulnerability for patients in pain is a function of an interaction between their pain conditions and elements of the research enterprise. Therefore, the identification of potential risks requires consideration not only of characteristics of patients with chronic pain, but also consideration of features of researchers, the quality of institutional oversight, and the medical/social environment within which the research is conducted. This paper provides an analysis of those risks and provides some suggestions as to how the risks might be better managed.

Tait, Raymond C.



Undiagnosed osteoid osteoma of the spine presenting as painful scoliosis from adolescence to adulthood: a case report  

PubMed Central

Presented here is a case of a young woman, with an undiagnosed osteoid osteoma of the spine, which presented with painful scoliosis in adolescence and was treated by bracing until her accession to adulthood. A more thorough investigation, years after the initial one, revealed the tumor. Surgical excision and stabilization offered the long-awaited cure. Misdiagnosis resulted in intractable pain for years, deformity, the discomfort of brace therapy, and the frustration of a prolonged yet ineffective treatment.

Sapkas, George; Efstathopoulos, Nicolas E; Papadakis, Michael



Highly effective oral amphotericin B formulation against murine visceral leishmaniasis.  


Visceral leishmaniasis is a deadly parasitic disease caused by obligate intramacrophage protozoans of the Leishmania genus. The World Health Organization estimates the annual death toll to be 50,000, with 500,000 new cases each year. Without treatment, visceral leishmaniasis is inevitably fatal. For the last 70 years, the first line of defense has been pentavalent antimonials; however, increased resistance has brought amphotericin B to the forefront of treatment options. Unfortunately, the difficult route of drug administration, toxicity issues, and cost prevent amphotericin B from reaching the infected population, and mortality continues to rise. Our reformulation of amphotericin B for oral administration has resulted in a highly efficacious antileishmanial treatment that significantly reduces or eradicates liver parasitemia in a murine model of visceral leishmaniasis. This formulation has overcome amphotericin B's significant physicochemical barriers to absorption and holds promise for the development of a self-administered oral therapy for the treatment of visceral leishmaniasis. PMID:19545212

Wasan, Kishor M; Wasan, Ellen K; Gershkovich, Pavel; Zhu, Xiaohua; Tidwell, Richard R; Werbovetz, Karl A; Clement, John G; Thornton, Sheila J



Neuropathic Pain  

PubMed Central

Neuropathic pain is triggered by lesions to the somatosensory nervous system that alter its structure and function so that pain occurs spontaneously and responses to noxious and innocuous stimuli are pathologically amplified. The pain is an expression of maladaptive plasticity within the nociceptive system, a series of changes that constitute a neural disease state. Multiple alterations distributed widely across the nervous system contribute to complex pain phenotypes. These alterations include ectopic generation of action potentials, facilitation and disinhibition of synaptic transmission, loss of synaptic connectivity and formation of new synaptic circuits, and neuroimmune interactions. Although neural lesions are necessary, they are not sufficient to generate neuropathic pain; genetic polymorphisms, gender, and age all influence the risk of developing persistent pain. Treatment needs to move from merely suppressing symptoms to a disease-modifying strategy aimed at both preventing maladaptive plasticity and reducing intrinsic risk.

Costigan, Michael; Scholz, Joachim; Woolf, Clifford J.



Myofascial Pain  

Microsoft Academic Search

\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Myofascial pain should be considered in patients with localized pain complaints without arthritic or neuropathic features.\\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Myofascial pain syndrome should not be diagnosed in patients with no physical findings. Myofascial pain requires the presence\\u000a of a taut band and muscular trigger points.\\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Active trigger points refer pain in predictable patterns.\\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Treatment of myofascial pain focuses on

Dawn A. Marcus


Visceral leishmaniasis in a soldier returning from Operation Enduring Freedom.  


This report presents a case of visceral leishmaniasis in a soldier returning from Operation Enduring Freedom. During the United States' last major military conflict, Operation Desert Storm, the diagnosis of multiple cases of visceral leishmaniasis led to policy changes, including a temporary ban on troop blood donation. This case demonstrates the applicability of recently developed Leishmania polymerase chain reaction and serological assays when conventional methods of diagnosis, such as tissue microscopy and culture, fail. PMID:15495722

Halsey, Eric S; Bryce, L Michelle; Wortmann, Glenn W; Weina, Peter J; Ryan, Jeffrey R; DeWitt, Caroline C



Fractionation of urea-pretreated squid visceral oil ethyl esters  

Microsoft Academic Search

Ethyl esters of squid (Illex argentinus) visceral oil contained 11.8% eicosapentaenoic acid (EPA) and 14.9% docosahexaenoic acid (DHA). The esters were treated with\\u000a urea to increase the contents of EPA and DHA. The non-urea complexing ethyl esters of squid visceral oil contained 28.2% EPA\\u000a and 35.6% DHA. This mixture was fractionated by molecular distillation to further increase the EPA or

Lucy Sun Hwang



Visceral Adiposity and the Prevalence of Hypertension in Japanese Americans  

Microsoft Academic Search

Background—Visceral adiposity is generally considered to play a key role in the metabolic syndrome, including hypertension. The purpose of this study was to evaluate cross-sectionally whether visceral adiposity is associated with prevalence of hypertension independent of other adipose depots and fasting plasma insulin. Methods and Results—Study subjects included 563 Japanese Americans with normal or impaired glucose tolerance or diabetes but

Tomoshige Hayashi; Edward J. Boyko; Donna L. Leonetti; Marguerite J. McNeely; Laura Newell-Morris; Steven E. Kahn; Wilfred Y. Fujimoto



Clinical and Experimental Advances in Treatment of Visceral Leishmaniasis  

Microsoft Academic Search

Visceral leishmaniaisis (kala-azar) is a disseminated proto- zoal infection, transmitted by sandfly bite, in which macro- phages of the liver, spleen, and bone marrow are preferentially parasitized and support intracellular replication. Most human infections caused by visceralizing strains of Leishmania are probably subclinical (13, 101, 139), attesting to innate resis- tance or, more likely, to T (Th1)-cell-dependent immune re- sponses




Elbow pain  


... common causes of elbow tendinitis are gardening, playing baseball, using a screwdriver, or overusing your wrist and ... involve: Antibiotics Corticosteroid shots Pain medicine Physical therapy Surgery (last resort)


Imaging host-Leishmania interactions: significance in visceral leishmaniasis.  


Leishmaniasis is a neglected disease that is associated with a spectrum of clinical manifestations ranging from self-healing cutaneous lesions to fatal visceral infections, which primarily depends on the parasite species. In visceral leishmaniasis (VL), as opposed to cutaneous leishmaniasis (CL), parasites that infect host cells at the sand fly bite site have the striking ability to disseminate to visceral organs where they proliferate and persist for long periods of time. Imaging the dynamics of the host-Leishmania interaction in VL provides a powerful approach to understanding the mechanisms underlying host cell invasion, Leishmania dissemination and persistence within visceral organs and, to dissecting the immune responses to infection. Therefore, by allowing the visualization of the critical steps involved in the pathogenesis of VL, state-of-the-art microscopy technologies have the great potential to aid in the identification of better intervention strategies for this devastating disease. In this review, we emphasize the current knowledge and the potential significance of imaging technologies in understanding the infection process of visceralizing Leishmania species. Then, we discuss how application of innovative microscopy technologies to the study of VL will provide rich opportunities for investigating host-parasite interactions at a previously unexplored level and elucidating visceral disease-promoting mechanisms. PMID:23772814

Forestier, C-L



Vertebral body innervation: Implications for pain.  


Vertebral fractures often cause intractable pain. To define the involvement of vertebral body innervation in pain, we collected specimens from male and female patients during percutaneous kyphoplasty, a procedure used for reconstruction of the vertebral body. Specimens were taken from 31 patients (9 men and 22 women) suffering high-intensity pain before surgery. In total, 1,876 histological preparations were obtained and analysed. Immunohistochemical techniques were used to locate the nerves in the specimens. The nerve fibres were labelled by indirect immunofluorescence with the primary antibody directed against Protein Gene Product 9.5 (PGP 9.5), a pan-neuronal marker; another primary antibody directed against type IV collagen (Col IV) was used to identify vessels and to determine their relationship with vertebral nerve fibres. The mean percentage of samples in which it was possible to identify nerve fibres was 35% in men and 29% in women. The percentages varied depending on the spinal level considered and the sex of the subject, nerve fibres being mostly present around vessels (95%). In conclusion, there is scarce innervation of the vertebral bodies, with a clear prevalence of fibres located around vessels. It seems unlikely that this pattern of vertebral body innervation is involved in vertebral pain or in pain relief following kyphoplasty. PMID:20020509

Buonocore, Michelangelo; Aloisi, Anna Maria; Barbieri, Massimo; Gatti, Anna Maria; Bonezzi, Cesare



Cerebral Stimulation for the Affective Component of Neuropathic Pain.  


OBJECTIVES: To review the current state of cerebral stimulation for neuropathic pain and to propose that cerebral stimulation should aim also at the affective sphere of chronic pain rather than solely focusing on the primary sensory-discriminative sphere. METHODS: The past and current goals of cerebral stimulation are reviewed as well as its limitations. A novel deep brain stimulation approach is proposed to evaluate this conceptual shift from somatosensory to affective sphere of pain targeting. APPROACH: Thalamic and other central pain syndromes are typically intractable to current treatment methods, including cerebral neuromodulation of somatosensory pathways, leading to long-term distress and disability. Our modern understanding of chronic pain pathophysiology is based largely on the neuromatrix theory, where cognitive, affective, and sensory-discriminative spheres contribute equally to the overall pain experience. During the last decade, the safety and feasibility of chronic stimulation of neural pathways related to mood and affect has been explored with promising results. Here, we propose a novel approach to modulate the affective sphere of chronic pain by targeting similar networks in patients with treatment-refractory central pain. Our primary goal is not to produce (or measure) analgesia, but rather to modulate the affective burden of chronic pain. DISCUSSION: Cerebral neuromodulation for neuropathic pain has had limited efficacy thus far. Shifting our aim to neural networks related to the affective sphere of pain may allow us to reduce pain conditioning and pain-related disability. Our ultimate goal is to promote rehabilitation from chronic pain-social and occupational. PMID:23094938

Machado, Andre G; Baker, Kenneth B; Plow, Ela; Malone, Donald A



Modulation of visceral hypersensitivity by glial cell line-derived neurotrophic factor family receptor ?-3 in colorectal afferents  

PubMed Central

Irritable bowel syndrome is characterized by colorectal hypersensitivity and contributed to by sensitized mechanosensitive primary afferents and recruitment of mechanoinsensitive (silent) afferents. Neurotrophic factors are well known to orchestrate dynamic changes in the properties of sensory neurons. Although pain modulation by proteins in the glial cell line-derived neurotrophic factor (GDNF) family has been documented in various pathophysiological states, their role in colorectal hypersensitivity remains unexplored. Therefore, we investigated the involvement of the GDNF family receptor ?-3 (GFR?3) signaling in visceral hypersensitivity by quantifying visceromotor responses (VMR) to colorectal distension before and after intracolonic treatment with 2,4,6-trinitrobenzene sulfonic acid (TNBS). Baseline responses to colorectal distension did not differ between C57BL/6 and GFR?3 knockout (KO) mice. Relative to intracolonic saline treatment, TNBS significantly enhanced the VMR to colorectal distension in C57BL/6 mice 2, 7, 10, and 14 days posttreatment, whereas TNBS-induced visceral hypersensitivity was significantly suppressed in GFR?3 KO mice. The proportion of GFR?3 immunopositive thoracolumbar and lumbosacral colorectal dorsal root ganglion neurons was significantly elevated 2 days after TNBS treatment. In single fiber recordings, responses to circumferential stretch of colorectal afferent endings in C57BL/6 mice were significantly increased (sensitized) after exposure to an inflammatory soup, whereas responses to stretch did not sensitize in GFR?3 KO mice. These findings suggest that enhanced GFR?3 signaling in visceral afferents may contribute to development of colorectal hypersensitivity.

Shinoda, M.; Feng, B.; Albers, K. M.; Gebhart, G. F.



Role of voltage gated Ca2+ channels in rat visceral hypersensitivity change induced by 2,4,6-trinitrobenzene sulfonic acid  

PubMed Central

Background Visceral pain is common symptom involved in many gastrointestinal disorders such as inflammatory bowel disease. The underlying molecular mechanisms remain elusive. We investigated the molecular mechanisms and the role for voltage gated calcium channel (VGCC) in the pathogenesis in a rat model of 2,4,6-trinitrobenzenesulfonic acid (TNBS) induced visceral inflammatory hypersensitivity. Results Using Agilent cDNA arrays, we found 172 genes changed significantly in dorsal root ganglia (DRG) of TNBS treated rats. Among these changed genes, Cav1.2 and Cav2.3 were significantly up-regulated. Then the RT-PCR and Western blot further confirmed the up-regulation of Cav1.2 and Cav2.3. The whole cell patch clamp recording of acutely dissociated colonic specific DRG neurons showed that the peak IBa density was significantly increased in colonic neurons of TNBS treated rats compared with control rats (?127.82?±?20.82 pA/pF Vs ?91.67?±?19.02 pA/pF, n?=?9, *P?visceral pain in TNBS induced inflammatory visceral hypersensitivity. Conclusion Cav1.2 and Cav2.3 in colonic primary sensory neurons play an important role in visceral inflammatory hyperalgesia, which maybe the potential therapeutic targets.



Neuromyelitis Optica: An Often Forgotten Cause of Intractable Nausea and Vomiting  

PubMed Central

Neuromyelitis optica, also known as Devic's disease, is a rare autoimmune disorder in which a patient's immune system affects the optic nerves and the spinal cord, leading to loss of vision and spinal cord dysfunction. We present our experience with a 38-year-old female who presented to our facility with complaints of intractable nausea and vomiting. After extensive evaluation, she was found to have neuromyelitis optica. Her symptoms completely resolved following institution of appropriate therapy. She made a significant recovery and has since been placed on chronic immunosuppressive therapy. Through this article we hope to bring attention to a significant cause of intractable nausea and vomiting that may often be forgotten in general medicine or gastroenterology services.

Enweluzo, Chijioke; Yarra, Pradeep



Neuromyelitis optica: an often forgotten cause of intractable nausea and vomiting.  


Neuromyelitis optica, also known as Devic's disease, is a rare autoimmune disorder in which a patient's immune system affects the optic nerves and the spinal cord, leading to loss of vision and spinal cord dysfunction. We present our experience with a 38-year-old female who presented to our facility with complaints of intractable nausea and vomiting. After extensive evaluation, she was found to have neuromyelitis optica. Her symptoms completely resolved following institution of appropriate therapy. She made a significant recovery and has since been placed on chronic immunosuppressive therapy. Through this article we hope to bring attention to a significant cause of intractable nausea and vomiting that may often be forgotten in general medicine or gastroenterology services. PMID:23904838

Enweluzo, Chijioke; Yarra, Pradeep



Mirror movements following cortical resection of polymicrogyria in a child with intractable epilepsy.  


Mirror movements may be congenital or acquired. There are few reports of acquired mirror movements in pediatric patients. Further, mirror movements in children with epilepsy have rarely been reported. A 9-year old male, with intractable partial epilepsy resulting from polymicrogyria of the right hemisphere, underwent cortical resection of the right frontotemporoparietal region for a malformation of cortical development. He developed left hemiplegia and mirror movements in the left hand in the postoperative period. Four months after surgery, he remained seizure-free with mild residual left-sided hemiplegia and persistent mirror movements. Mechanisms postulated for mirror movements include aberrant pyramidal tract development and transcallosal inhibitory pathways. The latter mechanism might have contributed to the mirror movements observed in this child. This study is the first report of mirror movements following focal cortical resection for intractable epilepsy due to polymicrogyria. PMID:16458827

RamachandranNair, Rajesh; Otsubo, Hiroshi; Ochi, Ayako; Rutka, James; Donner, Elizabeth J



[Visceral leishmaniasis in Central Asia and Kazakhstan].  


At present sporadic foci of visceral leishmaniasis (VL) are encountered mainly in the natural foci. The natural foci of VL are situated mainly in valleys and foothills. In southern areas of the Turkmen SSR the majority of cases were registered in small settlements situated near wells in interbarkhan lowerings. The reservoir of pathogen here may be Vulpes vulpes and dogs and the most likely vector is Phlebotomus turanicus. In Kazakhstan cases of VL are encountered in the thickets of the Syr-Darya floodlands in Kzyl-Orda Province, where the natural reservoir of the pathogen are Canis aureus L. and Vulpes corsac, and the vector is P. smirnovi. Synanthropic foci in Dzhambul and Chimkent, where dogs were most likely the source of the infection and P. longiductus was the vector, are at present inactive. The maps have been plotted where landscape dissemination of mosquitoes (VL vectors) is compared to places of habitation of Canis aureus L. and VL incidence in humans at peaks of the disease endemia. Medical personnel should be on the look-out for VL on the whole territory with VL natural foci. PMID:2146471

Dergacheva, T I; Darchenkova, N N


Visceral leishmaniasis: Experimental models for drug discovery  

PubMed Central

Visceral leishmaniasis (VL) or kala-azar is a chronic protozoan infection in humans associated with significant global morbidity and mortality. The causative agent is a haemoflagellate protozoan Leishmania donovani, an obligate intracellular parasite that resides and multiplies within macrophages of the reticulo-endothelial system. Most of the existing anti-leishmanial drugs have serious side effects that limit their clinical application. As an alternate strategy, vaccination is also under experimental and clinical trials. The in vitro evaluation designed to facilitate rapid testing of a large number of drugs has been focussed on the promastigotes milt little attention on the clinically relevant parasite stage, amastigotes. Screening designed to closely reflect the situation in vivo is currently time consuming, laborious, and expensive, since it requires intracellular amastigotes and animal model. The ability to select transgenic Leishmania expressing reporter proteins, such as the green fluorescent proteins (GFP) or the luciferase opened up new possibilities for the development of drug screening models. Many experimental animal models like rodents, dogs and monkeys have been developed, each with specific features, but none accurately reproduces what happens in humans. Available in vitro and in vivo methodologies for antileishmanial drug screening and their respective advantages and disadvantages are reviewed.

Gupta, Suman; Nishi



Pain Genes  

Microsoft Academic Search

Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors) signal the existence of tissue damage to the central nervous system (CNS), where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating

Tom Foulkes; John N. Wood



Knee Pain  


... when the triangular bone (patella) that covers the front of your knee slips out of place, usually to the outside of your knee. In some cases, the kneecap may stay displaced and you'll be able to see the dislocation. Hip or foot pain. If you have hip or foot pain, you ...


Heel Pain  


... pronation may also contribute to injury to the hip, knee, and lower back. Achilles tendinitis: Pain at the back of the heel is associated ... of steps can be taken to avoid heel pain and accompanying afflictions: Wear shoes that fit well—front, back, and sides—and have shock-absorbent soles, ...


Local anaesthetic thoracoscopy for intractable pneumothorax in a high-risk patient  

PubMed Central

The management of high-operative-risk patients with a pneumothorax is complicated. The case of a 79-year old man with an intractable secondary pneumothorax, who had taken oral steroids to control asthma, is presented. Since the patient could not tolerate general anaesthesia because of poor cardiac function, thoracoscopic surgery was performed under local anaesthesia. A successful lung fistula closure was achieved and the continuous air leakage disappeared immediately after the surgery.

Yutaka, Yojiro; Katakura, Hiromichi; Kaneda, Shohei; Yamanaka, Akira



Anterior callosotomy in the management of intractable epileptic seizures: Significance of the extent of resection  

Microsoft Academic Search

Summary We report our series of twenty consecutive patients who underwent corpus callosotomy for medically intractable epilepsy. The follow-up is 6.7±0.5 years. Sixteen of 20 patients (80%) had a favourable outcome. Six patients have remained free of major generalized motor seizures, and ten further patients experienced significant sustained reduction in the severity and frequency of the seizures. The type of

D. E. Sakas; J. Phillips



Intractable Recurrent Hepatitis A Virus Infection Requiring Repeated Liver Transplantation: A Case Report  

Microsoft Academic Search

Although hepatitis A virus (HAV) infection is usually self-limited, it may induce fulminant hepatitis. We present an unusual case of a 40-year-old, otherwise healthy man with intractable recurrent HAV infection requiring retransplantation after primary liver transplantation for HAV-associated fulminant liver failure. After the first living-donor liver transplantation, allograft function recovered uneventfully; however, beginning at 35 days, his serum total bilirubin

G. C. Park; S. Hwang; Y. D. Yu; P. J. Park; Y. I. Choi; G. W. Song; D. H. Jung; C. S. Ahn; K. H. Kim; D. B. Moon; T. Y. Ha; S. G. Lee



Treatment of intractable epilepsy in a female with SLC6A8 deficiency  

Microsoft Academic Search

A female heterozygous for a novel, disease causing, missense mutation in the X-linked cerebral creatine transporter (SLC6A8) gene (c.1067G>T, p.Gly356Val) presented with intractable epilepsy, mild intellectual disability and moderately reduced cerebral creatine levels. Treatment with creatine monohydrate, to enhance cerebral creatine transport, combined with l-arginine and l-glycine, to enhance cerebral creatine synthesis, resulted in complete resolution of seizures. Heterozygous SLC6A8

Saadet Mercimek-Mahmutoglu; Mary B. Connolly; Kenneth J. Poskitt; Gabriella A. Horvath; Noel Lowry; Gajja S. Salomons; Brett Casey; Graham Sinclair; Cynthia Davis; Cornelis Jakobs; Sylvia Stockler-Ipsiroglu



Hemispherectomy for intractable seizures in children: a report of 58 cases  

Microsoft Academic Search

Fifty-eight children who underwent anatomical, functional, or modified anatomical hemispherectomy for intractable seizures from 1986 to 1995 were evaluated for seizure control, motor function, and complications. Age at surgery ranged from 0.3 to 17.3 years (median 2.8 years). Twenty-seven anatomical, 27 functional, and 4 modified anatomical hemispherectomies were performed. Seizure control and motor function in the 50 patients with more

Warwick J. Peacock; Monica C. Wehby-Grant; W. Donald Shields; D. Alan Shewmon; Harry T. Chugani; Raman Sankar; Harry V. Vinters



Descending modulation of visceral nociceptive transmission from the locus coeruleus/subcoeruleus in the rat.  


The purpose of the present investigation was to examine whether electrical stimulation in the locus coeruleus/subcoeruleus (LC/SC) could modulate visceral pain evoked by noxious colorectal distention (CRD). Experiments were performed on 40 pentobarbital anesthetized male Sprague-Dawley rats. Extracellular potentials of single L(6)-S(2) spinal neuron were recorded with a carbon filament electrode. CRD (80 mmHg) was produced by inflating a balloon inside the descending colon and rectum. Electrical stimulation of the LC/SC (30, 50 and 70 microA, 100 Hz, 0.1 ms pulses) was delivered either ipsilaterally or contralaterally. Results showed that for 42/62 (68%) short-latency abrupt (SL-A) neurons, all of the short-latency sustained (SL-S) and long-latency (LL) neurons, LC/SC stimulation produced intensity-dependent attenuation of the CRD-evoked discharge. For 10/62 (16%) SL-A neurons, 6/8 (75%) inhibited (INHIB) neurons LC/SC stimulation increased the evoked discharge, for 10/62 (16%) SL-A neurons and 2/8 (25%) INHIB neurons, the evoked discharges were unaffected by the LC/SC stimulation. LC/SC stimulation also had different effects on the spontaneous activities of these neurons. The effects of LC/SC stimulation were the same both ipsilaterally and contralaterally either for the evoked discharges or for spontaneous activities. Following LC/SC lesions, LC/SC stimulation did not inhibit nociceptive responses, whereas inhibitory effects were observed by stimulation of the intact LC/SC contralateral to the recording site. These data suggest that the transmission of visceral pain was under the control of the centrifugal pathways from the LC/SC. PMID:18598853

Liu, Limin; Tsuruoka, Masayoshi; Maeda, Masako; Hayashi, Bunsho; Wang, Xiaomin; Inoue, Tomio



Cannabinoids in the management of difficult to treat pain  

PubMed Central

This article reviews recent research on cannabinoid analgesia via the endocannabinoid system and non-receptor mechanisms, as well as randomized clinical trials employing cannabinoids in pain treatment. Tetrahydrocannabinol (THC, Marinol®) and nabilone (Cesamet®) are currently approved in the United States and other countries, but not for pain indications. Other synthetic cannabinoids, such as ajulemic acid, are in development. Crude herbal cannabis remains illegal in most jurisdictions but is also under investigation. Sativex®, a cannabis derived oromucosal spray containing equal proportions of THC (partial CB1 receptor agonist ) and cannabidiol (CBD, a non-euphoriant, anti-inflammatory analgesic with CB1 receptor antagonist and endocannabinoid modulating effects) was approved in Canada in 2005 for treatment of central neuropathic pain in multiple sclerosis, and in 2007 for intractable cancer pain. Numerous randomized clinical trials have demonstrated safety and efficacy for Sativex in central and peripheral neuropathic pain, rheumatoid arthritis and cancer pain. An Investigational New Drug application to conduct advanced clinical trials for cancer pain was approved by the US FDA in January 2006. Cannabinoid analgesics have generally been well tolerated in clinical trials with acceptable adverse event profiles. Their adjunctive addition to the pharmacological armamentarium for treatment of pain shows great promise.

Russo, Ethan B



Cannabinoids in the management of difficult to treat pain.  


This article reviews recent research on cannabinoid analgesia via the endocannabinoid system and non-receptor mechanisms, as well as randomized clinical trials employing cannabinoids in pain treatment. Tetrahydrocannabinol (THC, Marinol((R))) and nabilone (Cesamet((R))) are currently approved in the United States and other countries, but not for pain indications. Other synthetic cannabinoids, such as ajulemic acid, are in development. Crude herbal cannabis remains illegal in most jurisdictions but is also under investigation. Sativex((R)), a cannabis derived oromucosal spray containing equal proportions of THC (partial CB(1) receptor agonist ) and cannabidiol (CBD, a non-euphoriant, anti-inflammatory analgesic with CB(1) receptor antagonist and endocannabinoid modulating effects) was approved in Canada in 2005 for treatment of central neuropathic pain in multiple sclerosis, and in 2007 for intractable cancer pain. Numerous randomized clinical trials have demonstrated safety and efficacy for Sativex in central and peripheral neuropathic pain, rheumatoid arthritis and cancer pain. An Investigational New Drug application to conduct advanced clinical trials for cancer pain was approved by the US FDA in January 2006. Cannabinoid analgesics have generally been well tolerated in clinical trials with acceptable adverse event profiles. Their adjunctive addition to the pharmacological armamentarium for treatment of pain shows great promise. PMID:18728714

Russo, Ethan B



Sagittal Abdominal Diameter and Visceral Adiposity  

PubMed Central

Background In the context of increasing obesity prevalence, the relationship between large visceral adipose tissue (VAT) volumes and type 2 diabetes mellitus (T2DM) is unclear. In a clinical sample of severely obese women (mean body mass index [BMI], 46 kg/m2) with fasting normoglycemia (n=40) or dysglycemia (impaired fasting glucose+diabetes; n=20), we sought to determine the usefulness of anthropometric correlates of VAT and associations with dysglycemia. Methods VAT volume was estimated using multi-slice computer tomography; anthropometric surrogates included sagittal abdominal diameter (SAD), waist circumference (WC) and BMI. Insulin sensitivity (Si), and beta-cell dysfunction, measured by insulin secretion (AIRg) and the disposition index (DI), were determined by frequently sampled intravenous glucose tolerance test. Results Compared to fasting normoglycemic women, individuals with dysglycemia had greater VAT (P<0.001) and SAD (P=0.04), but BMI, total adiposity and Si were similar. VAT was inversely associated with AIRg and DI after controlling for ancestry, Si, and total adiposity (standardized beta, ?0.32 and ?0.34, both P<0.05). In addition, SAD (beta=0.41, P=0.02) was found to be a better estimate of VAT volume than WC (beta=0.32, P=0.08) after controlling for covariates. Receiver operating characteristic analysis showed that VAT volume, followed by SAD, outperformed WC and BMI in identifying dysglycemic participants. Conclusions Increasing VAT is associated with beta-cell dysfunction and dysglycemia in very obese women. In the presence of severe obesity, SAD is a simple surrogate of VAT, and an indicator of glucose dysregulation.

Kahn, Henry S.; Gasevic, Danijela; Liang, Zhe; Frediani, Jennifer K.; Torres, William E.; Ziegler, Thomas R.; Phillips, Lawrence S.; Lin, Edward



Giant prosthetic reinforcement of the visceral sac.  


One hundred and seventy-nine patients with 237 hernias of the groin who were at high risk for recurrence after classic hernioplasty were operated upon; the procedure of giant prosthetic reinforcement of the visceral sac (GPRVS) was used. The patients in this series had predominantly recurrent and re-recurrent hernias. However, a few were obese with bilateral primary direct hernias and some had associated connective tissue disorders, such as Marfan and Ehlers-Danlos syndromes. GPRVS eliminates hernias of the groin by rendering the peritoneum inextensible by placing, in the preperitoneal space, a large prosthesis that extends far beyond the borders of the myopectineal orifice. The myopectineal orifice is the weak spot at which all hernias of the groin begin and is bounded by the rectus, oblique abdominal and iliopsoas muscles and the pectin of the pubis. In bilateral GPRVS, the peritoneum of both groins is reinforced with a single prosthesis inserted in the preperitoneal space through the midline. In unilateral GPRVS, the mesh envelops the peritoneum of a single groin. This simplifies the operation and makes it suitable for surgical centers that perform outpatient operations. The prosthesis with the best physical characteristics for GPRVS is Mersilene (polyester fiber). Unsutured prostheses of polypropylene and Teflon (polytetrafluoroethylene) may not adhere at the far edges, leading to a failure and recurrence. The over-all recurrence rate in this series of problem hernias was 3.7 per cent, which is extremely good. However, the rate becomes outstanding if recurrences resulting from meshes unsuitable for GPRVS are excluded. PMID:2814751

Wantz, G E



A rare clinic presentation of abdominal pain: rupture of splenic artery aneurysm: a case report  

Microsoft Academic Search

BACKGROUND: Splenic artery aneurysms (SAA) are uncommon but the most common visceral artery aneurysm. Splenic artery aneurysms are important to recognize because up to 25% may be complicated by rupture and the mortality rate after rupture is between 25% and 70%. CASE REPORT: We present a patient who have abdominal pain. Previously healthy 22-year-old female admitted to emergency department with

Sezgin Sarikaya; Baki Ekci; Can Aktas; Asli Cetin; Didem Ay; Alp Demirag



Treatment of chronic regional pain syndrome type 1 with palmitoylethanolamide and topical ketamine cream: modulation of nonneuronal cells  

PubMed Central

Chronic regional pain syndrome (CRPS) can be intractable to treat and patients sometimes suffer for many years. Therefore, new treatment strategies are needed to alleviate symptoms in CRPS patients. This case report describes a patient suffering from intractable CRPS type 1 for 13 years. Due to her swollen painful feet and left knee she is wheelchair-bound. The combination of palmitoylethanolamide and ketamine 10% cream reduced her pain by more than 50% after 1 month of treatment, and a marked reduction in swelling and skin discoloration was noticed. Furthermore, she could walk independently again and she experienced no side effects. Thus, palmitoylethanolamide and topical ketamine could be a combination therapy option for treating CRPS patients.

Keppel Hesselink, Jan M; Kopsky, David J



Postamputation pain: epidemiology, mechanisms, and treatment  

PubMed Central

Postamputation pain (PAP) is highly prevalent after limb amputation but remains an extremely challenging pain condition to treat. A large part of its intractability stems from the myriad pathophysiological mechanisms. A state-of-art understanding of the pathophysiologic basis underlying postamputation phenomena can be broadly categorized in terms of supraspinal, spinal, and peripheral mechanisms. Supraspinal mechanisms involve somatosensory cortical reorganization of the area representing the deafferentated limb and are predominant in phantom limb pain and phantom sensations. Spinal reorganization in the dorsal horn occurs after deafferentataion from a peripheral nerve injury. Peripherally, axonal nerve damage initiates inflammation, regenerative sprouting, and increased “ectopic” afferent input which is thought by many to be the predominant mechanism involved in residual limb pain or neuroma pain, but may also contribute to phantom phenomena. To optimize treatment outcomes, therapy should be individually tailored and mechanism based. Treatment modalities include injection therapy, pharmacotherapy, complementary and alternative therapy, surgical therapy, and interventions aimed at prevention. Unfortunately, there is a lack of high quality clinical trials to support most of these treatments. Most of the randomized controlled trials in PAP have evaluated medications, with a trend for short-term Efficacy noted for ketamine and opioids. Evidence for peripheral injection therapy with botulinum toxin and pulsed radiofrequency for residual limb pain is limited to very small trials and case series. Mirror therapy is a safe and cost-effective alternative treatment modality for PAP. Neuromodulation using implanted motor cortex stimulation has shown a trend toward effectiveness for refractory phantom limb pain, though the evidence is largely anecdotal. Studies that aim to prevent PA P using epidural and perineural catheters have yielded inconsistent results, though there may be some benefit for epidural prevention when the infusions are started more than 24 hours preoperatively and compared with nonoptimized alternatives. Further investigation into the mechanisms responsible for and the factors associated with the development of PAP is needed to provide an evidence-based foundation to guide current and future treatment approaches.

Hsu, Eugene; Cohen, Steven P



Urination - painful  


... such as yeast or other infections of the vulva and vagina Other causes of painful urination include: ... in the urine ? Are there any rashes or itching in the genital area? What medications are you ...


Ankle Pain  


... or outside of your ankle or along the Achilles tendon, which connects the muscles in your lower leg ... Common causes of ankle pain include: Achilles tendinitis Achilles tendon rupture Avulsion fracture Bone spurs Broken ankle/broken ...


Phantom Pain  


... often results in painful nerve activity. Poor-fitting artificial limb (prosthesis). Talk to your doctor to be sure you're putting your artificial limb on correctly and that it fits properly. If ...


Back Pain  


... with your spinal cord, muscles, nerves or disks. Magnetic resonance imaging (MRI) or computerized tomography (CT) scans. ... Devereaux M. Low back pain. Medical Clinics of North America. 2009;93:477. Hoy D, et al. ...


What Is Chronic Pain?  

MedlinePLUS Videos and Cool Tools

... Learned Going to the ER Communication Tools Pain Management Programs Videos Resources Glossary FAQs Surveys September is ... for Understanding Pain Pain Awareness Toolkits Home Pain Management Tools Videos What Is Chronic Pain? Featured Tool ...


[Wrist pain].  


Acute or chronic wrist pain is a relatively frequent complaint that may involve all age groups. The pain may be of osseous, articular, periarticular, neurologic, vascular origin, or be referred from the cervical spine, shoulder or elbow. The diagnosis should be oriented by a precise history and clinical examination. More specialised exams will be required according to clinical findings. Psychosocial and environmental influences need to be taken into consideration. PMID:17233497

Sadowski, M; Della Santa, D



Pain Relief after Cervical Ganglionectomy (C2 and C3) for the Treatment of Medically Intractable Occipital Neuralgia  

Microsoft Academic Search

Occipital neuralgia (ON) presents a diagnostic challenge because of the wide variety of symptoms, surgical findings, and postsurgical outcomes. Surgical removal of the second (C2) or third (C3) cervical sensory dorsal root ganglion is an option to treat ON. The goal of this study was to evaluate the short-term and the long-term efficacy of these procedures for management of cervical

Feridun Acar; Jonathan Miller; Kiarash J. Golshani; Zvi H. Israel; Shirley McCartney; Kim J. Burchiel



Axillofemoral bypass relieves visceral malperfusion in type B aortic dissection.  


A 58-year-old man with acute type B aortic dissection presented with right lower limb cyanosis, mesenteric ischemia, and acute renal failure. He was treated with extraanatomic right axillofemoral bypass surgery alone, recovered completely from renal, mesenteric, and lower extremity malperfusion shortly thereafter, and lived free of symptoms for the following year. Follow-up computed tomography angiograms documented adequate expansion of the true aortic lumen and good perfusion of visceral organs. Thus, managing such patients with coexisting visceral and extremity malperfusion may be accomplished with axillofemoral bypass exclusively, which can relieve ischemia of upstream abdominal organs and downstream lower extremities effectively and durably. PMID:23336885

Kuo, Hsun-Nan; Lai, Hui-Chin; Chang, Yi-Wen; Wang, Chung-Chi; Lee, Wen-Lieng; Chan, Si-Wa; Wang, Kuo-Yang; Ting, Chih-Tai; Liu, Tsun-Jui



[Unsuspected visceral leishmaniasis infiltrating a squamous cell carcinoma].  


Amastigotes of the genus Leishmania have been observed in biopsies of apparently unrelated lesions in patients with AIDS and visceral leishmaniasis. We describe the case of a 40-year-old man with human immunodeficiency virus infection and severe immunodepression in whom the presence of the parasite was detected as an incidental finding on histological study of a perianal squamous cell carcinoma. This finding led to the diagnosis and subsequent treatment of previously unsuspected visceral leishmaniasis. In a review of the literature we have found no previous examples of this association. PMID:21885024

Armengot-Carbó, M; Carmena-Ramón, R; Rodrigo-Nicolás, B; Ferrando-Marco, J



Burning mouth syndrome as a trigeminal small fibre neuropathy: Increased heat and capsaicin receptor TRPV1 in nerve fibres correlates with pain score  

Microsoft Academic Search

Burning mouth syndrome (BMS) is often an idiopathic chronic and intractable pain condition, affecting 1.5–5.5% of middle-aged and elderly women. We have studied the heat and capsaicin receptor TRPV1, and its regulator nerve growth factor (NGF), in BMS. Patients with BMS (n=10) and controls (n=10) were assessed for baseline and post-topical capsaicin pain scores, and their tongue biopsies immunostained for

Z. Yilmaz; T. Renton; Y. Yiangou; J. Zakrzewska; I. P. Chessell; C. Bountra; P. Anand



Vertebroplasty and kyphoplasty: complementary techniques for the treatment of painful osteoporotic vertebral compression fractures. A prospective non-randomised study on 154 patients  

Microsoft Academic Search

In a prospective study, we aimed to evaluate the potential use of kyphoplasty (KP) and vertebroplasty (VP) as complementary\\u000a techniques in the treatment of painful osteoporotic vertebral compression fractures (VCFs). After 1 month of conservative\\u000a treatment for VCFs, patients with intractable pain were offered treatment with KP or VP according to a treatment algorithm\\u000a that considers time from fracture (?t) and

Alessio Lovi; Marco Teli; Alessandro Ortolina; Francesco Costa; Maurizio Fornari; Marco Brayda-Bruno



Cinacalcet Reduces Serum Calcium Concentrations in Patients with Intractable Primary Hyperparathyroidism  

PubMed Central

Context: Patients with persistent primary hyperparathyroidism (PHPT) after parathyroidectomy or with contraindications to parathyroidectomy often require chronic treatment for hypercalcemia. Objective: The objective of the study was to assess the ability of the calcimimetic, cinacalcet, to reduce serum calcium in patients with intractable PHPT. Design: This was an open-label, single-arm study comprising a titration phase of variable duration (2–16 wk) and a maintenance phase of up to 136 wk. Setting: The study was conducted at 23 centers in Europe, the United States, and Canada. Patients: The study included 17 patients with intractable PHPT and serum calcium greater than 12.5 mg/dl (3.1 mmol/liter). Intervention: During the titration phase, cinacalcet dosages were titrated every 2 wk (30 mg twice daily to 90 mg four times daily) for 16 wk until serum calcium was 10 mg/dl or less (2.5 mmol/liter). If serum calcium increased during the maintenance phase, additional increases in the cinacalcet dose were permitted. Main Outcome Measure: The primary end point was the proportion of patients experiencing a reduction in serum calcium of 1 mg/dl or greater (0.25 mmol/liter) at the end of the titration phase. Results: Mean ± sd baseline serum calcium was 12.7 ± 0.8 mg/dl (3.2 ± 0.2 mmol/liter). At the end of titration, a 1 mg/dl or greater reduction in serum calcium was achieved in 15 patients (88%). Fifteen patients (88%) experienced treatment-related adverse events, none of which were serious. The most common adverse events were nausea, vomiting, and paresthesias. Conclusions: In patients with intractable PHPT, cinacalcet reduces serum calcium, is generally well tolerated, and has the potential to fulfill an unmet medical need.

Marcocci, Claudio; Chanson, Philippe; Shoback, Dolores; Bilezikian, John; Fernandez-Cruz, Laureano; Orgiazzi, Jacques; Henzen, Christoph; Cheng, Sunfa; Sterling, Lulu Ren; Lu, John; Peacock, Munro



Is Endovascular Therapy the Preferred Treatment for All Visceral Artery Aneurysms?  

Microsoft Academic Search

Endovascular intervention can provide an alternative method of treatment for visceral artery aneurysms. We conducted a retrospective review of all patients with visceral artery aneurysms at a single university medical center from 1990 to 2003, focusing on the outcome of endovascular therapy. Sixty-five patients with visceral artery aneurysms were identified: 39 splenic (SAA), 13 renal, seven celiac, three superior mesenteric

Stephanie S. Saltzberg; Thomas S. Maldonado; Patrick J. Lamparello; Neal S. Cayne; Matthew M. Nalbandian; Robert J. Rosen; Glenn R. Jacobowitz; Mark A. Adelman; Paul J. Gagne; Thomas S. Riles; Caron B. Rockman



Management of visceral artery aneurysms Conduta terapêutica em aneurismas de artérias viscerais  

Microsoft Academic Search

Objective: Visceral artery aneurysms, despite being uncommon, are important vascular diseases, since they frequently are life- threatening, and often fatal emergencies. The purpose of this study is to review our experience with treatments of visceral artery aneurysms. Method: Between 1988 and June, 2004, 37 visceral artery aneurysms were treated in 35 patients (17 male and 18 female) with average age

Roberto Chiesa; Domenico Astore; Renata Castellano; Laura Dordoni; Marcelo R. Liberato de Moura; Germano Melissano


Social Stress, Visceral Obesity, and Coronary Artery Atherosclerosis in Female Primates  

Microsoft Academic Search

Our previous work in cynomolgus monkeys demonstrated significant relationships between (i) social reorganization stress and visceral fat deposition, and (ii) central fat deposition and coronary artery atherosclerosis (CAA). Nevertheless, direct relationships between CAA and visceral fat have not been demonstrated in people or animals, nor have relationships among stress, visceral obesity, and CAA been observed within a single study. Here,

Carol A. Shively; Thomas C. Register; Thomas B. Clarkson



Regional Differences in the Cellular Immune Response to Experimental Cutaneous or Visceral Infection with Leishmania donovani  

Microsoft Academic Search

Infection with the protozoan Leishmania donovani can cause serious visceral disease or subclinical infection in humans. To better understand the pathogenesis of this dichotomy, we have investigated the host cellular immune response to cutaneous or visceral infection in a murine model. Mice infected in the skin developed no detectable visceral parasitism, whereas intravenous inoculation resulted in hepatosplenomegaly and an in-




Focused suggestion with somatic anchoring technique: rapid self-hypnosis for pain management.  


This article details a self-hypnosis technique designed to teach patients how to manage acute or chronic pain through directed focus. The focused suggestion with somatic anchoring technique has been used with various types of pain, including somatic pain (arthritis, post-injury pain from bone breaks, or muscle tears), visceral pain (related to irritable bowel disease), and neuropathic pain (related to multiple sclerosis). This technique combines cognitive restructuring and mindfulness meditation with indirect and direct suggestions during hypnosis. The case examples demonstrate how the focused suggestion with somatic anchoring technique is used with both acute and chronic pain conditions when use of long-term medication has been relatively ineffective. PMID:23724568

Donatone, Brooke



Clinical and physiological effects of stereotaxic bilateral amygdalotomy for intractable aggression.  


The amygdala is thought to be an important neural structure underlying the "fight-or-flight" response, but information on its role in humans is scarce. The clinical and psychophysiological effects of amygdalar destruction were studied in 2 patients who underwent bilateral amygdalotomy for intractable aggression. After surgery, both patients showed a reduction in autonomic arousal levels to stressful stimuli and in the number of aggressive outbursts, although both patients continued to have difficulty controlling aggression. The "taming effect" reported after bilateral amygdalar destruction may be due to the amygdala's inadequate processing of perceived threat stimuli that would normally produce a fight-or-flight response. PMID:9813786

Lee, G P; Bechara, A; Adolphs, R; Arena, J; Meador, K J; Loring, D W; Smith, J R



Successful use of recombinant factor VIIa in a patient with intractable bleeding during extracorporeal membrane oxygenation.  


Bleeding is still the most common complication during extracorporeal membrane oxygenation (ECMO) for temporary cardio-circulatory support. We present a case of a young man suffering from intractable hemorrhage during ECMO support, who was pre-treated with glycoprotein IIb/IIIa receptor antagonist Tirofiban due to a suspicion of myocardial ischemia. After failure of conventional hemostatic means, hemostasis was achieved by the donation of recombinant Factor VIIa (rFVIIa). Aspects of bleeding control during extracorporeal circulatory support, the use of Tirofiban and rFVIIa are discussed. PMID:16311981

Brose, S; Sirbu, H; Engel, M; Kuhlen, R; Autschbach, R



Superselective embolisation for control of intractable epistaxis from maxillary artery injury  

PubMed Central

Traumatic intractable epistaxis following fractures of the facial and base of skull rarely may be life-threatening. Common sites of injury are the internal carotid and maxillary artery. When conventional methods of arresting haemorrhage fail, the choices are then an open arterial ligation or superselective embolisation. This paper presents a patient with life-threatening epistaxis from a Le Fort type II fracture. Angiography revealed a maxillary artery injury in which superselective embolisation was performed and the haemorrhage was successfully arrested. A literature review of this technique is discussed, including its advantages and the relationship of the internal maxillary artery to facial fractures.

Singam, P; Thanabalan, J; Mohammed, Z



Undecidability and intractability results concerning datalog programs and their persistency numbers  

Microsoft Academic Search

F.1.1 [Computation,by abstract,devices]: Models of Computation—Automata; Bounded- action devices; Computability,theory ; F.1.3 [Computation,by abstract,devices]: Complexity Measures,and,Classes—Reducibility; F.4.2 [Mathematical,Logic,and,Formal,Languages]: Formal,Languages—Decision,Problems; H.2.3 [Database,Management]: Languages—Query Languages General Terms: Algorithms, Languages, Theory Additional Key Words and Phrases: Datalog, bounded treewidth hypergraphs, Persistent vari- ables, Persistency numbers, Boundedness, Undecidability, Intractability Authors’ addresses: Stavros Cosmadakis, University of Patras, 26500 Rio, Patras, Greece, email:

Stavros S. Cosmadakis; Eugénie Foustoucos; Anastasios Sidiropoulos



Albumin liver dialysis as pregnancy-saving procedure in cholestatic liver disease and intractable pruritus.  


Progressive familial intrahepatic cholestasis type 3 (PFIC3) is a rare cholestatic liver disease. Such liver disease can get worse by female hormone disorder. Albumin dialysis or Molecular Adsorbent Recirculating System (MARS) has been reported to reverse severe cholestasis-linked pruritus. Here, we report the first use of MARS during a spontaneous pregnancy and its successful outcome in a patient with PFIC3 and intractable pruritus. Albumin dialysis could be considered as a pregnancy-saving procedure in pregnant women with severe cholestasis and refractory pruritus. PMID:19030215

Lemoine, Maud; Revaux, Aurelie; Francoz, Claire; Ducarme, Guillaume; Brechignac, Sabine; Jacquemin, Emmanuel; Uzan, Michele; Ganne-Carrie, Nathalie



Does the pain-protective GTP cyclohydrolase haplotype significantly alter the pattern or severity of pain in humans with chronic pancreatitis?  

PubMed Central

Background Pain is often a dominant clinical feature of chronic pancreatitis but the frequency and severity is highly variable between subjects. We hypothesized that genetic polymorphisms contribute to variations in clinical pain patterns. Since genetic variations in the GTP cyclohydrolase (GCH1) gene have been reported to protect some patients from pain, we investigated the effect of the "pain protective haplotype" in well characterized patients with chronic pancreatitis (CP) or recurrent acute pancreatitis (RAP) from the North American Pancreatitis Study 2 (NAPS2). Results Subjects in the NAPS2 study were asked to rank their pain in one of 5 categories reflecting different levels of pain frequency and severity. All subjects were genotyped at rs8007267 and rs3783641 to determine the frequency of the GCH1 pain-protective haplotype. In Caucasian subjects the frequency of the pain-protective GCH1 haplotype was no different in the control group (n = 236), CP patients (n = 265), RAP patients (N = 131), or in CP patients subclassified by pain category compared to previously reported haplotype frequencies in the general Caucasian population. Conclusion The GCH1 pain-protective haplotype does not have a significant effect on pain patterns or severity in RAP or CP. These results are important for helping to define the regulators of visceral pain, and to distinguish different mechanisms of pain.

Lazarev, Mark; Lamb, Janette; Barmada, M Michael; Dai, Feng; Anderson, Michelle A; Max, Mitchell B; Whitcomb, David C



Visceral larva migrans presenting with hypereosinophilia.  


Toxocariasis is an infection caused by the ingestion of larvae of the dog Toxocara canis or the cat Toxocara cati. A 2.5 year old boy was admitted to our clinics with fever, abdominal pain and loss of appetite. His medical history included geophagia (pica) and amebiasis infection. On admission, the physical examination revealed hepatomegaly and pallor. There was marked eosinophilia with leukocytosis, anemia, hypergammaglobulinemia and elevated serum Ig E titers. Toxocariasis was confirmed by anti-Toxocara IgG and Western blot. After 7 days of albendazole therapy, leukocytosis persisted and a second course of albendazole combined with prednisolone was administered. After 3 weeks, the eosinophil count had decreased and the patient showed resolution of hepatomegaly, but Toxocara serology remained elevated. PMID:23619050

Ecevit, Çi?dem; Ba?, Özlem; Vergin, Canan; Öztürk, Aysel



Emergency endovascular repair of ruptured visceral artery aneurysms  

Microsoft Academic Search

BACKGROUND: Visceral artery aneurysms although rare, have very high mortality if they rupture. CASE PRESENTATION: An interesting case of a bleeding inferior pancreaticduodenal artery aneurysm is reported in a young patient who presented with hypovolemic shock while being treated in the hospital after undergoing total knee replacement. Endovascular embolization was successfully employed to treat this patient, with early hospital discharge.

Umar Sadat; Nadim Noor; Tjun Tang; Kevin Varty



The pathology associated with visceral toxicosis of catfish  

Technology Transfer Automated Retrieval System (TEKTRAN)

Visceral toxicosis of catfish (VTC) syndrome was recognized in the late 1990s and recently has been associated with exposure to Clostridium botulinum type E neurotoxin. Tentative diagnosis is based on clinical presentation and ross findings, and is confirmed by bioassay. In April 2009, channel cat...


Noxious visceral inputs enhance cutaneous tactile response in rat thalamus  

Microsoft Academic Search

The current study investigates whether visceral nociceptive inputs affect tactile processing in the thalamic ventroposterior lateral nucleus in anesthetized rats by means of extracellular single unit recordings. Twenty out of the 44 neurons had their response to tactile stimulation increased by preceding nociceptive colorectal distension (CRD), and this influence appear more potent than the opposite effect, tactile on CRD response.

Hong-Qi Zhang; Pei-Jing Rong; Shi-Ping Zhang; Elie D. Al-Chaer; William D. Willis



Visceral adipose tissue and cardiovascular risk factors in obese children  

Microsoft Academic Search

Objective: In adults visceral adipose tissue (VAT) has been shown to be more highly correlated with cardiovascular (CV) risk factors than are other measures of adiposity such as subcutaneous abdominal adipose tissue (SAAT), percent body fat (%BF), or total body fat mass (TFM). We examined the relations between these measures of fatness and CV risk factors in obese children.Study design:

Scott Owens; Bernard Gutin; Michael Ferguson; Jerry Allison; Warren Karp; Ngoc-Anh Le



Evaluating Eve: Visceral States Influence the Evaluation of Impulsive Behavior  

Microsoft Academic Search

Impulsive behavior is a common source of stigma. The authors argue that people often stigmatize impulsive behavior because they fail to appreciate the influence visceral impulses have on behavior. Because people tend to underestimate the motivational force of cravings for sex, drugs, food, and so forth, they are prone to stigmatize those who act on these impulses. In line with

Loran F. Nordgren; Joop van der Pligt; Frenk van Harreveld



Visceral Leishmaniasis with Ocular Involvement in a Dog.  

National Technical Information Service (NTIS)

Visceral leishmaniasis (kala-azar) was diagnosed in a 6-year-old female dog from northern Virginia. The disease was confined to the eyes and adjacent tissues and was manifested as a severe bilateral endophthalmitis and associated blepharitis. Leishmania d...

E. E. McConnell E. F. Chaffee I. G. Cashell F. M. Garner



Larger Amounts of Visceral Adipose Tissue in Asian Americans  

Microsoft Academic Search

Objective: Excess visceral adipose tissue (VAT) is recognized as an important risk factor for the development of coronary heart disease and type 2 diabetes. Several studies have reported less VAT in African Americans compared with whites. As little is known about the levels of VAT in Asians, we compared whole-body VAT in Asian Americans with European Americans.Research Methods and Procedures:

Yong-Woo Park; David B. Allison; Steven B. Heymsfield; Dympna Gallagher



Visceral injuries, wound infection and sepsis following electrical injuries  

Microsoft Academic Search

Visceral injuries, wound infection and sepsis were investigated in 226 inpatients who sustained electrical burns over a period of 15 years. Four patients who sustained thoracic and abdominal organ injuries were noted in this series. The patients had injuries of the small intestine, stomach, colon and the lung. All the patients received operative treatment. Two of them died of sepsis.

M. Haberal; N. Uçar; Ü. Bayraktar; Z. Öner; N. Bilgin



Epidemiological aspects of human and canine visceral leishmaniasis in Venezuela  

Microsoft Academic Search

Objective. To report recent data on the distribution of human and canine visceral leishma- niasis (VL) in Venezuela, and to highlight problems associated with effective control measures. Methods. We report the number of cases, incidence rate, age and sex distribution, and mor- tality rates for human VL (HVL) for the period of 1995 through 2000, based on National Reg- istry

Olga Zerpa; Marian Ulrich; Rafael Borges; Vestalia Rodríguez; Marta Centeno; Emilia Negrón; Doris Belizario; Jacinto Convit



Taking back taste: feminism, food and visceral politics  

Microsoft Academic Search

Despite much thoughtful agro-food scholarship, the politics of food lacks adequate appreciation because scholars have not developed a means to specify the links between the materialities of food and ideologies of food and eating. This article uses feminist theory to enliven a discussion of what the authors call visceral politics, and thus initiates a project of illustrating the mechanisms through

Allison Hayes-Conroy; Jessica Hayes-Conroy



Comparative salivary gland transcriptomics of sandfly vectors of visceral leishmaniasis  

Microsoft Academic Search

BACKGROUND: Immune responses to sandfly saliva have been shown to protect animals against Leishmania infection. Yet very little is known about the molecular characteristics of salivary proteins from different sandflies, particularly from vectors transmitting visceral leishmaniasis, the fatal form of the disease. Further knowledge of the repertoire of these salivary proteins will give us insights into the molecular evolution of

Jennifer M Anderson; Fabiano Oliveira; Shaden Kamhawi; Ben J Mans; David Reynoso; Amy E Seitz; Phillip Lawyer; Mark Garfield; MyVan Pham; Jesus G Valenzuela



Evaluation of PCR for diagnosis of visceral leishmaniasis  

Microsoft Academic Search

An evaluation of Leishmania PCR was performed with bone marrow, lymph node, and blood samples from 492 patients, 60 positive controls, and 90 negative controls. Results were compared with microscopy results for Giemsa-stained smears. PCR and microscopy of lymph node and bone marrow aspirates from patients with microscopically confirmed visceral leishmaniasis (VL) were equally sensitive. However, in patients clinically suspected




Treatment options for chronic abdominal pain in children and adolescents.  


Chronic abdominal pain is a common feature of most functional gastrointestinal disorders in children, including functional abdominal pain (FAP) and irritable bowel syndrome (IBS). FAP can impair a child's life and often leads to significant school absences. Although the underlying mechanism is likely multifactorial, early pain experiences during a vulnerable period in the developing nervous system can cause long-term changes in the brain-gut axis and ultimately may result in altered pain pathways and visceral hyperalgesia. Care providers often feel uncomfortable managing patients with chronic abdominal pain, as the pathophysiology is poorly understood, and limited data exist regarding safety and efficacy of therapeutic options in children. The primary goal of therapy in FAP is to alleviate pain symptoms and to help the child return to normal daily activities. Treatment should be individualized and chosen based on the severity of symptoms, the existence of comorbid psychological disorders, and the impact the disorder has on the child's school attendance and normal functioning. Various psychological interventions, such as cognitive-behavioral therapy, hypnosis, and guided imagery, have been successfully used in children with chronic abdominal pain. Pharmacologic therapies such as H(2) blockers, proton-pump inhibitors, tricyclic antidepressants, and various serotonergic drugs have been used, but good controlled trials are lacking. More studies are clearly needed to investigate the benefits and safety of pharmacologic therapy in children. Newer pharmacologic agents that target specific receptors involved in nociception, stress, and neurogenic inflammation currently are being developed. Future targets for visceral hyperalgesia should not only be aimed at alleviating symptoms but also should include prevention, particularly in cases with a suspected sensitizing event such as neonatal pain and postinfectious IBS. PMID:16942666

Miranda, Adrian; Sood, Manu



Transdermal buprenorphine controls central neuropathic pain.  


A 53-year-old male with peripheral sensorimotor neuropathy suffered an intracerebral hemorrhage resulting in right hemiparesis and hemisensory loss. Three months later, he developed constant and burning pain within the entire right side of his body. He was diagnosed with central pain syndrome and treated with antiepileptics and tricyclic antidepressants. Minimal analgesia was achieved, which was limited by intractable sedation and drowsiness. Patient was then treated with oral opioids (morphine and hydrocodone with acetaminophen) in escalating doses that produced cognitive impairment. After an opioid rotation was attempted, by switching morphine to transdermal fentanyl, there was no pain reduction or improved quality of life. A trial of buprenorphine was initiated, by administering transdermal patches in escalating doses in weekly intervals. Patient's pain was eventually successfully controlled with buprenorphine patch 60 ?g/h every 7 days. His self-reported Visual Analogue Scale pain scores decreased from an average of 8/10 to 2/10 or less. Patient's overall function and participation in home activities increased. Buprenorphine is a partial ?-receptor and a ?-? receptor antagonist known to block NMDA receptors and reduce hyperalgesia secondary to central sensitization.(1) Buprenorphine is also a partial agonist at the opioid receptor-like (ORL-1) receptor, which is found to be analgesic and antinociceptive at the level of the spinal cord.(1,2) The difference in analgesic responses between buprenorphine and other opioids may be due to different receptor G protein interactions and/or selective activation of neuronal K(ATP) channels by buprenorphine.(3) Deficient opening of K(ATP) channels has been shown to mediate neuropathic pain(4); therefore, activation of these channels by buprenorphine may contribute to its analgesic effect in neuropathic pain states wherein other opioids fail. More recently, there have been two case reports in which patients with neuropathic pain of different central etiology were successfully treated with buprenorphine.(5) Despite advances in understanding the pathology related to central pain, effective treatment options are limited. Buprenorphine may be an analgesic option for central pain management when opioids fail to reduce hypersensitivity or when patients exhibit intolerable side effects to other medications. PMID:23264319

Weiner, Michelle; Sarantopoulos, Constantine; Gordon, Eva


Outcomes of Disconnective Surgery in Intractable Pediatric Hemispheric and Subhemispheric Epilepsy  

PubMed Central

Objectives: To study the outcome of disconnective epilepsy surgery for intractable hemispheric and sub-hemispheric pediatric epilepsy. Methods: A retrospective analysis of the epilepsy surgery database was done in all children (age <18 years) who underwent a peri-insular hemispherotomy (PIH) or a peri-insular posterior quadrantectomy (PIPQ) from April 2000 to March 2011. All patients underwent a detailed pre surgical evaluation. Seizure outcome was assessed by the Engel's classification and cognitive skills by appropriate measures of intelligence that were repeated annually. Results: There were 34 patients in all. Epilepsy was due to Rasmussen's encephalitis (RE), Infantile hemiplegia seizure syndrome (IHSS), Hemimegalencephaly (HM), Sturge Weber syndrome (SWS) and due to post encephalitic sequelae (PES). Twenty seven (79.4%) patients underwent PIH and seven (20.6%) underwent PIPQ. The mean follow up was 30.5 months. At the last follow up, 31 (91.1%) were seizure free. The age of seizure onset and etiology of the disease causing epilepsy were predictors of a Class I seizure outcome. Conclusions: There is an excellent seizure outcome following disconnective epilepsy surgery for intractable hemispheric and subhemispheric pediatric epilepsy. An older age of seizure onset, RE, SWS and PES were good predictors of a Class I seizure outcome.

Thomas, Santhosh George; Chacko, Ari George; Thomas, Maya Mary; Babu, K. Srinivasa; Russell, Paul Swamidhas Sudhakar; Daniel, Roy Thomas



Hepatic parenchymal atrophy induction for intractable segmental bile duct injury after liver resection.  


Liver resection can result in various types of bile duct injuries but their treatment is usually difficult and often leads to intractable clinical course. We present an unusual case of hepatic segment III duct (B3) injury, which occurred after left medial sectionectomy for large hepatocellular carcinoma and was incidentally detected 1 week later due to bile leak. Since the pattern of this B3 injury was not adequate for operative biliary reconstruction, atrophy induction of the involved hepatic parenchyma was attempted. This treatment consisted of embolization of the segment III portal branch to inhibit bile production, induction of heavy adhesion at the bile leak site and clamping of the percutaneous transhepatic biliary drainage (PTBD) tube to accelerate segment III atrophy. This entire procedure, from liver resection to PTBD tube removal took 4 months. This patient has shown no other complication or tumor recurrence for 4 years to date. These findings suggest that percutaneous segmental portal vein embolization, followed by intentional clamping of external biliary drainage, can effectively control intractable bile leak from segmental bile duct injury. PMID:22469733

Hwang, Shin; Park, Gil-Chun; Ha, Tae-Yong; Ko, Gi-Young; Gwon, Dong-Il; Choi, Young-Il; Song, Gi-Won; Lee, Sung-Gyu



Role of topiramate in adults with intractable epilepsy, mental retardation, and developmental disabilities.  


The efficacy and safety of topiramate in patients with intractable mixed seizures, mental retardation (MR), and developmental disabilities (DD) were investigated. Twenty patients (eight females and 12 males) aged 21-57 years old with intractable epilepsy with mixed seizures, MR [profound (five), severe (three), moderate (two), mild (eight) and borderline (two)], and DD were treated with adjunctive topiramate 25 mg per day for 1 week followed by titration to clinical response (range 50-350 mg per day). Other antiepileptic drugs (AEDs) were decreased simultaneously. Topiramate therapy was discontinued in four patients for adverse events consisting of disorientation, unsteadiness, and pneumonia (one patient); anaphylactic shock from a tuna fish allergy (one); patient choice (one); and loss to follow-up (one). Seizures improved by gt-or-equal, slanted 50% in 11 of 16 patients (69%). Two patients (13%) were seizure free, including one patient who prior to topiramate therapy was seizure free but experiencing an intolerable adverse effect during therapy with another AED. Seizure duration and/or severity decreased in seven patients (44%). An increase in alertness was observed in 11 patients (59%). Topiramate was associated with improvement in seizure severity and alertness in this series and may be useful as adjunctive therapy in patients with mixed seizures, MR, and DD. PMID:11888260

Singh, Baldev K; White-Scott, Sheryl



[Medullary tegmentum lesion in a patients having intractable hiccups, nausea, and syncope].  


A 61-year-old female, having intractable hiccups, nausea, and syncope. Her systolic blood presure decreased by 30 mmHg on sitting position from supine position. Sinus arrest lasting more than three seconds were detected 52 times per day by 24 hour Holter electrocardiography. Brain MRI disclosed a small hyperintense lesion in the medullary tegmentum on T2-weighted images. She was diagnosed as having a relapse of multiple screlosis and her symptoms were improved by administration of high dose methylprednisolone (1,000 mg per day x 3 days) intravenously. In a patients, a stimulative lesion in the medullary tegmentum was suspected where the reflex centers of hiccups, nausea and blood pressure to exist. We are able to confirm a small hyperintense lesion in such a particular region by brain MRI. In case of syncope accompanied with intractable hiccups and nausea, we should consider a stimulative lesion in the medullary tegmentum. Moreover, sinus arrest other than orthostatic hypotension may be involved in the pathophysiology of syncope in correlation with the medullary tegmentum lesion. PMID:16886802

Shibazaki, Kensaku; Kurokawa, Katsumi; Murakami, Tatsufumi; Sunada, Yoshihide



Usefulness of magnetic motor evoked potentials in the surgical treatment of hemiplegic patients with intractable epilepsy.  


Five hemiplegic patients with intractable epilepsy were studied with transcranial magnetic stimulation (TMS) before and after various surgical treatments. These patients had unilateral widespread cerebral lesions acquired at various times, including congenital, infantile and childhood injury. Motor evoked potentials (MEPs) of the abductor pollicis brevis (APB) muscles were simultaneously recorded on both sides following TMS of the motor cortex in the respective hemisphere using a figure-8 or circular coil. In all patients with congenital disease, the abolition of motor function in the affected hemisphere was estimated by magnetic MEPs, and the hemiplegia did not deteriorate after functional hemispherectomy (HS) was performed in two of them. In two patients with acquired disease, HS was not performed because it was shown by magnetic maps that the motor function in the affected hemisphere remained. Furthermore, it was shown by electric MEPs using subdural electrodes that a patient who had had encephalitis in early childhood had a reorganised motor area in the parietal cortex of the affected hemisphere. The present findings indicate that magnetic MEPs are a very useful non-invasive method of assessing whether the motor area in the affected hemisphere can be resected in hemiplegic patients with intractable epilepsy. PMID:12915083

Kamida, Tohru; Baba, Hiroshi; Ono, Kenji; Yonekura, Masato; Fujiki, Minoru; Kobayashi, Hidenori



[Ketogenic diet for intractable childhood epilepsy; as an early option as well as a last resort].  


Since the 1920s, a ketogenic diet, of low-carbohydrate, adequate-protein and high-fat content, has been used for the treatment of intractable childhood epilepsy. A decade ago this diet was tried as a last resort in the treatment of intractable epilepsy. However, recent advances in ketogenic diet have enabled it to become more commonly used worldwide even early in the course of epilepsy. Two less-restrictive ketogenic diets, namely, the modified Atkins diet and low-glycemic-index treatment, have been developed. These diets allow the patients and their families to choose a more liberal menu. Furthermore, a randomized controlled trial found that the ketogenic diet has a significant benefit, which strengthens the supportive evidence. Recently, an international consensus statement guiding optimal clinical management has been published, allowing clinicians to provide standardized treatment. There has also been increased interest in investigating the mechanisms of action of ketogenic diet using various experimental models. The authors review the history, efficacy, side effects, and possible mechanisms underlying the ketogenic diet, as well as the experience with the ketogenic diet at Tokyo Women's Medical University. PMID:21441643

Ito, Susumu; Oguni, Hirokazu



Characteristics and management of intractable neck involvement in tularemia: report of 19 patients.  


The objective of this study is to determine the clinical characteristics and to evaluate the treatment options of intractable neck involvement in tularemia. The medical records of 19 tularemia patients with neck involvement were reviewed retrospectively. On physical examination, fluctuation indicating an abscess formation was detected in 78.9% of the patients. Bilateral involvement was seen in 15.8% of the patients. The most common clinical form was glandular form (63.1%). The most commonly involved lymph node group was upper jugular nodes (78.6%). Six patients underwent incision and drainage procedure, five patients underwent superselective neck dissection and eight patients had only medical treatment. Complete and immediate cure, and better tissue healing with less scarring could be achieved in all patients who underwent superselective neck dissections. In conclusion, intractable neck masses and an abscess can be the initial finding in tularemia, and a high index of suspicion is needed in the differential diagnosis. Superselective neck dissection is a safe and effective option in the treatment of long lasting cervical tularemia unless it responds to medical treatment. PMID:22068840

K?z?l, Yusuf; Aydil, Utku; Cebeci, Süleyman; Güzeldir, Osman Tu?rul; Inal, Erdo?an; Bayaz?t, Y?ld?r?m



Achilles Pain.  

ERIC Educational Resources Information Center

|Five ailments which can cause pain in the achilles tendon area are: (1) muscular strain, involving the stretching or tearing of muscle or tendon fibers; (2) a contusion, inflammation or infection called tenosynovitis; (3) tendonitis, the inflammation of the tendon; (4) calcaneal bursitis, the inflammation of the bursa between the achilles tendon…

Connors, G. Patrick


Breast pain  

PubMed Central

Introduction Breast pain may be cyclical (worse before a period) or non-cyclical, originating from the breast or the chest wall, and occurs at some time in 70% of women. Cyclical breast pain resolves spontaneously in 20% to 30% of women, but tends to recur in 60% of women. Non-cyclical pain responds poorly to treatment but tends to resolve spontaneously in half of women. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for breast pain? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 24 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, bromocriptine, combined oral contraceptive pill, danazol, diuretics, evening primrose oil, gestrinone, gonadorelin analogues, hormone replacement therapy (HRT), lisuride, low-fat diet, progestogens, pyridoxine, tamoxifen, tibolone, topical or oral non-steroidal anti-inflammatory drugs (NSAIDs), toremifene, and vitamin E.



Central sensitization: implications for the diagnosis and treatment of pain.  


Nociceptor inputs can trigger a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in central nociceptive pathways, the phenomenon of central sensitization. Central sensitization manifests as pain hypersensitivity, particularly dynamic tactile allodynia, secondary punctate or pressure hyperalgesia, aftersensations, and enhanced temporal summation. It can be readily and rapidly elicited in human volunteers by diverse experimental noxious conditioning stimuli to skin, muscles or viscera, and in addition to producing pain hypersensitivity, results in secondary changes in brain activity that can be detected by electrophysiological or imaging techniques. Studies in clinical cohorts reveal changes in pain sensitivity that have been interpreted as revealing an important contribution of central sensitization to the pain phenotype in patients with fibromyalgia, osteoarthritis, musculoskeletal disorders with generalized pain hypersensitivity, headache, temporomandibular joint disorders, dental pain, neuropathic pain, visceral pain hypersensitivity disorders and post-surgical pain. The comorbidity of those pain hypersensitivity syndromes that present in the absence of inflammation or a neural lesion, their similar pattern of clinical presentation and response to centrally acting analgesics, may reflect a commonality of central sensitization to their pathophysiology. An important question that still needs to be determined is whether there are individuals with a higher inherited propensity for developing central sensitization than others, and if so, whether this conveys an increased risk in both developing conditions with pain hypersensitivity, and their chronification. Diagnostic criteria to establish the presence of central sensitization in patients will greatly assist the phenotyping of patients for choosing treatments that produce analgesia by normalizing hyperexcitable central neural activity. We have certainly come a long way since the first discovery of activity-dependent synaptic plasticity in the spinal cord and the revelation that it occurs and produces pain hypersensitivity in patients. Nevertheless, discovering the genetic and environmental contributors to and objective biomarkers of central sensitization will be highly beneficial, as will additional treatment options to prevent or reduce this prevalent and promiscuous form of pain plasticity. PMID:20961685

Woolf, Clifford J



Central sensitization: Implications for the diagnosis and treatment of pain  

PubMed Central

Nociceptor inputs can trigger a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in central nociceptive pathways, the phenomenon of central sensitization. Central sensitization manifests as pain hypersensitivity, particularly dynamic tactile allodynia, secondary punctate or pressure hyperalgesia, aftersensations, and enhanced temporal summation. It can be readily and rapidly elicited in human volunteers by diverse experimental noxious conditioning stimuli to skin, muscles or viscera, and in addition to producing pain hypersensitivity, results in secondary changes in brain activity that can be detected by electrophysiological or imaging techniques. Studies in clinical cohorts reveal changes in pain sensitivity that have been interpreted as revealing an important contribution of central sensitization to the pain phenotype in patients with fibromyalgia, osteoarthritis, musculoskeletal disorders with generalized pain hypersensitivity, headache, temporomandibular joint disorders, dental pain, neuropathic pain, visceral pain hypersensitivity disorders and postsurgical pain. The comorbidity of those pain hypersensitivity syndromes that present in the absence of inflammation or a neural lesion, their similar pattern of clinical presentation and response to centrally acting analgesics, may reflect a commonality of central sensitization to their pathophysiology. An important question that still needs to be determined is whether there are individuals with a higher inherited propensity for developing central sensitization than others, and if so, whether this conveys an increased risk both of developing conditions with pain hypersensitivity, and their chronification. Diagnostic criteria to establish the presence of central sensitization in patients will greatly assist the phenotyping of patients for choosing treatments that produce analgesia by normalizing hyperexcitable central neural activity. We have certainly come a long way since the first discovery of activity-dependent synaptic plasticity in the spinal cord and the revelation that it occurs and produces pain hypersensitivity in patients. Nevertheless, discovering the genetic and environmental contributors to and objective biomarkers of central sensitization will be highly beneficial, as will additional treatment options to prevent or reduce this prevalent and promiscuous form of pain plasticity.

Woolf, Clifford J



Complex regional pain syndrome following transfemoral catheterization.  


Complex regional pain syndrome (CRPS) (previously reflex sympathetic dystrophy) is a chronic pain condition usually resulting as a consequence of trauma or surgery. Though described occasionally after vascular surgery, it is distinctly rare after percutaneous cardiovascular procedures. We report a case of CRPS following trans- femoral catheterization-related groin pseudoaneurysm. To our knowledge, this is the first such report following transfemoral catheterization. A 36-year-old female underwent an electrophysiological study and AV node re-entry tachycardia ablation using the left femoral vein approach. One month later she presented complaining of numbness and tingling in her left foot with swelling and mild groin discomfort. A lower extremity duplex scan showed a left common femoral artery pseudoaneurysm that was partially thrombosed and subsequently resolved spontaneously. The patient had intractable symptoms of pain, temperature changes, color changes, and trophic changes of the left foot. Conventional angiography was done to rule out occlusive arterial disease but just showed very sluggish flow. Further evaluation with transcutaneous oxymetry and 3-phase bone scan was consistent with microvascular dysfunction and poor cutaneous blood flow suggestive of cold-type CRPS. In this case report, we also review the clinical features and the vascular changes associated with CRPS and discuss the pathophysiology of the syndrome from a cardiovascular specialist's perspective. Interventionalists should be aware that CRPS is a possible, albeit rare, condition that may follow many vascular procedures that they perform on a daily basis. PMID:22045092

Saad, Andre; Knolla, Raelene; Gupta, Kamal




Microsoft Academic Search

To assess the effect of removing leishmania-infected dogs on the incidence of visceral leishmaniasis, a controlled intervention study was performed in northeast Brazil. The attempted elimination of seropositive dogs resulted in an initial significant decrease in the annual incidence of seroconversion among dogs from 36% to 6% over the first two years. In the following two years, the incidence increased



Central Pain Syndrome  


NINDS Central Pain Syndrome Information Page Table of Contents (click to jump to sections) What is Central Pain Syndrome? ... is being done? Clinical Trials Organizations What is Central Pain Syndrome? Central pain syndrome is a neurological ...


Assessing pain in patients.  


This article defines pain and discusses options for pain assessment. Both unidimensional and multidimensional pain assessment scales are considered and described. Nursing skills required to carry out pain assessment are identified and discussed. PMID:18376633

McLafferty, E; Farley, A


Pain Medications After Surgery  


... Modern pain medications and anesthesia can control post-surgical pain and help your body heal. By Mayo ... fewer complications. The time to talk about post-surgical pain relief and pain medications is before you ...


Rectal distention testing in patients with irritable bowel syndrome: Sensitivity, specificity, and predictive values of pain sensory thresholds  

Microsoft Academic Search

Background & Aims: Visceral hypersensitivity was detected in patients with functional gastrointestinal disorders and has been proposed as a biological marker of irritable bowel syndrome (IBS). The purpose of this study was to assess the sensitivity, specificity, and the predictive values of pain thresholds evaluated by rectal distention using an electronic barostat in patients with or without IBS and in

Mickael Bouin; Victor Plourde; Michel Boivin; Monique Riberdy; France Lupien; Marie Laganière; Pierre Verrier; Pierre Poitras



Issues in Defining Pain  

Microsoft Academic Search

We all have experienced pain at one time or the other, but scientifically what is pain? Most of us regard pain as a negative sensation that originates in traumatized tissues and warns of injury. Ancient philosophers considered pain an emotion. Aristotle, for example, called pain a passion of the soul. Pain in humans, and probably in animals, is in part

John S. Church


Shoulder pain  

PubMed Central

Introduction Shoulder pain covers a wide range of problems and affects up to 20% of the population. It is not a specific diagnosis. Shoulder pain can be caused by problems with the acromioclavicular joint, shoulder muscles, or referred pain from the neck. Rotator cuff problems account for 65-70% of cases of shoulder pain. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatment; topical drug treatment; local injections; non-drug treatment; and surgical treatment? We searched: Medline, Embase, The Cochrane Library and other important databases up to February 2006 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 53 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: arthroscopic laser subacromial decompression, corticosteroid injections (intra-articular), corticosteroids (oral, subacromial injection), electrical stimulation, extracorporeal shock wave therapy, guanethidine (intra-articular), ice, laser treatment, manipulation under anaesthesia (plus intra-articular injection in people with frozen shoulder), multidisciplinary biopsychosocial rehabilitation, nerve block, non-steroidal anti-inflammatory drugs (oral, topical or intra-articular injection), opioid analgesics, paracetamol, phonophoresis, physiotherapy (manual treatment, exercises), surgical arthroscopic decompression, transdermal glyceryl trinitrate, ultrasound.



Shoulder pain  

PubMed Central

Introduction Shoulder pain is a common problem with an estimated prevalence of 4% to 26%. About 1% of adults aged over 45 years consult their GP with a new presentation of shoulder pain every year in the UK. The aetiology of shoulder pain is diverse and includes pathology originating from the neck, glenohumeral joint, acromioclavicular joint, rotator cuff, and other soft tissues around the shoulder girdle. The most common source of shoulder pain is the rotator cuff, accounting for over two-thirds of cases. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatment, topical drug treatment, local injections, non-drug treatment, and surgical treatment? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 71 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, arthroscopic subacromial decompression, autologous whole blood injection, corticosteroids (oral, subacromial injection, or intra-articular injection), electrical stimulation, excision of distal clavicle, extracorporeal shock wave therapy, ice, laser treatment, manipulation under anaesthesia, suprascapular nerve block, non-steroidal anti-inflammatory drugs (oral, topical or intra-articular injection), opioid analgesics, paracetamol, physiotherapy (manual treatment, exercises), platelet-rich plasma injection, rotator cuff repair, shoulder arthroplasty, and ultrasound.



Thoracolumbar Junction Syndrome Causing Pain around Posterior Iliac Crest: A Case Report  

PubMed Central

Thoracolumbar junction syndrome is characterized by referred pain which may originate at the thoracolumbar junction, which extends from 12th thoracic vertebra to 2nd lumbar vertebra, due to functional abnormalities. Clinical manifestations include back pain, pseudo-visceral pain and pseudo-pain on the posterior iliac crest, as well as irritable bowel symptoms. During clinical examination, pain can be demonstrated by applying pressure on the facet joints or to the sides of the spinous processes. Radiological studies show only mild and insignificant degenerative changes in most cases. We report a 42-year-old female patient with osteogenesis imperfecta who suffered from chronic low back pain. Under the diagnosis of thoracolumbar junction syndrome, she was treated with an epidural block and a sympathetic nerve block, which improved her symptoms.

Kim, Soo-Ryu; Lee, Min-Ji; Lee, Seung-Jun; Kim, Dae-Hyun; Hong, Ji-Hee



Thoracolumbar Junction Syndrome Causing Pain around Posterior Iliac Crest: A Case Report.  


Thoracolumbar junction syndrome is characterized by referred pain which may originate at the thoracolumbar junction, which extends from 12th thoracic vertebra to 2nd lumbar vertebra, due to functional abnormalities. Clinical manifestations include back pain, pseudo-visceral pain and pseudo-pain on the posterior iliac crest, as well as irritable bowel symptoms. During clinical examination, pain can be demonstrated by applying pressure on the facet joints or to the sides of the spinous processes. Radiological studies show only mild and insignificant degenerative changes in most cases. We report a 42-year-old female patient with osteogenesis imperfecta who suffered from chronic low back pain. Under the diagnosis of thoracolumbar junction syndrome, she was treated with an epidural block and a sympathetic nerve block, which improved her symptoms. PMID:23560215

Kim, Soo-Ryu; Lee, Min-Ji; Lee, Seung-Jun; Suh, Young-Sung; Kim, Dae-Hyun; Hong, Ji-Hee



Back pain.  

PubMed Central

1. Back pain is very common and can be the result of a wide range of different conditions. A detailed history of the complaint often points towards the cause. Positional backache suggests a mechanical cause, unremitting pain may indicate malignancy or infection especially if accompanied by night sweats, whereas morning stiffness is more often the result of inflammation. 2. Examine the patient lying and standing as outlined. A general examination should also be performed if there is a history of weight loss, night sweats, or if the patient looks ill. 3. The vast majority of cases of backache are mechanical in origin. Plain x-rays are not normally contributory and should be avoided unless there are factors in the history and examination suggestive of infection or malignancy. 4. Patients with backache and sphincter disturbance and/or perineal anaesthesia require immediate hospital admission. 5. Analgesia and bed rest are the mainstays of treatment for acute backache of mechanical orig