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1

Spinal Cord Stimulation for Intractable Visceral Pain Due to Sphincter of Oddi Dysfunction  

PubMed Central

Sphincter of Oddi dysfunction (SOD) is a syndrome of chronic biliary pain or recurrent pancreatitis due to the functional obstruction of the pancreaticobiliary flow. We report a case of spinal cord stimulation (SCS) for chronic abdominal pain due to SOD. The patient had a history of cholecystectomy and had suffered from chronic right upper quadrant abdominal pain. The patient had been diagnosed as having SOD. The patient was treated with opioid analgesics and nerve blocks, including a splanchnic nerve block. However, two years later, the pain became intractable. We implanted percutaneous SCS at the T5-7 level for this patient. Visual analog scale (VAS) scores for pain and the amount of opioid intake decreased. The patient was tracked for more than six months without significant complications. From our clinical case, SCS is an effective and alternative treatment option for SOD. Further studies and long-term follow-up are necessary to understand the effectiveness and the limitations of SCS on SOD. PMID:25589948

Lee, Kang Hun; Lee, Sang Eun; Jung, Jae Wook

2015-01-01

2

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. PMID:19655104

Sengupta, Jyoti N.

2011-01-01

3

Intracerebroventricular opioids for intractable pain  

PubMed Central

When pain is refractory to systemic opioid and non-opioid analgesic therapy and palliative chemoradiation or ablative or stimulant neurosurgical procedures are not possible, palliative treatment becomes limited, particularly if the patient wishes to be at home at the end of life. Intracerebroventricular (ICV) infusion of morphine in the home setting might be presented as an option. The present article reviews the basic and clinical evidence of the efficacy and safety of ICV administration of opioids. Information was gathered from various bibliographic sources, including PubMed and others, and summarized and evaluated to assess the efficacy and safety of ICV opioids for pain relief. Results from ICV infusion of morphine into terminally ill patients refractory to other pain treatments have been reported since the early 1980s. Good efficacy has been achieved for the vast majority of patients, without serious development of analgesic tolerance. There have also been a low incidence of adverse effects, such as constipation and respiratory depression, and a significant retention of alertness associated with this route of administration. Intracerebroventricular infusion of opioid analgesics thus appears to be a safe and effective therapy for the palliative treatment of refractory pain. PMID:22295988

Raffa, Robert B; Pergolizzi, Joseph V

2012-01-01

4

Eosinophilic jejunitis presenting as intractable abdominal pain.  

PubMed

Eosinophilic gastroenteritis is an uncommon disease characterized by eosinophilic infiltration of the gastrointestinal tract. The clinical manifestations are related to the layer(s) and extent of the bowel involved. In this paper, we present a case of intractable abdominal pain caused by jejunal submucosal eosinophilic infiltration without mucosal involvement, diagnosed by deep endoscopic biopsies. The patient was successfully treated with steroids without need for surgery for diagnosis or therapy. PMID:25565932

Mungan, Zeynel; Attila, Tan; Kapran, Yersu; Tokatli, Ilyas Pinar; Unal, Zeynep

2014-09-01

5

Eosinophilic Jejunitis Presenting as Intractable Abdominal Pain  

PubMed Central

Eosinophilic gastroenteritis is an uncommon disease characterized by eosinophilic infiltration of the gastrointestinal tract. The clinical manifestations are related to the layer(s) and extent of the bowel involved. In this paper, we present a case of intractable abdominal pain caused by jejunal submucosal eosinophilic infiltration without mucosal involvement, diagnosed by deep endoscopic biopsies. The patient was successfully treated with steroids without need for surgery for diagnosis or therapy. PMID:25565932

Mungan, Zeynel; Attila, Tan; Kapran, Yersu; Tokatli, Ilyas Pinar; Unal, Zeynep

2014-01-01

6

Intractable pain--the present position.  

PubMed Central

The broad changes that have occurred in the treatment of intractable pain are considered. There is a new understanding of the anatomy and physiology of pain pathways and pain appreciation. Thus gate control theory, the spinal laminae, and the descending inhibitory pain pathway through the raphe nuclei are discussed in relation to the recent discovery of the opioid (enkephalin) systems. Out of this arises the stimulation methods of pain relief--transcutaneous neural stimulation, periaqueductal stimulation, and acupuncture. These are valuable in patients with a normal expectation of life. For patients with a shortened expectation of life other methods, especially destructive ones, are valuable (though in all types of chronic pain drug therapy is still the most used method). Basic changes in techniques and the equipment used to bring this about are detailed broadly. In particular, the use of the image intensifier X-ray machine and the stimulation and destruction available from the modern lesion generator when used in combination provide accuracy and safety. Techniques and methods are constantly altering and examples of this are given. All this costs money in time, personnel, and equipment; the costings of the Liverpool Centre for Pain Relief are given. Finally, the Pain Relief Foundation is in being in Liverpool in the grounds of Walton Hospital. This has been made possible by a large 'seed' donation by the Wolfson Foundation. Images Fig. 1 Fig. 2 PMID:6894676

Lipton, S.

1981-01-01

7

Early visceral pain predicts chronic pain after laparoscopic cholecystectomy.  

PubMed

Chronic pain after laparoscopic cholecystectomy is related to postoperative pain during the first postoperative week, but it is unknown which components of the early pain response is important. In this prospective study, 100 consecutive patients were examined preoperatively, 1week postoperatively, and 3, 6, and 12months postoperatively for pain, psychological factors, and signs of hypersensitivity. Overall pain, incisional pain (somatic pain component), deep abdominal pain (visceral pain component), and shoulder pain (referred pain component) were registered on a 100-mm visual analogue scale during the first postoperative week. Nine patients developed chronic unexplained pain 12months postoperatively. In a multivariate analysis model, cumulated visceral pain during the first week and number of preoperative biliary pain attacks were identified as independent risk factors for unexplained chronic pain 12months postoperatively. There were no consistent signs of hypersensitivity in the referred pain area either pre- or postoperatively. There were no significant associations to any other variables examined. The risk of chronic pain after laparoscopic cholecystectomy is relatively low, but significantly related to the visceral pain response during the first postoperative week. PMID:25250720

Blichfeldt-Eckhardt, Morten Rune; Ording, Helle; Andersen, Claus; Licht, Peter B; Toft, Palle

2014-11-01

8

[Transdermal fentanyl patch for the treatment of chronic intractable pain].  

PubMed

The purpose of the treatment of chronic non-cancer pain is the improvement of the patient's quality of life, not the complete alleviation of pain. In Japan transdermal fentanyl patch can be used for the treatment of chronic intractable pain including cancer pain and chronic non-cancer pain. In prescribing transdermal fentanyl patch for patients with chronic non-cancer pain, cares should be focused on the selection of the patients and the periodic and continuous observation of analgesic effect and side effects. Patients with mental disorders need the consultation with specialists. In most cases side effects such as nausea, vomiting, constipation and sedation can be well tolerated. However, respiratory suppression or over sedation would also occur and such side effects can sometimes be fatal. Furthermore, long term effects on endocrine and immune systems have not been clarified yet. Proper prescription of opioids during a limited period of time is definitely the primary concern of medical professionals. PMID:23905400

Ibuki, Takae

2013-07-01

9

Stimulation of primary motor cortex for intractable deafferentation pain.  

PubMed

The stimulation of the primary motor cortex (M1) has proved to be an effective treatment for intractable deafferentation pain. This treatment started in 1990, and twenty-eight studies involving 271 patients have been reported so far. The patients who have been operated on were suffering from post-stroke pain (59%), trigeminal neuropathic pain, brachial plexus injury, spinal cord injury, peripheral nerve injury and phantom-limb pain. The method of stimulation was: a) epidural, b) subdural, and c) within the central sulcus. Overall, considering the difficulty in treating central neuropathic pain, trigeminal neuropathic pain and certain types of refractory peripheral pain, the electrical stimulation of M1 is a very promising technique; nearly 60% of the treated patients improved with a higher than 50% pain relief after several months of follow-up and sometimes of a few years in most reports. The mechanism of pain relief by the electrical stimulation of M1 has been under investigation. Recently, repetitive transcranial magnetic stimulation (rTMS) of M1 has been reported to be effective on deafferentation pain. In the future, rTMS may take over from electrical stimulation as a treatment for deafferentation pain. PMID:17691289

Saitoh, Y; Yoshimine, T

2007-01-01

10

Psychophysical analysis of visceral and cutaneous pain in human subjects  

Microsoft Academic Search

Clinical evidence suggests that cutaneous and visceral pain differ in sensory, affective, and motivational realms, yet there has been little comparative characterization of these types of pain. This study uses psychophysical measures to compare directly visceral and cutaneous pain and sensitivity. Healthy subjects (10 males, seven females, age 19–29) evaluated perceptions evoked by balloon distention of the distal esophagus and

Irina A Strigo; M. Catherine Bushnell; Michel Boivin; Gary H Duncan

2002-01-01

11

Protease-activated receptors as therapeutic targets in visceral pain.  

PubMed

The protease-activated receptors (PARs) play a pivotal role in inflammatory and nociceptive processes. PARs have raised considerable interest because of their capacity to regulate numerous aspects of viscera physiology and pathophysiology. The present article summarizes research on PARs and proteases as signalling molecules in visceral pain. In particular, experiments in animal models suggest that PAR2 is important for visceral hypersensitivity. Moreover, endogenous PAR2 agonists seem to be released by colonic tissue of patients suffering from irritable bowel syndrome, suggesting a role for this receptor in visceral pain perception. Thus, PARs, together with proteases that activate them, represent exciting targets for therapeutic intervention on visceral pain. PMID:24396336

Cenac, Nicolas

2013-12-01

12

Visceral hyperalgesia in children with functional abdominal pain  

Microsoft Academic Search

Objective: Our purpose was to evaluate visceral sensitivity and psychologic profiles in children with functional gastrointestinal disorders. Study design: We measured visceral perception in the stomach and in the rectum by using an electronic barostat. Psychologic questionnaires were completed. Ten children with recurrent abdominal pain (RAP)(8 female, mean age 11.3 ± 0.8 years), 10 children with irritable bowel syndrome (IBS)

Carlo Di Lorenzo; Nader N. Youssef; Luther Sigurdsson; Lisa Scharff; Janet Griffiths; Arnold Wald

2001-01-01

13

Acupuncture for Visceral Pain: Neural Substrates and Potential Mechanisms  

PubMed Central

Visceral pain is the most common form of pain caused by varied diseases and a major reason for patients to seek medical consultation. Despite much advances, the pathophysiological mechanism is still poorly understood comparing with its somatic counterpart and, as a result, the therapeutic efficacy is usually unsatisfactory. Acupuncture has long been used for the management of numerous disorders in particular pain and visceral pain, characterized by the high therapeutic benefits and low adverse effects. Previous findings suggest that acupuncture depresses pain via activation of a number of neurotransmitters or modulators including opioid peptides, serotonin, norepinephrine, and adenosine centrally and peripherally. It endows us, by advancing the understanding of the role of ion channels and gut microbiota in pain process, with novel perspectives to probe the mechanisms underlying acupuncture analgesia. In this review, after describing the visceral innervation and the relevant afferent pathways, in particular the ion channels in visceral nociception, we propose three principal mechanisms responsible for acupuncture induced benefits on visceral pain. Finally, potential topics are highlighted regarding the future studies in this field. PMID:25614752

Chen, Shuping; Wang, Shubin; Rong, Peijing; Wang, Junying; Qiao, Lina; Feng, Xiumei; Liu, Junling

2014-01-01

14

Stress and visceral pain: from animal models to clinical therapies  

PubMed Central

Epidemiological studies have implicated stress (psychosocial and physical) as a trigger of first onset or exacerbation of irritable bowel syndrome (IBS) symptoms of which visceral pain is an integrant landmark. A number of experimental acute or chronic exteroceptive or interoceptive stressors induce visceral hyperalgesia in rodents although recent evidence also points to stress-related visceral analgesia as established in the somatic pain field. Underlying mechanisms of stress-related visceral hypersensitivity may involve a combination of sensitization of primary afferents, central sensitization in response to input from the viscera and dysregulation of descending pathways that modulate spinal nociceptive transmission or analgesic response. Biochemical coding of stress involves the recruitment of corticotropin releasing factor (CRF) signaling pathways. Experimental studies established that activation of brain and peripheral CRF receptor subtype 1 plays a primary role in the development of stress-related delayed visceral hyperalgesia while subtype 2 activation induces analgesic response. In line with stress pathways playing a role in IBS, non-pharmacologic and pharmacologic treatment modalities aimed at reducing stress perception using a broad range of evidence-based mind-body interventions and centrally-targeted medications to reduce anxiety impact on brain patterns activated by visceral stimuli and dampen visceral pain. PMID:21575632

Larauche, Muriel; Mulak, Agata; Taché, Yvette

2011-01-01

15

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)

1999-09-15

16

Pulsed radiofrequency treatment within brachial plexus for the management of intractable neoplastic plexopathic pain.  

PubMed

We report on the use of pulsed radiofrequency (RF) within the plexus for the management of intractable pain in three patients with metastatic or invasive plexopathy. The patients were a 38-year-old woman with a history of breast cancer 6 years earlier whose computed tomography (CT) scans revealed a mass lesion at the infraclavicular part of the right brachial plexus, a 68-year-old man diagnosed with advanced lung cancer whose CT scans revealed a bone metastasis in the right humerus invading the axillary region of the right brachial plexus, and a 67-year-old woman diagnosed with advanced lung cancer whose CT scans revealed a bone metastasis in the left humerus invading the axillary region of the left brachial plexus. Ultrasound-guided pulsed RF was performed within the interscalene brachial plexus. During the follow-up period, their intractable pain was moderately controlled. PMID:23070568

Arai, Young-Chang P; Nishihara, Makoto; Aono, Shuichi; Ikemoto, Tatsunori; Suzuki, Chiharu; Kinoshita, Akiko; Ushida, Takahiro

2013-04-01

17

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

PubMed

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

2008-01-01

18

Bupivacaine administered intrathecally versus rectally in the management of intractable rectal cancer pain in palliative care  

PubMed Central

Background Unacceptable adverse effects, contraindications to and/or ineffectiveness of World Health Organization step III “pain ladder” drugs causes needless suffering among a population of cancer patients. Successful management of severe cancer pain may require invasive treatment. However, a patient’s refusal of an invasive procedure necessitates that clinicians consider alternative options. Objective Intrathecal bupivacaine delivery as a viable treatment of intractable pain is well documented. There are no data on rectal bupivacaine use in cancer patients or in the treatment of cancer tenesmoid pain. This study aims to demonstrate that bupivacaine administered rectally could be a step in between the current treatment options for intractable cancer pain (conventional/conservative analgesia or invasive procedures), and to evaluate the effect of the mode of administration (intrathecal versus rectal) on the bupivacaine plasma concentration. Cases We present two Caucasian, elderly inpatients admitted to hospice due to intractable rectal/tenesmoid pain. The first case is a female with vulvar cancer, and malignant infiltration of the rectum/vagina. Bupivacaine was used intrathecally (0.25–0.5%, 1–2 mL every 6 hours). The second case is a female with ovarian cancer and malignant rectal infiltration. Bupivacaine was adminstered rectally (0.05–0.1%, 100 mL every 4.5–11 hours). Methods Total bupivacaine plasma concentrations were determined using the high-performance liquid chromatography-ultraviolet method. Results Effective pain control was achieved with intrathecal bupivacaine (0.077–0.154 mg·kg?1) and bupivacaine in enema (1.820 mg·kg?1). Intrathecal bupivacaine (0.5%, 2 mL) caused a drop in blood pressure; other side effects were absent in both cases. Total plasma bupivacaine concentrations following intrathecal and rectal bupivacaine application did not exceed 317.2 ng·mL?1 and 235.7 ng·mL?1, respectively. Bupivacaine elimination was slower after rectal than after intrathecal administration (t½= 5.50 versus 2.02 hours, respectively). Limitations This study reports two cases only, and there could be inter-patient variation. Conclusion Bupivacaine in boluses administered intrathecally (0.25%, 2 mL) provided effective, safe analgesia in advanced cancer patients. Bupivacaine enema (100 mg·100 mL?1) was shown to be a valuable option for control of end-of-life tenesmoid cancer pain. PMID:25336967

Zaporowska-Stachowiak, Iwona; Kowalski, Grzegorz; ?uczak, Jacek; Kosicka, Katarzyna; Kotlinska-Lemieszek, Aleksandra; Sopata, Maciej; G?ówka, Franciszek

2014-01-01

19

Intractable Facial Pain and Numb Chin due to Metastatic Esophageal Adenocarcinoma  

PubMed Central

The etiologies of facial pain are innumerable, thus facial pain misdiagnosis and resultant mismanagement is common. Numb chin syndrome presents with hypoesthesia and/or anesthesia in the dermatomal distribution of the inferior alveolar or the mental nerve. In this case report, we will discuss a case of intractable facial pain in a 57-year-old male with a history of esophageal adenocarcinoma who was initially misdiagnosed and treated as trigeminal neuralgia. During clinical examination, the loss of sensation in the inferior alveolar nerve distribution was identified and led to the diagnosis of mandibular metastasis. The details of the clinical presentation will be discussed in the context of accurate identification and diagnosis. Focal radiation to the metastatic location along with sphenopalatine ganglion radiofrequency ablation and medication management provided significant pain relief. This case report provides additional information to the current medical knowledge and it enhances the clinical vigilance of the clinicians when they encounter similar cases. We concluded that patients with a history of neoplasms who present with atypical symptoms of facial pain should undergo further investigation with advanced imaging. Targeted treatment based on an accurate diagnosis is the foundation of pain management. PMID:25606033

Elahi, Foad; Luke, Whitney; Elahi, Fazel

2014-01-01

20

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

PubMed Central

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 visceral nociception. Animal studies report that persistent changes including nociception-associated molecular expression (e.g. neurokinin-1 (NK-1) receptors) and activation of signal transduction cascades (such as the protein kinase A [PKA]-c-AMP-responsive element binding [CREB] cascade)-in spinal PSDC neurons are observed following visceral pain stimulation. The clinical practice of interruption of the spinal PSDC pathway in patients with cancer pain further supports a role of this group of neurons in the development and maintenance of visceral pain. We propose the hypothesis that general anesthetics might affect critical molecular targets such as NK-1 and glutamate receptors, as well as intracellular signaling by CaM kinase II, protein kinase C (PKC), PKA, and MAP kinase cascades in PSDC neurons, which contribute to the neurotransmission of visceral pain signaling. This would help elucidate the mechanism of antivisceral nociception by general anesthetics at the cellular and molecular levels and aid in development of novel therapeutic strategies to improve clinical management of visceral pain. PMID:18973669

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

2008-01-01

21

[Strontium-89 therapy and subarachnoid phenol block successfully eliminated intractable pain of metastasis in the patient with advanced urachal carcinoma].  

PubMed

We report a case of a 39-year-old man with intractable multifocal pain caused by metastatic urachal carcinoma to the bone. The patient underwent a partial cystectomy in May 2008, and lung metastasis occurred 9 months after the surgery. He then received salvage chemotherapy, but developed metastasis to the liver, brain, and bone. He was hospitalized due to a shoulder pain, a lower back pain, buttocks pain, numbness in both legs, and drop foot in right leg. MRI revealed metastases to the spine, and lumbar spinal canal stenosis with cauda equina compression. Even a combination of fentanyl-patch, oral acetaminophen, gabapentin and paroxetine was not effective for pain control. Strontium-89 therapy and subarachnoid phenol block successfully eliminated intractable pain. The patient could be discharged from hospital and received a palliative care at home for a short period of time. PMID:22189321

Arakawa, Yasuhiro; Inoue, Daisuke; Sakuyama, Toshikazu; Nagasaki, Eijiro; Aiba, Keisuke

2011-12-01

22

Intractable Chronic Low-Back Pain Caused by Ligamentopathia Treated Using a Spinous Process Plate (S-plate)  

PubMed Central

We report a case of intractable chronic low-back pain in a gymnast that was caused by ligamentopathia in the interspinous region of the lumbar vertebrae. Sprained interspinous ligaments are a common mechanical cause of acute low-back pain in athletes. Although conservative therapy is generally effective in such cases, in this case it was not. The patient experienced severe low-back pain during lumbar flexion with tension between the L5/S interspinous ligaments. We performed interspinous fixation by using a spinous process plate system, which has been developed for short in situ fusions, and following which the low-back pain resolved. Conservative therapy for low-back pain caused by ligamentopathia is first-line choice, but interspinous fixation with instrumentation might be recommended in intractable cases with conservative therapy. PMID:21124690

Iwatsuki, Koichi; Yoshimine, Toshiki; Yoshimura, Kazuhiro; Ishihara, Masahiro; Ohnishi, Yu-ichiro; Goto, Yuko

2010-01-01

23

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. PMID:22028723

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

2011-01-01

24

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

PubMed

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. PMID:22028723

Kopsky, David J; Keppel Hesselink, Jan M

2011-01-01

25

Motor cortex stimulation: functional magnetic resonance imaging-localized treatment for three sources of intractable facial pain.  

PubMed

Neuropathic facial pain can be a debilitating condition characterized by stabbing, burning, dysesthetic sensation. With a large range of causes and types, including deafferentation, postherpetic, atypical, and idiopathic, both medicine and neurosurgery have struggled to find effective treatments that address this broad spectrum of facial pain. The authors report the use of motor cortex stimulation to alleviate 3 distinct conditions associated with intractable facial pain: trigeminal deafferentation pain following rhizotomy, deafferentation pain secondary to meningioma, and postherpetic neuralgia. Functional MR imaging was used to localize facial areas on the precentral gyrus prior to surgery. All 3 patients experienced long-lasting complete or near-complete resolution of pain following electrode implantation. Efficacy in pain reduction was achieved through variation of stimulation settings over the course of treatment, and it was assessed using the visual analog scale and narrative report. Surgical complications included moderate postsurgical incisional pain, transient cerebral edema, and intraoperative seizure. The authors' results affirm the efficacy and broaden the application of motor cortex stimulation to several forms of intractable facial pain. PMID:20509733

Esfahani, Darian R; Pisansky, Marc T; Dafer, Rima M; Anderson, Douglas E

2011-01-01

26

Mechanisms Underlying the Analgesic Effect of Moxibustion on Visceral Pain in Irritable Bowel Syndrome: A Review  

PubMed Central

Irritable bowel syndrome (IBS) is a functional bowel disorder that causes recurrent abdominal (visceral) pain. Epidemiological data show that the incidence rate of IBS is as high as 25%. Most of the medications may lead to tolerance, addiction and toxic side effects. Moxibustion is an important component of traditional Chinese medicine and has been used to treat IBS-like abdominal pain for several thousand years in China. As a mild treatment, moxibustion has been widely applied in clinical treatment of visceral pain in IBS. In recent years, it has played an irreplaceable role in alternative medicine. Extensive clinical studies have demonstrated that moxibustion for treatment of visceral pain is simple, convenient, and inexpensive, and it is being accepted by an increasing number of patients. There have not been many studies investigating the analgesic mechanisms of moxibustion. Studies exploring the analgesic mechanisms have mainly focused on visceral hypersensitivity, brain-gut axis neuroendocrine system, and immune system. This paper reviews the latest developments in moxibustion use for treatment of visceral pain in IBS from these perspectives. It also evaluates potential problems in relevant studies on the mechanisms of moxibustion therapy to promote the application of moxibustion in the treatment of IBS. PMID:25093032

Huang, Renjia; Zhao, Jimeng; Wu, Luyi; Dou, Chuanzi; Liu, Huirong; Weng, Zhijun; Shi, Yin; Zhou, Cili; Wu, Huangan

2014-01-01

27

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

PubMed Central

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

2013-01-01

28

The Long-Term Safety and Efficacy of Intrathecal Therapy Using Sufentanil in Chronic Intractable Non-Malignant Pain  

PubMed Central

This report describes the long term safety and efficacy of intrathecal therapy using Sufentanil for the management of chronic intractable neuropathic pain in 12 chronic pain patients. Standardized psychological screening was used to determine treatment suitability. Evaluation data included the Visual Analog Scale (VAS), Wong-Baker Faces Scale, Brief Pain Inventory (BPI), Disability of Arm, Shoulder, and Hand (DASH), McGill Quality of Life Questionnaire, and complications (granulomas, toxicity, withdrawal, or deaths). SPSS version 18 was used for data analysis. Pre- and post- treatment BPI measures and pain scale scores showed a statistically significant difference. There were no complications directly related to drug toxicity, nor drug withdrawals, granulomas, or deaths. Intrathecal therapy with Sufentanil therapy offers a good treatment alternative for those cases that have failed both surgery and standard pain treatment. Strict patient selection based on psychological screening, control of co-morbidities, a proper pain management may contribute to successful outcome. PMID:25031819

Monsivais, Diane Burn

2014-01-01

29

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

PubMed Central

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

2013-01-01

30

Cutaneous nerve transection for the management of intractable upper extremity pain caused by invasive squamous cell carcinoma.  

PubMed

A recurrent clinical dilemma in the management of patients with painful metastatic lesions is achieving a balance between effective analgesic therapies versus intolerable side effects, in particular altered mental status. We present the case of an immunosuppressed patient post-lung transplant who was suffering from intractable pain caused by widely metastatic squamous cell carcinoma. The patient's progressive, excruciating neuropathic pain was localized to the area of the left wrist and forearm. Additionally, the patient complained of moderate pain at sites of tumor involvement on her right arm and scalp. Attempts to adequately manage her left upper extremity pain included a combination of pharmacologic treatments intended to treat neuropathic pain (gabapentin, SNRI, ketamine, opioids) and focused regional analgesia (infraclavicular infusion of local anesthetic). However, the patient developed intolerable side effects including altered mental status and delirium associated with the systemic agents and suboptimal control with the infraclavicular infusion. Given that the most severe pain was well localized, we undertook a diagnostic block of the cutaneous nerves of the left forearm. As this intervention significantly reduced her pain, we subsequently performed neurectomies to the left superficial radial nerve, lateral cutaneous nerve of the forearm and the posterior cutaneous nerve of the forearm. This resulted in immediate and continued relief of her left upper extremity pain without an altered mental status. Residual focal pain from lesions over her right arm and scalp was successfully managed with daily topical applications of lidocaine and capsaicin cream. Successful pain control continued until the patient's death five months later. PMID:21306862

Turnbull, John H; Gebauer, Sara L; Miller, Bruce L; Barbaro, Nicholas M; Blanc, Paul D; Schumacher, Mark A

2011-07-01

31

UNEXPLAINED VISCERAL PAIN IN CHILDREN: PATHOPHYSIOLOGY, CLINICAL FEATURES AND MANAGEMENT  

Technology Transfer Automated Retrieval System (TEKTRAN)

Many children experience recurrent episodes of abdominal pain, but it is unclear why this occurs. This article reviews our present understanding of this common condition and how it sometimes can relate to diet, inherent pain sensing ability, and the influence of how the parents perceive pain....

32

Combined ultrasound and fluoroscopic guidance for radiofrequency ablation of the obturator nerve for intractable cancer-associated hip pain.  

PubMed

Management of pain from skeletal metastases is notoriously difficult. Case reports and case series have described radiofrequency ablation of the obturator nerve branches to the femoral head for treatment of intractable hip pain. Ablation of the obturator branches to the femoral head is technically difficult because of bony and vascular anatomy, including close proximity of the femoral vessels. Here we present the case of a 79-year-old woman with intractable right hip pain and inability to ambulate secondary to metastatic non-small cell lung cancer in the femoral head and acetabulum, treated with thermal radiofrequency ablation of the obturator and femoral nerve branches to the femoral head. Ablation of the obturator nerve was done via anterior placement of the radiofrequency needle under combined ultrasound and fluoroscopic guidance, passing the radiofrequency needle between the femoral artery and femoral vein. Real-time ultrasound guidance was used to avoid vascular puncture. Thermal radiofrequency ablation resulted in sustained pain relief, and resumption in the ability of the patient to ambulate. From this case we suggest that an anterior approach to the obturator nerve branches to the femoral head may be technically feasible using combined ultrasound and fluoroscopic guidance to avoid vascular puncture. PMID:24452660

Stone, Jonathan; Matchett, Gerald

2014-01-01

33

[Suppression of visceral pain by action of the low intensity polarized light on acupuncture antinociceptive points].  

PubMed

In experiments on mice, statistically authentic weakening of visceral pain has been shown after an action of low intensity polarized light from a device Bioptron on antinociceptive acupuncture points (AP). Pain was caused by an intraperitoneal injection of 2% acetic acid (0.1 ml/10 g). The intensity of pain was judged on duration and frequency of painful behavioral reactions (writhing, licking of abdomen), as well as on duration of sleep, eating and motor activity. In animals which immediately after injections of acetic acid were exposed to polarized light of low intensity for 10 min, applied on any of antinociceptive APs (E-36, E-43, VC-8, RP-6), the duration of painful behavioral reaction was determined to be reduced, while that of non-painful one increased. The comparison of the total duration of the writhing at control and experimental mice showed that an activation of AP E-43 induced the greatest analgesic effect (76.5%), from AP VC-8 it was 76.3%, from RP-6--46.8%, and from E-36--41.4%. We have concluded that the effect of polarized light of low intensity on APs was a convenient non-pharmacological method of treating visceral pain. PMID:14663889

Lymans'ky?, Iu P; Tamarova, Z A; Huliar, S O

2003-01-01

34

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.

2011-08-01

35

Hydrogen sulphide induces ? opioid receptor-dependent analgesia in a rodent model of visceral pain  

Microsoft Academic Search

Background  Hydrogen sulphide (H2S) is a gaseous neuro-mediator that exerts analgesic effects in rodent models of visceral pain by activating KATP channels. A body of evidence support the notion that KATP channels interact with endogenous opioids. Whether H2S-induced analgesia involves opioid receptors is unknown.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The perception of painful sensation induced by colorectal distension (CRD) in conscious rats was measured by assessing

Eleonora Distrutti; Sabrina Cipriani; Barbara Renga; Andrea Mencarelli; Marco Migliorati; Stefano Cianetti; Stefano Fiorucci

2010-01-01

36

Probiotics VSL#3 Protect against Development of Visceral Pain in Murine Model of Irritable Bowel Syndrome  

PubMed Central

Background and Aims Irritable bowel syndrome (IBS) is linked to post-inflammatory and stress-correlated factors that cause changes in the perception of visceral events. Probiotic bacteria may be effective in treating IBS symptoms. Here, we have investigated whether early life administration of VSL#3, a mixture of 8 probiotic bacteria strains, protects against development of visceral hypersensitivity driven by neonatal maternal separation (NMS), a rat model of IBS. Methods Male NMS pups were treated orally with placebo or VSL#3 from days 3 to 60, while normal, not separated rats were used as controls. After 60 days from birth, perception of painful sensation induced by colorectal distension (CRD) was measured by assessing the abdominal withdrawal reflex (score 0–4). The colonic gene expression was assessed by using the Agilent Whole Rat Genome Oligo Microarrays platform and confirmed by real time PCR. Results NMS rats exhibited both hyperalgesia and allodynia when compared to control rats. VSL#3 had a potent analgesic effect on CRD-induced pain without changing the colorectal compliance. The microarray analysis demonstrated that NMS induces a robust change in the expression of subsets of genes (CCL2, NOS3, THP1, NTRK1, CCR2, BDRKRB1, IL-10, TNFRSF1B, TRPV4, CNR1 and OPRL1) involved in pain transmission and inflammation. TPH1, tryptophan hydroxylase 1, a validated target gene in IBS treatment, was markedly upregulated by NMS and this effect was reversed by VSL#3 intervention. Conclusions Early life administration of VSL#3 reduces visceral pain perception in a model of IBS and resets colonic expression of subsets of genes mediating pain and inflammation. Transcript profiling Accession number of repository for expression microarray data is GSE38942 (http://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSE38942). PMID:23691109

Distrutti, Eleonora; Cipriani, Sabrina; Mencarelli, Andrea; Renga, Barbara; Fiorucci, Stefano

2013-01-01

37

Hydrogen sulphide induces ? opioid receptor-dependent analgesia in a rodent model of visceral pain  

PubMed Central

Background Hydrogen sulphide (H2S) is a gaseous neuro-mediator that exerts analgesic effects in rodent models of visceral pain by activating KATP channels. A body of evidence support the notion that KATP channels interact with endogenous opioids. Whether H2S-induced analgesia involves opioid receptors is unknown. Methods The perception of painful sensation induced by colorectal distension (CRD) in conscious rats was measured by assessing the abdominal withdrawal reflex. The contribution of opioid receptors to H2S-induced analgesia was investigated by administering rats with selective ?, ? and ? opioid receptor antagonists and antisenses. To investigate whether H2S causes ? opioid receptor (MOR) transactivation, the neuronal like cells SKNMCs were challenged with H2S in the presence of MOR agonist (DAMGO) or antagonist (CTAP). MOR activation and phosphorylation, its association to ? arrestin and internalization were measured. Results H2S exerted a potent analgesic effects on CRD-induced pain. H2S-induced analgesia required the activation of the opioid system. By pharmacological and molecular analyses, a robust inhibition of H2S-induced analgesia was observed in response to central administration of CTAP and MOR antisense, while ? and ? receptors were less involved. H2S caused MOR transactivation and internalization in SKNMCs by a mechanism that required AKT phosphorylation. MOR transactivation was inhibited by LY294002, a PI3K inhibitor, and glibenclamide, a KATP channels blocker. Conclusions This study provides pharmacological and molecular evidence that antinociception exerted by H2S in a rodent model of visceral pain is modulated by the transactivation of MOR. This observation provides support for development of new pharmacological approaches to visceral pain. PMID:20540729

2010-01-01

38

The long-term safety and efficacy of opioids: A survey of 84 selected patients with intractable chronic noncancer pain  

PubMed Central

BACKGROUND: The use of opioids for chronic noncancer pain (CNCP) remains controversial. Despite a number of randomized controlled trials showing efficacy and safety in the short term, long-term data are limited. OBJECTIVE: To survey a selected cohort of patients with intractable CNCP with regard to long-term efficacy and safety of opioids. METHODS: The present study reports long-term results from a survey of 84 patients with CNCP. The majority of patients had neuropathic pain, were treated with opioids and were followed every three months for a median of 8.4 years. Outcomes examined were pain severity, adverse effects, pain relief, satisfaction, mood, problematic opioid use, tolerance, physical dependency, functional status, health-related quality of life, immune status, sexual function, morbidity and mortality. Measures included a numerical rating scale, the Hospital Anxiety and Depression Scale, Brief Pain Inventory interference scale, Pain Disability Index and Short-Form Health Survey 12, version 2. RESULTS AND CONCLUSIONS: Both long- and short-acting opioids were reported to be effective, with few significant long-term adverse effects in many subjects in the present selected cohort. The majority of patients reported at least 50% or greater pain relief and a moderate improvement in disability. Functional status and health-related quality of life scores were not severely affected. Problematic opioid use, tolerance and serious adverse effects, including constipation, were not major issues. The authors emphasize that the results obtained in the present selected group may not be generalizable to all CNCP patients in whom opioids are being initiated. PMID:20808965

Watson, C Peter N; Watt-Watson, Judy; Chipman, Mary

2010-01-01

39

Intractable Headache - The Pain in Your Head that Just Won't Quit  

MedlinePLUS

... We think that the brain of someone with constant, treatment-resistant pain actually processes information differently from the way people who don’t have constant pain. There is very exciting research going on ...

40

[Neural control disturbances of the gastrointestinal tract and visceral pain in inflammatory bowel diseases].  

PubMed

Inflammatory bowel disease (IBD) is a chronic intestinal inflammatory condition, the etiology of which is composed of factors such as the environment, genetic predisposition, gut dysbiosis and inadequate immune response. The pathologic findings in Crohn's disease and ulcerative colitis are related to dysfunction of gastrointestinal secretion and motility and also disturbed visceral sensory function, with accompanying intestinal and parenteral complications. The systemic inflammatory response affects neurological control via the gut-brain axis, which modulates the cooperation of the autonomic nervous system (ANS), enteric nervous system (ENS) and gut-associated lymphoid tissue (GALT). In chronic inflammation the intestinal neuropathy disrupts peristalsis and intestinal secretion as well as causing unpleasant symptoms of the patients. Pain receptors are stimulated by inflammatory mediators, and due to the intensified activation of the nociceptive system visceral hypersensitivity through central and peripheral sensitization is generated. Chronic visceral pain negatively influences the course of disease and the quality of the patient's life. The growing knowledge about the neurological control dysfunction of the intestine and immune system dysregulation could provide proper directives for treatment of inflammatory bowel diseases. PMID:23619229

Ciesielczyk, Katarzyna; Thor, Piotr J

2013-01-01

41

The management of intractable pain with adjuvant pulsed electromagnetic field therapy.  

PubMed

This case describes a 51-year-old woman who reported experiencing severe, constant pain, diffusely located in the region of her right mandible neck (primarily involving the mandible, lower right molars, the neck, the upper back, and the shoulder) during the course of several years. Surgical interventions (root canal, spinal fusion) were performed to address potential sources of pain. Despite these interventions, the patient reported severe pain after both surgeries, which persisted beyond the acute postoperative period. Additional pharmacological interventions and physical therapy were also attempted; nonetheless, the patient reported that pain remained severe and constant for approximately 2 years. On the basis of the patient's poor response to conventional treatments, a novel approach of botulinum toxin (BTX) injections was initiated. When pulsed electromagnetic field therapy was added, the need for BTX injections decreased, with the patient reporting a noticeable decrease in pain intensity and an improvement in quality of life measures. Currently, the patient continues to use pulsed electromagnetic field therapy regularly for pain management, which has allowed her to reduce the use of other interventions and avoid continued use of narcotic medications. Considering the need for multifaceted pain management approaches in the treatment of chronic pain, this case is relevant for wound care practitioners attending to patients with chronic postincisional wound pain because the outcome highlights the utility of a nonpharmacological, complementary pain management intervention for closed, yet persistently painful, postoperative wounds. PMID:24732123

Niezgoda, Jeffrey A; Hardin, Scott T; Kubat, Nicole; Acompanado, Jocelyn

2014-05-01

42

A Comparison of Two Opioid Analgesics for Relief of Visceral Pain Induced by Intestinal Resection in Rats  

Microsoft Academic Search

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

MELANIE B. GILLINGHAM; MELANEE D. CLARK; ELIZABETH M. DAHLY; LISA A. KRUGNER-HIGBY

2001-01-01

43

Intractable chest pain in cardiomyopathy: treatment by a novel technique of cardiac cryodenervation with quantitative immunohistochemical assessment of success.  

PubMed

A novel method of cardiac denervation by cryoablation has been developed experimentally. The technique uses liquid nitrogen delivered under pressure to ablate the principal sources of cardiac innervation--namely, the adventitia surrounding the aorta, pulmonary arteries, and veins. The technique has been verified experimentally both in vivo by physiological means and in vitro by quantitative immunohistochemistry and the measurement of myocardial noradrenaline concentrations. A 35 year old woman presented with intractable precordial pain, normal epicardial coronary arteries, and hypertrophic cardiomyopathy. Her symptoms were refractory to maximal medical treatment and she was thought to be unsuitable for either conventional myocardial revascularisation, autotransplantation, or allografting with the concomitant risk of transplant coronary artery disease. She therefore underwent cardiac denervation by the method developed in the laboratory. There was quantitative immunohistochemical evidence of extrinsic cardiac denervation associated with a considerable improvement in her symptoms. This improvement persisted during a follow up period of over 16 months. PMID:8280529

Gaer, J A; Gordon, L; Wharton, J; Polak, J M; Taylor, K M; McKenna, W; Parker, D J

1993-12-01

44

Heightened central affective response to visceral sensations of pain and discomfort in IBS.  

PubMed

BACKGROUND Typically, conventional functional imaging methods involve repeated exposures to sensory stimulation. In rectal distension (RD) studies that involve multiple distensions, however, it is difficult to disambiguate the central response to RD from pathological alterations in peripheral neural responses associated with relaxation and accommodation of the rectum. METHODS This study addressed potential confounders found in previous imaging studies by collecting functional magnetic resonance imaging studies (fMRI) data during a single slow ramp-tonic distension paradigm and analysing fMRI signal changes using independent component analysis. KEY RESULTS Compared with controls, IBS participants showed increased activation of the anterior cingulate cortices, insula and ventral medial prefrontal regions suggesting heightened affective responses to painful visceral stimuli. In addition, the failure by IBS patients to down-regulate activity within ventral medial prefrontal and the posterior cingulate/precuneus regions was suggestive of reduced sensitivity to somatic changes and delayed shifts away from rest in ;default network' activity patterns. Controls showed heightened activation of the thalamus, striatal regions and dorsolateral prefrontal cortex suggesting greater arousal and salience-driven sustained attention reactions and greater modulation of affective responses to discomfort and pain. CONCLUSION&INFERENCES This work points to alterations in the central response to visceral pain and discomfort in IBS, highlighting diminished modulation and heightened internalization of affective reactions. PMID:20003075

Hall, G B C; Kamath, M V; Collins, S; Ganguli, S; Spaziani, R; Miranda, K L; Bayati, A; Bienenstock, J

2010-03-01

45

Attempted Gene Therapy for Intractable Pain: Dexamethasone-Mediated Exogenous Control of ?-Endorphin Secretion in Genetically Modified Cells and Intrathecal Transplantation  

Microsoft Academic Search

For optimal neural transplantation using gene engineering, it might be important to control the expression of the transfected gene extrinsically as required. This strategy could be very useful for the treatment of intractable pain that responds to opioids. For this purpose, we established a genetically modified embryonal carcinoma cell line (P19) in which the expression of ?-endorphin (?-EP) could be

Keisuke Ishii; Mitsuo Isono; Ryo Inoue; Shigeaki Hori

2000-01-01

46

Effect of commensals and probiotics on visceral sensitivity and pain in irritable bowel syndrome.  

PubMed

The last ten years' wide progress in the gut microbiota phylogenetic and functional characterization has been made evidencing dysbiosis in several gastrointestinal diseases including inflammatory bowel diseases and irritable bowel syndrome (IBS). IBS is a functional gut disease with high prevalence and negative impact on patient's quality of life characterized mainly by visceral pain and/or discomfort, representing a good paradigm of chronic gut hypersensitivity. The IBS features are strongly regulated by bidirectional gut-brain interactions and there is increasing evidence for the involvement of gut bacteria and/or their metabolites in these features, including visceral pain. Further, gut microbiota modulation by antibiotics or probiotics has been promising in IBS. Mechanistic data provided mainly by animal studies highlight that commensals or probiotics may exert a direct action through bacterial metabolites on sensitive nerve endings in the gut mucosa, or indirect pathways targeting the intestinal epithelial barrier, the mucosal and/or systemic immune activation, and subsequent neuronal sensitization and/or activation. PMID:25181491

Theodorou, Vassilia; Belgnaoui, Afifa Ait; Agostini, Simona; Eutamene, Helene

2014-07-01

47

Effect of commensals and probiotics on visceral sensitivity and pain in irritable bowel syndrome.  

PubMed

The last ten years' wide progress in the gut microbiota phylogenetic and functional characterization has been made evidencing dysbiosis in several gastrointestinal diseases including inflammatory bowel diseases and irritable bowel syndrome (IBS). IBS is a functional gut disease with high prevalence and negative impact on patient's quality of life characterized mainly by visceral pain and/or discomfort, representing a good paradigm of chronic gut hypersensitivity. The IBS features are strongly regulated by bidirectional gut-brain interactions and there is increasing evidence for the involvement of gut bacteria and/or their metabolites in these features, including visceral pain. Further, gut microbiota modulation by antibiotics or probiotics has been promising in IBS. Mechanistic data provided mainly by animal studies highlight that commensals or probiotics may exert a direct action through bacterial metabolites on sensitive nerve endings in the gut mucosa, or indirect pathways targeting the intestinal epithelial barrier, the mucosal and/or systemic immune activation, and subsequent neuronal sensitization and/or activation. PMID:25184834

Theodorou, Vassilia; Ait Belgnaoui, Afifa; Agostini, Simona; Eutamene, Helene

2014-01-01

48

The effect of chemically induced colitis, psychological stress and their combination on visceral pain in female Wistar rats.  

PubMed

Visceral sensitivity is of pathophysiological importance in abdominal pain disorders and can be modulated by inflammation and stress. However, it is unclear whether inflammation and stress alter visceral perception independently of each other or in conjunction through neuroendocrine interactions. Therefore, we compared the short- and long-term effects of experimental colitis and water avoidance stress (WAS), alone or in combination, on visceral sensitivity in female Wistar rats. Colitis was induced by trinitrobenzene sulfonic acid (TNBS) and colonoscopically confirmed. During WAS, rats were placed on a platform surrounded by water for 1?h. Visceral sensitivity was assessed by quantifying the visceromotor responses (VMRs) to colorectal distension. Activation of the hypothalamic-pituitary-adrenal axis was determined by measuring serum corticosterone in a separate protocol. TNBS instillation resulted in overt colitis, associated with significant visceral hypersensitivity during the acute inflammatory phase (3 days post-TNBS; n?=?8/group); after colitis had subsided (28 days post-TNBS), hypersensitivity was resolved (n?=?4-8/group). Single WAS was associated with increased VMRs of a magnitude comparable to acute TNBS-induced hypersensitivity (n?=?8/group). However, after repetitive WAS no significant hypersensitivity was present (n?=?8/group). No additive effect of colitis and stress was seen on visceral pain perception (n?=?6-8/group). Corticosterone levels were only increased in acute TNBS-colitis, acute WAS and their combination. To conclude, both colitis and stress successfully induced short-term visceral hypersensitivity and activated the hypothalamic-pituitary-adrenal axis, but long-term effects were absent. In addition, our current findings do not support an additive effect of colitis and stress on visceral sensitivity in female Wistar rats. PMID:25089934

Deiteren, Annemie; Vermeulen, Wim; Moreels, Tom G; Pelckmans, Paul A; De Man, Joris G; De Winter, Benedicte Y

2014-09-01

49

Abdominal Implantation of Testicles in the Management of Intractable Testicular Pain in Fournier Gangrene  

PubMed Central

Fournier gangrene (FG) is a necrotizing soft tissue infection involving the superficial and fascial planes of the perineum. In many cases of FG, debridement of the scrotum is necessary, leaving definitive management of the exposed testicles a significant surgical challenge. Frequent incidental trauma to the testicles can cause severe pain, especially in laborers. Practical surgical solutions are few and not well detailed. Various options exist, including creating a neoscrotum with adjacent thigh tissue, split-thickness skin grafts (STSGs), or even creating a subcutaneous thigh pocket. We describe a case of abdominal implantation of bilateral testicles for persistent testicular pain in a case where STSGs did not provide adequate protection, adjacent thigh skin was not available for creation of a neoscrotum, and significant cord contracture occurred. We detail the advantages and disadvantages of the commonly described techniques, including this approach, and how in select individuals this may be a suitable alternative. PMID:24229025

Chan, Cyrus C.; Shahrour, Khaled; Collier, Ronald D.; Welch, Marlene; Chang, Shiliang; Williams, Mallory

2013-01-01

50

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. PMID:24043944

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

2013-01-01

51

Peripheral injection of sauvagine prevents repeated colorectal distension-induced visceral pain in female rats.  

PubMed

We investigated the effects of peripheral injection of sauvagine, a CRF2>CRF1 receptor (corticotropin-releasing factor) agonist compared with CRF, on two sets of tonic colorectal distension (CRDs 30, 40, 50 mmHg, 3-min on/off)-induced visceromotor response (VMR) measured as area under the curve (AUC) of abdominal muscle contraction in conscious female rats. Sauvagine (10 or 20 microg/kg, s.c.) abolished the 226.7+/-64.3% and 90.4+/-38.1% increase in AUC to the 2nd CRD compared with the 1st CRD (performed 30 min before) in female Fisher and Sprague-Dawley (SD) rats, respectively. CRF had no effect while the CRF1 antagonist, antalarmin (20 mg/kg, s.c.), alone or with sauvagine, blocked the enhanced response to the 2nd CRD, performed 60 min after the 1st CRD, and reduced further the AUC by 33.5+/-23.3% and 63.5+/-7.2%, respectively in Fisher rats. These data suggest that peripheral CRF2 receptor activation exerts antinociceptive effects on CRD-induced visceral pain, whereas CRF1 contributes to visceral sensitization. PMID:15949637

Million, Mulugeta; Maillot, Céline; Adelson, David A; Nozu, Tsukasa; Gauthier, Ariane; Rivier, Jean; Chrousos, George P; Bayati, Alfred; Mattsson, Hillevi; Taché, Yvette

2005-07-01

52

NMDA receptor mediates chronic visceral pain induced by neonatal noxious somatic stimulation.  

PubMed

NMDA receptors (NMDAR) are important in the development and maintenance of central sensitization. Our objective was to investigate the role of spinal neurons and NMDAR in the maintenance of chronic visceral pain. Neonatal rats were injected with acidic saline adjusted to pH 4.0 in the gastrocnemius muscle every other day for 12 days. In adult rats, NR1 and NR2B subunits were examined in the lumbo-sacral (LS) spinal cord. A baseline, visceromotor response (VMR) to graded colorectal distension (CRD) was recorded before and after administration of the NMDA antagonist, CGS-19755. Extracellular recordings were performed from CRD-sensitive LS spinal neurons and pelvic nerve afferents (PNA) before and after CGS-19755. Rats that received pH 4.0 saline injections demonstrated a significant increase in the expression NR2B subunits and VMR response to CRD>20mmHg. CGS-19755 (i.v. or i.t.) had no effect in naïve rats, but significantly decreased the response to CRD in pH 4.0 saline injected rats. CGS-19755 had no effect on the spontaneous firing of SL-A, but decreased that of SL-S. Similarly, CGS-19755 attenuates the responses of SL-S neurons to CRD, but had no effect on SL-A neurons or on the response characteristics of PNA fibers. Neonatal noxious somatic stimulation results in chronic visceral hyperalgesia and sensitizes a specific subpopulation of CRD-sensitive spinal neurons. The sensitization of these SL-S spinal neurons is attenuated by the NMDAR antagonist. The results of this study suggest that spinal NMDARs play an important role in the development of hyperalgesia early in life. PMID:25281204

Miranda, Adrian; Mickle, Aaron; Bruckert, Mitchell; Kannampalli, Pradeep; Banerjee, Banani; Sengupta, Jyoti N

2014-12-01

53

Neuromodulation for intractable headaches.  

PubMed

Intractable chronic headaches are a major challenge for both patients and healthcare professionals. Over the last two decades, implantable electrical neuromodulators, previously established to manage other forms of chronic pain, have been used increasingly for intractable primary and secondary headache disorders. We review the current approaches to the management of refractory headaches using neuromodulation. Indications, operative considerations and complications are discussed based on our experience and a review of the literature. The field of neuromodulation has been rapidly advancing, with many new targets being discovered and novel devices being developed for treating craniofacial pain. We discuss some of these targets, detailing the latest advances in the area of neuromodulation for intractable headaches. PMID:24488653

Hassanzadeh, Roya; Jones, Jeremy C; Ross, Edgar L

2014-02-01

54

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

1998-01-01

55

The "human visceral homunculus" to pain evoked in the oesophagus, stomach, duodenum and sigmoid colon.  

PubMed

The oesophagus, stomach, duodenum and sigmoid colon were electrically stimulated in 12 healthy volunteers with a thin nasal endoscope. The painful cortical evoked potentials (EPs) were recorded from 64 surface electrodes. The early EPs with latencies < 200 ms were studied and the corresponding dipole sources were calculated. The electrical current intensities needed to evoke pain were highest in the stomach and duodenum, compared to the other segments (F = 7.8; P < 0.001; post hoc analysis P < 0.05). The EP latencies after stimulation of the stomach and sigmoid colon were shorter compared with those to stimulation of the oesophagus and duodenum (all P values < 0.001). The EP amplitudes were higher to oesophagus stimulation (all P values < 0.001 except for the early positivity). The potential fields obtained after stimulation of the most distal segments (duodenum and sigmoid colon) were in general distributed more posteriorly compared to those recorded in the more proximal regions. The EP topographies to stimulation of all gut tracts were explained by a bilateral source in the second somatosensory (SII) area, by a dipole in the anterior cingulate cortex (ACC), and by a bilateral generator in the insular cortex. However, the position of the sources significantly changed depending on the stimulated gut tract. Moreover, while the SII and ACC sources were initially activated to oesophagus and stomach stimulation, the ACC and insular activities were the earliest ones after stimulation of the lower gut segments. The findings reflect differences in pathways and brain processing of visceral nociceptive inputs coming from either upper or lower gut and may improve our understanding of the brain-gut axis in health and disease. PMID:16676165

Drewes, Asbjørn Mohr; Dimcevski, Georg; Sami, Saber A K; Funch-Jensen, Peter; Huynh, Khiem Dinh; Le Pera, Domenica; Arendt-Nielsen, Lars; Valeriani, Massimiliano

2006-10-01

56

Regional neuroplastic brain changes in patients with chronic inflammatory and non-inflammatory visceral pain.  

PubMed

Regional cortical thickness alterations have been reported in many chronic inflammatory and painful conditions, including inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS), even though the mechanisms underlying such neuroplastic changes remain poorly understood. In order to better understand the mechanisms contributing to grey matter changes, the current study sought to identify the differences in regional alterations in cortical thickness between healthy controls and two chronic visceral pain syndromes, with and without chronic gut inflammation. 41 healthy controls, 11 IBS subjects with diarrhea, and 16 subjects with ulcerative colitis (UC) underwent high-resolution T1-weighted magnetization-prepared rapid acquisition gradient echo scans. Structural image preprocessing and cortical thickness analysis within the region of interests were performed by using the Laboratory of Neuroimaging Pipeline. Group differences were determined using the general linear model and linear contrast analysis. The two disease groups differed significantly in several cortical regions. UC subjects showed greater cortical thickness in anterior cingulate cortical subregions, and in primary somatosensory cortex compared with both IBS and healthy subjects. Compared with healthy subjects, UC subjects showed lower cortical thickness in orbitofrontal cortex and in mid and posterior insula, while IBS subjects showed lower cortical thickness in the anterior insula. Large effects of correlations between symptom duration and thickness in the orbitofrontal cortex and postcentral gyrus were only observed in UC subjects. The findings suggest that the mechanisms underlying the observed gray matter changes in UC subjects represent a consequence of peripheral inflammation, while in IBS subjects central mechanisms may play a primary role. PMID:24416245

Hong, Jui-Yang; Labus, Jennifer S; Jiang, Zhiguo; Ashe-Mcnalley, Cody; Dinov, Ivo; Gupta, Arpana; Shi, Yonggang; Stains, Jean; Heendeniya, Nuwanthi; Smith, Suzanne R; Tillisch, Kirsten; Mayer, Emeran A

2014-01-01

57

The kappa opioid receptor is associated with the perception of visceral pain.  

PubMed

mu-, delta- and kappa-opioid receptors are widely expressed in the central nervous system where they mediate the strong analgesic and mood-altering actions of opioids, and modulate numerous endogenous functions. To investigate the contribution of the kappa-opioid receptor (KOR) to opioid function in vivo, we have generated KOR-deficient mice by gene targeting. We show that absence of KOR does not modify expression of the other components of the opioid system, and behavioural tests indicate that spontaneous activity is not altered in mutant mice. The analysis of responses to various nociceptive stimuli suggests that the KOR gene product is implicated in the perception of visceral chemical pain. We further demonstrate that KOR is critical to mediate the hypolocomotor, analgesic and aversive actions of the prototypic kappa-agonist U-50,488H. Finally, our results indicate that this receptor does not contribute to morphine analgesia and reward, but participates in the expression of morphine abstinence. Together, our data demonstrate that the KOR-encoded receptor plays a modulatory role in specific aspects of opioid function. PMID:9863470

Black, D; Trevethick, M

1998-09-01

58

NTS1 and NTS2 mediate analgesia following neurotensin analog treatment in a mouse model for visceral pain.  

PubMed

Neurotensin (NT) analogs, NT69L, NT72, and NT79, differentially bind the two major neurotensin receptors, NTS1 and NTS2, to elicit effects similar to those of endogenous NT, including analgesia. Previous data strongly suggest NTS2 as the main receptor involved in NT- and NT analog-mediated visceral analgesia. However, this idea has yet to be confirmed with the use of mice lacking the NTS2 receptor. Here we use the writhing assay, a model of visceral pain, to investigate the analgesic effects of NT69L (binds NTS1 and NTS2 equally), NT79 (NTS2-selective), NT72 (NTS1 selective) and levocabastine (NTS2-selective) in WT, NTS1 knock-out, and NTS2 knock-out mice. Additionally, we investigate the role of NTS2 in the development of tolerance to NT69L-mediated visceral analgesia. All three NT analogs reduced writhing in the WT mice. NT79 and levocabsatine reduced writhing in the NTS1(-/-) mice while NT69L and NT72 showed significant analgesic effect in the NTS2(-/-) mice. In conclusion, the data shows that (1) both NTS1 and NTS2 are involved in mediating visceral analgesia and their respective roles appear to be NT analog-dependent; (2) NTS1 may inhibit NTS2-mediated analgesia; and (3) NTS2 is necessary for the development of tolerance to NT69L-mediated analgesia. PMID:22504145

Smith, Kristin E; Boules, Mona; Williams, Katrina; Richelson, Elliott

2012-06-15

59

Role of transient receptor potential channels in intestinal inflammation and visceral pain: novel targets in inflammatory bowel diseases.  

PubMed

: Transient receptor potential (TRP) channels are a large group of ion channels that are prevalent in mammalian tissues. They are widely distributed in the central and peripheral nervous systems, and in nonneuronal cells, where they are implicated in sensing temperature, noxious substances, and pain. TRPs play an important role in immune response and nociception and, therefore, may be involved in the pathogenesis of inflammatory bowel diseases, whose major symptoms include chronic inflammatory state and abdominal pain. In this review, we summarize what is known on TRP channels in inflammatory bowel disease and visceral pain; we focus in particular on TRPV1, TRPV4, TRPA1, and TRPM. We also analyze scientific reports that evidence potential use of TRP regulators in future inflammatory bowel disease treatment. PMID:25437822

Zieli?ska, Marta; Jarmu?, Agata; Wasilewski, Andrzej; Sa?aga, Maciej; Fichna, Jakub

2015-02-01

60

Modification of Visceral Sensitivity and Pain in Irritable Bowel Syndrome by 5HT3 Antagonism (Ondansetron)  

Microsoft Academic Search

Intrinsic neurons containing serotonin (5-HT) are involved in the regulation of gastrointestinal motor function and are also thought to be important in the modulation of visceral sensory function. We have evaluated the effect of a specific 5-HT3 antagonist (ondansetron, O) on visceral sensation and rectal compliance in a randomized, double-blind, cross-over, placebo (P) controlled study of·16 mg 3 times\\/day, in

Paul A. Goldberg; Michael A. Kamm; Paulo Setti-Carraro; Christian Roth

1996-01-01

61

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. PMID:20143462

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

2010-01-01

62

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. PMID:15985561

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; Taché, Y

2006-01-01

63

The development of tolerance to intrathecal morphine in rat models of visceral and cutaneous pain.  

PubMed

The development of tolerance to intrathecal morphine was studied in rats chronically implanted with intrathecal catheters connected to osmotic minipumps. Measures of cutaneous nociception were the hot plate (HP) and tail flick (TF) tests. Measures of visceral nociception were visceromotor (VM) responses to ramped colorectal distension (CRD) and cardiovascular (CV) responses to phasic colorectal distension. Tolerance to a continuous infusion of 6 or 20 nmol/h of morphine sulfate developed over 6 days. A significant reduction in the dose-dependent effects of intrathecal morphine in the TF and HP tests and VM and CV responses to CRD occurred in rats receiving continuous infusions of morphine. The development of tolerance to intrathecal morphine was similar in both cutaneous and visceral models. PMID:9665657

Ness, T J; Follett, K A

1998-05-22

64

The antinociceptive effect of intravenous imipramine in colorectal distension-induced visceral pain in rats: the role of serotonergic and noradrenergic receptors.  

PubMed

It has been shown that imipramine, a tricyclic antidepressant (TCA), is a potent analgesic agent. However, the effect of imipramine on visceral pain has not been extensively investigated. In the current study, our aim was to characterise the putative analgesic effect of intravenous imipramine on visceral pain in rats. Our second aim was to assess the involvement of serotonergic (5-HT?,?,?) and noradrenergic (?(2A, 2B, 2C)) receptor subtypes in this putative antinociceptive effect of imipramine. Male Sprague Dawley rats (250-300 g) were implanted with venous catheters for drug administration and implanted with enamelled nichrome electrodes for electromyography of the external oblique muscles. Noxious visceral stimulation was applied via by colorectal distension (CRD). The visceromotor responses (VMRs) to CRD were quantified electromyographically before and after imipramine administration at 5, 15, 30, 60, 90 and 120 min. In the antagonist groups, the agents were administered 10 min before imipramine. The administration of imipramine (5-40 mg/kg) produced a dose-dependent reduction in VMR. The administration of yohimbine (a nonselective ??-adrenoceptor antagonist, 1 mg/kg), BRL-44408 (an ?(2A)-adrenoceptor antagonist, 1 mg/kg) or MK-912 (an ?2C-adrenoceptor antagonist, 300 ?g/kg) but not imiloxan (an ?(2B)-adrenoceptor antagonist, 1 mg/kg) inhibited the antinociceptive effect of imipramine (20 mg/kg). Additionally, ketanserin (a 5-HT? receptor antagonist, 0.5, 1, and 2 mg/kg) and GR113808 (a 5-HT? receptor antagonist, 1 mg/kg) enhanced, and ondansetron (a 5-HT? receptor antagonist, 0.5, 1, and 2 mg/kg) failed to alter the imipramine-induced antinociceptive effect. Our data demonstrated that, in the CDR-induced rat visceral pain model, intravenous imipramine appeared to have antinociceptive potential and that ?(2A)-/?(2C)-adrenoceptors and 5-HT?/5-HT? receptors may be responsible for the antinociceptive effect of imipramine on visceral pain in rats. PMID:24582849

?lkaya, Fatih; Bilge, S S?rr?; Bozkurt, Ayhan; Ba?, Duygu B; Erdal, Arzu; Çiftçio?lu, Engin; Kesim, Yüksel

2014-07-01

65

Alleviating visceral cancer pain in patients with pancreatic cancer using cryoablation and celiac plexus block.  

PubMed

Little is known about the effects of pancreas cryoablation (PCA) on abdominalgia in pancreatic cancer patients or its synergism with celiac plexus block (CPB). In patients without abdominalgia, to investigate the effects of PCA; in patients with abdominalgia, to investigate the pain-alleviating effects of PCA+CPB. Sixty-two patients were enrolled in this retrospective review; 12 without abdominalgia refused PCA, 15 without abdominalgia received PCA to reduce their tumor load and 35 with abdominalgia received PCA+CPB to reduce tumor load and alleviate pain. All PCA and PCA+CPB procedures were performed successfully. Some slight adverse effects (e.g. increased serum amylase, abdominal distension and nausea, abdominal bleeding) had disappeared by 3weeks, spontaneously or after symptomatic treatment. In patients without abdominalgia, pain occurred in one-third of cases (all with pancreatic head cancer) after PCA but had stopped 1-12days after treatment; in patients with abdominalgia before treatment, pain stopped immediately after PCA+CPB in 18 cases and 2-24days after treatment in 17 (all with pancreatic head cancer); a significant difference was found between pretreatment and post-treatment pain frequency (P=0.0019), regardless of the presence of advanced (P=0.0096) or metastatic (P=0.0072) cancer. The average time to pain relief was approximately 7days after both PCA and PCA+CPB, and abdominalgia did not recur for more than 8weeks. PCA may cause short-term pain in some pancreatic cancer patients. Combined PCA+CPB can alleviate cancer pain for more than 8weeks, without severe side effects. PMID:23267876

Niu, Lizhi; Wang, Yu'e; Yao, Fei; Wei, Changqun; Chen, Yuxian; Zhang, Li; Chen, Jibing; Li, Jialiang; Zuo, Jiansheng; Xu, Kecheng

2013-04-01

66

Postprandial lower limb pain: An unusual presentation of visceral arteries occlusion.  

PubMed

This case report describes an atypical and unique presentation of mesenteric arteries occlusive disease. The patient presented with typical symptoms of chronic mesenteric ischemia, as well as with an atypical new symptom; postprandial buttock and lower limbs pain. Pain followed the time curve of the postprandial abdominal discomfort, starting 30?min after meals and gradually resolving within 2?h. The patient had been tolerating the signs of chronic mesenteric ischemia quite well by adjusting the quantity of food per meal to relieve symptoms. Angiography showed that the celiac artery, the superior mesenteric artery, and distal aorta were occluded, leaving the inferior mesenteric artery as the only feeding vessel of all abdominal viscera and both the lower limbs. Since an English medical literature search returned only one marginally similar case, we consider this case of iliac arteries' "steal syndrome" from the inferior mesenteric artery unique. PMID:25057158

Patelis, Nikolaos; Papoutsis, Konstantinos; Liakopoulos, Dimitrios; Koutsoumpelis, Andreas; Bakogiannis, Christos; Georgopoulos, Sotirios

2014-07-23

67

Diminished neurokinin-1 receptor availability in patients with two forms of chronic visceral pain.  

PubMed

Central sensitization and dysregulation of peripheral substance P and neurokinin-1 receptor (NK-1R) signaling are associated with chronic abdominal pain in inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). Although positron emission tomography (PET) has demonstrated that patients with injury-related chronic pain have diminished NK-1R availability in the brain, it is unknown whether these deficits are present in IBD and IBS patients, who have etiologically distinct forms of non-injury-related chronic pain. This study's aim was to determine if patients with IBD or IBS exhibit deficits in brain expression of NK-1Rs relative to healthy controls (HCs), the extent to which expression patterns differ across patient populations, and if these patterns differentially relate to clinical parameters. PET with [(18)F]SPA-RQ was used to measure NK-1R availability by quantifying binding potential (BP) in the 3 groups. Exploratory correlation analyses were performed to detect associations between NK-1R BP and physical symptoms. Compared to HCs, IBD patients had NK-1R BP deficits across a widespread network of cortical and subcortical regions. IBS patients had similar, but less pronounced deficits. BP in a subset of these regions was robustly related to discrete clinical parameters in each patient population. Widespread deficits in NK-1R BP occur in IBD and, to a lesser extent, IBS; however, discrete clinical parameters relate to NK-1R BP in each patient population. This suggests that potential pharmacological interventions that target NK-1R signaling may be most effective for treating distinct symptoms in IBD and IBS. PMID:23582152

Jarcho, Johanna M; Feier, Natasha A; Bert, Alberto; Labus, Jennifer A; Lee, Maunoo; Stains, Jean; Ebrat, Bahar; Groman, Stephanie M; Tillisch, Kirsten; Brody, Arthur L; London, Edythe D; Mandelkern, Mark A; Mayer, Emeran A

2013-07-01

68

Diminished neurokinin-1 receptor availability in patients with two forms of chronic visceral pain  

PubMed Central

Central sensitization and dysregulation of peripheral substance P and neurokinin-1 receptor (NK-1R) signaling are associated with chronic abdominal pain in inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). Although positron emission tomography (PET) has demonstrated that patients with injury-related chronic pain have diminished NK-1R availability in the brain, it is unknown whether these deficits are present in IBD and IBS patients, who have etiologically distinct forms of non-injury-related chronic pain. This study's aim was to determine if patients with IBD or IBS exhibit deficits in brain expression of NK-1Rs relative to healthy controls (HCs), the extent to which expression patterns differ across patient populations, and if these patterns differentially relate to clinical parameters. PET with [18F]SPA-RQ was used to measure NK-1R availability by quantifying binding potential (BP) in the 3 groups. Exploratory correlation analyses were performed to detect associations between NK-1R BP and physical symptoms. Compared to HCs, IBD patients had NK-1R BP deficits across a widespread network of cortical and subcortical regions. IBS patients had similar, but less pronounced deficits. BP in a subset of these regions was robustly related to discrete clinical parameters in each patient population. Widespread deficits in NK-1R BP occur in IBD and, to a lesser extent, IBS; however, discrete clinical parameters relate to NK-1R BP in each patient population. This suggests that potential pharmacological interventions that target NK-1R signaling may be most effective for treating distinct symptoms in IBD and IBS. PMID:23582152

Jarcho, Johanna M.; Feier, Natasha A.; Bert, Alberto; Labus, Jennifer A.; Lee, Maunoo; Stains, Jean; Ebrat, Bahar; Groman, Stephanie M.; Tillisch, Kirsten; Brody, Arthur L.; London, Edythe D.; Mandelkern, Mark A.; Mayer, Emeran A.

2014-01-01

69

Mechanisms of referred visceral pain: uterine inflammation in the adult virgin rat results in neurogenic plasma extravasation in the skin  

Microsoft Academic Search

The purpose of this study was to investigate the mechanisms of referred pain observed in female patients with pain from the reproductive organs. We developed a model of inflammatory uterine pain in the rat. Inflammation of the uterus in rats pretreated with Evans Blue Dye resulted in dye extravasation in the skin over the abdomen, groin, lower back, thighs, perineal

Ursula Wesselmann; Jean Lai

1997-01-01

70

Intraspinal sprouting of unmyelinated pelvic afferents after complete spinal cord injury is correlated with autonomic dysreflexia induced by visceral pain  

Microsoft Academic Search

Autonomic dysreflexia is a potentially life-threatening hypertensive syndrome following high thoracic (T) spinal cord injury (SCI). It is commonly triggered by noxious pelvic stimuli below the injury site that correlates with increased sprouting of primary afferent C-fibers into the lumbosacral (L\\/S) spinal cord. We have recently demonstrated that injury-induced plasticity of (L\\/S) propriospinal neurons, which relay pelvic visceral sensations to

S. Hou; H. Duale; A. G. Rabchevsky

2009-01-01

71

Midazolam for intractable hiccup  

Microsoft Academic Search

We describe two terminally ill cancer patients severely distressed by intractable hiccup. Commonly recommended treatments were ineffective. Intravenous midazolam 5–10 mg rapidly relieved the hiccup. Maintenance treatment comprised midazolam 40–120 mg\\/24 hr by continuous subcutaneous infusion.

Andrew Wilcock; Robert Twycross

1996-01-01

72

Effects of novel TRPA1 receptor agonist ASP7663 in models of drug-induced constipation and visceral pain.  

PubMed

Constipation is a major gastrointestinal motility disorder with clinical need for effective drugs. We previously reported that transient receptor potential ankyrin 1 (TRPA1) is highly expressed in enterochromaffin (EC) cells, which are 5-hydroxytryptamine (5-HT)-releasing cells, and might therefore be a novel target for constipation. Here, we examined the effects of ASP7663, a novel and selective TRPA1 agonist, in constipation models as well as an abdominal pain model. ASP7663 activated human, rat, and mouse TRPA1 and released 5-HT from QGP-1 cells, and oral but not intravenous administration of ASP7663 significantly improved the loperamide-induced delay in colonic transit in mice. While pretreatment with the TRPA1 antagonist HC-030031 and vagotomy both inhibited the ameliorating effect of oral ASP7663 on the colonic transit, both orally and intravenously administered ASP7663 significantly inhibited colorectal distension (CRD)-induced abdominal pain response in rats. Taken together, these results demonstrate that ASP7663 exerts both anti-constipation and anti-abdominal pain actions, the former is likely triggered from the mucosal side of the gut wall via activation of vagus nerves while the latter is assumed to be provoked through systemic blood flow. We conclude that ASP7663 can be an effective anti-constipation drug with abdominal analgesic effect. PMID:24291101

Kojima, Ryosuke; Nozawa, Katsura; Doihara, Hitoshi; Keto, Yoshihiro; Kaku, Hidetaka; Yokoyama, Toshihide; Itou, Hiroyuki

2014-01-15

73

Intractable verrucous hyperplasia: a surgically corrected case.  

PubMed

Skin problems commonly occur after lower limb amputation. Wart-like lesions of verrucous hyperplasia is one such skin anomaly that develops on the residual-limb. The process is reversible if external compression in combination with adequate control of bacterial infection and edema is applied. Prosthetic adjustments usually help with this condition. However, we experienced an intractable verrucous hyperplasia case in a 65-year-old female. She complained of a painful, oozing, verrucous papule at the amputation site. Despite management with typical treatment procedures, the lesion worsened. Surgical treatment was therefore carried out. This case demonstrated that an intractable case is possible despite appropriate management and sometimes surgical correction is necessary. PMID:25479281

Chang, Ji Hea; Moon, Hee Bong; Kim, Chang Jae; Nam, Kiyeun; Lee, Ho Jun; Kwon, Bum Sun; Park, Jin-Woo

2014-12-01

74

Trial ultrasound-guided continuous left stellate ganglion blockade before surgical gangliolysis in a patient with a left ventricular assist device and intractable ventricular tachycardia: a pain control application to a complex hemodynamic condition.  

PubMed

Stellate ganglion blockade for cardiac dysrhythmia is a well-described technique but infrequently used to manage ventricular tachycardia (VT). In patients with left ventricular assist devices (LVADs), these dysrhythmias cause increased morbidity because of right ventricular dysfunction, and often severe discomfort. Continuous stellate ganglion blockade may yield valuable information on a diagnostic and therapeutic basis in preparation for definitive, permanent interventions. We describe the successful management of intractable VT with continuous left stellate ganglion blockade, followed by surgical gangliolysis in a patient with an LVAD. PMID:25303796

Smith, Daryl I; Jones, Carolyn; Morris, Garret K; Kralovic, Sarah; Massey, H Todd; Sifain, Andrew

2015-01-01

75

Pain.  

PubMed

Invasive stimulation of the motor (precentral) cortex using surgically implanted epidural electrodes is indicated for the treatment of neuropathic pain that is refractory to medical treatment. Controlled trials have demonstrated the efficacy of epidural motor cortex stimulation (MCS), but MCS outcome remains variable and validated criteria for selecting good candidates for implantation are lacking. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive approach that could be used as a preoperative tool to predict MCS outcome and also could serve as a therapeutic procedure in itself to treat pain disorders. This requires repeated rTMS sessions and a maintenance protocol. Other studies have also demonstrated the efficacy of transcranial direct current stimulation (tDCS) in relieving chronic pain syndromes. The most studied target is the precentral cortex, but other targets, such as the prefrontal and parietal cortices, could be of interest. The analgesic effects of cortical stimulation relate to the activation of various circuits modulating neural activities in remote structures, such as the thalamus, limbic cortex, insula, or descending inhibitory controls. In addition to the treatment of refractory neuropathic pain by epidural MCS, new developments of this type of strategy are ongoing, for other types of pain syndrome and stimulation techniques. PMID:24112914

Lefaucheur, Jean-Pascal

2013-01-01

76

Intractable hiccups during stroke rehabilitation  

Microsoft Academic Search

Objective: To study the frequency of intractable hiccups during stroke rehabilitation and the impact on rehabilitation management.Design: Case series, retrospective chart review.Setting: Inpatient stroke rehabilitation floor within a tertiary care teaching hospital.Patients: Three patients admitted for stroke rehabilitation with hiccups of at least 48 hours out of 270 consecutive cases.Interventions: None.Main Outcome Measure: Response to pharmacologic treatment.Results: All three subjects

Ashok Kumar; Alexander W. Dromerick

1998-01-01

77

Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain  

Microsoft Academic Search

This study compared the efficacy of a tetrahydrocannabinol:cannabidiol (THC:CBD) extract, a nonopioid analgesic endocannabinoid system modulator, and a THC extract, with placebo, in relieving pain in patients with advanced cancer. In total, 177 patients with cancer pain, who experienced inadequate analgesia despite chronic opioid dosing, entered a two-week, multicenter, double-blind, randomized, placebo-controlled, parallel-group trial. Patients were randomized to THC:CBD extract

Jeremy R. Johnson; Mary Burnell-Nugent; Dominique Lossignol; Elena Doina Ganae-Motan; Richard Potts; Marie T. Fallon

2010-01-01

78

Targeting TRP channels for pain relief.  

PubMed

Preclinical research has recently uncovered new molecular mechanisms underlying the generation and transduction of pain, many of which represent opportunities for pharmacological intervention. Manipulating temperature-sensitive Transient Receptor Potential (TRP) channels (so-called "thermoTRPs") on nociceptive neurons is a particularly attractive strategy in that it targets the beginning of the pain pathway. In the focus of current drug development efforts are the heat-sensitive TRPV1, warm-activated TRPV3, cold-responsive TRPA1, and cool-activated TRPM8 channels. TRPV1 desensitization by topical agonists (e.g. high concentration capsaicin creams and patches) has been in clinical use for decades to alleviate chronic painful conditions like diabetic neuropathy. Currently, site-specific resiniferatoxin (an ultrapotent capsaicin analogue) injections are being evaluated as "molecular scalpels" to achieve permanent analgesia in cancer patients with chronic, intractable pain. In the past few years a number of potent, small molecule TRPV1, TRPV3 and TRPA1 antagonists have been advanced into clinical trials for the treatment of inflammatory, neuropathic and visceral pain. TRPM8 antagonists are following closely behind for cold allodynia. Early TRPV1 antagonists in the clinic, however, showed worrisome adverse effects including hyperthermia and impaired noxious heat sensation. These adverse effects placed the patients at risk for scalding injury and prompted their withdrawal from the clinical trials. Second generation TRPV1 antagonists that do not cause core body temperature elevation have been reported, although the therapeutic utility of this class of compounds is not yet known. This review discusses the promise and challenges of developing TRP channel antagonists as a new generation of pain therapeutics. PMID:23500195

Brederson, Jill-Desiree; Kym, Philip R; Szallasi, Arpad

2013-09-15

79

Disruption of the kappa-opioid receptor gene in mice enhances sensitivity to chemical visceral pain, impairs pharmacological actions of the selective kappa-agonist U-50,488H and attenuates morphine withdrawal.  

PubMed Central

***micro***-, delta- and kappa-opioid receptors are widely expressed in the central nervous system where they mediate the strong analgesic and mood-altering actions of opioids, and modulate numerous endogenous functions. To investigate the contribution of the kappa-opioid receptor (KOR) to opioid function in vivo, we have generated KOR-deficient mice by gene targeting. We show that absence of KOR does not modify expression of the other components of the opioid system, and behavioural tests indicate that spontaneous activity is not altered in mutant mice. The analysis of responses to various nociceptive stimuli suggests that the KOR gene product is implicated in the perception of visceral chemical pain. We further demonstrate that KOR is critical to mediate the hypolocomotor, analgesic and aversive actions of the prototypic kappa-agonist U-50, 488H. Finally, our results indicate that this receptor does not contribute to morphine analgesia and reward, but participates in the expression of morphine abstinence. Together, our data demonstrate that the KOR-encoded receptor plays a modulatory role in specific aspects of opioid function. PMID:9463367

Simonin, F; Valverde, O; Smadja, C; Slowe, S; Kitchen, I; Dierich, A; Le Meur, M; Roques, B P; Maldonado, R; Kieffer, B L

1998-01-01

80

Giant PICA aneurysm presenting as intractable hiccups  

Microsoft Academic Search

We report a 23-year-old female with rare intractable hiccups caused by a giant posterior inferior cerebellar artery (PICA) aneurysm compressing the medulla oblongata, which resolved after surgical resection of the aneurysm and decompression of the medulla oblongata. We review the literature on lesions in the posterior fossa presenting as intractable hiccups.

Shanu Gambhir; Amardeep Singh; Bhavna Maindiratta; Matthias Jaeger; Balsam Darwish; Mark Sheridan

2010-01-01

81

Gabapentin for Intractable Hiccups in Palliative Care  

Microsoft Academic Search

Intractable hiccups are not common in the general population or in the palliative care population but can adversely impact quality of life and cause other complications such as weight loss and sleep disturbance. Many treatments have been proposed for intractable hiccups, but there is little consensus regarding treatment in the medical literature. This is partly because hiccups are relatively uncommon

Monica L. Tegeler; Steven J. Baumrucker

2008-01-01

82

Oral S (+)Ketamine Does Not Change Visceral Perception in Health  

Microsoft Academic Search

Application of N-methyl-d-aspartate (NMDA)-receptor antagonists may hold promise for the treatment of visceral pain. In this study we evaluated the effect of oral S(+)-ketamine (sKET), a noncompetitive NMDA-receptor antagonist, on visceral sensitivity in healthy volunteers. Eight healthy volunteers (five male, three female) underwent a gastric barostat study following oral administration of placebo, 25 mg sKET, and 50 mg sKET. Studies

Sjoerd D. Kuiken; Sake J. Th. Van Den Berg; Guido N. J. Tytgat; Guy E. E. Boeckxstaens

2004-01-01

83

Non-Cardiac Chest Pain  

MedlinePLUS

... been termed “Esophageal or visceral hypersensitivity” (enhanced esophageal perception or sensitivity to balloon distension). Although the cause ... can be used to improve this exaggerated pain perception. Non-esophageal Causes of NCCP NCCP is a ...

84

Travelers' Health: Leishmaniasis, Visceral  

MedlinePLUS

... longer-term travelers (such as expatriates and deployed soldiers) to the Mediterranean region and other areas where ... Visceral leishmaniasis: clinical observations in 4 US army soldiers deployed to Afghanistan or Iraq, 2002–2004. Arch ...

85

Molecular pain, a new era of pain research and medicine.  

PubMed

Molecular pain is a relatively new and rapidly expanding research field that represents an advanced step from conventional pain research. Molecular pain research addresses physiological and pathological pain at the cellular, subcellular and molecular levels. These studies integrate pain research with molecular biology, genomics, proteomics, modern electrophysiology and neurobiology. The field of molecular pain research has been rapidly expanding in the recent years, and has great promise for the identification of highly specific and effective targets for the treatment of intractable pain. Although several existing journals publish articles on classical pain research, none are specifically dedicated to molecular pain research. Therefore, a new journal focused on molecular pain research is needed. Molecular Pain, an Open Access, peer-reviewed, online journal, will provide a forum for molecular pain scientists to communicate their research findings in a targeted manner to others in this important and growing field. PMID:15813987

Gu, Jianguo; Zhuo, Min; Caterina, Michael; MacDermott, Amy B; Malmberg, Annika; Neugebauer, Volker; Yoshimura, Megumu

2005-01-01

86

Use of paced respiration to alleviate intractable hiccups (Singultus): a case report.  

PubMed

Heart rate variability (HRV) biofeedback is an emerging treatment for many health conditions involving dysregulation of the autonomic nervous system including hypertension, gastric pain, anxiety, and depression. Hiccups are frequently considered an annoyance. However, when intractable (lasting over 1 month), they can become debilitating, with some patients resorting to invasive treatments that often involve the phrenic nerve. Theoretically, HRV biofeedback should also provide a means to stimulate the phrenic nerve and could be an alternative option. We report the successful treatment of a 5 year-long case of intractable hiccups with one session of HRV biofeedback training. These results suggest that biofeedback may be a useful, non-invasive means of relieving intractable hiccups. No clear causality can be inferred from a single case, and further study is needed to determine if this finding has wider applicability. PMID:23568280

Hurst, Duane F; Purdom, Catherine L; Hogan, Michael J

2013-06-01

87

Pain pharmacology: focus on opioids  

PubMed Central

Summary The incidence of chronic pain is estimated to be 20–25% worldwide. Although major improvements in pain control have been obtained, more than 50% of the patients reports inadequate relief. It is accepted that chronic pain, if not adequately and rapidly treated, can become a disease in itself, often intractable and maybe irreversible. This is mainly due to neuroplasticity of pain pathways. In the present review I will discuss about pain depicting the rational for the principal pharmacological interventions and finally focusing on opioids, that represent a primary class of drug to treat pain. PMID:25568646

Fornasari, Diego

2014-01-01

88

The intractable cigarette ‘filter problem’  

PubMed Central

Background When lung cancer fears emerged in the 1950s, cigarette companies initiated a shift in cigarette design from unfiltered to filtered cigarettes. Both the ineffectiveness of cigarette filters and the tobacco industry's misleading marketing of the benefits of filtered cigarettes have been well documented. However, during the 1950s and 1960s, American cigarette companies spent millions of dollars to solve what the industry identified as the ‘filter problem’. These extensive filter research and development efforts suggest a phase of genuine optimism among cigarette designers that cigarette filters could be engineered to mitigate the health hazards of smoking. Objective This paper explores the early history of cigarette filter research and development in order to elucidate why and when seemingly sincere filter engineering efforts devolved into manipulations in cigarette design to sustain cigarette marketing and mitigate consumers' concerns about the health consequences of smoking. Methods Relevant word and phrase searches were conducted in the Legacy Tobacco Documents Library online database, Google Patents, and media and medical databases including ProQuest, JSTOR, Medline and PubMed. Results 13 tobacco industry documents were identified that track prominent developments involved in what the industry referred to as the ‘filter problem’. These reveal a period of intense focus on the ‘filter problem’ that persisted from the mid-1950s to the mid-1960s, featuring collaborations between cigarette producers and large American chemical and textile companies to develop effective filters. In addition, the documents reveal how cigarette filter researchers' growing scientific knowledge of smoke chemistry led to increasing recognition that filters were unlikely to offer significant health protection. One of the primary concerns of cigarette producers was to design cigarette filters that could be economically incorporated into the massive scale of cigarette production. The synthetic plastic cellulose acetate became the fundamental cigarette filter material. By the mid-1960s, the meaning of the phrase ‘filter problem’ changed, such that the effort to develop effective filters became a campaign to market cigarette designs that would sustain the myth of cigarette filter efficacy. Conclusions This study indicates that cigarette designers at Philip Morris, British-American Tobacco, Lorillard and other companies believed for a time that they might be able to reduce some of the most dangerous substances in mainstream smoke through advanced engineering of filter tips. In their attempts to accomplish this, they developed the now ubiquitous cellulose acetate cigarette filter. By the mid-1960s cigarette designers realised that the intractability of the ‘filter problem’ derived from a simple fact: that which is harmful in mainstream smoke and that which provides the smoker with ‘satisfaction’ are essentially one and the same. Only in the wake of this realisation did the agenda of cigarette designers appear to transition away from mitigating the health hazards of smoking and towards the perpetuation of the notion that cigarette filters are effective in reducing these hazards. Filters became a marketing tool, designed to keep and recruit smokers as consumers of these hazardous products. PMID:21504917

2011-01-01

89

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

2012-01-01

90

The effect of stellate ganglion block on intractable lymphedema after breast cancer surgery.  

PubMed

Lymphedema of the upper limb after breast cancer surgery is a disease that carries a life-long risk and is difficult to cure once it occurs despite the various treatments which have been developed. Two patients were referred from general surgery department for intractable lymphedema. They were treated with stellate ganglion blocks (SGBs), and the circumferences of the mid-point of their each upper and lower arms were measured on every visit to the pain clinic. A decrease of the circumference in each patient was observed starting after the second injection. A series of blocks were established to maintain a prolonged effect. Both patients were satisfied with less swelling and pain. This case demonstrates the benefits of an SGB for intractable upper limb lymphedema. PMID:25589949

Kim, Jin; Park, Hahck Soo; Cho, Soo Young; Baik, Hee Jung; Kim, Jong Hak

2015-01-01

91

The Effect of Stellate Ganglion Block on Intractable Lymphedema after Breast Cancer Surgery  

PubMed Central

Lymphedema of the upper limb after breast cancer surgery is a disease that carries a life-long risk and is difficult to cure once it occurs despite the various treatments which have been developed. Two patients were referred from general surgery department for intractable lymphedema. They were treated with stellate ganglion blocks (SGBs), and the circumferences of the mid-point of their each upper and lower arms were measured on every visit to the pain clinic. A decrease of the circumference in each patient was observed starting after the second injection. A series of blocks were established to maintain a prolonged effect. Both patients were satisfied with less swelling and pain. This case demonstrates the benefits of an SGB for intractable upper limb lymphedema. PMID:25589949

Kim, Jin; Cho, Soo Young; Baik, Hee Jung; Kim, Jong Hak

2015-01-01

92

Pain acceptance moderates the relation between pain and negative affect in female osteoarthritis and fibromyalgia patients  

Microsoft Academic Search

Background: Chronic pain is often intractable despite advanced medical and psychotherapeutic treatments. Pain acceptance is emerging\\u000a as a promising complement to control-based pain management strategies and a likely approach to maintaining quality of life\\u000a for chronic pain patients.Purpose: This theoretically based analysis of an existing database examined the extent to which pain acceptance predicted weekly reports\\u000a of positive affect (PA)

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

2007-01-01

93

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.  

PubMed

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

2013-11-01

94

The Intractability of Computing the Hamming Distance  

E-print Network

The Intractability of Computing the Hamming Distance Bodo Manthey 1,, R¨udiger Reischuk Universit Abstract Given a string x and a language L, the Hamming distance of x to L is the minimum Hamming distance prove that there is a language in AC0 such that both Hamming and edit distance to this language are hard

Al Hanbali, Ahmad

95

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. PMID:22912637

Kumar, Rajiv; Nylén, Susanne

2012-01-01

96

Purinergic mechanisms and pain--an update.  

PubMed

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 P2Y?? 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

2013-09-15

97

T-type calcium channels: functional regulation and implication in pain signaling.  

PubMed

Low-voltage-activated T-type Ca(2+) channels (T-channels), especially Cav3.2 among the three isoforms (Cav3.1, Cav3.2, and Cav3.3), are now considered to play pivotal roles in processing of pain signals. Cav3.2 T-channels are functionally modulated by extracellular substances such as hydrogen sulfide and ascorbic acid, by intracellular signaling molecules including protein kinases, and by glycosylation. Cav3.2 T-channels are abundantly expressed in both peripheral and central endings of the primary afferent neurons, regulating neuronal excitability and release of excitatory neurotransmitters such as substance P and glutamate, respectively. Functional upregulation of Cav3.2 T-channels is involved in the pathophysiology of inflammatory, neuropathic, and visceral pain. Thus, Cav3.2 T-channels are considered to serve as novel targets for development of drugs for treatment of intractable pain resistant to currently available analgesics. PMID:23903007

Sekiguchi, Fumiko; Kawabata, Atsufumi

2013-01-01

98

Noninvasive treatment alternative for intractable startle epilepsy  

PubMed Central

We describe a treatment alternative for intractable, startle-provoked, epileptic seizures in four children aged between 8 and 14. Three of the four children had symptomatic localization-related epilepsy. They all suffered from intractable epilepsy precipitated by sudden sounds. The fact that seizures tended to occur with high frequency – more than one seizure a day – had a clear impact on daily life. Clinical seizure pattern demonstrated asymmetric tonic posturing in all four children. Three children experienced several seizure types including focal seizure onset. All children had focal neurological signs or learning disabilities or a combination of both. Our noninvasive treatment method using psychoeducational counseling and sound generators was applied in four children, resulting in a seizure frequency reduction of ? 50% in two of them.

Klinkenberg, Sylvia; Ubbink, Sander; Vles, Johannes; de Louw, Anton; van Hall, Mariette Debeij; Scheijen, Dyon; Brokx, Jan

2014-01-01

99

Pediatric visceral leishmaniasis in Albania  

Microsoft Academic Search

Objective: Visceral leishmaniasis (VL) in children is endemic in southern Europe but has not been previously reported from Albania. This prospective study reports the clinical and laboratory findings in 50 children with visceral leishmaniasis, the value of a direct agglutination test (DAT), and the result of treatment with meglumine antimonate.Materials and Methods: Sera obtained from 50 children with VL confirmed

Gjeorgjina Lito; Farzin Davachi; Genc Sulcebe; Hamaide Bregu; Mira Basha

2002-01-01

100

Primary sclerosing cholangitis as an intractable disease  

PubMed Central

Summary Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease of unknown origin which eventually results in liver cirrhosis. The disease is reported to be more common among the Western population than in the Asian population. Asian experience remains limited. Diagnosis and treatment standards in the Far East have largely followed those in the West, including liver transplantation. Unlike in the West, however, recent reports from Japan have presented with a higher recurrence rate of PSC after liver transplantation, suggesting the intractable nature of the disease even after the replacement of the entire affected organ. PMID:25343066

Tamura, Sumihito; Sugawara, Yasuhiko; Kokudo, Norihiro

2012-01-01

101

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. PMID:22915879

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

2010-01-01

102

[Two cases of medicinal treatment of diabetic post treatment painful neuropathy].  

PubMed

Painful diabetic neuropathy is a common, difficult-to-manage complication of diabetes. We report two case of intractable painful diabetic neuropathy which occurred after the rapid lowering of blood sugar level. Although pregabalin, antidepressants, opioid analgetics and various nerve block did not improve their pain, clomipramine dramatically reduced their pain. PMID:24498768

Yanaki, Masashi; Iwade, Motoyo; Yamagata, Katsuyuki; Hamada, Keiko; Ozaki, Kyoko; Higuchi, Hideyuki; Ozaki, Makoto

2013-12-01

103

Amygdalar neuromelanosis intractable epilepsy without leptomeningeal involvement.  

PubMed

Neurocutaneous melanosis (NCM) is a rare, congenital neuroectodermal dysplasia generally resulting in early death from neurological decline due to leptomeningeal involvement. Nonmeningeal CNS epileptogenic lesions presenting in later childhood in the absence of leptomeningeal disease are rare. This report summarizes a rare presentation and curative epilepsy surgery. The authors discuss the case of a 14-year-old girl with NCM who originally presented with intractable partial-onset seizures. The MRI, PET, and SPECT studies subsequently revealed a focal epileptogenic source in the right temporal lobe. Results of video-electroencephalography monitoring concurred with the imaging findings, and a right temporal lobectomy was performed including the medial structures. Following surgery, histopathological features of the lesion included multiple scattered mononuclear cells with brown pigmentation in the amygdala specimen. The patient remains seizure free 2 years postresection, and no longer needs medication for seizure management. This patient presented with an atypical CNS manifestation of NCM that is curable by epilepsy surgery. Her intractable epilepsy developed secondary to amygdalar neuromelanosis, which had no associated leptomeningeal melanosis, an uncommon occurrence. As evidenced by the lack of seizure activity following resection, the patient's quality of life greatly improved after neurological surgery. PMID:23641959

Taylor, Douglas R; Wait, Scott D; Wheless, James W; Boop, Frederick A

2013-07-01

104

Somatic Pain Sensitivity in Children With Recurrent Abdominal Pain  

Microsoft Academic Search

OBJECTIVE:Evidence is accumulating that recurrent abdominal pain (RAP) in children is associated with visceral hyperalgesia. However, it is not known whether somatic sensitivity is altered as well. Therefore, the aim of our study was to assess somatic pain sensitivity in children with RAP and healthy controls at the abdomen and a distal site (thenar).METHODS:We examined 20 children with RAP (age

Katrin Zohsel; Johanna Hohmeister; Herta Flor; Christiane Hermann

2008-01-01

105

Neurobiological Mechanisms of Pelvic Pain  

PubMed Central

Pelvic pain is a common condition which significantly deteriorates health-related quality of life. The most commonly identified causes of pain in the pelvic region are gynaecologic, urologic, gastrointestinal, neurological, and musculoskeletal. However, in up to 33% of patients the source of this symptom is not identified, frustrating both patients and health-care professionals. Pelvic pain may involve both the somatic and visceral systems, making the differential diagnosing challenging. This paper aimed to review the mechanisms involved in pelvic pain perception by analyzing the neural plasticity and molecules which are involved in these complex circuits. PMID:25110704

Leone Roberti Maggiore, Umberto; Candiani, Massimo

2014-01-01

106

Oral Azithromycin for Treatment of Intractable Rosacea  

PubMed Central

Rosacea is a common chronic cutaneous disorder that primarily occurs on the convex surfaces of the central face and is often characterized by exacerbations and remissions. A case of a 52-yr-old woman visited our clinic in February 2008 complaining typical features of rosacea including multiple pinhead to rice-sized erythematous papules. We applied various conventional treatments including topical benzoyl peroxide and metronidazole as well as oral metronidazole, isotretinoin, and doxycycline. The lesions were not controlled but were rather aggravated by complications from these treatments. Therefore, we prescribed oral azithromycin, which has anti-inflammatory effects and reduces reactive oxygen species. Ten weeks after the administration of oral azithromycin, 500 mg per day for 2 weeks, the lesions had mostly disappeared and no specific side effects related to the azithromycin were noted. Oral azithromycin dosing 500 mg/day for 2 weeks is effective for treatment of intractable rosacea. PMID:21532865

Kim, Jae-Hong; Oh, Yoon Seok

2011-01-01

107

Medullary neurosarcoidosis presenting with intractable hiccoughs.  

PubMed

Hiccoughs (singultus) are a complex physiological process characterized by sudden brief involuntary contractions of the diaphragm. They most commonly occur from peripheral mechanisms that result in diaphragmatic irritation, but also occur from brain stem lesions such as that seen in Wallenberg's syndrome. They are uncommon in sarcoidosis and it is remarkably rare when hiccoughs are the presenting symptom of neurosarcoidosis. We report a patient with sarcoidosis who presented with intractable hiccoughs due to an inflammatory medullary lesion. Evaluation revealed an enhancing lesion in the dorsomedial medulla that resolved after aggressive immune-modulating therapy. In the absence of a clear peripheral lesion that would potentially affect the diaphragm, the diagnosis of neurosarcoidosis involving the brainstem should be considered in patients with sarcoidosis. PMID:22613488

John, Seby; Parambil, Joseph; Culver, Daniel; Tavee, Jinny

2012-08-01

108

Main ion channels and receptors associated with visceral hypersensitivity in irritable bowel syndrome  

PubMed Central

Irritable bowel syndrome (IBS) is a very frequent functional gastrointestinal disorder characterized by recurrent abdominal pain or discomfort and alteration of bowel habits. The IBS physiopathology is extremely complex. Visceral hypersensitivity plays an important role in the pathogenesis of abdominal pain in both in vitro and in vivo models of this functional disorder. In order to obtain a general view of the participation of the main ion channels and receptors regarding the visceral hypersensitivity in the IBS and to describe their chemical structure, a literature review was carried out. A bibliographical research in the following electronic databases: Pubmed and Virtual Library in Health (BVS) was fulfilled by using the search terms “ion channels” “or” “receptors” “and” “visceral hypersensitivity” “or” “visceral nociception” “and” “irritable bowel syndrome”. Original and review articles were considered for data acquisition. The activation of the ATP ion-gated channels, voltage-gated sodium (Nav) and calcium (Cav) channels, as well as the activation of protease-activated receptors (PAR2), transient receptor potential vanilloide-1, serotonin, cannabinoids and cholecystokinin are involved in the genesis of visceral hypersensitivity in IBS. The involvement of ion channels and receptors concerning visceral hypersensitivity is noteworthy in IBS models. PMID:24976114

de Carvalho Rocha, Heraldo Arcela; Dantas, Bruna Priscilla Vasconcelos; Rolim, Thaísa Leite; Costa, Bagnólia Araújo; de Medeiros, Arnaldo Correia

2014-01-01

109

Visceral myopathy presenting as acute appendicitis and ogilvie syndrome.  

PubMed

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. PMID:23738185

Kharbuja, Punyaram; Thakur, Raghvendra; Suo, Jian

2013-01-01

110

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. PMID:23738185

Kharbuja, Punyaram; Thakur, Raghvendra; Suo, Jian

2013-01-01

111

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)

1999-11-15

112

Runx1-deficient afferents impair visceral nociception, exacerbating dextran sodium sulfate-induced colitis.  

PubMed

Colitis is a group of inflammatory and auto-immune disorders that affect the tissue lining of the gastrointestinal (GI) system. Studies of chemically-induced animal models of colitis have indicated that nociceptive afferents or neuropeptides have differing effects on GI inflammation. However, the molecular mechanisms involved in visceral pain and the role of visceral sensory afferents involved in the modulation of colitis remains unclear. A previous study demonstrated that Runx1, a Runt domain transcription factor, is restricted to nociceptors. In these neurons, Runx1 regulates the expression of numerous ion channels and receptors, controlling the lamina-specific innervation patterns of nociceptive afferents in the spinal cord. Moreover, mice that lack Runx1 exhibit specific defects in thermal and neuropathic pain. To examine the function of Runx1 in visceral nociception, we employed double-transgenic mice (WntCre: Runx1(F)(/)(F)), in which the expression of Runx1 was specifically disrupted in the sensory neurons. To determine the role of Runx1 in visceral pain sensation, the WntCre: Runx1(F)(/)(F) mice and their control littermates (Runx1(F)(/)(F)) were treated using dextran sodium sulfate (DSS) to induce colitis. The results indicated that disrupted Runx1 in the sensory afferents resulted in: (1) impairment of the visceral pain sensation in murine DSS-induced colitis; (2) exacerbating the phenotypes in murine DSS-induced colitis; (3) a differential effect on the production of pro- and anti-inflammatory cytokines in the colon tissues isolated from mice treated using DSS and 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis; and (4) alteration of the distribution of lymphocytes and mast cells in mucosa. These results show that the function of Runx1 in sensory afferents is vital for modulating visceral pain and the neuro-immune axis. PMID:24041578

Hung, Shih-Ping; Sheu, Ming-Jen; Ma, Ming Chieh; Hu, Jui-Ting; Sun, Ya-Yun; Lee, Chin-Cheng; Chung, Yuan-Chiang; Tsai, Yi-Ju; Wang, Jing-Yuan; Chen, Chih-Li

2013-09-13

113

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. PMID:16952558

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.

2007-01-01

114

Epidemiology of visceral leishmaniasis  

PubMed Central

Leishmania species are the causative agents of leishmaniasis, a neglected tropical disease. These parasitic protozoans are usually transmitted between vertebrate hosts by the bite of blood sucking female phlebotomine sand flies. This review focuses on the two parasites causing most human visceral leishmaniasis (VL), which leads to substantial health problems or death for up to 400,000 people per year. Except for travel cases, Leishmania donovani infections are restricted to the (sub-)tropics of Asia and Africa, where transmission is mostly anthroponotic, while Leishmania infantum occurs in the drier parts of Latin America as well as in the Mediterranean climate regions of the Old World, with the domestic dog serving as the main reservoir host. The prevalence of VL caused by L. infantum has been declining where living standards have improved. In contrast, infections of L. donovani continue to cause VL epidemics in rural areas on the Indian subcontinent and in East Africa. The current review compares and contrasts these continental differences and suggests priorities for basic and applied research that might improve VL control. Transmission cycles, pathogenesis, diagnosis, treatment and prognosis, prevention (including vector control), surveillance, transmission modeling, and international control efforts are all reviewed. Most case detection is passive, and so routine surveillance does not usually permit accurate assessments of any changes in the incidence of VL. Also, it is not usually possible to estimate the human inoculation rate of parasites by the sand fly vectors because of the limitations of survey methods. Consequently, transmission modeling rarely passes beyond the proof of principle stage, and yet it is required to help develop risk factor analysis for control programs. Anthroponotic VL should be susceptible to elimination by rapid case detection and treatment combined with local vector control, and one of the most important interventions may well be socioeconomic development. PMID:24833919

Ready, Paul D

2014-01-01

115

Low back pain.  

PubMed Central

The studies reviewed here show that the duration and severity of individual episodes of back pain can be lessened, reducing recurrences and their cost in terms of suffering and lost work. Frank examines differential diagnosis; acute, chronic, and intractable pain; and service implications. Modern management emphasises self care, and bed rest should usually not be longer than 48 hours. A return to physical fitness and other activities, including employment, is actively encouraged. Medication has a role in facilitating these objectives. Two points are especially emphasised: strategies to manage low back pain must be long term and preventive; and the responsibility to keep fit, maintain an exercise programme, and remain relaxed so as to avoid physically stressing the spine is that of the individual, not of the professionals. Images FIG 2 PMID:8347190

Frank, A

1993-01-01

116

Imipramine decreases oesophageal pain perception in human male volunteers  

PubMed Central

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. ?? Keywords: antidepressants; imipramine; visceral hyperalgesia; oesophageal balloon; distension; functional bowel syndromes PMID:9691919

Peghini, P; Katz, P; Castell, D

1998-01-01

117

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

...applies electrical current to subsurface areas of a patient's brain to treat severe intractable pain. The stimulator consists...receiver with electrodes that are placed within a patient's brain and an external transmitter for transmitting the...

2014-04-01

118

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

2009-01-01

119

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

2005-01-01

120

Stereotactic Mesencephalotomy for Cancer - Related Facial Pain  

PubMed Central

Cancer-related facial pain refractory to pharmacologic management or nondestructive means is a major indication for destructive pain surgery. Stereotactic mesencephalotomy can be a valuable procedure in the management of cancer pain involving the upper extremities or the face, with the assistance of magnetic resonance imaging (MRI) and electrophysiologic mapping. A 72-year-old man presented with a 3-year history of intractable left-sided facial pain. When pharmacologic and nondestructive measures failed to provide pain alleviation, he was reexamined and diagnosed with inoperable hard palate cancer with intracranial extension. During the concurrent chemoradiation treatment, his cancer-related facial pain was aggravated and became medically intractable. After careful consideration, MRI-based stereotactic mesencephalotomy was performed at a point 5 mm behind the posterior commissure, 6 mm lateral to and 5 mm below the intercommissural plane using a 2-mm electrode, with the temperature of the electrode raised to 80? for 60 seconds. Up until now, the pain has been relatively well-controlled by intermittent intraventricular morphine injection and oral opioids, with the pain level remaining at visual analogue scale 4 or 5. Stereotactic mesencephalotomy with the use of high-resolution MRI and electrophysiologic localization is a valuable procedure in patients with cancer-related facial pain. PMID:25289131

Kim, Deok-ryeong; Lee, Sang-won

2014-01-01

121

Visceral hypersensitivity and electromechanical dysfunction as therapeutic targets in pediatric functional dyspepsia  

PubMed Central

Functional gastrointestinal disorders (FGID) are common clinical syndromes diagnosed in the absence of biochemical, structural, or metabolic abnormalities. They account for significant morbidity and health care expenditures and are identifiable across variable age, geography, and culture. Etiology of abdominal pain associated FGIDs, including functional dyspepsia (FD), remains incompletely understood, but growing evidence implicates the importance of visceral hypersensitivity and electromechanical dysfunction. This manuscript explores data supporting the role of visceral hypersensitivity and electromechanical dysfunction in FD, with focus on pediatric data when available, and provides a summary of potential therapeutic targets. PMID:25133041

Rosen, John M; Cocjin, Jose T; Schurman, Jennifer V; Colombo, Jennifer M; Friesen, Craig A

2014-01-01

122

Visceral hypersensitivity and electromechanical dysfunction as therapeutic targets in pediatric functional dyspepsia.  

PubMed

Functional gastrointestinal disorders (FGID) are common clinical syndromes diagnosed in the absence of biochemical, structural, or metabolic abnormalities. They account for significant morbidity and health care expenditures and are identifiable across variable age, geography, and culture. Etiology of abdominal pain associated FGIDs, including functional dyspepsia (FD), remains incompletely understood, but growing evidence implicates the importance of visceral hypersensitivity and electromechanical dysfunction. This manuscript explores data supporting the role of visceral hypersensitivity and electromechanical dysfunction in FD, with focus on pediatric data when available, and provides a summary of potential therapeutic targets. PMID:25133041

Rosen, John M; Cocjin, Jose T; Schurman, Jennifer V; Colombo, Jennifer M; Friesen, Craig A

2014-08-01

123

Kaposi's sarcoma with visceral involvement after intraarticular and epidural injections of corticosteroids.  

PubMed

Kaposi's sarcoma has been reported in patients receiving immunosuppressive therapy, most of whom are organ transplant recipients. The development of Kaposi's sarcoma after treatment with corticosteroids has been reported in only 38 patients who have not had acquired immunodeficiency syndrome or undergone organ transplantation. Cutaneous Kaposi's sarcoma developed 2 months after intraarticular steroid injections in a man with ulnar nerve entrapment. The lesions regressed spontaneously after 3 months but reappeared with visceral involvement 18 months later, shortly after initiation of a course of epidural steroid injections for treatment of low back pain. The cutaneous lesions and some visceral lesions rapidly regressed after cessation of treatment. PMID:8408835

Trattner, A; Hodak, E; David, M; Neeman, A; Sandbank, M

1993-11-01

124

Ketamine: An Introduction for the Pain and Palliative Medicine Physician  

Microsoft Academic Search

A history of an escalating chronic intractable pain in a patient with cryoglob- ulinemia, vasculitis, and severe cutaneous ulcerations is presented. A strategy of progressive, multi-agent, N-methyl-D-aspartate-receptor (NMDA-R) blockade that resulted in adequate pain control and a three-fold reduction in opioid con- sumption is described. Diagnostic process of neuropathic pain and the role of NMDA-R in the development of hyperalgesia

Tomasz Okon

2007-01-01

125

Neurotrophin signaling and visceral hypersensitivity  

PubMed Central

Neurotrophin family are traditionally recognized for their nerve growth promoting function and are recently identified as crucial factors in regulating neuronal activity in the central and peripheral nervous systems. The family members including nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and neurotrophin-3 (NT-3) are reported to have distinct roles in the development and maintenance of sensory phenotypes in normal states and in the modulation of sensory activity in disease. This paper highlights receptor tyrosine kinase (Trk) -mediated signal transduction by which neurotrophins regulate neuronal activity in the visceral sensory reflex pathways with emphasis on the distinct roles of NGF and BDNF signaling in physiologic and pathophysiological processes. Viscero-visceral cross-organ sensitization exists widely in human diseases. The role of neurotrophins in mediating neural cross talk and interaction in primary afferent neurons in the dorsal root ganglia (DRG) and neurotrophin signal transduction in the context of cross-organ sensitization are also discussed. PMID:25484893

Qiao, Li-Ya

2014-01-01

126

Schisandra chinensis reverses visceral hypersensitivity in a neonatal-maternal separated rat model  

PubMed Central

Visceral hypersensitivity is an important characteristic feature of functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). This study evaluated the effect of Schisandra chinensis on visceral hyperalgesia induced by neonatal maternal separation (NMS) in an IBS rat model. The visceromotor responses to colorectal balloon distension (CRD) were measured by abdominal withdrawal reflex (AWR) and electromyographic activities (EMG). NMS control rats (receiving vehicle) underwent aggravated visceral pain in response to CRD as compared to normal rats, evidenced by the reduced pain threshold, enhanced AWR scores and EMG responses. Treatment with a 70% ethanol extract of S. chinensis (0.3 g/kg and 1.5 g/kg per day) for seven days resulted in an increase in the pain threshold (NMS control: 19.1 ± 1.0 mmHg vs low-dose: 24.8 ± 1.3 mmHg and high-dose: 25.2 ± 1.8 mmHg, p<0.01), and abolished the elevated AWR and EMG responses to CRD in NMS rats (AUC values of EMG response curve were: 1952 ± 202 in NMS control group vs 1074 ± 90 in low-dose group and 1145 ± 92 in high-dose group, p<0.001), indicating that S. chinensis could reverse the visceral hypersensitivity induced by early-life stress event. The result of ELSA measurement shows that the elevated serotonin (5-HT) level in the distal colon of NMS rats returned to normal level after treatment with S. chinensis. Moreover, the increase in pain threshold in rats treated with S. chinensis was associated with a decline of the mRNA level of 5-HT3 receptor in the distal colon. All available results demonstrate that S. chinensis can reverse visceral hypersensitivity induced by neonatal-maternal separation, and the effect may be mediated through colonic 5-HT pathway in the rat. PMID:22230486

Yang, Jia-Ming; Xian, Yan-Fang; Ip, Paul SP; Wu, Justin CY; Lao, Lixing; Fong, Harry HS; Sung, Joseph JY; Berman, Brian; Yeung, John HK; Che, Chun-Tao

2012-01-01

127

Surgical treatment in familial visceral myopathy.  

PubMed Central

In a kindred with a familial visceral myopathy, seven patients had operations seeking relief of chronic abdominal pain and other symptoms of intestinal obstruction; one patient had an 80% cystectomy and a Y-V-plasty of the bladder neck for urinary retention. Five patients with megaduodenum had bypass operations; a side-to-side duodenojejunostomy was done in four and a retrocolic gastrojejunostomy in one. Two of these died of postoperative complications, and one developed symptomatic adhesions. Two other patients who had duodenojejunostomy have done well for 6 years and 1 1/2 years respectively. One patient with dilation of the distal jejunum and proximal ileum had relief of intestinal obstructive symptoms from jejunostomy to decompress the destal jejunum. One patient who had a resection of the descending and sigmoid colon for sigmoid volvulus has done well for four years. Three of these seven patients developed peritonitis postoperatively, and two had symptomatic adhesions after operations. Duodenal aspiration from a patient who developed postoperative peritonitis grew E. coli, 10(13) colonies per ml. After review of the results of operations in other families and in our kindred, we favor side-to-side duodenojejunostomy in megaduodenum. Duodenal aspirate must be cultured before operation. Evidence of bacterial overgrowth in the aspirate should prompt appropriate antibiotic treatment to reduce the likelihood of sepsis. Images Fig. 2. Fig. 3. Fig. 4. PMID:426561

Anuras, S; Shirazi, S; Faulk, D L; Gardner, G D; Christensen, J

1979-01-01

128

Groin pain  

MedlinePLUS

Pain - groin; Lower abdominal pain; Genital pain; Perineal pain ... Common causes of groin pain include: Pulled muscle, tendon, or ligaments in the leg. This problem often occurs in people who play sports such as ...

129

Novel insights in the role of peripheral corticotropin-releasing factor and mast cells in stress-induced visceral hypersensitivity.  

PubMed

Visceral hypersensitivity is one of the hallmarks in irritable bowel syndrome (IBS) pathophysiology. Stress is well known to affect visceral sensitivity in humans and rodents, an effect which is associated in part with alterations of intestinal epithelial permeability in rodents. Although the pathophysiology of visceral hypersensitivity is still unclear, two key factors have been identified as playing a major role in its modulation, namely peripheral corticotropin-releasing factor (CRF) and mast cells. In a recent study in Neurogastroenterology and Motility, van den Wijngaard et al. demonstrate that the mast-cell dependent visceral hypersensitivity observed in maternally separated rats after an acute exposure to a psychological stress can be prevented but not reversed by the peripherally restricted CRF receptor antagonist, ?-helical CRF(9-41). They further show that the preventive effect of the CRF receptor antagonist is linked to a stabilization of mast cells and maintenance of the epithelial barrier at the colonic level. These data suggest that post stress mast cell activation and subsequent visceral hypersensitivity are not targeted by peripheral CRF receptor antagonists. These novel insights in the role of peripheral CRF in the modulation of stress-induced visceral hypersensitivity add to our growing understanding of the mechanisms that may lie at the origin of visceral pain disturbances following stress and will contribute to enhance the development of drugs that may have potential therapeutic benefits for IBS patients. PMID:22316289

Larauche, M

2012-03-01

130

Lamotrigine for intractable migraine-like headaches in Sturge-Weber syndrome.  

PubMed

We herein report that naratriptan remarkably improved intractable migraine-like headaches in a patient with Sturge-Weber syndrome (SWS) despite his past history of cerebral infarction. In addition, lamotrigine had a prophylactic effect on his visual aura and headaches. An 18-year-old male patient with SWS had intractable migraine-like headaches every several months from the age of 3years. His migraine-like headaches were characterized by pulsating attacks preceded by left homonymous hemianopsia, which persisted after headache disappearance. In addition, after 14years of age, the pulsating headaches were preceded by photophobia without homonymous hemianopsia and occurred almost daily. Headache pains were not improved by acetaminophen or loxoprofen sodium hydrate. Furthermore, various prophylactic drugs were ineffective. After obtaining informed consent, naratriptan was administered. The pain severity was reduced and the duration of headache with homonymous hemianopsia was shortened from several days to several hours. Interestingly, naratriptan also shortened the duration of homonymous hemianopsia to several hours. We confirmed that his headache attacks were not epileptic seizures by ictal electroencephalography. However, 25mg/day of lamotrigine had a prophylactic effect on the frequency of headache. Moreover, lamotrigine led to complete remission of his headache without homonymous hemianopsia. Lamotrigine may have an advantage in terms of reducing the risk of cerebrovascular disease caused by migraine-like headaches and the use of triptans. The most effective management for migraine-like headaches in patients with SWS has not been established. Lamotrigine is a potentially effective option for patients with SWS with migraine-like headaches. PMID:23877022

Nomura, Shohei; Shimakawa, Shuichi; Fukui, Miho; Tanabe, Takuya; Tamai, Hiroshi

2014-05-01

131

Inguinoscrotal pain resistant to conventional treatment  

PubMed Central

Inguinoscrotal pain (ISP) is a common complaint that affects almost all age groups. The etiology may be vascular, neurogenic, visceral, muscular or psychological. Most causes of ISP are benign, but Pott's spine as a cause of ISP, when missed, may lead to serious outcomes. PMID:25624580

Jain, Anuj; Agarwal, Anil

2015-01-01

132

Systematic mechanism-orientated approach to chronic pancreatitis pain  

PubMed Central

Pain in chronic pancreatitis (CP) shows similarities with other visceral pain syndromes (i.e., inflammatory bowel disease and esophagitis), which should thus be managed in a similar fashion. Typical causes of CP pain include increased intrapancreatic pressure, pancreatic inflammation and pancreatic/extrapancreatic complications. Unfortunately, CP pain continues to be a major clinical challenge. It is recognized that ongoing pain may induce altered central pain processing, e.g., central sensitization or pro-nociceptive pain modulation. When this is present conventional pain treatment targeting the nociceptive focus, e.g., opioid analgesia or surgical/endoscopic intervention, often fails even if technically successful. If central nervous system pain processing is altered, specific treatment targeting these changes should be instituted (e.g., gabapentinoids, ketamine or tricyclic antidepressants). Suitable tools are now available to make altered central processing visible, including quantitative sensory testing, electroencephalograpy and (functional) magnetic resonance imaging. These techniques are potentially clinically useful diagnostic tools to analyze central pain processing and thus define optimum management approaches for pain in CP and other visceral pain syndromes. The present review proposes a systematic mechanism-orientated approach to pain management in CP based on a holistic view of the mechanisms involved. Future research should address the circumstances under which central nervous system pain processing changes in CP, and how this is influenced by ongoing nociceptive input and therapies. Thus we hope to predict which patients are at risk for developing chronic pain or not responding to therapy, leading to improved treatment of chronic pain in CP and other visceral pain disorders. PMID:25574079

Bouwense, Stefan AW; de Vries, Marjan; Schreuder, Luuk TW; Olesen, Søren S; Frøkjær, Jens B; Drewes, Asbjørn M; van Goor, Harry; Wilder-Smith, Oliver HG

2015-01-01

133

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

2001-01-01

134

Intractable hiccup and nausea with periaqueductal lesions in neuromyelitis optica  

Microsoft Academic Search

Intractable hiccup and nausea (IHN) was found in eight of 47 cases of relapsing neuromyelitis optica (NMO) (17%) but in none of 130 cases of multiple sclerosis (MS). IHN resolved with methylprednisolone. In six cases, MRI detected linear medullary lesions involving the pericanal region, the area postrema, and the nucleus tractus solitarius. Like long and centrally located myelitis, a linear

T. Misu; K. Fujihara; I. Nakashima; S. Sato; Y. Itoyama

2005-01-01

135

Intractable Hiccups as Presenting Symptom of Brainstem Tumor in Children  

Microsoft Academic Search

Hiccups are an unusual presenting symptom of brainstem tumors in children. An 8-year-old boy is described who presented with hiccups 2½ years prior to any major neurological manifestation. Central nervous system etiologies of hiccups are discussed. Intractable hiccups have seldom been described as a presenting symptom of brainstem tumors. We present a patient who presented to us with this symptom

Asma Q. Fischer

1982-01-01

136

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. PMID:22606588

Burcharth, Jakob; Olsen, Caroline; Rosenberg, Jacob

2011-01-01

137

Acute abdomen and perforated bowel with a rare pathology: nonfamilial visceral myopathy.  

PubMed

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. PMID:22606588

Burcharth, Jakob; Olsen, Caroline; Rosenberg, Jacob

2011-01-01

138

Pharmacological pain management in chronic pancreatitis  

PubMed Central

Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge. Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles that seen in neuropathic and chronic pain disorders. An important ultimate outcome of such aberrant pain processing is that once the disease has advanced and the pathophysiological processes are firmly established, the generation of pain can become self-perpetuating and independent of the initial peripheral nociceptive drive. Consequently, the management of pain by traditional methods based on nociceptive deafferentation (e.g., surgery and visceral nerve blockade) becomes difficult and often ineffective. This novel and improved understanding of pain aetiology requires a paradigm shift in pain management of chronic pancreatitis. Modern mechanism based pain treatments taking into account altered pain processing are likely to increasingly replace invasive therapies targeting the nociceptive source, which should be reserved for special and carefully selected cases. In this review, we offer an overview of the current available pharmacological options for pain management in chronic pancreatitis. In addition, future options for pain management are discussed with special emphasis on personalized pain medicine and multidisciplinarity. PMID:24259960

Olesen, Søren S; Juel, Jacob; Graversen, Carina; Kolesnikov, Yuri; Wilder-Smith, Oliver HG; Drewes, Asbjørn M

2013-01-01

139

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

2006-01-01

140

Chelating luminal zinc mimics hydrogen sulfide-evoked colonic pain in mice: possible involvement of T-type calcium channels  

Microsoft Academic Search

Luminal hydrogen sulfide (H2S) causes colonic pain and referred hyperalgesia in mice through activation of T-type Ca2+ channels. To test a hypothesis that H2S might chelate and remove endogenous Zn2+ that inhibits the Cav3.2 isoform of T-type Ca2+ channels, facilitating visceral nociception, we asked if intracolonic (i.col.) administration of Zn2+ chelators mimics H2S-induced visceral nociception. Visceral nociceptive behavior and referred

M. Matsunami; S. Kirishi; T. Okui; A. Kawabata

2011-01-01

141

Abdominal pain  

MedlinePLUS

Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is ...

142

Flank pain  

MedlinePLUS

Pain - side; Side pain ... Flank pain can be a sign of a kidney problem. However, since many organs are in this area, other causes are possible. If you have flank pain and fever , chills, blood in the urine, or ...

143

Corticotrophin-releasing factor 1 activation in the central amygdale and visceral hyperalgesia.  

PubMed

Corticotropin-releasing factor (CRF)-CRF1 receptor in the brain plays a key role in stress-related alterations of behavior including anxiety/depression, and autonomic and visceral functions. In particular, CRF1 signaling mediates hypersensitivity to colorectal distension (CRD) in various models (early life adverse events, repeated psychological stress, chronic high anxiety, postcolonic inflammation, or repeated nociceptive CRD). So far, knowledge of brain sites involved is limited. A recent article demonstrates in rats that CRF microinjected into the central amygdala (CeA) induces a hyperalgesic response to CRD and enhances the noradrenaline and dopamine levels at this site. The visceral and noradrenaline, unlike dopamine, responses were blocked by a CRF1 antagonist injected into the CeA. Here, we review the emerging role that CRF-CRF1 signaling plays in the CeA to induce visceral hypersensitivity. In the somatic pain field, CRF in the CeA was shown to induce pain sensitization. This is mediated by the activation of postsynaptic CRF1 receptors and protein kinase A signaling that increases N-methyl-d-aspartate receptor neurotransmission. In addition, the activation of tetraethylamonium-sensitive ion channels such as Kv3 accelerates repolarization and firing rate. Whether facilitation of pain transmission underlies CRF action in the CeA-induced visceral hypersensitivity will need to be delineated. CRF1 signaling in the CeA is also an important component of the neuronal circuitry inducing anxiety-like behavior and positioned at the interphase of the reciprocal relationship between pain and affective state. The hyperactivity of this system may represent the neuroanatomical and biochemical substrate contributing to the coexpression of hypersensitivity to CRD and mood disorders in subsets of irritable bowel syndrome patients. PMID:25557223

Taché, Y

2015-01-01

144

Biomarkers for visceral hypersensitivity identified by classification of electroencephalographic frequency alterations  

NASA Astrophysics Data System (ADS)

Abdominal pain is frequently related to visceral hypersensitivity. This is associated with increased neuronal excitability in the central nervous system (CNS), which can be manifested as discrete electroencephalographic (EEG) alterations. In the current placebo-controlled study, visceral hypersensitivity was evoked by chemical irritation of the esophagus with acid and capsaicin perfusion. The resulting hyperexcitability of the CNS was evaluated by evoked brain potentials following painful electrical stimulations of a remote organ—the rectosigmoid colon. Alterations in individual EEG power distributions between baseline and after perfusion were quantified by extracting features from the evoked brain potentials using an optimized discrete wavelet transform. Visceral hypersensitivity was identified as increased EEG power in the delta, theta and alpha frequency bands. By applying a support vector machine in regression mode, the individual baseline corrected alterations after sensitization were discriminated from alterations caused by placebo perfusions. An accuracy of 91.7% was obtained (P < 0.01). The regression value representing the overall alteration of the EEG correlated with the degree of hyperalgesia (P = 0.03). In conclusion, this study showed that classification of EEG can be used to detect biomarkers reflecting central neuronal changes. In the future, this may be used in studies of pain physiology and pharmacological interventions.

Graversen, Carina; Brock, Christina; Mohr Drewes, Asbjørn; Farina, Dario

2011-10-01

145

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 PMID:2246659

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

1990-01-01

146

Supraspinal TRPV1 modulates the emotional expression of abdominal pain.  

PubMed

The transient receptor potential vanilloid receptor type-1 (TRPV1) is critically involved in peripheral nociceptive processes of somatic and visceral pain. However, the role of the capsaicin receptor in the brain regarding visceral pain remains elusive. Here, we studied the contribution of TRPV1 to abdominal pain transmission at different nociceptive pathway levels using TRPV1 knock-out mice, resiniferatoxin-mediated deletion of TRPV1-positive primary sensory neurons, and intracerebral TRPV1 antagonism. We found that constitutive genetic TRPV1 deletion or peripheral TRPV1 deletion reduced acetic acid-evoked abdominal constrictions, without affecting referred abdominal hyperalgesia or allodynia in an acute pancreatitis model of visceral pain. Notably, intracerebral TRPV1 antagonism by SB 366791 significantly reduced chemical and inflammatory spontaneous abdominal nocifensive responses, as observed by reduced expressions of nociceptive facial grimacing, illustrating the affective component of pain. In addition to the established role of cerebral TRPV1 in anxiety, fear, or emotional stress, we demonstrate here for the first time that TRPV1 in the brain modulates visceral nociception by interfering with the affective component of abdominal pain. PMID:25139591

Jurik, Angela; Ressle, Andrea; Schmid, Roland M; Wotjak, Carsten T; Thoeringer, Christoph K

2014-10-01

147

Visceral fat thickness measured by ultrasonography can estimate not only visceral obesity but also risks of cardiovascular and  

Microsoft Academic Search

Background: Visceral obesity is closely associated with cardiovas- cular disease and the metabolic syndrome. Estimating the amount of visceral fat is important and requires a straightforward, reliable, and practical method. Objective: We investigated whether visceral fat thickness (VFT) measured by ultrasonography can adequately assess visceral fat ac- cumulation and predict cardiovascular or metabolic diseases. Design: Diabetic patients (240 men and

Soo Kyung Kim; Hae Jin Kim; Kyu Yeon Hur; Sung Hee Choi; Chul Woo Ahn; Sung Kil Lim; Kyung Rae Kim; Hyun Chul Lee; Kap Bum Huh; Bong Soo Cha

148

A new paradigm in chronic bladder pain.  

PubMed

ABSTRACT The concept of visceral pain has moved from organ-centered disease to a conceptualization based on pathophysiological mechanisms, integrating psychosocial and sexual dimensions. The terms painful bladder syndrome and bladder pain syndrome have been coined to include all patients with bladder pain. There is substantial overlap between IC/BPS and other pelvic/abdominal pain syndromes IC/BPS is likely to be underdiagnosed and undertreated in both men and women IC/BPS requires a multidisciplinary team approach toward management. This report is adapted from paineurope 2014; Issue 2, ©Haymarket Medical Publications Ltd, and is presented with permission. Paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication. PMID:25348226

Wesselmann, Ursula

2014-12-01

149

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. PMID:23342211

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

2013-01-01

150

Laser Light Scattering Characterization of Special Intractable Macromolecules in Solution  

Microsoft Academic Search

This review summerizes the recent advances in characterization of some special intractable macromolecules in solution by laser\\u000a light scattering. Since both static and dynamic laser light scattering (LLS) are theoretically well established, we focus\\u000a the discussion on experimental details, such as the design of a high-temperature LLS spectrometer, the sample clarification,\\u000a a novel differential refractometer, and some newly developed methods

Chi Wu

151

Olanzapine and baclofen for the treatment of intractable hiccups.  

PubMed

Intractable hiccups are a relatively uncommon condition characterized by involuntary, spasmodic contractions of the diaphragm. This type of hiccups generally has a duration of more than 1 month. We describe a 59-year-old kidney transplant recipient with a complicated medical history (atrial fibrillation, chronic renal failure, type 2 diabetes mellitus, gastroesophageal reflux, gout, hypertension, hyperlipidemia, and obstructive sleep apnea) who developed intractable hiccups that significantly affected his quality of life. Despite an extensive gastrointestinal and pulmonary evaluation, and treatment failures with several different drug regimens--metoclopramide, desipramine, amantadine, cyclobenzaprine, phenytoin, and lorazepam--his hiccups were eventually controlled with a combination of baclofen and low-dose olanzapine therapy. Baclofen is a c-aminobutyric acid (GABA) analog that contains a phenylethylamine moiety. It is hypothesized that having both GABA and phenylethylamine properties activates inhibitory neurotransmitters, most notably GABA, which may in turn block the hiccup stimulus. The exact mechanism through which olanzapine is effective in patients with hiccups is not fully understood. It is thought that the effect is, in part, due to serotonin augmenting phrenic motoneuronal activity on the reflex arcs involved in the generation of hiccups within the spinal cord. In addition, since olanazapine is a dopamine antagonist, particularly a dopamine D?-receptor antagonist, this could also have played a role in its effectiveness in treating our patient. Strong evidence for a specific treatment regimen for intractable hiccups is lacking in the primary literature. Our case report adds to the available literature, as there are currently no published data on the use of combination therapy for the treatment of intractable hiccups, and the combination of baclofen and olanzapine significantly improved our patient's quality of life. PMID:24551889

Thompson, Amy N; Ehret Leal, Julie; Brzezinski, Walter A

2014-01-01

152

A clinical trial of gene therapy for chronic pain  

PubMed Central

The first human trial of gene therapy for chronic pain, a phase 1 study of a non-replicating herpes simplex virus (HSV)-based vector engineered to express preproenkephalin in patients with intractable pain from cancer, began enrolling subjects in December 2008. In this article we describe the rationale underlying this potential approach to treatment of pain, the preclinical animal data in support of this approach, the design of the study, and studies with additional HSV-based vectors that may be used to develop treatment for other types of pain. PMID:19818042

Wolfe, Darren; Wechuck, James; Krisky, David; Mata, Marina; Fink, David J.

2011-01-01

153

Targeting Pain-evoking Transient Receptor Potential Channels for the Treatment of Pain.  

PubMed

Chronic pain affects billions of lives globally and is a major public health problem in the United States. However, pain management is still a challenging task due to a lack of understanding of the fundamental mechanisms of pain. In the past decades transient receptor potential (TRP) channels have been identified as molecular sensors of tissue damage and inflammation. Activation/sensitization of TRP channels in peripheral nociceptors produces neurogenic inflammation and contributes to both somatic and visceral pain. Pharmacological and genetic studies have affirmed the role of TRP channels in multiple forms of inflammatory and neuropathic pain. Thus pain-evoking TRP channels emerge as promising therapeutic targets for a wide variety of pain and inflammatory conditions. PMID:24396340

Luo, Jialie; Walters, Edgar T; Carlton, Susan M; Hu, Hongzhen

2013-12-01

154

Targeting Pain-evoking Transient Receptor Potential Channels for the Treatment of Pain  

PubMed Central

Chronic pain affects billions of lives globally and is a major public health problem in the United States. However, pain management is still a challenging task due to a lack of understanding of the fundamental mechanisms of pain. In the past decades transient receptor potential (TRP) channels have been identified as molecular sensors of tissue damage and inflammation. Activation/sensitization of TRP channels in peripheral nociceptors produces neurogenic inflammation and contributes to both somatic and visceral pain. Pharmacological and genetic studies have affirmed the role of TRP channels in multiple forms of inflammatory and neuropathic pain. Thus pain-evoking TRP channels emerge as promising therapeutic targets for a wide variety of pain and inflammatory conditions PMID:24396340

Luo, Jialie; Walters, Edgar T.; Carlton, Susan M.; Hu, Hongzhen

2013-01-01

155

Efficacy of Sumatriptan in Two Pediatric Cases With Abdominal Pain-Related Functional Gastrointestinal Disorders: Does the Mechanism Overlap That of Migraine?  

Microsoft Academic Search

We successfully treated 2 pediatric cases of abdominal pain-related functional gastrointestinal disorder with sumatriptan. When 9 years old, patient 1 developed periodic abdominal pain that was intractable to medication and remitted spontaneously. She was diagnosed with abdominal migraine, categorized as H2c in the Rome III criteria for functional gastrointestinal disorders. At age 12, intranasal sumatriptan relieved her pain, and her

Yosuke Kakisaka; Keisuke Wakusawa; Kazuhiro Haginoya; Akiko Saito; Mitsugu Uematsu; Hiroyuki Yokoyama; Tetsuo Sato; Shigeru Tsuchiya

2010-01-01

156

Multimodal imaging in nonlesional medically intractable focal epilepsy.  

PubMed

Identification and localization of epileptogenic zone (EZ) is vital in patients with medically-intractable focal epilepsy, who may be candidates for potentially curative resective epilepsy surgery. Presence of a lesion on magnetic resonance imaging (MRI) influences both diagnostic classification and selection for surgery. However, the implications for MRI-negative cases are not well-defined for such patients. Most of these patients undergo invasive long-term Electroencephalography recordings before a final decision regarding resection is possible. Recent developments in structural and functional neuroimaging which include quali-quantitative MRI, Positron Emission Tomography, Single Photon Emission Computed Tomography, and functional MRI have significantly changed presurgical epilepsy evaluation. Source analysis based on electrophysiological information, using either EEG or magnetoencephalography are also promising in order to noninvasively localize the EZ and to guide surgery in medically-intractable focal epilepsy patients that exhibit nonlesional MRI. This chapter aims to review the value of the combined use of structural and functional imaging techniques, and how this multimodal approach improves both selection of surgical candidates and post-operative outcomes in medically-intractable nonlesional focal epilepsy. PMID:25553362

Morales-Chacon, Lilia Maria; Alfredo Sanchez Catasus, Carlos; Minou Baez Martin, Margarita; Rodriguez Rojas, Rafael; Lorigados Pedre, Lourdes; Estupiñan Diaz, Barbara

2015-01-01

157

The Efficacy and Tolerability of Rufinamide in Intractable Pediatric Epilepsy  

PubMed Central

Background and Purpose: Rufinamide (RUF) is a novel antiepileptic drug (AED) and its efficacy has been proven in Lennox-Gastaut syndrome (LGS). However, there is a lack of data regarding the efficacy in pediatric intractable epilepsies other than LGS. The purpose of the study was to explore the efficacy and tolerability of RUF in pediatric patients with intractable epilepsies as well as LGS. Methods: This retrospective observation study was conducted in Samsung medical center from August 2010 to September 2011. Thirty seven patients (27 males, 10 females, aged between 1.8 and 18.4 years), with refractory epilepsies or LGS were treated with RUF as an adjunctive drug. Efficacy was represented by the response rate and retention rate over the study period. Tolerability was measured as the number of patients who showed adverse effects. Results: The overall response rate was 21.6% during the 12 months of the study period with 5.4% of seizure-free patients. The retention rate was 54% and ineffectiveness was the most common reason for discontinuation of RUF. The most common adverse effects were insomnia and somnolence. Conclusions: RUF may be considered to be an efficacious and safe AED for pediatric patients with intractable epilepsies as well as LGS. PMID:24649460

Kim, Jae Yeon; Lee, Cha Gon; Yu, Hee Joon; Nam, Sook Hyun; Lee, Jeehun; Lee, Munhyang

2012-01-01

158

Chronic spinal cord stimulation in medically intractable orthostatic tremor  

PubMed Central

Background Orthostatic tremor with its sense of unsteadiness when standing may have a devastating effect on affected persons. Currently, there are no other treatment options in those who do not respond or who do not tolerate medical treatment. Objectives To report on a pilot study on spinal cord stimulation in medically intractable orthostatic tremor. Methods Chronic spinal cord stimulation (SCS) was performed in two patients with medically?intractable orthostatic tremor via quadripolar plate electrodes implanted at the lower thoracic spine. The electrodes were connected to implantable pulse generators. Results Subjective and objective improvement of unsteadiness was achieved within a frequency range of 50 to 150?Hz, and occurred in the presence of stimulation?induced paraesthesia. With optimized stimulation settings polygraphic electromyelogram (EMG) recordings continued to show the typical 14–16?Hz EMG activity. The beneficial effect of SCS was maintained at long?term follow?up. Conclusions The results of this pilot study indicate that SCS may be an option in patients with otherwise intractable orthostatic tremor. PMID:16735398

Krauss, J K; Weigel, R; Blahak, C; Bäzner, H; Capelle, H?H; Grips, E; Rittmann, M; Wöhrle, J C

2006-01-01

159

Animal models of pancreatitis: Can it be translated to human pain study?  

PubMed Central

Chronic pancreatitis affects many individuals around the world, and the study of the underlying mechanisms leading to better treatment possibilities are important tasks. Therefore, animal models are needed to illustrate the basic study of pancreatitis. Recently, animal models of acute and chronic pancreatitis have been thoroughly reviewed, but few reviews address the important aspect on the translation of animal studies to human studies. It is well known that pancreatitis is associated with epigastric pain, but the understanding regarding to mechanisms and appropriate treatment of this pain is still unclear. Using animal models to study pancreatitis associated visceral pain is difficult, however, these types of models are a unique way to reveal the mechanisms behind pancreatitis associated visceral pain. In this review, the animal models of acute, chronic and un-common pancreatitis are briefly outlined and animal models related to pancreatitis associated visceral pain are also addressed. PMID:24259952

Zhao, Jing-Bo; Liao, Dong-Hua; Nissen, Thomas Dahl

2013-01-01

160

Validation of a Symptom Provocation Test for Laboratory Studies of Abdominal Pain and Discomfort in Children and Adolescents  

Microsoft Academic Search

Objective Assessed the convergent and discriminant validity of a water load symptom provocation test (WL-SPT) in creating visceral sensations similar to the naturally occurring sensations experienced by children with functional abdominal pain. Methods Participants were pediatric patients with functional abdominal pain (N = 110) and healthy school children (N = 120) between the ages of 8 and 16 years. Pain

Lynn S. Walker; Sara E. Williams; Craig A. Smith; Judy Garber; Deborah A. Van Slyke; Tricia Lipani; John W. Greene; Howard Mertz; Bruce D. Naliboff

2006-01-01

161

Visceral larva migrans caused by Trichuris vulpis.  

PubMed Central

Two brothers with visceral larva migrans caused by Trichuris vulpis were diagnosed after they had been investigated for an eosinophilia. Both patients were almost asymptomatic. The diagnosis of visceral larva migrans was based on the results of immunoelectrophoretic studies and no liver biopsy was performed. After administration of thiabendazole, the number of eosinophils and serum total IgE levels gradually decreased, and the patients have remained well. PMID:7436519

Sakano, T; Hamamoto, K; Kobayashi, Y; Sakata, Y; Tsuji, M; Usui, T

1980-01-01

162

Sympathetic Neural Activation in Visceral Obesity  

Microsoft Academic Search

Methods and Results—MSNA (microneurography), body composition (dual energy x-ray absorptiometry), and abdominal visceral and subcutaneous fat (computed tomography) were measured in 37 sedentary men across a wide range of adiposity. MSNA was 55% higher in men with HAVF compared with men with LAVF (334 versus 212 bursts\\/min, P0.05). Furthermore, MSNA was more closely associated with the level of abdominal visceral

Guy E. Alvarez; Stacy D. Beske; Tasha P. Ballard; Kevin P. Davy

2010-01-01

163

Hepatopulmonary syndrome associated with visceral leishmaniasis.  

PubMed

Leishmaniasis caused by Leishmania infantum is endemic in the Mediterranean region. Its visceral form can present a diagnostic challenge owing to the disease's wide spectrum of clinical presentations. We describe the very atypical case of a 66-year-old male Caucasian patient with hepatopulmonary syndrome and an exceptionally rare expression of visceral leishmaniasis in a disseminated form with mucocutaneous involvement presenting as an autoimmune systemic disease. PMID:25391614

Martis, Nihal; Pomares, Christelle; Jeandel, Pierre Yves; Lazure, Thierry; Marty, Pierre; Rosenthal, Eric

2015-02-01

164

Idiopathic Thoracic Epidural Lipomatosis with Chest Pain  

PubMed Central

Spinal epidural lipomatosis (SEL) is an overgrowth of the normally encapsulated adipose tissue in the epidural space around the spinal cord in the thoracic and lumbar spine causing compression of the neural components. Idiopathic SEL in non-obese patients is exceptional. Idiopathic SEL can result in thoracic myelopathy and lumbar radiculopathy. A thoracic radiculopathy due to idiopathic SEL has not been reported yet. We report a case of idiopathic SEL with intractable chest pain and paresthesia. We suggest that idiopathic SEL should be considered as a cause of chest pain. PMID:22053234

Lee, Sang-Beom; Chang, Jae-Chil; Jin, So-Young

2011-01-01

165

Idiopathic thoracic epidural lipomatosis with chest pain.  

PubMed

Spinal epidural lipomatosis (SEL) is an overgrowth of the normally encapsulated adipose tissue in the epidural space around the spinal cord in the thoracic and lumbar spine causing compression of the neural components. Idiopathic SEL in non-obese patients is exceptional. Idiopathic SEL can result in thoracic myelopathy and lumbar radiculopathy. A thoracic radiculopathy due to idiopathic SEL has not been reported yet. We report a case of idiopathic SEL with intractable chest pain and paresthesia. We suggest that idiopathic SEL should be considered as a cause of chest pain. PMID:22053234

Lee, Sang-Beom; Park, Hyung-Ki; Chang, Jae-Chil; Jin, So-Young

2011-08-01

166

Involvement of kappa-opioid receptors in visceral nociception in mice.  

PubMed

It has been shown that the behavioural responses to chemically evoked visceral nociception are increased in transgenic mice lacking the kappa-opioid receptor (KOR). The aim of the present study was to evaluate the contribution of KOR in mechanically evoked visceral pain by performing colorectal distension (CRD) and monitoring the subsequent visceromotor response (VMR) in control mice (KOR(+/+)) and in mice lacking KOR (KOR(-/-)). Pseudo-affective visceral pain responses were evoked in conscious mice using increasing (10-80 mmHg) and repeated (12 x 55 mmHg) phasic CRD paradigms. The resulting VMR was determined by monitoring the electromyographic activity of the abdominal muscle. The increasing and repeated CRD paradigms, respectively, evoked similar responses in both KOR(+/+) and KOR(-/-) mice. The selective KOR-agonists U-69593 (5 and 25 mg kg(-1), s.c.) and asimadoline (25 mg kg(-1), s.c.) significantly decreased the VMR in KOR(+/+) mice, while having no effect in KOR(-/-) mice. In contrast, the selective mu-opioid receptor agonist fentanyl significantly reduced the VMR in both types of mice and appeared more efficacious in KOR(-/-) mice. The opioid receptor antagonist naloxone (0.3-30 mg kg(-1) s.c.) did not affect the response to CRD in C57BL/6 mice at any dose tested. In conclusion, the data confirm that the KOR agonists used in this study inhibit the VMR to CRD in mice by acting via KOR receptors. In addition, the data suggest that the endogenous opioid system is not likely to modulate the VMR to mechanically evoked visceral pain in mice. PMID:18643891

Larsson, M H; Bayati, A; Lindström, E; Larsson, H

2008-10-01

167

Heel pain  

MedlinePLUS

Pain - heel ... Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: When the tendon that connects the back ...

168

Wrist pain  

MedlinePLUS

Pain - wrist ... Carpal tunnel syndrome: A common cause of wrist pain is carpal tunnel syndrome . You may feel aching, ... become weak, making it difficult to grasp things. Pain may extend up to your elbow. Carpal tunnel ...

169

Ankle pain  

MedlinePLUS

Pain - ankle ... Ankle pain is often due to an ankle sprain. An ankle sprain is an injury to the ligaments, which ... the joint. In addition to ankle sprains, ankle pain can be caused by: Damage or swelling of ...

170

Elbow pain  

MedlinePLUS

Pain - elbow ... Elbow pain can be caused by a variety of problems. A common cause in adults is tendinitis , an inflammation ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...

171

Foot pain  

MedlinePLUS

Pain - foot ... Foot pain may be due to: Aging Being on your feet for long periods of time Being overweight A ... other sports activity The following can cause foot pain: Arthritis and gout : Common in the big toe, ...

172

Neck Pain  

MedlinePLUS

... Pregnancy and Rheumatic Disease Sex and Arthritis Neck Pain PRINT Download PDF Description Saying, “It’s a pain ... requires expensive or uncomfortable tests. What is neck pain? Acute strain may occur after sleeping in an ...

173

Pain Relievers  

MedlinePLUS

Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There ... also have a slightly different response to a pain reliever. Over-the-counter (OTC) medicines are good for ...

174

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

1986-01-01

175

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. PMID:21937614

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

2012-01-01

176

Efficacy of long term weekly ACTH therapy for intractable epilepsy.  

PubMed

Background: Adrenocorticotropic hormone (ACTH) therapy is the first-line therapy for infantile spasms, and is effective for many other intractable epilepsies. While spasms may respond to ACTH for weeks, a substantial proportion of patients develop recurrent seizures over a yearly period. To maintain efficacy, we treated two children with intractable epilepsy with weekly ACTH therapy for 1year and described the changes in clinical seizures, electroencephalograms, developmental assessments and side effects. Subjects and methods: A girl with infantile spasms due to lissencephaly and a boy with atypical absence seizures were studied. In both cases, seizures were frequent and resistant to antiepileptic drugs; electroencephalograms showed continuous epileptiform activities, and the patients' development was delayed and stagnant prior to ACTH treatment. The initial ACTH therapy (daily 0.015mg/kg for 2weeks, 0.015mg/kg every 2days for 1week, 0.0075mg/kg every 2days for 1week), was transiently effective in both cases. The second-round ACTH therapy consisted of the initial ACTH therapy protocol followed by weekly ACTH injections (0.015mg/kg or 0.0075mg/kg) for 1year. Both cases were followed for at least 1year after therapy. Results: In both patients, clinical seizures were completely controlled during and 1year after the second-round AHCH therapy. Continuous epileptiform discharges disappeared, while intermittent interictal epileptiform discharges remained. Both patients showed some developmental gains after achieving seizure control. No serious side effects were recorded. Conclusion: Further studies are warranted to determine if a long-term weekly ACTH is a safe and effective treatment for intractable epilepsy. PMID:25149137

Inui, Takehiko; Kobayashi, Tomoko; Kobayashi, Satoru; Sato, Ryo; Endo, Wakaba; Kikuchi, Atsuo; Nakayama, Tojo; Uematsu, Mitsugu; Takayanagi, Masaru; Kato, Mitsuhiro; Saitsu, Hirotomo; Matsumoto, Naomichi; Kure, Shigeo; Haginoya, Kazuhiro

2014-08-19

177

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. PMID:23930253

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

2013-01-01

178

[Insular psammomatous meningioma presenting intractable complex partial seizures].  

PubMed

We describe a 30-year-old female with intractable symptomatic epilepsy caused by an insular calcified mass, which was histologically proved as psammomatous meningioma. Seizures were described as consciousness impairment, motionless stare and automatism. After total removal of the tumor with a neuronavigation system and motor evoked potential (MEP) monitoring, seizures completely disappeared without neurological deficit. We emphasize that insular meningioma presents complex partial seizures which mimic medial temporal lobe epilepsy and seizures are controlled by total resection of the tumor. PMID:22915702

Imoto, Hirochika; Fujii, Masami; Maruta, Yuichi; Sadahiro, Hirokazu; Ideguchi, Makoto; Ishihara, Hideyuki; Nomura, Sadahiro; Suzuki, Michiyasu

2012-09-01

179

Adult rumination syndrome: Differentiation from psychogenic intractable vomiting.  

PubMed

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. PMID:23226859

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

2012-07-01

180

Management of visceral vascular anomalies.  

PubMed

Vascular malformations affect the viscera less commonly than the head and neck, extremities, and extra-cavitary soft tissues. They present with a wide spectrum of symptoms and findings including pain, respiratory compromise, hemoptysis, chylothorax, ascites, gastrointestinal bleeding, and obstruction. Management options depend upon the subtype of malformation and anatomic extent and may include sclerotherapy, embolization, surgical extirpation, coloanal pull-through, and occasionally more innovative individualized surgical approaches. PMID:25241101

Dasgupta, Roshni; Fishman, Steven J

2014-08-01

181

Correlation between Complicated Diverticulitis and Visceral Fat  

PubMed Central

The aim of this study was to examine the relationship of complications related to diverticulitis and visceral obesity. The study was based on a retrospective case note review conducted at the Hanyang University Hospital. Patients were diagnosed with diverticulitis based on clinical symptoms and abdominal computed tomography (CT) findings and divided into two groups: those admitted with complicated diverticulitis and those with a simple diverticulitis episode. We compared the body mass index (BMI) and degree of visceral obesity, measured by abdominal CT. The study included 140 patients, 87 (62.1%) were simple diverticulitis and 53 (37.9%) were complicated diverticulitis. In the complicated diverticulitis group, 9 (6.4%) cases were recurrent, 29 (20.7%) were perforation or abscess patients, and 28 (20%) were patients with systemic inflammatory response syndrome (SIRS). Of the SIRS patients, 13 were involved in other complication groups. When comparing in the two groups, the complicated diverticulitis group had a significantly higher visceral fat area (128.57 cm2 vs 102.80 cm2, P = 0.032) and a higher ratio of visceral fat area/subcutaneous fat area (0.997 vs 0.799, P = 0.014). Visceral obesity is significantly associated with complications of diverticulitis. PMID:22022188

Jeong, Jong Heon; Kim, Jin Ok; Tae, Hye Jin; Jung, Suk Hyun; Lee, Kang Nyeong; Jun, Dae Won; Lee, Oh Young; Yoon, Byung Chul; Choi, Ho Soon; Hahm, Joon Soo; Song, Soon Young

2011-01-01

182

Is there a role for acupuncture in endometriosis pain, or ‘endometrialgia’?  

Microsoft Academic Search

Endometriosis is a common cause of pelvic pain in women, many of whom suffer a progression of symptoms over their menstrual life. Symptoms may include combinations of abnormal visceral sensations and emotional distress. Endometriosis pain, or ‘endometrialgia’ often has a negative influence on the ability to work, on family relationships and sense of worth.Endometrialgia is often considered to be a

Thomas Lundeberg; Iréne Lund

2008-01-01

183

Duodenal switch for intractable reflux gastroesophagitis after proximal gastrectomy.  

PubMed

Reflux gastroesophagitis is a common postgastrectomy complication after proximal gastrectomy, and conservative treatments including protease inhibitors and proton pump inhibitors are effective in most patients. Here we report a patient with severe reflux gastroesophagitis after proximal gastrectomy, in whom surgical treatment of duodenal switch was effective. An 80-year-old man complained of intractable heartburn, anorexia, and body weight loss after having undergone proximal gastrectomy, with reconstruction by esophagogastrostomy with valvuloplasty and pyloroplasty, for early gastric cancer 14 months before referral to our department. Oral administration of protease inhibitors and proton pump inhibitors was ineffective. Laboratory evaluation showed poor nutritional status. On endoscopic examination, we noted the redness, bleeding, and multiple erosions in the esophagus and the gastric remnant. He was diagnosed to have severe gastroesophagitis due to reflux of duodenal juice into the gastric remnant and esophagus. We performed duodenal switch to divert duodenal juice from the gastric remnant and esophagus; the duodenum was transected 2 cm distal to the pylorus, the duodenal distal end was closed, and a 50-cm Roux limb from the proximal jejunum was anastomosed to the proximal end of the duodenum. The heartburn disappeared postoperatively, and endoscopic examination revealed marked improvement of the reflux gastroesophagitis. One year postoperatively, the patient is free from symptoms including heartburn. His body weight increased, and laboratory data showed improvement in nutritional status. In conclusion, the duodenal switch may be surgical treatment of choice for intractable reflux gastroesophagitis after proximal gastrectomy. PMID:23803250

Someya, Soutoku; Shibata, Chikashi; Tanaka, Naoki; Kudoh, Katsuyoshi; Naitoh, Takeshi; Miura, Koh; Unno, Michiaki

2013-01-01

184

Therapeutic options for intractable hematuria in advanced bladder cancer.  

PubMed

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

2013-07-01

185

[Repeated syncope episodes caused by intractable hiccups; a case report].  

PubMed

A 66-year-old man visited our hospital with a chief complaint of a sore throat. On examination, the pharyngeal and laryngeal mucosa was reddish and localized mucosal erosion was present on the left side. Based on an initial diagnosis of acute pharyngitis caused by bacteriological infection or mycotic infection, treatment with antibacterial and antimycotic agents was initiated. However, the patient's sore throat gradually worsened and he developed intractable hiccups. Intravenous steroids were given for the treatment of the severe sore throat, and this symptom was gradually alleviated. However, the intractable hiccups persisted. In addition, the patient began to have convulsive syncope episodes and was subsequently admitted to our hospital. Further examination revealed that the syncope episodes were linked to the hiccups. To treat the hiccups, baclofen and Chinese medicine were prescribed, and the convulsive syncope episodes disappeared immediately. The patient's hiccups also improved and disappeared six days thereafter. Based on this clinical evidence, we concluded that the hiccups were caused by pharyngitis, resulting in the stimulation of the glossopharyngeal nerve, while the convulsive syncope episodes were a type of situational syncope related to hiccups. PMID:24313063

Sueyoshi, Shintaro; Shin, Buichiro; Nakashima, Tadashi

2013-10-01

186

Pelvic Pain  

MedlinePLUS

Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

187

Back Pain  

MedlinePLUS

NINDS Back Pain Information Page Condensed from Low Back Pain Fact Sheet Table of Contents (click to jump to sections) ... Trials Organizations Additional resources from MedlinePlus What is Back Pain? Acute or short-term low back pain generally ...

188

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. PMID:20861241

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

2011-01-01

189

Vesicourethral dysfunction following pelvic visceral ablative surgery.  

PubMed

Management of vesicourethral dysfunction after a major extirpative pelvic visceral operation could be complex and difficult owing to the variety of partial and complete functional and anatomical derangements produced by the primary operation. We report our experience with 22 patients who suffered various types of vesicourethral dysfunctions after extirpative pelvic visceral surgery, 5 of whom had preoperative studies. The surgical procedures were abdominoperineal resection in 9 patients, proctocolectomy in 3, anterior resection of the rectum in 2 and radical hysterectomy in 8. All 22 patients underwent urodynamic evaluations. The abnormalities noted on the preoperative urodynamic evaluations in patients about to undergo extirpative pelvic visceral surgery suggest the need for routine preoperative assessment of the lower urinary tract for an accurate understanding of the postoperative changes. PMID:6471186

Yalla, S V; Andriole, G L

1984-09-01

190

Sequential multiple visceral arteries dissections without aortic involvement.  

PubMed

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

2013-05-01

191

Visceral leishmaniasis in a psoriatic arthritis patient treated with methotrexate.  

PubMed

Visceral leishmaniasis, in Greece, represents a relatively rare, potentially fatal clinical entity. Here we describe a case of visceral leishmaniasis infection in a 65-year old Greek male with psoriatic arthritis treated with methotrexate, who presented with high grade fever, chills, splenomegaly, pancytopenia and polyclonal hypergammaglobulinaemia. A diagnosis of visceral leishmaniasis was finally established. Visceral leishmaniasis should be included in the differential diagnosis for infections in patients receiving methotrexate for rheumatic diseases, especially in endemic areas. PMID:25269966

Hadjipetrou, Athanasios; Anyfantakis, Dimitrios; Gkogkou, Argyro; Palla, Katerina; Lagoudaki, Eirini; Milonaki, Theoharoula; Kastanakis, Serafim

2014-09-01

192

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

193

Prevention of vagotonia and pain during radiofrequency ablation of liver tumors.  

PubMed

Radiofrequency ablation (RFA) is frequently used to treat early stage hepatocellular carcinoma. Two of the most cumbersome side-effects of the ablation procedure are intractable pain and vagotonia when deep sedation is not used. We describe local injection of anesthetic into Glisson's sheath as a new technique for overcoming these problems. Lidocaine was injected into Glisson's sheath when radiofrequency ablation of hepatocellular carcinomas, which were located adjacent to Glisson's sheath, could not be continued due to severe pain (n?=?8) or bradycardia (n?=?3). In all three patients who showed vagotonia with bradycardia during the ablations, injection of lidocaine prevented bradycardia, allowing completion of the radiofrequency ablation. Pain was reduced in all eight patients who experienced pain during ablation. No side-effects were observed during the procedures. Injection of anesthetic into Glisson's sheath is simple and effective for reducing intractable pain and vagotonia associated with RFA. PMID:24593141

Nakamura, Shinichiro; Nouso, Kazuhiro; Onishi, Hideki; Kuwaki, Kenji; Hagihara, Hiroaki; Takeuchi, Yasuto; Wada, Nozomu; Morimoto, Yuki; Miyahara, Koji; Yasunaka, Tetsuya; Ikeda, Fusao; Miyake, Yasuhiro; Kobayashi, Yoshiyuki; Shiraha, Hidenori; Ishikawa, Shinichi; Takaki, Akinobu; Yamamoto, Kazuhide

2014-12-01

194

Percutaneous spinal cord stimulation for chronic pain: indications and patient selection.  

PubMed

Percutaneous spinal cord stimulation has a clinical benefit in selected patients with chronic neuropathic pain related to failed back surgery syndrome and complex regional pain syndrome. Patients with other peripheral neuropathic pain syndromes may also respond favorably. The cause of the chronic pain must be established to rule out remediable causes. Drug abuse or aberrant drug-related behaviors should be assessed before proceeding. A psychological evaluation identifies patients who may not benefit. Risk factors for infection should be corrected where possible. This safe, reversible treatment should be considered early for patients with intractable peripheral neuropathic pain. PMID:25240659

Nagel, Sean J; Lempka, Scott F; Machado, Andre G

2014-10-01

195

COMPARISON OF VISCERAL FAT AND GONADAL FAT VOWMES OF YELLOWTAIL  

E-print Network

NOTES COMPARISON OF VISCERAL FAT AND GONADAL FAT VOWMES OF YELLOWTAIL ROCKFISH, SEBASTES FLAVIDUS 1964; Pereyra et al. 1969; Lorz et al. 1983). Annual cycles of visceral fat volume and gonad volume are documented in Guillemot (1982) and Guillemot et al. (1985). The studies showed that visceral fat volume

196

Insulinoma presenting as medically intractable temporal lobe epilepsy.  

PubMed

We describe a female insulinoma patient who presented with recurrent attacks of abnormal behavior, confusion, and seizure. Her interictal EEG showed epileptiform discharges on the left temporal area, therefore she was initially misdiagnosed as temporal lobe epilepsy. In the video-EEG monitoring, hypoglycemic state was detected during the seizure attack, so the right diagnosis was made after the endocrinologic investigations. After surgical removal of the tumor, the patient became seizure-free, and no abnormality was found in the follow-up EEG after six months. Since insulinoma shares some common clinical and EEG features with complex partial seizure of temporal lobe origin, insulioma should be included in the differential diagnosis for medically intractable temporal lobe epilepsy. PMID:24977127

Park, So-Hee; Kim, Dong Wook

2014-06-01

197

Insulinoma Presenting as Medically Intractable Temporal Lobe Epilepsy  

PubMed Central

We describe a female insulinoma patient who presented with recurrent attacks of abnormal behavior, confusion, and seizure. Her interictal EEG showed epileptiform discharges on the left temporal area, therefore she was initially misdiagnosed as temporal lobe epilepsy. In the video-EEG monitoring, hypoglycemic state was detected during the seizure attack, so the right diagnosis was made after the endocrinologic investigations. After surgical removal of the tumor, the patient became seizure-free, and no abnormality was found in the follow-up EEG after six months. Since insulinoma shares some common clinical and EEG features with complex partial seizure of temporal lobe origin, insulioma should be included in the differential diagnosis for medically intractable temporal lobe epilepsy. PMID:24977127

Park, So-Hee; Kim, Dong Wook

2014-01-01

198

A Case of Intractable Suspected Perilymph Fistula with Severe Depression  

PubMed Central

A 68-year-old woman presented dizziness whenever she put her finger into the right ear and also complained of water-streaming tinnitus, which indicated she would have been suffering from perilymph fistula. An exploratory tympanotomy was conducted. Leakage of perilymph from the round window was suspected, although the cochlin-tomoprotein (CTP) results were negative. After the procedure, the patient's finger-induced dizziness, tinnitus, and vertigo spells disappeared completely. However, her dizzy symptom did not improve. The patient also complained of general fatigue, weight loss, and insomnia, which led us to suspect comorbid depression. Antidepressants and vestibular rehabilitation treatment resulted in a significant improvement in her dizziness. Although it is not apparent whether the patient had a perilymph fistula, this case demonstrates the importance of evaluating not only physical symptoms but also psychological comorbidity, especially when the physical symptoms are intractable despite treatment. PMID:25395985

Oishi, Naoki; Tsutsumi, Tomoko; Ogawa, Kaoru

2014-01-01

199

Topiramate-induced intractable cough during migraine prophylaxis.  

PubMed

Topiramate is a highly effective drug in migraine prophylaxis and is considered a first-line treatment. The evidence for the efficacy of topiramate is based upon the results of several large, randomized, double-blind, placebo-controlled trials. Adverse events (AEs) are common and require discontinuation of the treatment in about 20-25% of patients, but they are rarely severe. There are reviews regarding topiramate-related AEs representing a large number of patients treated in controlled trials. The most common AEs are weight loss, dizziness, somnolence, abnormal thinking, fatigue, ataxia, confusion, paresthesias, impaired concentration, nervousness, amnesia, and language difficulties. The development of cough has never been reported as an AE during topiramate prophylaxis for migraine. We present 3 cases in which the prophylactic treatment for migraine with topiramate was discontinued due to the onset of primary intractable coughing. PMID:19751366

Maggioni, Ferdinando; Mampreso, Edoardo; Mainardi, Federico; Lisotto, Carlo; Malvindi, Maria Lucia; Zanchin, Giorgio

2010-02-01

200

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

2002-01-01

201

Maternal Visceral Adiposity by Consistency of Lactation  

PubMed Central

The purpose of this study was to examine the assocation between lactation and maternal visceral adiposity among US women who were on average 7 years postpartum. This cross-sectional analysis included 89 women who gave birth between 1997 and 2002, who did not have preeclampsia, prepregnancy hypertension or prepregnancy diabetes, and enrolled in The Women and Infant Study of Healthy Hearts (WISH). Computed tomography was used to assess abdominal adiposity. History of lactation was self-reported. Visceral adiposity was greater by 36.96 cm2 (95% CI: 20.92,53.01) among mothers who never breastfed than mothers who breastfed for ?3 months after every birth, even after adjustment for age, parity, years since last birth, site, socioeconomic, lifestyle, psychological, and family history variables, early adult BMI, and current BMI. Similarly, in fully adjusted models, mothers who breastfed any of their children for less than 3 months had 20.38 cm2 (95% CI: 2.70, 38.06) greater visceral adiposity than mothers who consistently breastfed all their children for 3 or more months. This study found that 7 years postpartum visceral fat depots are significantly greater among mothers who lactated for less than 3 months after the birth of each of their children. These results provide a potential physiologic basis for prior findings that women who do not consistently breastfeed are at an increased risk of diabetes, cardiovascular disease, and the metabolic syndrome. PMID:21404071

Catov, Janet; Ness, Roberta; Schwarz, Eleanor Bimla

2013-01-01

202

Endovascular Embolisation of Visceral Artery Pseudoaneurysms  

PubMed Central

Objective. To evaluate the technical success, safety, and outcome of endovascular embolization procedure in management of visceral artery pseudoaneurysms. Materials and Methods. 46 patients were treated for 53 visceral pseudoaneurysms at our institution. Preliminary diagnostic workup in all cases was performed by contrast enhanced abdominal CT scan and/or duplex ultrasound. In all patients, embolization was performed as per the standard departmental protocol. For data collection, medical records and radiology reports of all patients were retrospectively reviewed. Technical success, safety, and outcome of the procedure were analyzed. Results. Out of 46 patients, 13 were females and 33 were males. Mean patient age was 44.79 ± 13.9 years and mean pseudoaneurysm size was 35 ± 19.5?mm. Technical success rate for endovascular visceral pseudoaneurysm coiling was 93.47% (n = 43). Complication rate was 6.52% (n = 3). Followup was done for a mean duration of 21 ± 1.6 months (0.5–69 months). Complete resolution of symptoms or improvement in clinical condition was seen in 36 patients (80%) out of those 45 in whom procedure was technically successful. Conclusion. Results of embolization of visceral artery pseudoaneurysms with coils at our center showed high success rate and good short term outcome. PMID:25132992

Khattak, Yasir Jamil; Alam, Tariq; Hamid Shoaib, Rana; Sayani, Raza; Haq, Tanveer-ul; Awais, Muhammad

2014-01-01

203

Venereal transmission of canine visceral leishmaniasis  

Microsoft Academic Search

Leishmania chagasi, the agent of visceral leishmaniasis in dogs in the Americas has a tropism to the male genital system, particularly the epididymis, prepuce, and glans penis, resulting in shedding of Leishmania in the semen. The goal of this study was to verify the possibility of venereal transmission of L. chagasi. Twelve Leishmania-free bitches, housed in the absence of the

Fabiana L. Silva; Raquel G. Oliveira; Teane M. A. Silva; Mariana N. Xavier; Ernane F. Nascimento; Renato L. Santos

2009-01-01

204

Monoamines in the brain cerebrospinal fluid of facial pain patients.  

PubMed Central

The purpose of the study was to assay monoamines in cerebrospinal fluid (CSF) obtained from the trigeminal cistern of 64 patients with intractable facial pain. The CSF was analyzed for homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA), and 3-methoxy-4-hydroxyphenylglycol (MHPG), end-product markers of activity for the dopamine, serotonin, and norepinephrine systems, respectively. HVA averaged 121 ng/mL in these facial pain patients, compared to 150 to 550 ng/mL in 10 studies of ventricular brain CSF in assorted psychiatric and pain patients. 5-HIAA averaged 29 to ng/mL in our facial pain patients compared to 60 to 120 ng/mL in nine studies of ventricular brain CSF in assorted psychiatric and neurological patients. Trigeminal cistern CSF MHPG averaged 9 ng/mL, similar to the range of 13 studies of lumbar CSF of assorted psychiatric and pain diagnoses. These results indicate that (1) the electrochemical detection method provides a unique way of accurately measuring nanogram concentrations of multiple monoamines in a little as 0.25 mL of CSF; (2) trigeminal cistern and posterior fossa brain CSF monoamine metabolites reflect a different profile of dopaminergic and serotonergic functioning in these facial pain patients from that previously reported with lumbar CSF measurements of other patients; and (3) trigeminal sensory ganglion or brain dopamine and serotonin systems may be concomitantly dysfunctional in intractable facial pain. PMID:7504420

Bouckoms, A. J.; Sweet, W. H.; Poletti, C.; Lavori, P.; Carr, D.; Matson, W.; Gamache, P.; Aronin, N.

1992-01-01

205

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. PMID:15269068

Burnett, C; Juszczak, E; Sullivan, P

2004-01-01

206

A rare differential diagnosis to occupational neck pain: bilateral stylohyoid syndrome  

PubMed Central

Chronic neck pain is widely prevalent and a common source of disability in the working-age population. Etiology of chronic neck pain includes neck sprain, mechanical or muscular neck pain, myofascial pain syndrome, postural neck pain as well as pain due to degenerative changes. We report the case of a 42 year old secretary, complaining about a longer history of neck pain and limited movement of the cervical spine. Surprisingly, the adequate radiologic examination revealed a bilateral ossification of the stylohyoid ligament complex. Her symptoms remained intractable from conservative treatment consisting of anti-inflammatory medication as well as physical therapy. Hence the patient was admitted to surgical resection of the ossified stylohyoid ligament complex. Afterwards she was free of any complaints and went back to work. Therefore, ossification of the stylohyoid ligament complex causing severe neck pain and movement disorder should be regarded as a rare differential diagnosis of occupational related neck pain. PMID:16800878

Kirchhoff, Gertrud; Kirchhoff, Chlodwig; Buhmann, Sonja; Kanz, Karl-Georg; Lenz, Miriam; Vogel, Tobias; Kichhoff, Rainer Maria

2006-01-01

207

Low back pain - acute  

MedlinePLUS

Backache; Low back pain; Lumbar pain; Pain - back; Acute back pain; Back pain - new; Back pain - short-term; Back strain - new ... back supports most of your body's weight. Low back pain is the number two reason that Americans see ...

208

Ribcage pain  

MedlinePLUS

... not cause the pain in those who have pleurisy (swelling of the lining of the lungs) or ... Inflammation of cartilage near the breastbone ( costochondritis ) Osteoporosis Pleurisy (the pain is worse when breathing deeply)

209

Back Pain  

MedlinePLUS

... 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 ...

210

Back Pain  

MedlinePLUS

Back Pain The Centers for Disease Control and Prevention’s 2008 Health Report states that over 27% of the ... States population age 18 and older have active back pain. As many as 80-90% of Americans will ...

211

The association of mast cells and serotonin in children with chronic abdominal pain of unknown etiology  

Microsoft Academic Search

BACKGROUND: Abdominal pain of unknown origin affects up to 20% of school-aged children. Evaluation of children is symptom-based without clear guidelines to investigate molecular mechanisms of abdominal pain. Aberrant molecular mechanisms may increase intestinal permeability leading to interactions between the immune and nervous systems, subclinical inflammation, and visceral pain. This study evaluated the association between interleukin-6 (IL-6), mast cell infiltrates,

Tara J Taylor; Nader N Youssef; Ravi Shankar; David E Kleiner; Wendy A Henderson

2010-01-01

212

Neck pain  

MedlinePLUS

Pain - neck; Neck stiffness ... this as having a stiff neck. If neck pain involves nerves, you may feel numbness, tingling, or ... A common cause of neck pain is muscle strain or tension. Usually, ... Such activities include: Bending over a desk for hours Poor ...

213

Geriatric pain  

Microsoft Academic Search

Geriatric pain will be a significant health care problem in the next millennium. Pain can be acute due to trauma or surgery,\\u000a and chronic due to medical illnesses and their sequels. In this article, management of geriatric chronic pain is discussed.

Daniel Lynch

1999-01-01

214

Chronic Pain  

Microsoft Academic Search

The primary purposes of acute pain and the reason it is noxious are to interrupt ongoing activity in order to warn the sufferer of tissue damage, to discourage movement that might exacerbate injury or prevent healing, and to teach the organism to avoid the pain-producing circumstances. Therefore, it is no wonder that when pain persists to become chronic, many sufferers

Malcolm H. Johnson

215

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. PMID:19800336

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

2009-01-01

216

Stress-Related Alterations of Visceral Sensation: Animal Models for Irritable Bowel Syndrome Study  

PubMed Central

Stressors of different psychological, physical or immune origin play a critical role in the pathophysiology of irritable bowel syndrome participating in symptoms onset, clinical presentation as well as treatment outcome. Experimental stress models applying a variety of acute and chronic exteroceptive or interoceptive stressors have been developed to target different periods throughout the lifespan of animals to assess the vulnerability, the trigger and perpetuating factors determining stress influence on visceral sensitivity and interactions within the brain-gut axis. Recent evidence points towards adequate construct and face validity of experimental models developed with respect to animals' age, sex, strain differences and specific methodological aspects such as non-invasive monitoring of visceromotor response to colorectal distension as being essential in successful identification and evaluation of novel therapeutic targets aimed at reducing stress-related alterations in visceral sensitivity. Underlying mechanisms of stress-induced modulation of visceral pain involve a combination of peripheral, spinal and supraspinal sensitization based on the nature of the stressors and dysregulation of descending pathways that modulate nociceptive transmission or stress-related analgesic response. PMID:21860814

Mulak, Agata; Taché, Yvette

2011-01-01

217

Parent attention versus distraction: Impact on symptom complaints by children with and without chronic functional abdominal pain  

Microsoft Academic Search

The objective of this study was to assess the impact of parent attention and distraction on symptom complaints by children with and without chronic functional abdominal pain. The water load symptom provocation task was used to induce visceral discomfort in pediatric patients with abdominal pain (N=104) and well children (N=119), ages 8–16 years. Parents were randomly assigned and trained to

Lynn S. Walker; Sara E. Williams; Craig A. Smith; Judy Garber; Deborah A. Van Slyke; Tricia A. Lipani

2006-01-01

218

Availability and Utilization of Opioids for Pain Management: Global Issues  

PubMed Central

Background Pain can significantly influence an individual's health status and can have serious negative consequences: poor nutrition, decreased appetite, abnormal sleep patterns, fatigue, and impairment of daily living activities. Pain can cause psychological impairment and decrease healing and recovery from injuries and illness. A hallmark of many chronic conditions, pain affects more patients' lives than diabetes mellitus, heart disease, and cancer combined. However, many chronic sufferers do not have access to effective pain management for a variety of reasons, including limited access, restrictions, and personal and cultural biases. Methods This review summarizes issues of access, distribution, and cultural bias with regard to opioid agents and seeks to clarify the challenges related to opioid delivery. The considerable negative physical and mental consequences of chronic pain are discussed for the general and palliative care population. Results Opioids are an effective treatment for various intractable painful conditions, but problems in global opioid access for safe and rational use in pain management contribute to unnecessary suffering. These problems persist despite increased understanding in recent years of the pathophysiology of pain. Conclusions Comprehensive guidelines for goal-directed and patient-friendly chronic opiate therapy will potentially enhance the outlook for future chronic pain management. The improvement of pain education in undergraduate and postgraduate training will benefit patients and clinicians. The promise of new medications, along with the utilization of multimodal approaches, has the potential to provide effective pain relief to future generations of sufferers. PMID:24940131

Manjiani, Deepak; Paul, D. Baby; Kunnumpurath, Sreekumar; Kaye, Alan David; Vadivelu, Nalini

2014-01-01

219

[Cyriax's syndrome. A cause of diagnostic error in abdominal pains].  

PubMed

The slipping rib syndrome is characterized by upper abdominal pain due to irritation of the intercostal nerve by incomplete dislocation of the costal cartilage of the 8th, 9th, or 10th ribs. Twenty-three new cases are reported and the literature is reviewed. Diagnosis is only clinical. The pain is precipitated by movement and certain postures; it is faithfully reproduced by pressure on one particular point of the costal margin and is relieved by local injection of an anaesthetic. Pain from a slipping rib is usually attributed to visceral causes, which is a source of diagnostic errors. PMID:2830611

Monnin, J L; Pierrugues, R; Bories, P; Michel, H

220

Mechanisms of Acupuncture-Electroacupuncture on Persistent Pain  

PubMed Central

In the last decade, preclinical investigations of electroacupuncture mechanisms on persistent tissue-injury (inflammatory), nerve-injury (neuropathic), cancer, and visceral pain have increased. These studies show that electroacupuncture activates the nervous system differently in health than in pain conditions, alleviates both sensory and affective inflammatory pain, and inhibits inflammatory and neuropathic pain more effectively at 2–10 Hz than at 100 Hz. Electroacupuncture blocks pain by activating a variety of bioactive chemicals through peripheral, spinal, and supraspinal mechanisms. These include opioids, which desensitize peripheral nociceptors and reduce pro-inflammatory cytokines peripherally and in the spinal cord, and serotonin and norepinephrine, which decrease spinal n-methyl-d-aspartate receptor subunit GluN1 phosphorylation. Additional studies suggest that electroacupuncture, when combined with low dosages of conventional analgesics, provides effective pain management that can forestall the side effects of often-debilitating pharmaceuticals. PMID:24322588

Zhang, Ruixin; Lao, Lixing; Ren, Ke; Berman, Brian M.

2014-01-01

221

Mechanisms of acupuncture-electroacupuncture on persistent pain.  

PubMed

In the last decade, preclinical investigations of electroacupuncture mechanisms on persistent tissue injury (inflammatory), nerve injury (neuropathic), cancer, and visceral pain have increased. These studies show that electroacupuncture activates the nervous system differently in health than in pain conditions, alleviates both sensory and affective inflammatory pain, and inhibits inflammatory and neuropathic pain more effectively at 2 to 10 Hz than at 100 Hz. Electroacupuncture blocks pain by activating a variety of bioactive chemicals through peripheral, spinal, and supraspinal mechanisms. These include opioids, which desensitize peripheral nociceptors and reduce proinflammatory cytokines peripherally and in the spinal cord, and serotonin and norepinephrine, which decrease spinal N-methyl-D-aspartate receptor subunit GluN1 phosphorylation. Additional studies suggest that electroacupuncture, when combined with low dosages of conventional analgesics, provides effective pain management which can forestall the side effects of often-debilitating pharmaceuticals. PMID:24322588

Zhang, Ruixin; Lao, Lixing; Ren, Ke; Berman, Brian M

2014-02-01

222

[Visceral hypersensitivity: a concept within our reach].  

PubMed

Despite significant advances in the recognition of etiological factors and pathological mechanisms, the pathophysiology of functional gastrointestinal disorders (FGD) is still not fully understood. Visceral hypersensitivity has been recognized as a characteristic of patients with FGD, especially in patients with irritable bowel syndrome (IBS). Visceral afferent input is modulated by a variety of mechanisms, operating between the gastrointestinal tract and the brain. Dysfunction of these regulatory mechanisms could distort gastrointestinal perceptions. Recent findings suggest that in the majority of cases of IBS the primary abnormality may be at the periphery with alterations of the motor and secretory sensory activity. Although imaging techniques indicate that there are also differences in cortical activation. Furthermore, selective serotonin reuptake inhibitors may benefit FGD. Recent pharmacological studies suggest that 5-HT3 antagonist such as alosetron and cilansetron, and 5-HT4 agonist such as legaserod and prucalopride may also have a potential use in FGD. PMID:12643225

Quera, Rodrigo; Valenzuela, Jorge

2003-01-01

223

Responsive neurostimulation for the treatment of medically intractable epilepsy.  

PubMed

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

2013-08-01

224

On the Computational Intractability of Exact and Approximate Dictionary Learning  

NASA Astrophysics Data System (ADS)

The efficient sparse coding and reconstruction of signal vectors via linear observations has received a tremendous amount of attention over the last decade. In this context, the automated learning of a suitable basis or overcomplete dictionary from training data sets of certain signal classes for use in sparse representations has turned out to be of particular importance regarding practical signal processing applications. Most popular dictionary learning algorithms involve NP-hard sparse recovery problems in each iteration, which may give some indication about the complexity of dictionary learning but does not constitute an actual proof of computational intractability. In this technical note, we show that learning a dictionary with which a given set of training signals can be represented as sparsely as possible is indeed NP-hard. Moreover, we also establish hardness of approximating the solution to within large factors of the optimal sparsity level. Furthermore, we give NP-hardness and non-approximability results for a recent dictionary learning variation called the sensor permutation problem. Along the way, we also obtain a new non-approximability result for the classical sparse recovery problem from compressed sensing.

Tillmann, Andreas M.

2015-01-01

225

Intractable hiccup caused by spinal cord lesions in demyelination disease  

PubMed Central

Objective This study aimed to summarize the clinical features of patients who presented intractable hiccup (IH) without brain and medulla oblongata (MO) lesions. Method This study included six patients who were diagnosed with inflammatory demyelinating myelitis, categorized as neuromyelitis optica (NMO), multiple sclerosis (MS), and myelitis. Patients who presented IH with cervical lesions but without MO lesions were also included. Clinical profiles, laboratory data, and magnetic resonance imaging findings were analyzed. Results Three out of six patients were diagnosed with NMO, whereas the remaining three were diagnosed with acute myelitis, recurrent myelities, and MS, respectively. The duration of hiccup was from 2 to 23 days (average = 9.33 ± 8.64 days). Five patients (83.33%, patients 1–5) had long segmental lesions and one had a patchy lesion. None of these patients had any MO lesions. Half of them were successfully treated with high-dose methylprednisolone combined with gamma-aminobutyric acid (GABA) inhibitor. Conclusion IH occurred in patients without MO lesion. However, the mechanism remained unclear. Immune factors of demyelinating neuropathy stimulated the hiccup reflex arch. Cervical cord lesions may activate the hiccup center. In general, IH can be controlled by IVMP combined with GABA inhibitor. Unilateral phrenic nerve block may elicit no effect. PMID:24090474

Hao, Xiao-ting; Wang, Lu; Yan, Bo; Zhou, Hong-yu

2013-01-01

226

Epilepsy Surgery in Pediatric Intractable Epilepsy with Destructive Encephalopathy  

PubMed Central

Background and Purpose: The aim of the current study is to review the clinical features, surgery outcomes and parental satisfaction of children with destructive encephalopathy who underwent epilepsy surgery due to medically intractable seizures. Methods: 48 patients who underwent epilepsy surgery from October 2003 to August 2011 at Severance Children’s Hospital have been reviewed. The survey was conducted for functional outcomes and parental satisfaction at least 1 year after the surgery. Results: Epileptic encephalopathy including Lennox-Gastaut syndrome and infantile spasms was more prevalent than symptomatic focal epilepsy. Hypoxic ischemic injury accounted for most of the underlying etiology of the destructive encephalpathy, followed by central nervous system infection and head trauma. 27 patients (56.3%) underwent resective surgery and 21 patients (43.7%) underwent palliative surgery. 16 patients (33.3%) achieved seizure free and 27 parents (87.5%) reported satisfaction with the outcome of their children’s epilepsy surgery. In addition, 14 parents (77.8 %) whose children were not seizure free reported satisfaction with their children’s improvement in cognitive and behavior issues. Conclusions: Epilepsy surgery in destructive encephalopathy was effective for controlling seizures. Parents reported satisfaction not only with the surgical outcomes, but also with improvement of cognitive and behavior issues. PMID:24649473

Park, So Young; Kwon, Hye Eun; Kang, Hoon-Chul; Lee, Joon Soo; Kim, Dong Seok; Kim, Heung Dong

2013-01-01

227

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.

1983-08-01

228

Low back pain - chronic  

MedlinePLUS

Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... waist, leads to pain. Many people with chronic back pain have arthritis. Or they may have extra wear ...

229

PKC? receptor mediates visceral nociception and hyperalgesia following exposure to PTSD-like stress in the spinal cord of rats  

PubMed Central

Background Clinical studies indicate that patients with post-traumatic stress disorder (PTSD) frequently share comorbidity with numerous chronic pain conditions. However, the sustained effects of PTSD-like stress over time on visceral nociception and hyperalgesia have been rarely studied, and the underlying mechanisms of stress-induced modulation of visceral hyperalgesia remain elusive. The purpose of this study was to investigate the characterization of visceral nociception and hyperalgesia over time in rats exposed to PTSD-like stress, and to explore the potential role of protein kinase C gamma (PKC?) in mediating visceral hyperalgesia following exposure to PTSD-like stress. Results On day 1, the rats exposed to single-prolonged stress (SPS, an established animal model for PTSD) exhibited an analgesic response and its visceromotor response (VMR) to graded colorectal distention (CRD) at 40 and 60 mmHg was reduced compared with the control group (all P?visceral sensitivity to CRD, and contributes to the maintenance of visceral hyperalgesia, which is associated with enhanced PKC? expression in the spinal cord. Functional blockade of the PKC? receptors attenuates SPS-induced visceral hyperalgesia. Thus, the present study identifies a specific molecular mechanism for visceral hyperalgesia which may pave the way for novel therapeutic strategies for PTSD-like conditions. PMID:23837410

2013-01-01

230

Ultrasonography for the Evaluation of Visceral Fat and Cardiovascular Risk  

Microsoft Academic Search

Visceral fat accumulation is associated with increased cardiovascular risk. Clinical evaluation of visceral fat is limited because of the lack of reliable and low-cost methods. To assess the correlation between ultrasonography and computed tomography (CT) for the evaluation of visceral fat, 101 obese women, age 50.567.7 years with a body mass index of 39.265.4 kg\\/m2, were submitted to ultrasonograph and

Fernando F. Ribeiro-Filho; Alessandra N. Faria; Sérgio Ajzen; Artur B. Ribeiro; Maria Teresa Zanella; Sandra R. G. Ferreira

231

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. PMID:19400724

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

2009-01-01

232

Cancer Pain  

Microsoft Academic Search

The effectiveness of cancer pain therapy is influenced by the attitudes and knowledge of the treating physicians. As part of a quality improvement project in the management of cancer pain, a survey of 236 medical practitioners was conducted. One hundred seventy-six respondents (74.5%) completed the survey. Fifty-two percent treated patients with cancer pain several times a week or more. Whereas

Rama Sapir; Raphael Catane; Nurith Strauss-Liviatan; Nathan I. Cherny

1999-01-01

233

Molecular Hydrogen Attenuates Neuropathic Pain in Mice  

PubMed Central

Neuropathic pain remains intractable and the development of new therapeutic strategies are urgently required. Accumulating evidence indicates that overproduction of oxidative stress is a key event in the pathogenesis of neuropathic pain. However, repeated intra-peritoneal or intrathecal injections of antioxidants are unsuitable for continuous use in therapy. Here we show a novel therapeutic method against neuropathic pain: drinking water containing molecular hydrogen (H2) as antioxidant. The effect of hydrogen on neuropathic pain was investigated using a partial sciatic nerve ligation model in mice. As indicators of neuropathic pain, temporal aspects of mechanical allodynia and thermal hyperalgesia were analysed for 3 weeks after ligation. Mechanical allodynia and thermal hyperalgesia were measured using the von Frey test and the plantar test, respectively. When mice were allowed to drink water containing hydrogen at a saturated level ad libitum after ligation, both allodynia and hyperalgesia were alleviated. These symptoms were also alleviated when hydrogen was administered only for the induction phase (from day 0 to 4 after ligation). When hydrogen was administered only for the maintenance phase (from day 4 to 21 after ligation), hyperalgesia but not allodynia was alleviated. Immunohistochemical staining for the oxidative stress marker, 4-hydroxy-2-nonenal and 8-hydroxydeoxyguanosine, showed that hydrogen administration suppressed oxidative stress induced by ligation in the spinal cord and the dorsal root ganglion. In conclusion, oral administration of hydrogen water may be useful for alleviating neuropathic pain in a clinical setting. PMID:24941001

Kawaguchi, Masanori; Satoh, Yasushi; Otsubo, Yukiko; Kazama, Tomiei

2014-01-01

234

Central pain.  

PubMed

Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The topic addressed in this issue is central pain, a neuropathic pain syndrome caused by a lesion in the brain or spinal cord that sensitizes one's perception of pain. It is a debilitating condition caused by various diseases such as multiple sclerosis, strokes, spinal cord injuries, or brain tumors. Varied symptoms and the use of pharmacological medicines and nonpharmacological therapies will be addressed. PMID:25295639

Singh, Supreet

2014-12-01

235

Mechanisms and management of functional abdominal pain.  

PubMed

Functional abdominal pain syndrome is characterised by frequent or continuous abdominal pain associated with a degree of loss of daily activity. It has a reported population prevalence of between 0.5% and 1.7%, with a female preponderance. The pathophysiology of functional abdominal pain is incompletely understood although it has been postulated that peripheral sensitisation of visceral afferents, central sensitisation of the spinal dorsal horn and aberrancies within descending modulatory systems may have an important role. The management of patients with functional abdominal pain requires a tailored multidisciplinary approach in a supportive and empathetic environment in order to develop an effective therapeutic relationship. Patient education directed towards an explanation of the pathophysiology of functional abdominal pain is in our opinion a prerequisite step and provides the rationale for the introduction of interventions. Interventions can usefully be categorised into general measures, pharmacotherapy, psychological interventions and 'step-up' treatments. Pharmacotherapeutic/step-up options include tricyclic antidepressants, serotonin noradrenergic reuptake inhibitors and the gabapentinoids. Psychological treatments include cognitive behavioural therapy and hypnotherapy. However, the objective evidence base for these interventions is largely derived from other chronic pain syndrome, and further research is warranted in adult patients with functional abdominal pain. PMID:25193056

Farmer, Adam D; Aziz, Qasim

2014-09-01

236

PAIN SCALES (ATTACHMENT A)  

E-print Network

PAIN SCALES (ATTACHMENT A) 0-10 NUMERIC PAIN INTENSITY SCALE 0 1 2 3 4 5 6 7 8 9 10 NO PAIN MODERATE WORST PAIN PAIN #12;PAIN SCALES (ATTACHMENT A) FLACC PAIN SCALE The FLACC is a behavioral pain assessment scale for use in non-verbal patients unable to provide numeric reports of pain. SCORING Categories

Oliver, Douglas L.

237

Characteristics and safety assessment of intractable proteins in genetically modified crops.  

PubMed

Genetically modified (GM) crops may contain newly expressed proteins that are described as "intractable". Safety assessment of these proteins may require some adaptations to the current assessment procedures. Intractable proteins are defined here as those proteins with properties that make it extremely difficult or impossible with current methods to express in heterologous systems; isolate, purify, or concentrate; quantify (due to low levels); demonstrate biological activity; or prove equivalency with plant proteins. Five classes of intractable proteins are discussed here: (1) membrane proteins, (2) signaling proteins, (3) transcription factors, (4) N-glycosylated proteins, and (5) resistance proteins (R-proteins, plant pathogen recognition proteins that activate innate immune responses). While the basic tiered weight-of-evidence approach for assessing the safety of GM crops proposed by the International Life Sciences Institute (ILSI) in 2008 is applicable to intractable proteins, new or modified methods may be required. For example, the first two steps in Tier I (hazard identification) analysis, gathering of applicable history of safe use (HOSU) information and bioinformatics analysis, do not require protein isolation. The extremely low level of expression of most intractable proteins should be taken into account while assessing safety of the intractable protein in GM crops. If Tier II (hazard characterization) analyses requiring animal feeding are judged to be necessary, alternatives to feeding high doses of pure protein may be needed. These alternatives are discussed here. PMID:24662477

Bushey, Dean F; Bannon, Gary A; Delaney, Bryan F; Graser, Gerson; Hefford, Mary; Jiang, Xiaoxu; Lee, Thomas C; Madduri, Krishna M; Pariza, Michael; Privalle, Laura S; Ranjan, Rakesh; Saab-Rincon, Gloria; Schafer, Barry W; Thelen, Jay J; Zhang, John X Q; Harper, Marc S

2014-07-01

238

Effects of Combined Opioids on Pain and Mood in Mammals  

PubMed Central

The authors review the opioid literature for evidence of increased analgesia and reduced adverse side effects by combining mu-opioid-receptor (MOR) agonists, kappa-opioid-receptor (KOR) agonists, and nonselective low-dose-opioid antagonists (LD-Ant). We tested fentanyl (MOR agonist) and spiradoline (KOR agonist), singly and combined, against somatic and visceral pain models. Combined agonists induced additive analgesia in somatic pain and synergistic analgesia in visceral pain. Other investigators report similar effects and reduced tolerance and dependence with combined MOR agonist and KOR agonist. LD-Ant added to either a MOR agonist or KOR agonist markedly enhanced analgesia of either agonist. In accordance with other place-conditioning (PC) studies, our PC investigations showed fentanyl-induced place preference (CPP) and spiradoline-induced place aversion (CPA). We reduced fentanyl CPP with a low dose of spiradoline and reduced spiradoline CPA with a low dose of fentanyl. We propose combined MOR agonist, KOR agonist, and LD-Ant to produce superior analgesia with reduced adverse side effects, particularly for visceral pain. PMID:22550575

Rech, Richard H.; Mokler, David J.; Briggs, Shannon L.

2012-01-01

239

Is Intraoperative Electrocorticography Reliable in Children with Intractable Neocortical Epilepsy?  

PubMed Central

Summary Purpose To study the relation between the spike frequency during intraoperative electrocorticography (ECoG) under general anesthesia with isoflurane and that during extraoperative ECoG monitoring in children with intractable neocortical epilepsy. Methods Twenty-one children (age, 1–16 years; 15 boys and six girls) who underwent intraoperative and extraoperative ECoG monitoring with subdural electrode arrays were studied. The spike frequency and the spatial pattern of spike frequency were compared between intraoperative and extraoperative ECoGs for each patient (by using Wilcoxon signed-ranks and Spearman’s rank correlation, respectively). Results In 15 of 21 patients, the spike frequency was significantly lower during intraoperative than during extraoperative ECoG (mean z = ?6.3; p < 0.001). In four of 21 patients, no significant difference was found in the spike frequency between intraoperative and extraoperative recordings. In two of 21 patients, spike frequency reached one spike/min neither during intraoperative nor extraoperative recording; therefore appropriate comparison of spike frequency was not possible. A significant positive correlation in the spike-frequency pattern was seen between intraoperative and extraoperative recordings in nine of nine cases who had ?10 spikes/min during intraoperative ECoG (mean rho =0.62; p < 0.01), in five of six cases with one to nine spikes/min (mean rho =0.50; p < 0.01), and in none of five cases with less than one spike/min (mean rho =0.13). Conclusions General anesthesia often decreases the spike frequency in children with neocortical epilepsy, yet intraoperative ECoG can reliably reflect the awake interictal spiking pattern when spike frequency exceeds one spike/min during intraoperative ECoG recording. PMID:15329074

Asano, Eishi; Benedek, Krisztina; Shah, Aashit; Juhász, Csaba; Shah, Jagdish; Chugani, Diane C.; Muzik, Otto; Sood, Sandeep; Chugani, Harry T.

2007-01-01

240

Role of Perivascular and Visceral Adipose Tissues in Murine Models of Obesity and Atherosclerosis: A Dissertation.  

E-print Network

??Expansion of visceral adipose tissue correlates with the metabolic syndrome and increased cardiovascular risk. Hypertrophied visceral fat becomes inflamed, causing increased lipolysis, decreased triglyceride storage,… (more)

Fitzgibbons, Timothy P.

2012-01-01

241

Beyond pain  

Microsoft Academic Search

The purpose of the present article is to provide unification to a number of somewhat disparate themes in the chronic pain and phobia literature. First, we present a summary review of the early writings and current theoretical perspectives regarding the role of avoidance in the maintenance of chronic pain. Second, we present an integrative review of recent empirical investigations of

Gordon J. G Asmundson; Peter J Norton; G. Ron Norton

1999-01-01

242

Pain frequency moderates the relationship between pain catastrophizing and pain  

PubMed Central

Background: Pain frequency has been shown to influence sensitization, psychological distress, and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method: A non-clinical (247 students) and a clinical (223 pain patients) sample completed the Danish versions of the Pain Catastrophizing Scale (PCS), Beck Depression Inventory, and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency. Results: In both samples, high pain frequency was found to moderate the association between pain catastrophizing and pain intensity, whereas low pain frequency did not. The psychometric properties and the factor structure of the Danish version of the PCS were confirmed. Conclusions: This is the first study to validate the Danish version of the PCS and to show that pain frequency moderates the relationship between pain catastrophizing and reported pain in both non-clinical and clinical populations. PMID:25646089

Kjøgx, Heidi; Zachariae, Robert; Pfeiffer-Jensen, Mogens; Kasch, Helge; Svensson, Peter; Jensen, Troels S.; Vase, Lene

2014-01-01

243

Pharmacologic management of pain at the end of life.  

PubMed

Although many patients experience debilitating pain at the end of life, there are many options to improve analgesia and quality of life. Pain assessment using a validated tool, with attention to patient function and specific goals, helps tailor individual treatment plans. The World Health Organization pain ladder offers a stepwise guideline for approaching pain management. However, for many patients with terminal illness, strong opioids are necessary for efficient and effective analgesia. Equianalgesic dosing tables and expert guidelines aid in initiating, monitoring, and adjusting doses of oral and parenteral opioids. Clinicians should feel comfortable administering a repeat dose after the time to peak analgesic effect if the patient is still in pain. In patients with constant pain, using scheduled long-acting opioids may significantly improve pain control. Among pain subtypes, visceral pain management usually requires multiple drugs. Neuropathic pain responds well to adjuvant pharmacotherapies, such as anticonvulsants or antidepressants, in addition to opioids. Opioid-induced hyperalgesia can occur with any dose of an opioid, but is more common with higher doses of parenteral morphine and hydromorphone. With appropriate counseling, most patients with a history of substance abuse will comply with a pain treatment plan. PMID:25077499

Groninger, Hunter; Vijayan, Jaya

2014-07-01

244

Drug policy for visceral leishmaniasis: a cost-effectiveness analysis: Drug policy for visceral leishmaniasis  

Microsoft Academic Search

Summary objective To facilitate the choice of the best visceral leishmaniasis (VL) treatment strategy for first-line health services in (VL)-endemic areas, we compared in a formal decision analysis the cost and the cost- effectiveness of the different available options. methods We selected four drug regimens for VL on the basis of frequency of use, feasibility and reported efficacy studies. The

V. Vanlerberghe; G. Diap; P. J. Guerin; F. Meheus; S. Gerstl; P. Van der Stuyft; M. Boelaert

2007-01-01

245

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. PMID:23631531

2013-01-01

246

Immune Regulation during Chronic Visceral Leishmaniasis  

PubMed Central

Visceral leishmaniasis is a chronic parasitic disease associated with severe immune dysfunction. Treatment options are limited to relatively toxic drugs, and there is no vaccine for humans available. Hence, there is an urgent need to better understand immune responses following infection with Leishmania species by studying animal models of disease and clinical samples from patients. Here, we review recent discoveries in these areas and highlight shortcomings in our knowledge that need to be addressed if better treatment options are to be developed and effective vaccines designed. PMID:25010815

Faleiro, Rebecca J.; Kumar, Rajiv; Hafner, Louise M.; Engwerda, Christian R.

2014-01-01

247

Severity of Coronary Artery Disease and Visceral Fat Obesity  

Microsoft Academic Search

Background:The visceral fat obesity is known to be associated with coronary artery disease. We investigated the relation between visceral fat obesity and the severity of coronary artery disease by angiography. Methods: The coronary artery disease (CAD group included 54 angina patients (43 men and 11 women with angiographically demonstrated coronary artery disease. The control group included angiographically normal 28 controls

Jeongkee Seo; Dong Soo Kim; Hyuck Moon Kwon; Yangsoo Jang; Hyun-Seung Kim; Hongkeun Cho; Eunyoung Cho; Jongho Lee

1998-01-01

248

Visceral leishmaniasis in captive wild canids in Brazil  

Microsoft Academic Search

Visceral leishmaniasis (VL) is endemic in Belo Horizonte (State of Minas Gerais, Brazil). Leishmania sp. can naturally infect several species of mammals, and the domestic dog is the most important reservoir of the disease in South America. This report describes five cases of visceral leishmaniasis in Brazilian canids. Among 15 animals kept in captivity in a zoo in Belo Horizonte

Marcela M. Luppi; Marcelo C. C. Malta; Teane M. A. Silva; Fabiana L. Silva; Rafael O. C. Motta; Ildikó Miranda; Roselene Ecco; Renato L. Santos

2008-01-01

249

Antinociceptive Effect of Intrathecal Microencapsulated Human Pheochromocytoma Cell in a Rat Model of Bone Cancer Pain  

PubMed Central

Human pheochromocytoma cells, which are demonstrated to contain and release met-enkephalin and norepinephrine, may be a promising resource for cell therapy in cancer-induced intractable pain. Intrathecal injection of alginate-poly (l) lysine-alginate (APA) microencapsulated human pheochromocytoma cells leads to antinociceptive effect in a rat model of bone cancer pain, and this effect was blocked by opioid antagonist naloxone and alpha 2-adrenergic antagonist rauwolscine. Neurochemical changes of cerebrospinal fluid are in accordance with the analgesic responses. Taken together, these data support that human pheochromocytoma cell implant-induced antinociception was mediated by met-enkephalin and norepinephrine secreted from the cell implants and acting at spinal receptors. Spinal implantation of microencapsulated human pheochromocytoma cells may provide an alternative approach for the therapy of chronic intractable pain. PMID:25007069

Li, Xiao; Li, Guoqi; Wu, Shaoling; Zhang, Baiyu; Wan, Qing; Yu, Ding; Zhou, Ruijun; Ma, Chao

2014-01-01

250

What a Pain! Kids and Growing Pains  

MedlinePLUS

... Main Page The Pink Locker Society What a Pain! Kids and Growing Pains KidsHealth > Kids > Illnesses & Injuries > Aches, Pains & Injuries > What ... something doctors call growing pains . What Are Growing Pains? Growing pains aren't a disease. You probably ...

251

Reproducibility of pain measurement and pain perception  

Microsoft Academic Search

The reproducibility of both the conscious experience of pain and the reproducibility of psychophysical assessments of pain remain critical, yet poorly characterized factors in pain research and treatment. To assess the reproducibility of both the pain experience and two methods of pain assessment, 15 subjects evaluated experimental heat pain during four weekly sessions. In each session, both brief (5s) and

Elisa M. Rosier; Michael J. Iadarola; Robert C. Coghill

2002-01-01

252

Visceral Leishmaniasis in Ethiopia: An Evolving Disease  

PubMed Central

Visceral leishmaniasis (also known as kala-azar) is classified as one of the most neglected tropical diseases. It is becoming a growing health problem in Ethiopia, with endemic areas that are continually spreading. The annual burden of visceral leishmaniasis (VL) in Ethiopia is estimated to be between 4,500 and 5,000 cases, and the population at risk is more than 3.2 million. There has been a change in the epidemiology of VL in Ethiopia. Over the last decades, almost all cases and outbreaks of VL were reported from arid and semi-arid parts of the country; however, recent reports indicated the introduction of this disease into the highlands. Migration of labourers to and from endemic areas, climatic and environmental changes, and impaired immunity due to HIV/AIDS and malnutrition resulted in the change of VL epidemiology. HIV spurs the spread of VL by increasing the risk of progression from asymptomatic infection towards full VL. Conversely, VL accelerates the onset of AIDS. In Ethiopia, VL epidemiology remains complex because of the diversity of risk factors involved, and its control is becoming an increasing challenge. This paper reviews the changes in epidemiology of VL in Ethiopia and discusses some of the possible explanations for these changes. The prospects for novel approaches to VL control are discussed, as are the current and future challenges facing Ethiopia's public health development program. PMID:25188253

Leta, Samson; Dao, Thi Ha Thanh; Mesele, Frehiwot; Alemayehu, Gezahegn

2014-01-01

253

Genetically modified organisms and visceral leishmaniasis.  

PubMed

Vaccination is the most effective method of preventing infectious diseases. Since the eradication of small pox in 1976, many other potentially life compromising if not threatening diseases have been dealt with subsequently. This event was a major leap not only in the scientific world already burdened with many diseases but also in the mindset of the common man who became more receptive to novel treatment options. Among the many protozoan diseases, the leishmaniases have emerged as one of the largest parasite killers of the world, second only to malaria. There are three types of leishmaniasis namely cutaneous (CL), mucocutaneous (ML), and visceral (VL), caused by a group of more than 20 species of Leishmania parasites. Visceral leishmaniasis, also known as kala-azar is the most severe form and almost fatal if untreated. Since the first attempts at leishmanization, we have killed parasite vaccines, subunit protein, or DNA vaccines, and now we have live recombinant carrier vaccines and live attenuated parasite vaccines under various stages of development. Although some research has shown promising results, many more potential genes need to be evaluated as live attenuated vaccine candidates. This mini-review attempts to summarize the success and failures of genetically modified organisms used in vaccination against some of major parasitic diseases for their application in leishmaniasis. PMID:24860575

Chhajer, Rudra; Ali, Nahid

2014-01-01

254

Breast pain  

MedlinePLUS

... breast pain. For example, hormone level changes from menstruation or pregnancy often cause breast tenderness. Some amount ... unless a woman is taking hormone replacement therapy) Menstruation and premenstrual syndrome (PMS) Pregnancy -- breast tenderness tends ...

255

Penis pain  

MedlinePLUS

Pain - penis; Priapism ... Bladder stone Bites, either human or insect Cancer of the penis Erection that does not go away (priapism) Genital herpes Infected hair follicles Infected prosthesis of the penis Infection under the ...

256

Involvement of cannabinoid receptors in gut motility and visceral perception  

PubMed Central

From a historical perspective to the present day, all the evidence suggests that activation of cannabinoid receptors (CBRs) is beneficial for gut discomfort and pain, which are symptoms related to dysmotility and visceral perception. CBRs comprise G-protein coupled receptors that are predominantly in enteric and central neurones (CB1R) and immune cells (CB2R). In the last decade, evidence obtained from the use of selective agonists and inverse agonists/antagonists indicates that manipulation of CB1R can alter (1) sensory processing from the gut, (2) brain integration of brain-gut axis, (3) extrinsic control of the gut and (4) intrinsic control by the enteric nervous system. The extent to which activation of CB1R is most critical at these different levels is related to the region of the GI tract. The upper GI tract is strongly influenced by CB1R activation on central vagal pathways, whereas intestinal peristalsis can be modified by CB1R activation in the absence of extrinsic input. Actions at multiple levels make the CB1R a target for the treatment of functional bowel disorders, such as IBS. Since low-grade inflammation may act as a trigger for occurrence of IBS, CB2R modulation could be beneficial, but there is little supporting evidence for this yet. The challenge is to accomplish CBR activation while minimizing adverse effects and abuse liabilities. Potential therapeutic strategies involve increasing signaling by endocannabinoids (EC). The pathways involved in the biosynthesis, uptake and degradation of EC provide opportunities for modulation of CB1R and some recent evidence with inhibitors of EC uptake and metabolism suggest that these could be exploited for therapeutic gain. PMID:15100166

Hornby, Pamela J; Prouty, Stephen M

2004-01-01

257

[Persistent gluteal pain after embolization of the hypogastric arteries. An unexpected complication].  

PubMed

Ligation or embolization of the hypogastric arteries for control of intractable hemorrhage from the bladder has been used in the past with equal results and without ill effect. Gluteal pain following hypogastric embolization is common and was reported to be resolved in less than 48 hours. A 57 year old man in our ward underwent a bilateral hypogastric embolization. The bleeding decreased considerably but a severe gluteal pain and claudication ensued. The pain persisted over a month necessitating frequent Morphine injections. We propose to use superselective catheterization technique in the future sparing the superior gluteal artery. PMID:6677707

Greenstein, A; Merimsky, E; Papo, J; Braf, Z

1983-01-01

258

Comparative Study of Endolymphatic Sac Decompression and Vestibular Neurectomy in Intractable Meniere's Disease.  

PubMed

To comparative study the clinical effect of endolymphatic sac decompression (ELSD) and vestibular neurectomy (VN) in intractable Meniere's disease (MD). The study included 30 MD intractable patients, 21 of which underwent ELSD and nine of which were treated by VN via retrosigmoid approach. Follow-up period ranged from 3 to 6 years. In 21 patients by ELSD, excellent vertigo control and good control were noted in 11 patients (52.4 %) and 4 patients (19.0 %), partial control in 4 and no control in 2 patients. All the 9 patients by VN, vertigo was excellent control. ELSD can improve hearing and tinnitus, but VN not. VN can achieve much better effect in improving vertigo in intractable MD patients. But relative to ELSD, it has much more disadvantages. PMID:25621233

Liu, Yiqing; Han, Jie; Zhou, Xuanchen; Luan, Deheng; Xie, Fengyang; Gao, Kun

2015-03-01

259

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.

1989-05-01

260

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. PMID:18728714

Russo, Ethan B

2008-01-01

261

Interventional modalities to treat cancer-related pain.  

PubMed

Cancer-related pain is a significant cause of morbidity in those affected by both primary and metastatic disease. Although oral, transdermal, and parenteral opioid medications are an integral part of the World Health Organization's analgesic ladder, their use may be limited by side effects. Fortunately, there are advanced interventional pain management strategies effective in reducing pain in the cancer patient while mitigating the aforementioned side effects. Celiac plexus blocks and neurolysis have been proven effective in treating cancers of the abdominal viscera (ie, pancreas). Transversus abdominis plane blocks, neurolysis, and catheter placement can be used to treat cancer pain associated with the abdominal wall. Peripheral nerve blocks and catheter placement at the brachial and lumbosacral plexus or peripheral nerves treat cancer pain associated with the upper and lower limbs, whereas paravertebral and intercostal blocks treat cancer pain associated with the chest wall and ribs. Finally, alternate drug delivery methods such as intrathecal drug delivery systems concentrate medication at central opioid receptors without affecting the peripheral receptors implicated in unwanted side effects. This article provides an overview of these interventions, including indications, contraindications, and potential complications of advanced interventional pain management options available for the treatment of intractable cancer-related pain. PMID:25485914

Moeschler, Susan M; Rosenberg, Casandra; Trainor, Drew; Rho, Richard H; Mauck, W David

2014-12-01

262

Intractable hiccup accompanying pleural effusion: reversible clipping of an intrathoracic phrenic nerve.  

PubMed

Hiccup is usually a self-limiting condition, and can be treated with medications and physical maneuvers. However, hiccup episodes continuing for days or weeks can be incapacitating, and disturb work, sleep, and eating. Therefore, timely therapeutic intervention is needed to achieve early resolution of this treatable condition. We report on a successful phrenic nerve block for intractable hiccups, which consisted of thoracoscopic nerve clipping under general anesthesia and reversal under local anesthesia. This method has the advantage of assured diaphragmatic functional recovery while controlling intractable hiccups. PMID:23752012

Kim, Jae Jun; Sa, Young Jo; Cho, Deog Gon; Kim, Young Du; Kim, Chi Kyung; Moon, Seok Whan

2013-06-01

263

Disseminated visceral coccidiosis in sandhill cranes.  

PubMed

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. PMID:6511579

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

1984-12-01

264

Venereal transmission of canine visceral leishmaniasis.  

PubMed

Leishmania chagasi, the agent of visceral leishmaniasis in dogs in the Americas has a tropism to the male genital system, particularly the epididymis, prepuce, and glans penis, resulting in shedding of Leishmania in the semen. The goal of this study was to verify the possibility of venereal transmission of L. chagasi. Twelve Leishmania-free bitches, housed in the absence of the insect vector, copulated with multiple naturally infected dogs that were shedding Leishmania in the semen. PCR analysis of serially collected ejaculates indicated that shedding of Leishmania in the semen is intermittent. Three bitches seroconverted, and six were PCR positive by the end of the experimental period (165 days after the last copulation). These data support the notion that L. chagasi may be sexually transmitted from naturally infected dogs to susceptible bitches in the absence of the biological insect vector. PMID:19046812

Silva, Fabiana L; Oliveira, Raquel G; Silva, Teane M A; Xavier, Mariana N; Nascimento, Ernane F; Santos, Renato L

2009-03-01

265

[Chronic intestinal pseudoobstruction due to visceral myopathy].  

PubMed

A case is reported of a chronic intestinal pseudoobstruction with lethal outcome in a 6-year-old boy. The clinical symptoms and radiology examination showed ileus without mechanical obstruction. During the observation the patient developed left sided mydriasis and grand mal seizures with lactacidosis. He was treated conservatively which included total parenteral nutrition, fluid-sodium supplements, intravenous erythromycin and somatostatin, correction of acidosis. On the 48th day he died suddenly of cardiac failure at the intensive care unit. The gastrointestinal and neurologic symptoms with lactacidosis suggested the possibility of mitochondrial myopathy. Postmortem histopathology showed visceral myopathy. Molecular genetic analysis could not confirm the presence of the mDNA mutation. PMID:17611183

Kovács, Márta; Veres, Gábor; Szônyi, László; Dezsôfi, Antal; Bodánszky, Hedvig; Illyés, György; Schaff, Zsuzsa; Arató, András

2007-07-15

266

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.

1984-01-01

267

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. PMID:23426608

Hsu, Eugene; Cohen, Steven P

2013-01-01

268

The roles of neurotensin and its analogues in pain.  

PubMed

Neurotensin (NT) is an endogenous 13 amino acid neuropeptide with profound opioid-independent analgesic effects. This role of NT is thought to be mediated by both neurotensin receptor subtype 1 (NTS1) and neurotensin receptor subtype 2 (NTS2). NT and its receptors are widely distributed in the pain circuits in central nervous system. Thus NT might modulate pain in many structures of pain pathway, such as spinal cord, rostroventral medulla (RVM) and periaqueductal gray (PAG). Actually either intrathecal application of NT or direct injection of NT into RVM or PAG or intracerebroventricular injection of NT showed analgesic effects. NT exerted its antinociceptive effects in both acute pain and chronic pain models. The analgesic effects of NT were originally found in acute pain experiments. In the case of pathological pain, for example, formalin injection induced inflammatory pain and sciatic nerve constriction induced neuropathic pain, NT also shows antinociceptive effects. The effects exist in somatic pain as well as visceral pain induced by noxious colorectal distension (CRD) or writhing test. It should be noted that NT plays an important role in stress-induced antinociception (SIAN), especially in higher intensity stress experiments. However as a neuropeptide, NT is susceptible to degradation by peptidases and cannot cross the blood-brain barrier (BBB). Great efforts have been made to find NT analogues that are more biologically stable and could inhibit pain by systematic administration. The present review focuses on the analgesic role and the underlying mechanisms of NT and its analogues in pain, especially in chronic pain models. PMID:25345606

Feng, Yu-Peng; Wang, Jian; Dong, Yu-Lin; Wang, Ya-Yun; Li, Yun-Qing

2015-01-01

269

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. PMID:19014702

Lazarev, Mark; Lamb, Janette; Barmada, M Michael; Dai, Feng; Anderson, Michelle A; Max, Mitchell B; Whitcomb, David C

2008-01-01

270

Neuron-glial communication mediated by TNF-? and glial activation in dorsal root ganglia in visceral inflammatory hypersensitivity.  

PubMed

Communication between neurons and glia in the dorsal root ganglia (DRG) and the central nervous system is critical for nociception. Both glial activation and proinflammatory cytokine induction underlie this communication. We investigated whether satellite glial cell (SGC) and tumor necrosis factor-? (TNF-?) activation in DRG participates in a 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced rat model of visceral hyperalgesia. In TNBS-treated rats, TNF-? expression increased in DRG and was colocalized to SGCs enveloping a given neuron. These SGCs were activated as visualized under electron microscopy: they had more elongated processes projecting into the connective tissue space and more gap junctions. When nerves attached to DRG (L6-S1) were stimulated with a series of electrical stimulations, TNF-? were released from DRG in TNBS-treated animals compared with controls. Using a current clamp, we noted that exogenous TNF-? (2.5 ng/ml) increased DRG neuron activity, and visceral pain behavioral responses were reversed by intrathecal administration of anti-TNF-? (10 ?g·kg(-1)·day(-1)). Based on our findings, TNF-? and SGC activation in neuron-glial communication are critical in inflammatory visceral hyperalgesia. PMID:24627565

Song, Dan-dan; Li, Yong; Tang, Dong; Huang, Li-ya; Yuan, Yao-zong

2014-05-01

271

Visceral angioedema due to angiotensin-converting enzyme inhibitor therapy.  

PubMed

Visceral angioedema is an uncommon but serious complication of therapy with angiotensin-converting enzyme (ACE) inhibitors. We report a case, review the literature, and discuss the incidence, features, and clinical recognition of this condition. PMID:21536824

Korniyenko, Aleksandr; Alviar, Carlos L; Cordova, Juan P; Messerli, Franz H

2011-05-01

272

Familial visceral myopathy: a family with at least six involved members.  

PubMed Central

A family with at least six members affected by hollow organ visceral myopathy is described. Patients in the first or second decades of life developed symptoms which included weight loss, nausea and vomiting, abdominal pain and distension, constipation and diarrhoea, and urinary symptoms. The radiological features of the disease consisted of oesophageal aperistalsis, megaduodenum, and variable dilatation of the small and large bowel. Four patients had urinary tract involvement with dilatation of the ureters and/or incomplete bladder emptying. Two patients were severely affected and needed home parenteral nutrition and surgical treatment; others were symptomatic but remained well. The characteristic pathological abnormality was vacuolar degeneration predominantly affecting the longitudinal muscle. The disease in this family appears to be transmitted by autosomal dominant mode of inheritance. Images Fig. 2 Fig. 5 Fig. 6 Fig. 7 PMID:2806997

Rodrigues, C A; Shepherd, N A; Lennard-Jones, J E; Hawley, P R; Thompson, H H

1989-01-01

273

Inflammatory Back Pain vs. Mechanical Back Pain  

MedlinePLUS Videos and Cool Tools

... cause. Specifically, is the back pain inflammatory in nature or mechanical? INFLAMMATORY VS MECHANICAL BACK PAIN VIDEO: ... determing if the back pain is inflammatory in nature and related to a disease such as ankylosing ...

274

Visceral gout in a rough legged hawk (Buteo lagopus).  

PubMed

Visceral gout is reported for the first time in a rough legged hawk (Buteo lagopus). Urate crystals were present on the pericardium, thoracic and abdominal air sacs, and the ventral surface of the liver. The liver and spleen also had urate crystals throughout the parenchyma. There was no indication of articular or renal involvement. The immediate cause of death in this hawk was not identified, but appeared to result from multiple factors, including the visceral gout. PMID:3625918

Murnane, R D; Garner, M M

1987-07-01

275

Methods of Estimation of Visceral Fat: Advantages of Ultrasonography  

Microsoft Academic Search

Objective: To compare methods for the assessment of visceral fat with computed tomography (CT) and establish cutoffs to define visceral obesity based on such alternative methods.Research Methods and Procedures: One hundred women (50.4 ± 7.7 years; BMI 39.2 ± 5.4 kg\\/m2) underwent anthropometric evaluation, bioelectrical impedance, DXA, abdominal ultrasonography (US), and CT scan.Results: Waist circumference, waist-to-hip ratio (WHR), and US-determined

Fernando F. Ribeiro-Filho; Alessandra N. Faria; Sergio Azjen; Maria-Teresa Zanella; Sandra R. G. Ferreira

2003-01-01

276

Insulin Resistance and Visceral Fat Obesity in Hyperlipidemia  

Microsoft Academic Search

Background and Objectives:Insulin resistance is associated with hyperlipidemia. Recently, visceral fat adiposity is reported to be associated with insulin resistance and hyperlipidemia. We investigated insulin resistance and visceral fat adiposity in hyperlipidemic patients. Materials and Method:Hyperlipidemic group included 14 hyperlipidemic patients (total cholesterol ? 220 mg\\/dl and triglyceride ? 400 mg\\/dl without hypertension, angina, impaired glucose tolerance and diabetes mellitus

Hae-Jin Lee; Gilja Shin; Hong-Keun Cho

1999-01-01

277

Emergency endovascular repair of ruptured visceral artery aneurysms  

E-print Network

ral World Journal of Emergency ssBioMed CentSurgery Open AcceCase report Emergency endovascular repair of ruptured visceral artery aneurysms Umar Sadat*, Nadim Noor, Tjun Tang and Kevin Varty Address: Cambridge Vascular Unit, Addenbrooke... 's Hospital, Cambridge, UK Email: Umar Sadat* - sadat.umar@gmail.com; Nadim Noor - nadimnoor@doctors.org.uk; Tjun Tang - tt279@cam.ac.uk; Kevin Varty - kevin.varty@addenbrookes.nhs.uk * Corresponding author Abstract Background: Visceral artery aneurysms...

Sadat, Umar; Noor, Nadim; Tang, Tjun Y; Varty, Kevin

2007-07-02

278

Peroxisome proliferator-activated receptor agonists modulate neuropathic pain: a link to chemokines?  

PubMed Central

Chronic pain presents a widespread and intractable medical problem. While numerous pharmaceuticals are used to treat chronic pain, drugs that are safe for extended use and highly effective at treating the most severe pain do not yet exist. Chronic pain resulting from nervous system injury (neuropathic pain) is common in conditions ranging from multiple sclerosis to HIV-1 infection to type II diabetes. Inflammation caused by neuropathy is believed to contribute to the generation and maintenance of neuropathic pain. Chemokines are key inflammatory mediators, several of which (MCP-1, RANTES, MIP-1?, fractalkine, SDF-1 among others) have been linked to chronic, neuropathic pain in both human conditions and animal models. The important roles chemokines play in inflammation and pain make them an attractive therapeutic target. Peroxisome proliferator-activated receptors (PPARs) are a family of nuclear receptors known for their roles in metabolism. Recent research has revealed that PPARs also play a role in inflammatory gene repression. PPAR agonists have wide-ranging effects including inhibition of chemokine expression and pain behavior reduction in animal models. Experimental evidence suggests a connection between the pain ameliorating effects of PPAR agonists and suppression of inflammatory gene expression, including chemokines. In early clinical research, one PPAR? agonist, palmitoylethanolamide (PEA), shows promise in relieving chronic pain. If this link can be better established, PPAR agonists may represent a new drug therapy for neuropathic pain. PMID:25191225

Freitag, Caroline M.; Miller, Richard J.

2014-01-01

279

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

280

Proposing a Master One-Way Function Polynomial Morphology * Intractability Metric  

E-print Network

Proposing a Master One-Way Function Polynomial Morphology * Intractability Metric Gideon Samid, for that ciphersystem will be the result of hashing of p. We can write therefore: c=p2 crypto. And conversely: p = c operation of an arbitrary string using a given cipher system may be regarded as a "sterile" metrics

281

The Intractability of Computing the Hamming Bodo Manthey and Rudiger Reischuk  

E-print Network

The Intractability of Computing the Hamming Distance Bodo Manthey and R¨udiger Reischuk Universit/reischuk@tcs.uni-luebeck.de Abstract. Given a string x and a language L, the Hamming distance of x to L is the minimum Hamming distance prove that there is a language in AC0 such that both Hamming and edit distance to this language are hard

Al Hanbali, Ahmad

282

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

2005-01-01

283

Intractable Hiccups: The Role of Cerebral MR in Cases without Systemic Cause  

Microsoft Academic Search

PURPOSE: To look for central nervous system abnormalities as possible causes of intractable hiccups. METHODS: Of a series of 50 patients with chronic (ie, lasting more than 48 hours) hiccups, a prospective study identified a subgroup of 9 patients with no clinical or gastroesopha- geal abnormalities (according to endoscopy, pH monitoring, and manometry). We performed in all 9 patients brain

K. Marsot-Dupuch; V. Bousson; J. Cabane; J. M. Tubiana

284

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

2006-01-01

285

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 2y…

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

2008-01-01

286

Intractable Postpartum Hemorrhage Resulting from Uterine Artery Pseudoaneurysm: Superselective Arteriographic Embolization via the Collateral Route  

SciTech Connect

We present a patient with intractable postpartum hemorrhage resulting from uterine artery pseudoaneurysm despite bilateral hypogastric artery ligation who was successfully treated by an endovascular approach via the collateral route. Although there is a good argument for postponing surgery until transcatheter embolization has been attempted, this case shows that embolization can still be successful even if the iliac vessels have been ligated.

Doenmez, Halil, E-mail: hdonmez68@yahoo.com; Oztuerk, M. Halil; Guergen, Fatma; Soylu, Serra O.; Hekimoglu, Baki [S.B. Diskapi Yildirim Beyazit Egitim ve Arastirma Hastanesi, Department of Radiology (Turkey)

2007-04-15

287

Visceral analgesic effect of 5-HT4 receptor agonist in rats involves the rostroventral medulla (RVM)  

PubMed Central

The 5-HT4 receptor agonist tegaserod (TEG) has been reported to modulate visceral pain. However, the underlying mechanism remains unknown. The objective of the present study was to examine the analgesic mechanism and site of action of TEG. In male rats, visceral pain was assessed by measuring visceromotor response (VMR) to colorectal distension (CRD). Inflammation was induced by intracolonic injection of tri-nitrobenzene sulfonic acid (TNBS). The effect of TEG on the VMR was tested by injecting intraperitoneal (i.p.), intrathecal (i.t.), intracerebroventricular (i.c.v) or in the rostroventral medulla (RVM). The effect of the drug was also tested on responses of CRD-sensitive pelvic nerve afferents (PNA) and lumbo-sacral (LS) spinal neurons. Systemic injection of TEG attenuated VMR in naive and TNBS-treated rats. Similarly, supraspinal, but not spinal, injection of TEG attenuated the VMR. While GR113808, (selective 5-HT4 antagonist) blocked the effect, naloxone (NLX) an opioid receptor antagonist reversed the effect of TEG. Although i.t. NLX did not block the inhibitory effect of TEG in VMR study, i.t. injection of ?2-adrenergic receptor antagonist yohimbine blocked the effect of TEG when given systemically. While TEG had no effect on the responses of CRD-sensitive PNA, it inhibited the responses of CRD-sensitive LS neurons in spinal intact condition. This inhibition was blocked by GR113808, NLX and ?-funaltrexamine (?-FNA) when injected into the RVM. Results indicate that TEG produces analgesia via activation of supraspinal 5-HT4 receptors which triggers the release of opioids at supraspinal site, which activates descending noradrenergic pathways to the spinal cord to produce analgesia. PMID:24334068

Sengupta, Jyoti N.; Mickle, Aaron; Kannampalli, Pradeep; Spruell, Russell; McRorie, John; Shaker, Reza; Miranda, Adrian

2015-01-01

288

Prospective study of POLG mutations presenting in children with intractable epilepsy: Prevalence and clinical features  

PubMed Central

Purpose To assess the frequency and clinical features of childhood-onset intractable epilepsy caused by the most common mutations in the POLG gene, which encodes the catalytic subunit of mitochondrial DNA polymerase gamma. Methods Children presenting with nonsyndromic intractable epilepsy of unknown etiology but without documented liver dysfunction at presentation were eligible for this prospective, population-based study. Blood samples were analyzed for the three most common POLG mutations. If any of the three tested mutations were found, all the exons and the exon–intron boundaries of the POLG gene were sequenced. In addition, we retrospectively reviewed the notes of patients presenting with intractable epilepsy in which we had found POLG mutations. All available clinical data were collected by questionnaire and by reviewing the medical records. Key Findings We analyzed 213 blood DNA samples from patients fulfilling the inclusion criteria of the prospective study. Among these, five patients (2.3%) were found with one of the three common POLG mutations as homozygous or compound heterozygous states. In addition, three patients were retrospectively identified. Seven of the eight patients had either raised cerebrospinal fluid (CSF) lactate (n = 3) or brain magnetic resonance imaging (MRI) changes (n = 4) at presentation with intractable epilepsy. Three patients later developed liver dysfunction, progressing to fatal liver failure in two without previous treatment with sodium valproate (VPA). Furthermore, it is worth mentioning that one patient presented first with an autism spectrum disorder before seizures emerged. Significance Mutations in POLG are an important cause of early and juvenile onset nonsyndromic intractable epilepsy with highly variable associated manifestations including autistic features. This study emphasizes that genetic testing for POLG mutations in patients with nonsyndromic intractable epilepsies is very important for clinical diagnostics, genetic counseling, and treatment decisions because of the increased risk for VPA-induced liver failure in patients with POLG mutations. We recommend POLG gene testing for patients with intractable seizures and at least one elevated CSF lactate or suggestive brain MRI changes (predominantly abnormal T2-weighted thalamic signal) with or without status epilepticus, epilepsia partialis continua, or liver manifestations typical for Alpers disease, especially when the disease course is progressive. PMID:23448099

Uusimaa, Johanna; Gowda, Vasantha; McShane, Anthony; Smith, Conrad; Evans, Julie; Shrier, Annie; Narasimhan, Manisha; O'Rourke, Anthony; Rajabally, Yusuf; Hedderly, Tammy; Cowan, Frances; Fratter, Carl; Poulton, Joanna

2013-01-01

289

Central Pain Syndrome  

MedlinePLUS

NINDS Central Pain Syndrome Information Page Table of Contents (click to jump to sections) What is Central Pain Syndrome? Is there ... being done? Clinical Trials Organizations What is Central Pain Syndrome? Central pain syndrome is a neurological condition ...

290

Somatoform pain disorder  

MedlinePLUS

Pain disorder ... thought to be related to emotional stress. The pain was often said to be "all in their head." However, patients with somatoform pain disorder seem to experience painful sensations in a ...

291

Complex Regional Pain Syndrome  

MedlinePLUS

Complex regional pain syndrome (CRPS) is a chronic pain condition. It causes intense pain, usually in the arms, hands, legs, or feet. ... in skin temperature, color, or texture Intense burning pain Extreme skin sensitivity Swelling and stiffness in affected ...

292

Chronic Pain Medicines  

MedlinePLUS

MENU Return to Web version Chronic Pain | Chronic Pain Medicines How is chronic pain treated? Treatment of chronic ... or she tells you how to use your pain medicine. If you have questions about side effects or ...

293

Correlations between social-emotional feelings and anterior insula activity are independent from visceral states but influenced by culture  

PubMed Central

The anterior insula (AI) maps visceral states and is active during emotional experiences, a functional confluence that is central to neurobiological accounts of feelings. Yet, it is unclear how AI activity correlates with feelings during social emotions, and whether this correlation may be influenced by culture, as studies correlating real-time AI activity with visceral states and feelings have focused on Western subjects feeling physical pain or basic disgust. Given psychological evidence that social-emotional feelings are cognitively constructed within cultural frames, we asked Chinese and American participants to report their feeling strength to admiration and compassion-inducing narratives during fMRI with simultaneous electrocardiogram recording. Trial-by-trial, cardiac arousal and feeling strength correlated with ventral and dorsal AI activity bilaterally but predicted different variance, suggesting that interoception and social-emotional feeling construction are concurrent but dissociable AI functions. Further, although the variance that correlated with cardiac arousal did not show cultural effects, the variance that correlated with feelings did. Feeling strength was especially associated with ventral AI activity (the autonomic modulatory sector) in the Chinese group but with dorsal AI activity (the visceral-somatosensory/cognitive sector) in an American group not of Asian descent. This cultural group difference held after controlling for posterior insula (PI) activity and was replicated. A bi-cultural East-Asian American group showed intermediate results. The findings help elucidate how the AI supports feelings and suggest that previous reports that dorsal AI activation reflects feeling strength are culture related. More broadly, the results suggest that the brain's ability to construct conscious experiences of social emotion is less closely tied to visceral processes than neurobiological models predict and at least partly open to cultural influence and learning. PMID:25278862

Immordino-Yang, Mary Helen; Yang, Xiao-Fei; Damasio, Hanna

2014-01-01

294

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. PMID:23658493

Keppel Hesselink, Jan M; Kopsky, David J

2013-01-01

295

Treatment of chronic regional pain syndrome type 1 with palmitoylethanolamide and topical ketamine cream: modulation of nonneuronal cells.  

PubMed

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. PMID:23658493

Keppel Hesselink, Jan M; Kopsky, David J

2013-01-01

296

Human visceral leishmaniasis: a picture from Italy.  

PubMed

The aim of our study was to describe the distribution of Visceral Leishmaniasis (VL) in Italy, focusing on HIV-infected patients, to estimate the burden of the disease and the public health actions that should be undertaken. A review of official notifications and hospitalization data has been performed. From 2006 to 2008, a total of 289 cases of VL were notified; the overall notification rate was 1.63/1,000,000 (95% CI 1.45-1.83). In total, 1192 VL-associated hospitalizations were detected, with a hospitalization rate of 6.71/1,000,000 (95% CI 6.34-7.10). For the age group "? 24 years", a statistically significant increase was detected (p<0.05). A total of 68.9% (n = 821) of hospitalizations were detected in HIV-positive patients. The geographic distribution of rates revealed a significant increase in the north-eastern area of the country. Our study confirms that the epidemiological pattern of VL is changing and that, in Italy, control measures and preventive strategies should be based on not only the official notification system but also hospital data. This would lead to the identification of areas of parasite spread and to the creation of awareness campaigns geared toward general practitioners in the affected areas. Easy case detection would allow for timely public health actions and strategies for the implementation of more effective interventions for reservoir control. PMID:23999330

Abdalmaula, Giuma Harun; Barbadoro, Pamela; Marigliano, Anna; Illuminati, Diego; Di Stanislao, Francesco; D'Errico, Marcello Mario; Prospero, Emilia

2013-12-01

297

[Visceral leishmaniasis in Central Asia and Kazakhstan].  

PubMed

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

1990-01-01

298

T-type calcium channels: an emerging therapeutic target for the treatment of pain  

Microsoft Academic Search

It has become generally accepted that presynaptic high voltage-activated N-type calcium channels located in the spinal dorsal horn are a validated clinical target for therapeutic interventions associated with severe intractable pain. Low voltage-activated (T-type) calcium channels play a number of critical roles in nervous system function, including controlling thalamocortical bursting behaviours and the generation of spike wave discharges associated with

Terrance P. Snutch; Laurence S. David

2006-01-01

299

Percutaneous renal sympathetic nerve ablation for loin pain haematuria syndrome.  

PubMed

Loin pain haematuria syndrome (LPHS) is a severe renal pain condition of uncertain origin and often resistant to treatment. Nephrectomy and renal autotrasplantation have occasionally been performed in very severe cases. Its pathogenesis is controversial. A 40-year-old hypertensive lady was diagnosed with LPHS after repeated diagnostic imaging procedures had ruled out any renal, abdominal or spinal conditions to justify pain. Notwithstanding treatment with three drugs, she had frequent hypertensive crises during which the loin pain was dramatically exacerbated. Vascular causes of the pain and hypertension were investigated and excluded. Her renal function was normal. The patient was referred to a multidisciplinary pain clinic, but had no significant improvement in her pain symptoms despite the use of non-steroidal anti-inflammatory drugs, adjuvant antidepressants and opioid-like agents. The pain and the discomfort were so severe that her quality of life was very poor, and her social and professional activities were compromised. Nephrectomy and renal autotransplantation have occasionally been performed in these cases. Since visceral pain signals flow through afferent sympathetic fibres, we felt that percutaneous catheter-based radiofrequency ablation of the renal sympathetic nerve fibres (recently introduced for the treatment of drug-resistant hypertension) could be valuable for pain relief. We treated the patient with radiofrequency ablation (Medtronic Symplicity Catheter) applied only to the right renal artery. After a 6-month follow-up, the patient is pain free and normotensive with all drugs withdrawn. She has experienced no hypertensive crises in the meantime. This observation suggests that percutaneous sympathetic denervation could prove to be an effective mini-invasive strategy for the treatment of chronic renal pain, and LPHS in particular. PMID:23658250

Gambaro, Giovanni; Fulignati, Pierluigi; Spinelli, Alessio; Rovella, Valentina; Di Daniele, Nicola

2013-09-01

300

Cooperative hernia study. Pain in the postrepair patient.  

PubMed Central

BACKGROUND: The Cooperative Hernia Study assessed postoperative pain in a prospective trial as part of a larger study looking at the recurrence rate and other morbidity of the Bassini, McVay, and Shouldice repairs. METHODS: Patients were randomized to one of three surgical hernia repairs. Patients were seen in follow-up at 6, 12, and 24 months and were assessed for the presence of pain, numbness, paresthesia, and recurrence. RESULTS: Three hundred fifteen patients were seen in follow-up, with 276 seen at the 2-year mark. At 1 year, 62.9% of patients had groin or inguinal pain and 11.9% of patients had moderate to severe pain; 53.6% had pain and 10.6% of patients continued to report moderate to severe pain 2 years postoperatively. The predictors for long-term postoperative pain were as follows: absence of a visible bulge before the operation (p < 0.001); presence of numbness in the surgical area postoperatively (p < 0.05); and patient requirement of more than 4 weeks out of work postoperatively (p < 0.004). Three distinct chronic pains were identified. The most common and most severe pain was somatic, localized to the common ligamentous insertion to the public tubercle. The second was neuropathic and was referable to the ilioinguinal or genitofemoral nerve distribution. This was likely because of injury to the genitofemoral nerves, either at surgery or subsequently by encroachment of scar. The third pain was visceral, ejaculatory pain. Twenty-four percent of patients had postoperative numbness at 2 years, independent of the type of repair. Numbness was most common in the distribution of cutaneous branches of the ilioinguinal and iliohypogastric nerves. CONCLUSION: Pain or numbness are common late sequelae of traditional external surgical hernia repairs. Strategies need to be developed to reduce the risk of these complications. PMID:8916874

Cunningham, J; Temple, W J; Mitchell, P; Nixon, J A; Preshaw, R M; Hagen, N A

1996-01-01

301

Disodium Cromoglycate Reverses Colonic Visceral Hypersensitivity and Influences Colonic Ion Transport in a Stress-Sensitive Rat Strain  

PubMed Central

The interface between psychiatry and stress-related gastrointestinal disorders (GI), such as irritable bowel syndrome (IBS), is well established, with anxiety and depression the most frequently occurring comorbid conditions. Moreover, stress-sensitive Wistar Kyoto (WKY) rats, which display anxiety- and depressive-like behaviors, exhibit GI disturbances akin to those observed in stress-related GI disorders. Additionally, there is mounting preclinical and clinical evidence implicating mast cells as significant contributors to the development of abdominal visceral pain in IBS. In this study we examined the effects of the rat connective tissue mast cell (CTMC) stabiliser, disodium cromoglycate (DSCG) on visceral hypersensitivity and colonic ion transport, and examined both colonic and peritoneal mast cells from stress-sensitive WKY rats. DSCG significantly decreased abdominal pain behaviors induced by colorectal distension in WKY animals independent of a reduction in colonic rat mast cell mediator release. We further demonstrated that mast cell-stimulated colonic ion transport was sensitive to inhibition by the mast cell stabiliser DSCG, an effect only observed in stress-sensitive rats. Moreover, CTMC-like mast cells were significantly increased in the colonic submucosa of WKY animals, and we observed a significant increase in the proportion of intermediate, or immature, peritoneal mast cells relative to control animals. Collectively our data further support a role for mast cells in the pathogenesis of stress-related GI disorders. PMID:24367692

Carroll, Siobhan Yvonne; O’Mahony, Siobhain Mary; Grenham, Susan; Cryan, John Francis; Hyland, Niall Patrick

2013-01-01

302

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. PMID:23560215

Kim, Soo-Ryu; Lee, Min-Ji; Lee, Seung-Jun; Kim, Dae-Hyun; Hong, Ji-Hee

2013-01-01

303

Thoracolumbar Junction Syndrome Causing Pain around Posterior Iliac Crest: A Case Report.  

PubMed

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

2013-03-01

304

Gastrointestinal (GI) permeability is associated with trait anxiety in children with functional abdominal pain (FAP) and Irritable Bowel Syndrome (IBS)  

Technology Transfer Automated Retrieval System (TEKTRAN)

FAP and IBS affect 10-15% of school age children and bear many physiological similarities to irritable bowel syndrome (IBS) in adults (e.g., functional pain, visceral hyperalgesia). Animal models of IBS have suggested a relationship between neonatal stress and increased GI permeability later in life...

305

Paining Out: An Integrative Pain Therapy Model  

Microsoft Academic Search

This article describes and evaluates an integrative pain therapy model as a beneficial form of pain-management for chronic\\u000a pain. The author based his model on cognitive-behavioral modalities, progressive relaxation combined with art therapy, sensory\\u000a awareness combined with indirect clinical hypnosis, formal clinical hypnosis and self-hypnosis. Those techniques were applied\\u000a in small group settings to systematically alter pain perception, pain interpretations

Mirko Pavlek

2008-01-01

306

Visceral leishmaniasis among hypersplenic patients in Dakahlia Governorate, Egypt.  

PubMed

Generally speaking, with rapid international travel, it is very common to diagnose infectious diseases in areas where they were not known before. Nowadays, visceral leishmaniasis (VL) is documented in Egypt mainly in Al Agamy, Alexandria. Another case of infantile visceral leishmaniasis was identified in an adult farmer (unusual host) in Banha. Other studies all over Egypt (based on clinical and or serological diagnosis rather than demonstration of the parasites) raised the possibility of adult affection with visceral leishmaniasis. The point is that visceral leishmaniasis, shares many clinical manifestations with other diseases known in Egypt as schistosomiasis mansoni, hepatic amoebiasis, toxoplasmosis, and malaria. In the present study, out of 22 human cases with hypersplenism and suggesting manifestations, four gave seropositivity for VL, by the indirect haemagglutination tests (128 & more). Two of these four patients gave seropositivity by dot-ELISA (1:8000). Amastigotes of Leishmania parasite were demonstrated in the splenic smears obtained during splenectomy. One culture obtained from these two cases grew promastigotes. Typing is ongoing. It was concluded that visceral leishmaniasis should be in mind and considered in the differential diagnosis of patients with hepatosplenomegaly or hypersplenism in Egypt. PMID:8376875

el Mahdy, A; Morsy, T A; Youssef, M S; el Shazly, A M; Hammoda, N E

1993-08-01

307

Clinical Issues in Pain Management Clinical Issues in Pain Management  

E-print Network

Example: Chronic low back pain Recurrent acute pain Intermittent episodes of acute pain Chronic becausePain Clinical Issues in Pain Management #12;Clinical Issues in Pain Management: Acute Pain By definition, acute pain goes on for six months or less During acute pain, there is an urgent search for relief

Meagher, Mary

308

Modulation of enteric neurons by interleukin-6 and corticotropin-releasing factor contributes to visceral hypersensitivity and altered colonic motility in a rat model of irritable bowel syndrome.  

PubMed

The search for effective therapeutic strategies for irritable bowel syndrome (IBS) is hampered by an incomplete understanding of its underlying pathophysiology. Stress and altered plasma cytokine profiles indicative of immune activation are characteristic of the disorder. The neuromodulatory effects of interleukin-6 (IL-6) and corticotropin-releasing factor receptor (CRFR) 1 in visceral pain and stress-induced defecation in the Wistar Kyoto (WKY) rat model of IBS were investigated. Sprague Dawley and WKY rats were administered anti-IL-6 receptor antibodies (xIL-6R, 0.5 mg kg(-1) i.p) with or without the CRFR1 antagonist antalarmin (10 mg kg(-1) i.p). Post-intervention, the pain threshold to colorectal distension and stress-induced faecal output were compared and changes in colonic mucosal protein expression were investigated. The neuro-stimulatory effects of IBS plasma on the myenteric plexus is mediated by IL-6, IL-8 and CRF. The stimulatory effects of these soluble factors on myenteric neuron excitability and colonic contractility were additive. Moreover, inhibition of IL-6 and CRF1 receptors in vivo in the WKY IBS rat model normalized stress-induced defecation (P < 0.01) and visceral pain sensitivity (P < 0.001) with associated changes in protein expression of the tight junction proteins occludin and claudin 2, the visceral pain-associated T-type calcium channel CaV3.2 and intracellular signalling molecules STAT3, SOCS3 and ERK1/2. These studies demonstrate the additive effects of immune and stress factors on myenteric neuronal excitability. Moreover, combined targeting of peripheral IL-6 and CRF1 receptors is effective in alleviating IBS-like symptoms in the WKY rat. Thus, crosstalk between stress and immune factors during IBS flares may underlie symptom exacerbation. PMID:25260633

Buckley, Maria M; O'Halloran, Ken D; Rae, Mark G; Dinan, Timothy G; O'Malley, Dervla

2014-12-01

309

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. PMID:23408092

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

2013-01-01

310

Painful hypoadrenalism.  

PubMed

A 61-year-old man presented with diffuse myalgia and arthralgia. The physical examination showed diffuse musculoskeletal tenderness and joint stiffness without the presence of synovitis or arthritis. Nerve conduction study showed combined mild axonal degenerative and demyelinating change. Muscle biopsy analysis showed unspecific mild muscle atrophy with myopathic changes found on electromyography. A diagnosis of isolated adrenocorticotropic hormone deficiency was made on the basis of endocrinological evaluation. The widespread musculoskeletal pain resolved as a result of administration of physiological dose of hydrocortisone replacement. In a patient with unexplained rheumatic symptoms, adrenocortical insufficiency should be considered in the possible aetiology. PMID:22700071

Hoshino, Chisho; Satoh, Noriyuki; Narita, Masashi; Kikuchi, Akio; Inoue, Minoru

2011-01-01

311

Painful hypoadrenalism  

PubMed Central

A 61-year-old man presented with diffuse myalgia and arthralgia. The physical examination showed diffuse musculoskeletal tenderness and joint stiffness without the presence of synovitis or arthritis. Nerve conduction study showed combined mild axonal degenerative and demyelinating change. Muscle biopsy analysis showed unspecific mild muscle atrophy with myopathic changes found on electromyography. A diagnosis of isolated adrenocorticotropic hormone deficiency was made on the basis of endocrinological evaluation. The widespread musculoskeletal pain resolved as a result of administration of physiological dose of hydrocortisone replacement. In a patient with unexplained rheumatic symptoms, adrenocortical insufficiency should be considered in the possible aetiology. PMID:22700071

Hoshino, Chisho; Satoh, Noriyuki; Narita, Masashi; Kikuchi, Akio; Inoue, Minoru

2011-01-01

312

A case of relapsed visceral Kaposi's sarcoma with bilateral chylothoraces successfully treated with paclitaxel.  

PubMed

Chylothorax is a rare complication of visceral Kaposi's sarcoma. We report a case with bilateral chylothoraces secondary to relapsed visceral Kaposi's sarcoma who was successfully treated with paclitaxel chemotherapy. PMID:25122577

Natarajan, Pavithra; Miller, Alastair

2014-08-13

313

Glucagon-Induced Vasospasm of Hepatic Artery Branches During Visceral Angiography  

SciTech Connect

Glucagon is often used in radiology to decrease bowel motility for enhanced imaging, including visceral digital subtraction angiography. We present a case in which branch hepatic artery vasospasm followed the intravenous administration of glucagon during visceral angiography.

Dziedzic, T. Scott; Smith, Tony P., E-mail: smith146@mc.duke.ed [Duke University Medical Center, Department of Radiology (United States)

2008-07-15

314

Embolization—An optional treatment for intractable hemorrhage from a malignant rectovaginal fistula  

Microsoft Academic Search

PURPOSE: Patients rarely have intractable hemorrhage from rectovaginal fistulas, which usually require surgical intervention. This report presents our experience with nonsurgical treatment of a high-risk patient with uncontrolled hemorrhage originating from a malignant rectovaginal fistula. METHODS: A 74-year-old female developed uncontrolled hemorrhage from a malignant rectovaginal fistula. Because of her poor physical condition, an embolization with metal clips of the

T. Dushnitsky; Y. Ziv; A. Peer; A. Halevy

1999-01-01

315

Percutaneous Cyanoacrylate Glue Injection into the Renal Pseudoaneurysm to Control Intractable Hematuria After Percutaneous Nephrolithotomy  

SciTech Connect

We report a case of a 43-year-old man who developed intractable hematuria after percutaneous nephrolithotomy. Angiography detected a pseudoaneurysm arising from the lower polar artery; however, embolization could not be performed because of unfavorable vascular anatomy. A percutaneous thrombin injection under ultrasound guidance initially controlled the bleeding, but hematuria subsequently recurred as a result of recanalization of the aneurysm. The case was successfully managed with ultrasound- and fluoroscopic-guided direct injection of cyanoacrylate glue into the pseudoaneurysm.

Lal, Anupam, E-mail: dralal@rediffmail.com; Kumar, Ajay; Prakash, Mahesh; Singhal, Manphool [Post Graduate Institute of Medical Education and Research (PGIMER), Department of Radiodiagnosis and Imaging (India); Agarwal, Mayank Mohan; Sarkar, Debansu [Post Graduate Institute of Medical Education and Research (PGIMER), Department of Urology (India); Khandelwal, Niranjan [Post Graduate Institute of Medical Education and Research (PGIMER), Department of Radiodiagnosis and Imaging (India)

2009-07-15

316

X-linked immune dysregulation, neonatal insulin dependent diabetes, and intractable diarrhoea.  

PubMed Central

Four related male infants presented with neonatal diabetes mellitus, immune dysregulation with extremely high concentrations of immunoglobulin E, and intractable diarrhoea. They were all from one family, and all of them died. As far as is known this X-linked recessive disorder has not been described before. It is suggested that this is a new immunodeficiency in which type 2 T helper responses predominate. PMID:8777684

Peake, J. E.; McCrossin, R. B.; Byrne, G.; Shepherd, R.

1996-01-01

317

Urolithiasis presenting as right flank pain: a case report  

PubMed Central

Background: Urolithiasis refers to renal or ureteral calculi referred to in lay terminology as a kidney stone. Utolithiasis is a potential emergency often resulting in acute abdominal, low back, flank or groin pain. Chiropractors may encounter patients when they are in acute pain or after they have recovered from the acute phase and should be knowledgeable about the signs, symptoms, potential complications and appropriate recommendations for management. Case presentation: A 52 year old male with acute right flank pain presented to the emergency department. A ureteric calculus with associated hydronephrosis was identified and he was prescribed pain medications and discharged to pass the stone naturally. One day later, he returned to the emergency department with severe pain and was referred to urology. He was managed with a temporary ureteric stent and antibiotics. Conclusion: This case describes a patient with acute right flank and lower quadrant pain which was diagnosed as an obstructing ureteric calculus. Acute management and preventive strategies in patients with visceral pathology such as renal calculi must be considered in patients with severe back and flank pain as it can progress to hydronephrosis and kidney failure. PMID:23483000

Chung, Chadwick; Stern, Paula J.; Dufton, John

2013-01-01

318

The usefulness of mesenterium thickness as an index of visceral fat accumulation  

Microsoft Academic Search

Visceral fat syndrome, which includes visceral fat accumulation, glucose intolerance, hyperlipidemia, and hypertension, refers\\u000a to a highly atherogenic state with a cluster of risk factors secondary to visceral fat accumulation. Although X-ray computed\\u000a tomography (CT) is used commonly in diagnosis of visceral fat accumulation, it is expensive and exposes the patient to radiation.\\u000a Some indices obtained using ultrasonography, which is

Tomoko Ono; Nobuyuki Taniguchi; Masaaki Osawa; Akira Onoguchi; Syukuko Kaneko; Yoshitaka Nakazawa; Mikihiko Kawano; Kouichi Itoh

2003-01-01

319

Drosophila as a Model for Intractable Epilepsy: Gilgamesh Suppresses Seizures in parabss1 Heterozygote Flies  

PubMed Central

Intractable epilepsies, that is, seizure disorders that do not respond to currently available therapies, are difficult, often tragic, neurological disorders. Na+ channelopathies have been implicated in some intractable epilepsies, including Dravet syndrome (Dravet 1978), but little progress has been forthcoming in therapeutics. Here we examine a Drosophila model for intractable epilepsy, the Na+ channel gain-of-function mutant parabss1 that resembles Dravet syndrome in some aspects (parker et al. 2011a). In particular, we identify second-site mutations that interact with parabss1, seizure enhancers, and seizure suppressors. We describe one seizure-enhancer mutation named charlatan (chn). The chn gene normally encodes an Neuron-Restrictive Silencer Factor/RE1-Silencing Transcription factor transcriptional repressor of neuronal-specific genes. We identify a second-site seizure-suppressor mutation, gilgamesh (gish), that reduces the severity of several seizure-like phenotypes of parabss1/+ heterozygotes. The gish gene normally encodes the Drosophila ortholog of casein kinase CK1g3, a member of the CK1 family of serine-threonine kinases. We suggest that CK1g3 is an unexpected but promising new target for seizure therapeutics. PMID:23797108

Howlett, Iris C.; Rusan, Zeid M.; Parker, Louise; Tanouye, Mark A.

2013-01-01

320

Magnetoencephalography-guided epilepsy surgery for children with intractable focal epilepsy: SickKids experience.  

PubMed

We introduced magnetoencephalography (MEG)-guided epilepsy surgery for children with intractable focal epilepsy at The Hospital for Sick Children (SickKids) in Toronto, Canada. Surgical candidacy and decisions on surgical procedure for children with intractable focal epilepsy are based on long-term scalp video EEG (VEEG) results, magnetic resonance imaging (MRI) findings, and the distribution of MEG spike sources. After multidisciplinary discussion at the seizure conference, for the patients requiring intracranial VEEG, custom-made subdural electrode grids are designed using three-dimensional MRI superimposed with MEG spike sources to cover the area of clustered MEG spike sources. At the first surgery, neurosurgeons use the intraoperative neuronavigation system to visualize the area of clustered spike dipoles and somatosensory evoked fields on MEG to place the subdural grid and depth electrodes. At the second surgery, the area of seizure onset and active interictal spike discharges on the intracranial VEEG recording, which usually correlates with the zone of clustered MEG spike sources, is resected. This combination leads to successful surgical outcome to control seizures in these challenging paediatric patients. MEG is a useful tool in children with intractable focal epilepsy to determine the surgical candidacy and focal cortical resection to stop seizures. PMID:18313780

Ochi, Ayako; Otsubo, Hiroshi

2008-05-01

321

The Ketogenic and Atkins Diets Effect on Intractable Epilepsy: A Comparison  

PubMed Central

Objective Intractable epilepsy is a major difficulty in child neurology, because the numbers of drugs that are available for treatment are limited and new treatments such as diets must be tried. Now there are some diets available for treating patients with intractable epilepsy. The oldest diet is the classic ketogenic diet and one of the newest diets is the modified Atkins diet. Patients have a harder time accepting the classic ketogenic diet than the Atkins diet, which is easier to accept because the food tastes better. This study compares the efficacy of the ketogenic diet and the Atkins diet for intractable epilepsy in children. Materials & Methods This study is a clinical trial survey with sample size of 40 children with refractory epilepsy who were patients at Mofid hospital in Tehran, Iran. Initially, from Jan 2005–Oct 2007, 20 children were treated with the Atkins diet, and then from Oct 2007–March 2010, the other group was treated with the classic ketogenic diet and the results were compared. Results In this study, response to treatment was greater than a 50% reduction in seizures and at the end of first, second, and third months for the ketogenic diet were 55%, 30%, and 70% and for the Atkins diet were 50%, 65%, and 70%, respectively. Conclusion The results of this study show that there is no significant difference between the classic Ketogenic diet and the Atkins diet at the end of first, second, and third months and both had similar responses to the treatments. PMID:25143768

GHAZAVI, Ahad; TONEKABONI, Seyed Hassan; KARIMZADEH, Parvaneh; NIKIBAKHSH, Ahmad Ali; KHAJEH, Ali; FAYYAZI, Afshin

2014-01-01

322

When Sex Is Painful  

MedlinePLUS

How common is painful sex? Pain during intercourse is very common—nearly 3 out of 4 women have pain during intercourse at some time during ... a long-term problem. What causes pain during sex? Pain during sex may be a sign of ...

323

Low Back Pain  

MedlinePLUS

MENU Return to Web version Low Back Pain Overview What is low back pain? Low back pain is a common problem for many people. It can be caused by many ... lift and exercise correctly. Symptoms When is low back pain serious? Call your family doctor if: Pain goes ...

324

Intractable hiccup as the presenting symptom of cavernous hemangioma in the medulla oblongata: a case report and literature review.  

PubMed

A case of intractable hiccup developed by cavernous hemangioma in the medulla oblongata is reported. There have been only five previously reported cases of medullary cavernoma that triggered intractable hiccup. The patient was a 28-year-old man who was presented with intractable hiccup for 15 days. It developed suddenly, then aggravated progressively and did not respond to any types of medication. On magnetic resonance images, a well-demarcated and non-enhancing mass with hemorrhagic changes was noted in the left medulla oblongata. Intraoperative findings showed that the lesion was fully embedded within the brain stem and pathology confirmed the diagnosis of cavernous hemangioma. The hiccup resolved completely after the operation. Based on the presumption that the medullary cavernoma may trigger intractable hiccup by displacing or compression the hiccup arc of the dorsolateral medulla, surgical excision can eliminate the symptoms, even in the case totally buried in brainstem. PMID:25237438

Lee, Kyung-Hwa; Moon, Kyung-Sub; Jung, Min-Young; Jung, Shin

2014-06-01

325

Intractable Hiccup as the Presenting Symptom of Cavernous Hemangioma in the Medulla Oblongata: A Case Report and Literature Review  

PubMed Central

A case of intractable hiccup developed by cavernous hemangioma in the medulla oblongata is reported. There have been only five previously reported cases of medullary cavernoma that triggered intractable hiccup. The patient was a 28-year-old man who was presented with intractable hiccup for 15 days. It developed suddenly, then aggravated progressively and did not respond to any types of medication. On magnetic resonance images, a well-demarcated and non-enhancing mass with hemorrhagic changes was noted in the left medulla oblongata. Intraoperative findings showed that the lesion was fully embedded within the brain stem and pathology confirmed the diagnosis of cavernous hemangioma. The hiccup resolved completely after the operation. Based on the presumption that the medullary cavernoma may trigger intractable hiccup by displacing or compression the hiccup arc of the dorsolateral medulla, surgical excision can eliminate the symptoms, even in the case totally buried in brainstem. PMID:25237438

Lee, Kyung-Hwa; Jung, Min-Young; Jung, Shin

2014-01-01

326

Multiple roles for NaV1.9 in the activation of visceral afferents by noxious inflammatory, mechanical, and human disease-derived stimuli.  

PubMed

Chronic visceral pain affects millions of individuals worldwide and remains poorly understood, with current therapeutic options constrained by gastrointestinal adverse effects. Visceral pain is strongly associated with inflammation and distension of the gut. Here we report that the voltage-gated sodium channel subtype NaV1.9 is expressed in half of gut-projecting rodent dorsal root ganglia sensory neurons. We show that NaV1.9 is required for normal mechanosensation, for direct excitation and for sensitization of mouse colonic afferents by mediators from inflammatory bowel disease tissues, and by noxious inflammatory mediators individually. Excitatory responses to ATP or PGE2 were substantially reduced in NaV1.9(-/-) mice. Deletion of NaV1.9 substantially attenuates excitation and subsequent mechanical hypersensitivity after application of inflammatory soup (IS) (bradykinin, ATP, histamine, PGE2, and 5HT) to visceral nociceptors located in the serosa and mesentery. Responses to mechanical stimulation of mesenteric afferents were also reduced by loss of NaV1.9, and there was a rightward shift in stimulus-response function to ramp colonic distension. By contrast, responses to rapid, high-intensity phasic distension of the colon are initially unaffected; however, run-down of responses to repeat phasic distension were exacerbated in NaV1.9(-/-) afferents. Finally colonic afferent activation by supernatants derived from inflamed human tissue was greatly reduced in NaV1.9(-/-) mice. These results demonstrate that NaV1.9 is required for persistence of responses to intense mechanical stimulation, contributes to inflammatory mechanical hypersensitivity, and is essential for activation by noxious inflammatory mediators, including those from diseased human bowel. These observations indicate that NaV1.9 represents a high-value target for development of visceral analgesics. PMID:24972070

Hockley, James R F; Boundouki, George; Cibert-Goton, Vincent; McGuire, Cian; Yip, Ping K; Chan, Christopher; Tranter, Michael; Wood, John N; Nassar, Mohammed A; Blackshaw, L Ashley; Aziz, Qasim; Michael, Gregory J; Baker, Mark D; Winchester, Wendy J; Knowles, Charles H; Bulmer, David C

2014-10-01

327

Visceral fat in relation to health: is it a major culprit or simply an innocent bystander?  

Microsoft Academic Search

The aim of this review is to look critically at the widely accepted notion that visceral fat accumulation is the main determinant of obesity related diseases. Most of the epidemiological evidence is based on anthropometric indicators of fatness and fat distribution and their implications for visceral fat accumulation may not be unequivocal. In most cross-sectional studies in which visceral fat

JC Seidell; C Bouchard

1997-01-01

328

Increased Amount of Visceral Fat in Patients with Psoriasis Contributes to Metabolic Syndrome  

Microsoft Academic Search

Background: Psoriasis is associated with obesity and metabolic syndrome. Metabolic syndrome is associated with visceral fat accumulation. There is no study on the accumulation of visceral fat in patients with psoriasis. Objective: The aim of this study was to compare the visceral fat accumulation in patients with psoriasis and controls. Subjects and Methods: 46 patients with psoriasis and 46 sex-

Ali Balci; Didem Didar Balci; Zafer Yonden; Inan Korkmaz; Julide Zehra Yenin; Ebru Celik; Nese Okumus; Ertugrul Egilmez

2010-01-01

329

Visceral Fat: Higher Responsiveness of Fat Mass and Gene Expression to Calorie Restriction than Subcutaneous Fat  

Microsoft Academic Search

Visceral fat accumulation is accompanied by several metabolic disorders. Here, we investigate the improvement of visceral fat accumulation in the early phase of diet. Hyperlipidemic obese patients received a low-calorie diet (1000 kcal\\/day) for 14 days. Visceral and subcutaneous fat accumulation was analyzed us- ing ultrasonography. After 14 days of the diet, the average vis- ceral fat of obese patients

YIN LI; HIDEAKI BUJO; KAZUO TAKAHASHI; MANABU SHIBASAKI; YANJUAN ZHU; YURIKO YOSHIDA; YUKO OTSUKA; NAOTAKE HASHIMOTO; YASUSHI SAITO

2003-01-01

330

Relationship between Visceral Fat and Cardiovascular Disease Risk Factors: The Tanno and Sobetsu Study  

Microsoft Academic Search

We assessed the amount of visceral fat using ultrasonography (US) and studied its relationship to cardiovascular disease risk factors, particularly blood pressure. The subjects in the first study were 45 male and 61 female outpatients. We measured the visceral fat area (VFA) of each subject using abdominal CT and waist circumference (WC), and visceral fat distance (VFD) using US. The

Yu Chiba; Shigeyuki Saitoh; Satoru Takagi; Hirofumi Ohnishi; Nobuo Katoh; Junichi Ohata; Motoya Nakagawa; Kazuaki Shimamoto

2007-01-01

331

Abdominal Visceral Fat Thickness Measured by Ultrasonography Predicts the Presence and Severity of Coronary Artery Disease  

Microsoft Academic Search

Abdominal visceral fat plays a critical role in the pathogenesis of metabolic syndrome, which is a risk factor for coronary artery disease (CAD). Ultrasonography (US) distinctively quantifies visceral fat and subcutaneous fat. We measured the maximum preperitoneal visceral fat thickness (Vmax) and the minimum subcutaneous fat thickness (Smin) by US in 185 patients who underwent coronary angiography. Although the 144

Kosuke Hamagawa; Yoshihisa Matsumura; Toru Kubo; Kayo Hayato; Makoto Okawa; Katsutoshi Tanioka; Naohito Yamasaki; Hiroaki Kitaoka; Toshikazu Yabe; Masanori Nishinaga; Yoshinori L. Doi

2010-01-01

332

Clinical usefulness of quantitative evaluation of visceral fat by ultrasonography  

Microsoft Academic Search

Purpose  The aim of this work was to evaluate the usefulness of a proposed method for visceral fat volume assessment by ultrasonography\\u000a (US) in identifying those at risk of metabolic syndrome, and also to establish the most suitable cutoff level of waist circumference\\u000a for the diagnosis of visceral adiposity.\\u000a \\u000a \\u000a \\u000a Methods  One hundred and fifty-two outpatients with metabolic diseases such as hypertension, diabetes,

Seiji Nakanishi; Bunzo Matsuura; Masashi Hirooka; Teruhisa Ueda; Tetsuji Niiya; Shinya Furukawa; Masanori Abe; Yoichi Hiasa; Yoshikazu Kubo; Morikazu Onji

2007-01-01

333

Acute tryptophan depletion alters the effective connectivity of emotional arousal circuitry during visceral stimuli in healthy women  

PubMed Central

Objective Alterations in serotonin signalling within the brain–gut axis have been implicated in the pathophysiology of irritable bowel syndrome (IBS) and is a treatment target. Acute tryptophan depletion (ATD) decreases brain serotonin (5-hydroxytryptamine; 5-HT) levels, and increases visceral perception and negative emotional bias in patients with IBS. The aim of the present study was to determine the effect of ATD on brain activity and connectivity during visceral stimuli in healthy women, and to compare the ATD-induced brain connectivity of an arousal circuit in female patients with IBS without ATD. Methods 12 healthy females (19–25 years) were studied under placebo (PLA) conditions and ATD. Functional MRI measurements were performed during a rectal barostat protocol, consisting of random non-painful and maximal tolerable distensions. Partial least squares analyses and structural equation modelling were used to evaluate the effect of ATD on functional and effective brain connectivity during distension. Results in healthy controls under ATD were compared with the effective connectivity of brain responses to 45 mm Hg rectal distension in 14 female patients with constipation-predominant IBS (IBS-C) (24–50 years). Results In healthy controls, ATD resulted in increased response of an extensive brain network to balloon distension, including the amygdala and nodes of emotional arousal and homeostatic afferent networks. The effect was greater during high inflation, suggesting greater engagement of the central serotonion system with more aversive visceral stimuli. Effective connectivity analysis revealed a profound effect of ATD on coupling between emotional arousal network nodes, resulting in loss of negative feedback inhibition of the amygdala. A near-identical pattern was identified in the patients with IBS-C. Conclusions The findings are consistent with an ATD-induced disinhibition of and increased connectivity within an emotional arousal network during aversive stimulation. Together with the previous demonstration of ATD-induced visceral hyperalgesia in healthy controls, and the near-identical effective connectivity pattern observed in patients with IBS-C, these findings suggest that dysregulation of this brain network may play a role in central pain amplification and IBS pathophysiology. PMID:21402618

Labus, J S; Mayer, E A; Jarcho, J; Kilpatrick, L A; Kilkens, T O C; Evers, E A T; Backes, W H; Brummer, R-J M; van Nieuwenhoven, M A

2013-01-01

334

Epidemiology of Visceral Leishmaniasis in Georgia  

PubMed Central

This study investigated the transmission and prevalence of Leishmania parasite infection of humans in two foci of Visceral Leishmaniasis (VL) in Georgia, the well known focus in Tbilisi in the East, and in Kutaisi, a new focus in the West of the country. The seroprevalence of canine leishmaniasis was investigated in order to understand the zoonotic transmission. Blood samples of 1575 dogs (stray and pet) and 77 wild canids were tested for VL by Kalazar Detect rK39 rapid diagnostic tests. Three districts were investigated in Tbilisi and one in Kutaisi. The highest proportions of seropositive pet dogs were present in District #2 (28.1%, 82/292) and District #1 (26.9%, 24/89) in Tbilisi, compared to 17.3% (26/150) of pet dogs in Kutaisi. The percentage of seropositive stray dogs was also twice as high in Tbilisi (16.1%, n?=?670) than in Kutaisi (8%, n?=?50); only 2/58 wild animals screened were seropositive (2. 6%). A total of 873 Phlebotomine sand flies were collected, with 5 different species identified in Tbilisi and 3 species in Kutaisi; 2.3% of the females were positive for Leishmania parasites. The Leishmanin Skin Test (LST) was performed on 981 human subjects in VL foci in urban areas in Tbilisi and Kutaisi. A particularly high prevalence of LST positives was observed in Tbilisi District #1 (22.2%, 37.5% and 19.5% for ages 5–9, 15–24 and 25–59, respectively); lower prevalence was observed in Kutaisi (0%, 3.2% and 5.2%, respectively; P<0.05). This study shows that Tbilisi is an active focus for leishmaniasis and that the infection prevalence is very high in dogs and in humans. Although exposure is as yet not as high in Kutaisi, this is a new VL focus. The overall situation in the country is alarming and new control measures are urgently needed. PMID:24603768

Babuadze, Giorgi; Alvar, Jorge; Argaw, Daniel; de Koning, Harry P.; Iosava, Merab; Kekelidze, Merab; Tsertsvadze, Nikoloz; Tsereteli, David; Chakhunashvili, Giorgi; Mamatsashvili, Tamar; Beria, Nino; Kalandadze, Irine; Ejov, Mikhail; Imnadze, Paata

2014-01-01

335

Bone pain or tenderness  

MedlinePLUS

... cause of the pain, your doctor may prescribe: Antibiotics Anti-inflammatory medicines Hormones Laxatives (if you develop constipation during prolonged bed rest) Pain relievers If pain is related to thinning bones, you may need treatment for osteoporosis .

336

What Is Back Pain?  

MedlinePLUS

... some types of treatments for chronic back pain. Hot or Cold Packs (or Both) Hot or cold packs can soothe sore, stiff backs. ... helps reduce swelling and numbs deep pain. Using hot or cold packs may relieve pain, but this ...

337

Prevent Back Pain  

MedlinePLUS

... Everyday Healthy Living > Safety > Prevent Back Pain Prevent Back Pain The Basics Take Action! Ver en español Content ... Basics One of the best ways to prevent back pain is to keep your back muscles strong. Follow ...

338

Medications for back pain  

MedlinePLUS

Your back pain may not go away completely, or it may get more painful at times. Learning to take care ... home and how to prevent repeat episodes of back pain may help you avoid surgery. Different medications can ...

339

Convergence of visceral and somatic inputs onto subnucleus reticularis dorsalis neurones in the rat medulla.  

PubMed Central

1. In anaesthetized rats, recordings were made within the medullary subnucleus reticularis dorsalis (SRD) from neurones that exhibited convergence of nociceptive inputs from the entire surface of the body. Neurones with total nociceptive convergence responded to supramaximal percutaneous electrical stimuli (2 ms duration) with early and late peaks due to the activation of A delta and C fibres, respectively, no matter which part of the body was stimulated. Neurones with partial nociceptive convergence responded to identical stimuli with an A delta peak of activation regardless of which part of the body was stimulated and with a C peak of activation from some, mainly contralateral, parts of the body. The characteristics of the responses of these neurones to graded colo-rectal distension (< or = 100 mmHg) were analysed. 2. The majority of neurones with total nociceptive convergence (n = 13 out of 16) responded to colo-rectal distension by increasing their firing rates. Although these neurones were virtually unresponsive to the lowest pressure employed (12.5 mmHg), they increased their discharges monotonically for distensions in the 26-100 mmHg range and these responses were sometimes followed by after-discharges. One of these neurones, which exhibited a high level of spontaneous activity, was inhibited during colo-rectal distension. None of the neurones with partial nociceptive convergence recorded (n = 10) ever changed its firing rate during increases of intracolonic pressure up to 100 mmHg. 3. It is concluded that neurones with total nociceptive convergence give monotonic stimulus-response relationships for colo-rectal distensions. Thus, neurones with total nociceptive convergence can encode the strength of visceral stimuli, probably within the noxious range, just as they have previously been shown to do for thermal and mechanical cutaneous stimuli. Together with previous electrophysiological and neuroanatomical findings, this study provides further evidence for the convergence of noxious inputs onto single SRD neurones. 4. It is suggested that neurones with total nociceptive convergence could be a link in spino-bulbospinal loops involved in autonomic reactions to strong visceral stimulation. In addition, SRD neurones could be an important supraspinal relay in the mechanisms of visceral pain. PMID:1302266

Roy, J C; Bing, Z; Villanueva, L; Le Bars, D

1992-01-01

340

Solitary Painful Osseous Metastases: Correlation of Imaging Features with Pain Palliation after Radiofrequency Ablation—A Multicenter American College of Radiology Imaging Network Study  

PubMed Central

Purpose: To identify the correlation of pre- and postablation imaging features with pain relief, pain intensity, and patient mood after radiofrequency (RF) ablation of solitary painful osseous metastases. Materials and Methods: This prospective, multicenter group trial was approved by each institutional review board. Participants were enrolled between November 1, 2001, and April 6, 2006. Written informed consent was obtained from all subjects, and patient confidentiality protocols were followed in compliance with HIPAA. Computed tomography (CT)-guided RF ablation and contrast material–enhanced 1-month follow-up CT and/or magnetic resonance imaging were performed in 49 subjects (24 men, 25 women; age range, 34–83 years) with a confirmed malignant solitary bone lesion of maximum dimension of 8 cm or smaller that was causing intractable pain. Pain intensity and patient mood were measured before and after RF ablation. Tumor imaging features were recorded. Unadjusted and adjusted linear mixed-effects models, with a random intercept for each subject, were used to model patient mood, pain relief, and pain intensity scores at three times after ablation as a function of each tumor characteristic. Results: Decreased postablation tumor pain correlated with preablation tumor volume (P = .02) and pathologic fracture (P = .01), while pain relief correlated with pathologic fracture (P = .03) and percentage of bone-tumor interface (BTI) ablated (P = .02). Conversely, presence of an irregular rim after ablation (P = .02) and rim thickness (P = .01) correlated with increased pain. There was no evidence in this study that RF ablation of larger tumor percentage or larger volume leads to better pain relief or decreased pain (P > .05). Conclusion: Existing pathologic fracture and smaller tumor size appear to be predictive parameters of success when selecting patients for palliative RF ablation of painful solitary osseous metastases. Successful palliation also appears to be related to the percentage of BTI ablated. © RSNA, 2013 PMID:23657892

Guenette, Jeffrey P.; Lopez, Michael J.; Kim, Eunhee

2013-01-01

341

Complex Regional Pain Syndrome  

MedlinePLUS

... any treatment? Because there is no cure for CRPS, treatment is aimed at relieving painful symptoms. Doctors may prescribe topical analgesics, antidepressants, corticosteroids, and opioids to relieve pain. ...

342

Pathology and pathogenesis of disseminated visceral coccidiosis in cranes  

Microsoft Academic Search

Disseminated visceral coccidiosis (DVC) caused by Eimeria spp. was recognized as a disease entity in captive sandhill cranes (Grus canadensis) and whooping cranes (Grus americana) in the late 1970s. While most avian species of Eimeria inhabit the intestinal tract of its host, the crane eimerians, Eimeria reichenowi and Eimeria gruis, invade and multiply systemically and complete their development in both

Meliton N. Novilla; James W. Carpenter

2004-01-01

343

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...

344

Familial resemblance for abdominal visceral fat: the HERITAGE family study  

Microsoft Academic Search

OBJECTIVES: Abdominal visceral fat (AVF) is considered a risk factor for diabetes, atherogenic lipid profiles and hypertension. However, little is known about the genetic contribution to AVF as compared to total body fat. DESIGN: AVF was assessed by computerized tomography, and total body fat (fat mass) was assessed by underwater weighing in 86 families participating in the Heritage Family Study.

T Rice; JP Després; EW Daw; J Gagnon; IB Borecki; L Pérusse; AS Leon; JS Skinner; JH Wilmore; DC Rao; C Bouchard

1997-01-01

345

Visceral adipose tissue: a critical review of intervention strategies  

Microsoft Academic Search

OBJECTIVE: To review the published literature regarding the effect of caloric restriction, pharmacologic intervention, and exercise to promote the loss of visceral adipose tissue (VAT)DESIGN: A review was conducted of published studies which measured VAT using computed tomography or magnetic resonance imaging before and after caloric restriction, pharmacologic therapy, or exercise.STUDIES REVIEWED: 23 separate studies were reviewed. Men represented 38%

JJ Zachwieja; Steven R. Smith

1999-01-01

346

Visceral Fat Accumulation as a Risk Factor for Prostate Cancer  

Microsoft Academic Search

Objective: No clear association between obesity or body fat distribution and prostate cancer has been shown. We investigated the relation between visceral fat accumulation as measured by computed tomography (CT) and the occurrence of prostate cancer.Research Methods and Procedures: We compared body fat distribution assessed by a direct method (CT) in 63 prostate cancer cases with 63 age-matched healthy community

Pedro von Hafe; Francisco Pina; Ana Pérez; Margarida Tavares; Henrique Barros

2004-01-01

347

SERODIAGNOSIS AND EPIDEMIOLOGY OF VISCERAL LEISHMANIASIS IN TURKEY  

Microsoft Academic Search

Infantile Mediterranean visceral leishmaniasis (IVL) and anthroponotic cutaneous leishmaniasis (ACL) have long been known to exist in the western and southeastern Turkey, respectively. To further study these and other related diseases, a recombinant antigen (rK39) specific to VL was used in an ELISA for serodiagnosis of selected patients and for screening dog reservoir populations in several endemic sites. Among 24

SERAY OZENSOY; YUSUF OZBEL; NEVIN TURGAY; M. ZIYA ALKAN; KADRI GUL; A. GILMAN-SACHS; K.-P. CHANG; STEVEN G. REED; M. ALI OZCEL

348

Visceral larva migrans presenting with hypereosinophilia.  

PubMed

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

2013-01-01

349

Opioids in chronic noncancer pain: More faces from the crowd  

PubMed Central

BACKGROUND: The use of opioids for chronic noncancer pain (CNCP) remains very controversial. There are several randomized controlled trials, mostly in neuropathic pain, reporting efficacy and safety in the short term, but more long-term data are needed. Randomized controlled trials may be limited in providing data about the patients who benefit from often high-dose opioids over the long term. The present article provides details of these patients and adds to a previous case series. METHODS: The present article contains 17 case reports of 11 CNCP conditions (followed to 2011) selected to illustrate specific issues from a survey of 84 patients with intractable CNCP treated with opioids and followed every three months for a median of 11 years. The previous published survey of this group reported outcomes of pain severity, adverse effects, pain relief, satisfaction, mood, problematic opioid use, tolerance, physical dependency, functional status, health-related quality of life (HRQL), immune status and sexual function. The outcome measures for that study included a numerical rating scale for pain, the Hospital Anxiety and Depression Scale, the Brief Pain Inventory Interference Scale, the Pain Disability Index and, for HRQL, the Short-Form Health Survey 12 version 2. Most patients in the total sample reported 50% or greater relief and a moderate improvement in disability. Scores for functional status and HRQL were not severely affected. Problematic use, tolerance and serious adverse effects, including constipation, were not major issues. These selected patient reports were chosen, not to illustrate optimal results, but rather important aspects of the diagnoses, opioids and doses, the paucity of intolerable adverse effects, particular issues (concurrent addiction history, bipolar disorder and combination therapy), disease-specific and other outcomes and duration of follow-up with complex pain problems. RESULTS: Opioids were found to be safe and useful in the long term for these particular patients, as well as in the larger group from which they originated. INTERPRETATION: These 17 reports of patients with intractable CNCP treated with opioids with some success over many years puts a face on more of the participants in the larger survey of 84 subjects, suggesting that this approach is effective and safe for some patients over many years. PMID:22891192

Watson, C Peter N

2012-01-01

350

Peripheral Pain Mechanisms in Chronic Widespread Pain  

PubMed Central

Clinical symptoms of chronic widespread pain (CWP) conditions including fibromyalgia (FM), include pain, stiffness, subjective weakness, and muscle fatigue. Muscle pain in CWP is usually described as fluctuating and often associated with local or generalized tenderness (hyperalgesia and/or allodynia). This tenderness related to muscle pain depends on increased peripheral and/or central nervous system responsiveness to peripheral stimuli which can be either noxious (hyperalgesia) or non-noxious (allodynia). For example, patients with muscle hyperalgesia will rate painful muscle stimuli higher than normal controls, whereas patients with allodynia may perceive light touch as painful, something that a “normal” individual will never describe as painful. The pathogenesis of such peripheral and/or central nervous system changes in CWP is unclear, but peripheral soft tissue changes have been implicated. Indirect evidence from interventions that attenuate tonic peripheral nociceptive impulses in patients with CWP syndromes like FM suggest that overall FM pain is dependent on peripheral input. More importantly, allodynia and hyperalgesia can be improved or abolished by removal of peripheral impulse input. Another potential mechanism for CWP pain is central disinhibition. However, this pain mechanism also depends on tonic impulse input, even if only inadequately inhibited. Thus a promising approach to understanding CWP is to determine whether abnormal activity of receptors in deep tissues is fundamental to the development and maintenance of this chronic pain disorder. Conclusions Most CWP patients present with focal tissue abnormalities including myofascial trigger points, ligamentous trigger points, or osteoarthritis of the joints and spine. While not predictive for the development of CWP these changes nevertheless represent important pain generators that may initiate or perpetuate chronic pain. Local chemical mediators, including lactic acid, ATP, and cytokines seem to play an important role in sensitizing deep tissue nociceptors of CWP patients. Thus the combination of peripheral impulse input and increased central pain sensitivity may be responsible for wide-spread chronic pain disorders including FM. PMID:22094192

Staud, Roland

2011-01-01

351

Amygdala activity contributes to the dissociative effect of cannabis on pain perception.  

PubMed

Cannabis is reported to be remarkably effective for the relief of otherwise intractable pain. However, the bases for pain relief afforded by this psychotropic agent are debatable. Nonetheless, the frontal-limbic distribution of cannabinoid receptors in the brain suggests that cannabis may target preferentially the affective qualities of pain. This central mechanism of action may be relevant to cannabinoid analgesia in humans, but has yet to be demonstrated. Here, we employed functional magnetic resonance imaging to investigate the effects of delta-9-tetrahydrocannabinol (THC), a naturally occurring cannabinoid, on brain activity related to cutaneous ongoing pain and hyperalgesia that were temporarily induced by capsaicin in healthy volunteers. On average, THC reduced the reported unpleasantness, but not the intensity of ongoing pain and hyperalgesia: the specific analgesic effect on hyperalgesia was substantiated by diminished activity in the anterior mid cingulate cortex. In individuals, the drug-induced reduction in the unpleasantness of hyperalgesia was positively correlated with right amygdala activity. THC also reduced functional connectivity between the amygdala and primary sensorimotor areas during the ongoing-pain state. Critically, the reduction in sensory-limbic functional connectivity was positively correlated with the difference in drug effects on the unpleasantness and the intensity of ongoing pain. Peripheral mechanisms alone cannot account for the dissociative effects of THC on the pain that was observed. Instead, the data reveal that amygdala activity contributes to interindividual response to cannabinoid analgesia, and suggest that dissociative effects of THC in the brain are relevant to pain relief in humans. PMID:23273106

Lee, Michael C; Ploner, Markus; Wiech, Katja; Bingel, Ulrike; Wanigasekera, Vishvarani; Brooks, Jonathan; Menon, David K; Tracey, Irene

2013-01-01

352

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

PubMed Central

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 onset and tumor growth were monitored for 21 days. The surgical procedure performed without arthrotomy allowed recording of incidental pain in free-moving rats. Along with the gradual development of mechanical allodynia and hyperalgesia, behavioral signs of ambulatory pain were detected at day 14 by using a dynamic weight-bearing apparatus. Osteopenia was revealed from day 14 concomitantly with disorganization of the trabecular architecture (µCT). Bone metastases were visualized as early as day 8 by MRI (T1-Gd-DTPA) before pain detection. PET (Na18F) co-registration revealed intra-osseous activity, as determined by anatomical superimposition over MRI in accordance with osteoclastic hyperactivity (TRAP staining). Pain and bone destruction were aggravated with time. Bone remodeling was accompanied by c-Fos (spinal) and ATF3 (DRG) neuronal activation, sustained by astrocyte (GFAP) and microglia (Iba1) reactivity in lumbar spinal cord. Our animal model demonstrates the importance of simultaneously recording pain and tumor progression and will allow us to better characterize therapeutic strategies in the future. PMID:21048940

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

2010-01-01

353

STUDIES ON CONTROL OF VISCERAL LEISHMANIASIS: IMPACT OF DOG CONTROL ON CANINE AND HUMAN VISCERAL LEISHMANIASIS IN JACOBINA, BAHIA, BRAZIL  

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

DAVID A. ASHFORD; JOHN R. DAVID; MIRALBA FREIRE; ROBERTA DAVID; ITALO SHERLOCK

354

Exercise-Related Transient Abdominal Pain (ETAP).  

PubMed

Exercise-related transient abdominal pain (ETAP), commonly referred to as 'stitch', is an ailment well known in many sporting activities. It is especially prevalent in activities that involve repetitive torso movement with the torso in an extended position, such as running and horse riding. Approximately 70 % of runners report experiencing the pain in the past year and in a single running event approximately one in five participants can be expected to suffer the condition. ETAP is a localized pain that is most common in the lateral aspects of the mid abdomen along the costal border, although it may occur in any region of the abdomen. It may also be related to shoulder tip pain, which is the referred site from tissue innervated by the phrenic nerve. ETAP tends to be sharp or stabbing when severe, and cramping, aching, or pulling when less intense. The condition is exacerbated by the postprandial state, with hypertonic beverages being particularly provocative. ETAP is most common in the young but is unrelated to sex or body type. Well trained athletes are not immune from the condition, although they may experience it less frequently. Several theories have been presented to explain the mechanism responsible for the pain, including ischemia of the diaphragm; stress on the supportive visceral ligaments that attach the abdominal organs to the diaphragm; gastrointestinal ischemia or distension; cramping of the abdominal musculature; ischemic pain resulting from compression of the celiac artery by the median arcuate ligament; aggravation of the spinal nerves; and irritation of the parietal peritoneum. Of these theories, irritation of the parietal peritoneum best explains the features of ETAP; however, further investigations are required. Strategies for managing the pain are largely anecdotal, especially given that its etiology remains to be fully elucidated. Commonly purported prevention strategies include avoiding large volumes of food and beverages for at least 2 hours prior to exercise, especially hypertonic compounds; improving posture, especially in the thoracic region; and supporting the abdominal organs by improving core strength or wearing a supportive broad belt. Techniques for gaining relief from the pain during an episode are equivocal. This article presents a contemporary understanding of ETAP, which historically has received little research attention but over the past 15 years has been more carefully studied. PMID:25178498

Morton, Darren; Callister, Robin

2015-01-01

355

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. PMID:19470620

Marcocci, Claudio; Chanson, Philippe; Shoback, Dolores; Bilezikian, John; Fernandez-Cruz, Laureano; Orgiazzi, Jacques; Henzen, Christoph; Cheng, Sunfa; Sterling, Lulu Ren; Lu, John; Peacock, Munro

2009-01-01

356

[A case of Guillain-Barré syndrome with severe pain successfully controlled with acetaminophen, gabapentin, and parenterally infused fentanyl].  

PubMed

We presented a case of an 8-year-old boy with Guillain-Barré syndrome characterized by severe intractable pain in the soma and lower extremities, which appeared 2 weeks after a febrile cold. At his first visit to our hospital, he could not stand or walk because of the severe pain, and muscle weakness and absence of deep tendon reflexes were observed. Guillain-Barré syndrome was diagnosed on the basis of cerebrospinal fluid study results, nerve conduction velocity, and spinal cord magnetic resonance imaging. His pain was scored as a five on a six-point visual analog scale, and it persisted despite routine supportive therapy. The pain was successfully controlled with parenterally infused fentanyl. It is suspected that opioid analgesics are useful for severe pain control in patients with Guillain-Barré syndrome. PMID:25154227

Suzuki, Toshihiro; Hashimoto, Yuji; Anzai, Satoshi; Nagasawa, Kasumi

2014-07-01

357

Retroperitoneal myoma and chronic pelvic pain: case report and literature review  

Microsoft Academic Search

We present a case of a postmenopausal diabetic hypertensive female with a solitary retroperitoneal myoma (2,025 g) and no\\u000a smooth muscle (myomatic) nodules on visceral and parietal peritoneum. She complained of chronic pelvic pain in absence of\\u000a internal female genitalia (except uterine cervix), high frequency of urination, pelvic discomfort, and feeling of heaviness.\\u000a The patient had undergone hysterectomy with bilateral adnexectomies

Malina Lukanova; Ehab Akkary; Yordan Popov; Dimitar Stoykov; Margarita Nikolova

2010-01-01

358

Chronic Pain and Fatigue  

E-print Network

Chronic Pain and Fatigue Research Center Department of Anesthesiology 24 Frank Lloyd Wright Dr, information regarding this condition The UMHS Chronic Pain and Fatigue Research Center (CPFRC) offers of other pain syndromes such as irritable bowel, pelvic pain, and headaches. The FM Workshop is conducted

Shyy, Wei

359

PAIN MEDICINE POSITION PAPER  

Microsoft Academic Search

Current Status Since the 1950s, significant advances in the treatment of pain have resulted in greater relief for an increasing number of patients. However, the quality of pain care delivery in the United States continues to fall remarkably short of the current potential for optimal care. Pain medicine remains fragmented, and the absence of a unified organizational model of pain

Michel Y. Dubois; Rollin M. Gallagher; Philipp M. Lippe

2009-01-01

360

Chronic pelvic pain.  

PubMed

Chronic pelvic pain is pain lasting longer than 6 months and is estimated to occur in 15% of women. Causes of pelvic pain include disorders of gynecologic, urologic, gastroenterologic, and musculoskeletal systems. The multidisciplinary nature of chronic pelvic pain may complicate diagnosis and treatment. Treatments vary by cause but may include medicinal, neuroablative, and surgical treatments. PMID:24280400

Stein, Sharon L

2013-12-01

361

Role of hyperbaric medicine for intractable leg ulcers: a case report.  

PubMed

We present a case report of intractable multifactorial leg ulcer that was treated successfully with multiple approaches including hyperbaric oxygen treatment (HBOT) to prepare for skin grafting. A 66-year-old female with a history of rheumatoid arthritis and Felty's syndrome presented with a non-healing ulcer on her left leg that was caused by a trauma. She failed multiple treatment options including debridement, different wound dressings, antibiotics, anti-inflammatories and vein closure procedure. She finally healed with skin graft following HBOT that prepared the wound bed before the procedure. PMID:25289650

Skeik, N; Kia, F; Klosterman, D

2014-10-01

362

Low abdominal subcutaneous preadipocyte adipogenesis is associated with visceral obesity, visceral adipocyte hypertrophy, and a dysmetabolic state  

PubMed Central

Subcutaneous adipose tissue expansion through adipogenesis is increasingly recognized as a major determinant of body fat distribution and obesity-related cardiometabolic alterations. Our objective was to assess whether adipogenic rates of cultured human primary preadipocytes from the visceral and subcutaneous compartments relate to visceral obesity and cardiometabolic alterations. We recruited 35 women undergoing gynecological surgery and assessed body fat distribution by CT as well as fasting plasma lipids and glycemia. Fat samples from the greater omentum and abdominal subcutaneous (SC) compartments were used to assess mature adipocyte cell size and establish primary preadipocyte cultures. Differentiation was induced using adipogenic media and adipogenic rates were assessed using Oil Red O (ORO) absorbance/DNA content ratio and glyceraldehyde 3-phosphate dehydrogenase (G3PDH) activity/DNA of differentiated cells. We found a lower adipogenic capacity of omental (OM) preadipocytes than SC preadipocytes originating from the same women (P < 0.05). Whereas only OM cell size was different among groups of low vs high OM adipogenic rate, SC adipogenic rates were clearly related to increased OM cell size and dyslipidemia when women were separated on median value of either ORO/DNA or G3PDH activity/DNA ratios. When matched for BMI, women with low SC preadipocyte adipogenic rates had a higher visceral adipose tissue area (P < 0.01), omental adipocyte hypertrophy (P < 0.05), higher VLDL-lipid content (P < 0.01) and higher fasting glycemia (P < 0.05) than those with low SC adipogenic rates. In conclusion, low abdominal subcutaneous preadipocyte differentiation capacity in vitro is associated with visceral obesity, visceral adipocyte hypertrophy, and a dysmetabolic state. PMID:25068086

Lessard, Julie; Laforest, Sofia; Pelletier, Mélissa; Leboeuf, Mathieu; Blackburn, Line; Tchernof, André

2014-01-01

363

Opioids for neuropathic pain  

Microsoft Academic Search

Whether opioids are effective for neuropathic pain has been a matter of controversy for decades. Within limits, it is clear\\u000a that opioids in general are effective for neuropathic pain. Furthermore, there is no evidence that opioids are any less effective\\u000a for neuropathic pain than for non-neuropathic pain, no evidence that opioids are less effective for neuropathic pain than\\u000a are other

Nathaniel Katz; Christine Benoit

2005-01-01

364

Growing pains in children  

PubMed Central

We review the clinical manifestations of "growing pains", the most common form of episodic childhood musculoskeletal pain. Physicians should be careful to adhere to clear clinical criteria as described in this review before diagnosing a child with growing pain. We expand on current theories on possible causes of growing pains and describe the management of these pains and the generally good outcome in nearly all children. PMID:17550631

Uziel, Yosef; Hashkes, Philip J

2007-01-01

365

Sphingosine Lysolipids in the CNS: Endogenous Cannabinoid Antagonists or a Parallel Pain Modulatory System?  

PubMed Central

A significant number of patients experience chronic pain and the intractable side effects of currently prescribed pain medications. Recent evidence indicates important pain modulatory roles for two classes of G-protein-coupled receptors that are activated by endogenous lipid ligands, the endocannabinoid (eCB) and sphingosine-1-phosphate (S1P) receptors, which are widely expressed in both the immune and nervous systems. In the central nervous system (CNS), CB1 cannabinoid and S1P1 receptors are most abundantly expressed and exhibit overlapping anatomical distributions and similar signaling mechanisms. The eCB system has emerged as a potential target for treatment of chronic pain, but comparatively little is known about the roles of S1P in pain regulation. Both eCB and S1P systems modulate pain perception via the central and peripheral nervous systems. In most paradigms studied, the eCB system mainly inhibits pain perception. In contrast, S1P acting peripherally at S1P1 and S1P3 receptors can enhance sensitivity to various pain stimuli or elicit spontaneous pain. However, S1P acting at S1P1 receptors and possibly other targets in the CNS can attenuate sensitivity to various pain stimuli. Interestingly, other endogenous sphingolipid derivatives might play a role in central pain sensitization. Moreover, these sphingolipids can also act as CB1 cannabinoid receptor antagonists, but the physiological relevance of this interaction is unknown. Overall, both eCB and sphingolipid systems offer promising targets for the treatment of chronic pain. This review compares and contrasts the eCB and S1P systems with a focus on their roles in pain modulation, and considers possible points of interaction between these systems. PMID:23782998

Selley, Dana E.; Welch, Sandra P.; Sim-Selley, Laura J.

2014-01-01

366

Breakthrough pain: characteristics and impact in patients with cancer pain  

Microsoft Academic Search

Few surveys have been performed to define the characteristics and impact of breakthrough pain in the cancer population. In this cross-sectional survey of inpatients with cancer, patients responded to a structured interview (the Breakthrough Pain Questionnaire) designed to characterize breakthrough pain, and also completed measures of pain and mood (Memorial Pain Assessment Card (MPAC)), pain-related interference in function (Brief Pain

Russell K Portenoy; David Payne; Paul Jacobsen

1999-01-01

367

Transient receptor potential ankyrin 1 mediates chronic pancreatitis pain in mice  

PubMed Central

Chronic pancreatitis (CP) is a devastating disease characterized by persistent and uncontrolled abdominal pain. Our lack of understanding is partially due to the lack of experimental models that mimic the human disease and also to the lack of validated behavioral measures of visceral pain. The ligand-gated cation channel transient receptor potential ankyrin 1 (TRPA1) mediates inflammation and pain in early experimental pancreatitis. It is unknown if TRPA1 causes fibrosis and sustained pancreatic pain. We induced CP by injecting the chemical agent trinitrobenzene sulfonic acid (TNBS), which causes severe acute pancreatitis, into the pancreatic duct of C57BL/6 trpa1+/+ and trpa1-/- mice. Chronic inflammatory changes and pain behaviors were assessed after 2–3 wk. TNBS injection caused marked pancreatic fibrosis with increased collagen-staining intensity, atrophy, fatty replacement, monocyte infiltration, and pancreatic stellate cell activation, and these changes were reflected by increased histological damage scores. TNBS-injected animals showed mechanical hypersensitivity during von Frey filament probing of the abdomen, decreased daily voluntary wheel-running activity, and increased immobility scores during open-field testing. Pancreatic TNBS also reduced the threshold to hindpaw withdrawal to von Frey filament probing, suggesting central sensitization. Inflammatory changes and pain indexes were significantly reduced in trpa1-/- mice. In conclusion, we have characterized in mice a model of CP that resembles the human condition, with marked histological changes and behavioral measures of pain. We have demonstrated, using novel and objective pain measurements, that TRPA1 mediates inflammation and visceral hypersensitivity in CP and could be a therapeutic target for the treatment of sustained inflammatory abdominal pain. PMID:23558009

Cattaruzza, Fiore; Johnson, Cali; Leggit, Alan; Grady, Eileen; Schenk, A. Katrin; Cevikbas, Ferda; Cedron, Wendy; Bondada, Sandhya; Kirkwood, Rebekah; Malone, Brian; Steinhoff, Martin; Bunnett, Nigel

2013-01-01

368

Transient receptor potential ankyrin 1 mediates chronic pancreatitis pain in mice.  

PubMed

Chronic pancreatitis (CP) is a devastating disease characterized by persistent and uncontrolled abdominal pain. Our lack of understanding is partially due to the lack of experimental models that mimic the human disease and also to the lack of validated behavioral measures of visceral pain. The ligand-gated cation channel transient receptor potential ankyrin 1 (TRPA1) mediates inflammation and pain in early experimental pancreatitis. It is unknown if TRPA1 causes fibrosis and sustained pancreatic pain. We induced CP by injecting the chemical agent trinitrobenzene sulfonic acid (TNBS), which causes severe acute pancreatitis, into the pancreatic duct of C57BL/6 trpa1(+/+) and trpa1(-/-) mice. Chronic inflammatory changes and pain behaviors were assessed after 2-3 wk. TNBS injection caused marked pancreatic fibrosis with increased collagen-staining intensity, atrophy, fatty replacement, monocyte infiltration, and pancreatic stellate cell activation, and these changes were reflected by increased histological damage scores. TNBS-injected animals showed mechanical hypersensitivity during von Frey filament probing of the abdomen, decreased daily voluntary wheel-running activity, and increased immobility scores during open-field testing. Pancreatic TNBS also reduced the threshold to hindpaw withdrawal to von Frey filament probing, suggesting central sensitization. Inflammatory changes and pain indexes were significantly reduced in trpa1(-/-) mice. In conclusion, we have characterized in mice a model of CP that resembles the human condition, with marked histological changes and behavioral measures of pain. We have demonstrated, using novel and objective pain measurements, that TRPA1 mediates inflammation and visceral hypersensitivity in CP and could be a therapeutic target for the treatment of sustained inflammatory abdominal pain. PMID:23558009

Cattaruzza, Fiore; Johnson, Cali; Leggit, Alan; Grady, Eileen; Schenk, A Katrin; Cevikbas, Ferda; Cedron, Wendy; Bondada, Sandhya; Kirkwood, Rebekah; Malone, Brian; Steinhoff, Martin; Bunnett, Nigel; Kirkwood, Kimberly S

2013-06-01

369

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. PMID:23537331

2013-01-01

370

Intractable Persistent Direction-Changing Geotropic Nystagmus Improved by Lateral Semicircular Canal Plugging  

PubMed Central

Antigravitational deviation of the cupula of the lateral semicircular canal, which is also called light cupula, evokes persistent direction-changing geotropic nystagmus with a neutral point. No intractable cases of this condition have been reported. In our case, a 67-year-old man complained of positional vertigo 3 months after developing idiopathic sudden hearing loss in the right ear with vertigo. He showed a persistent direction-changing geotropic nystagmus with a leftward beating nystagmus in the supine position. The nystagmus resolved when his head was turned approximately 30° to the right. He was diagnosed with light cupula of the right lateral semicircular canal and was subsequently treated with an antivertiginous agent. However, his symptoms and positional nystagmus did not improve, so the right lateral semicircular canal was plugged by surgery. One month after surgery, his positional vertigo and nystagmus were completely resolved. We speculated that the cause of the patient's intractable light cupula was an enlarged cupula caused by his idiopathic sudden hearing loss.

Saito, Kazuya; Doi, Katsumi

2015-01-01

371

A Monte Carlo Metropolis-Hastings algorithm for sampling from distributions with intractable normalizing constants.  

PubMed

Simulating from distributions with intractable normalizing constants has been a long-standing problem in machine learning. In this letter, we propose a new algorithm, the Monte Carlo Metropolis-Hastings (MCMH) algorithm, for tackling this problem. The MCMH algorithm is a Monte Carlo version of the Metropolis-Hastings algorithm. It replaces the unknown normalizing constant ratio by a Monte Carlo estimate in simulations, while still converges, as shown in the letter, to the desired target distribution under mild conditions. The MCMH algorithm is illustrated with spatial autologistic models and exponential random graph models. Unlike other auxiliary variable Markov chain Monte Carlo (MCMC) algorithms, such as the Møller and exchange algorithms, the MCMH algorithm avoids the requirement for perfect sampling, and thus can be applied to many statistical models for which perfect sampling is not available or very expensive. The MCMH algorithm can also be applied to Bayesian inference for random effect models and missing data problems that involve simulations from a distribution with intractable integrals. PMID:23607562

Liang, Faming; Jin, Ick-Hoon

2013-08-01

372

Benzodiazepine sensitivity testing in the management of intractable seizure disorders in childhood.  

PubMed

The use of benzodiazepine sensitivity testing in the management of 40 children with intractable seizure disorders was studied. The aetiology and clinical syndromes varied widely with myoclonic, atonic and complex absence seizures predominating. Twenty-five cases had mixed seizure disorders. There was, likewise, a wide range of EEG abnormalities. Seven cases were in non-convulsive status at the time of testing. Diazepam (0.2 mg/kg) was given slowly intravenously and its effect on the EEG was observed. In 21 cases epileptiform activity was abolished. No change was seen in 13 cases and an unusual result was seen in 3. There was a paradoxical response in 3 cases, two of these associated with clinical seizures. Only 1 child in non-convulsive status had a positive result. Following testing, 32 patients went on to long-term oral benzodiazepine treatment. Twenty-one of these patients showed subsequent clinical improvement and 16/21 (76%) had had a positive sensitivity test previously. Eleven of these patients did not improve on long-term treatment. Seven out of the 11 (64%) had had a negative sensitivity test. These results suggest that the benzodiazepine sensitivity test is of value in the long-term management of intractable seizure disorders in childhood, but also emphasise the variability and unpredictability of response to benzodiazepine treatment. PMID:2441952

Livingston, J H; Anderson, A; Brown, J K; McInnes, A

1987-09-01

373

Treatment of intractable arterial hemorrhage during stereotactic brain biopsy with thrombin. Report of three patients.  

PubMed

Of 165 consecutive patients undergoing computerized tomography- or magnetic resonance imaging-guided stereotactic brain biopsies at the Cleveland Clinic between June, 1987, and November, 1989, four patients (2.4%) developed arterial hemorrhage refractory to conventional efforts to secure hemostasis. Craniotomy was performed in one of these patients to control the hemorrhage; in the other three, 0.5 to 2 cc of thrombin (5000 U/cc) was slowly injected via the biopsy cannula, resulting in immediate control of bleeding in all three cases. Postoperatively, the first two patients treated with 1 to 2 cc of thrombin were slow to awaken; one had evidence of vasospasm by transcranial Doppler ultrasound studies and multiple infarcts on cranial computerized tomography, while the other had a moderate-sized frontal hematoma with intracranial hypertension. After prolonged recovery periods, only mild neurological deficits persisted in both patients. The third patient, treated with 0.5 cc of thrombin, had an uneventful postoperative course. Thrombin is highly effective for stopping intractable arterial hemorrhage during stereotactic brain biopsy; however, it is a vasospastic agent and may have been responsible for the cerebral infarctions in one patient. Therefore, thrombin should be used only as a last resort, short of craniotomy, to control intractable arterial hemorrhage during stereotactic brain biopsy. PMID:1988604

Chimowitz, M I; Barnett, G H; Palmer, J

1991-02-01

374

Tackling learning intractability through topological organization and regulation of cortical networks.  

PubMed

A key challenge in evolving control systems for robots using neural networks is training tractability. Evolving monolithic fixed topology neural networks is shown to be intractable with limited supervision in high dimensional search spaces. Common strategies to overcome this limitation are to provide more supervision by encouraging particular solution strategies, manually decomposing the task and segmenting the search space and network. These strategies require a supervisor with domain knowledge and may not be feasible for difficult tasks where novel concepts are required. The alternate strategy is to use self-organized task decomposition to solve difficult tasks with limited supervision. The artificial neural tissue (ANT) approach presented here uses self-organized task decomposition to solve tasks. ANT inspired by neurobiology combines standard neural networks with a novel wireless signaling scheme modeling chemical diffusion of neurotransmitters. These chemicals are used to dynamically activate and inhibit wired network of neurons using a coarse-coding framework. Using only a global fitness function that does not encourage a predefined solution, modular networks of neurons are shown to self-organize and perform task decomposition. This approach solves the sign-following task found to be intractable with conventional fixed and variable topology networks. In this paper, key attributes of the ANT architecture that perform self-organized task decomposition are shown. The architecture is robust and scalable to number of neurons, synaptic connections, and initialization parameters. PMID:24805039

Thangavelautham, Jekanthan; D'Eleuterio, Gabriele M T

2012-04-01

375

Acid sensing by visceral afferent neurons  

PubMed Central

Acidosis in the gastrointestinal tract can be both a physiological and pathological condition. While gastric acid serves digestion and protection from pathogens, pathological acidosis is associated with defective acid containment, inflammation and ischaemia. The pH in the oesophagus, stomach and intestine is surveyed by an elaborate network of acid-sensing mechanisms to maintain homeostasis. Deviations from physiological values of extracellular pH (7.4) are monitored by multiple acid sensors expressed by epithelial cells and sensory neurons. Protons evoke multiple currents in primary afferent neurons, which are carried by several acid-sensitive ion channels. Among these, acid-sensing ion channels (ASICs) and transient receptor potential (TRP) vanilloid-1 (TRPV1) ion channels have been most thoroughly studied. ASICs survey moderate decreases in extracellular pH whereas TRPV1 is activated only by severe acidosis resulting in pH values below 6. Other molecular acid sensors comprise TRPV4, TRPC4, TRPC5, TRPP2 (PKD2L1), epithelial Na+ channels, two-pore domain K+ (K2P) channels, ionotropic purinoceptors (P2X), inward rectifier K+ channels, voltage-activated K+ channels, L-type Ca2+ channels and acid-sensitive G protein-coupled receptors. Most of these acid sensors are expressed by primary sensory neurons, although to different degrees and in various combinations. Since upregulation and overactivity of acid sensors appear to contribute to various forms of chronic inflammation and pain, acid-sensitive ion channels and receptors are also considered as targets for novel therapeutics. PMID:20456281

Holzer, Peter

2011-01-01

376

Omega-Conotoxins as Experimental Tools and Therapeutics in Pain Management  

PubMed Central

Neuropathic pain afflicts a large percentage of the global population. This form of chronic, intractable pain arises when the peripheral or central nervous systems are damaged, either directly by lesion or indirectly through disease. The comorbidity of neuropathic pain with other diseases, including diabetes, cancer, and AIDS, contributes to a complex pathogenesis and symptom profile. Because most patients present with neuropathic pain refractory to current first-line therapeutics, pharmaceuticals with greater efficacy in pain management are highly desired. In this review we discuss the growing application of ?-conotoxins, small peptides isolated from Conus species, in the management of neuropathic pain. These toxins are synthesized by predatory cone snails as a component of paralytic venoms. The potency and selectivity with which ?-conotoxins inhibit their molecular targets, voltage-gated Ca2+ channels, is advantageous in the treatment of neuropathic pain states, in which Ca2+ channel activity is characteristically aberrant. Although ?-conotoxins demonstrate analgesic efficacy in animal models of neuropathic pain and in human clinical trials, there remains a critical need to improve the convenience of peptide drug delivery methods, and reduce the number and severity of adverse effects associated with ?-conotoxin-based therapies. PMID:23470283

Hannon, Heidi E.; Atchison, William D.

2013-01-01

377

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

E-print Network

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 onset and tumor growth were monitored for 21 days. The surgical procedure performed without arthrotomy allowed recording of incidental pain in free-moving rats. Along with the gradual development of mechanical allodynia and hyperalgesia, behavioral signs of ambulatory pain were detected at day 14 by using a dynamic weight-bearing apparatus. Osteopenia was revealed from day 14 concomitantly with disorganization of the trabecular architecture (mCT). Bone metastases were visualized as early as day 8 by MRI (T1-Gd-DTPA) before pain detection. PET (Na 18 F) co-registration revealed intra-osseous activity, as determined by anatomical superimposition over MRI in accordance with osteoclastic hyperactivity (TRAP staining). Pain and bone destruction were aggravated with time. Bone remodeling was accompanied by c-Fos (spinal) and ATF3 (DRG) neuronal activation, sustained by astrocyte (GFAP) and microglia (Iba1) reactivity in lumbar spinal cord. Our animal model demonstrates the importance of simultaneously

Louis Doré-savard; Valérie Otis; Karine Belleville; Myriam Lemire; Mélanie Archambault; Jean-françois Beaudoin; Nicolas Beaudet; Roger Lecomte; Martin Lepage

378

An Introduction Significance of Pain  

E-print Network

Inflammation or nerve damage !!65 -90 million in US !!Arthritis !!Neuropathic pain !!Back pain !!MigraineAn Introduction to: Pain #12;Significance of Pain !!Pain is adaptive !!Alerts us to danger !!Motivates escape and avoidance learning !!Motivates recuperation !!Congenital insensitivity to pain !!Pain

Meagher, Mary

379

[Pain therapy in irritable bowel syndrome].  

PubMed

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal diseases. It is characterized by chronic abdominal pain, typically associated with altered bowel habits that cannot be explained by structural abnormalities in routine diagnostic workup. Based on the predominant symptom, IBS can be divided into different subtypes: IBS with predominant constipation, diarrhea, bloating, or pain. Knowledge about the complex and multifactorial IBS pathophysiology has increased tremendously in recent years, e.g., IBS may be related to alterations in gastrointestinal motility, visceral sensitivity, and the mucosal immune system. It is important, both for the patient and the physician, that IBS diagnosis is made quickly and thoroughly based on the typical symptom complex and exclusion of relevant differential diagnoses and to reassure the patient that IBS is a chronic, but benign disease. These components are the fundamental basis for a good patient-physician relationship and for a successful long-term management of this potentially very compromising disorder. IBS therapy is based on general measures as well as symptom-oriented medical therapy, where improvement of abdominal pain is one of the main goals in treating IBS patients. Several pain treatment options are available, which may be used long-term or on demand and which may be combined with other therapies. General medical approaches include antispasmodics, improvement of bowel function, phytotherapy, and probiotics. Especially in patients with psychological comorbidities, antidepressants may be used. Modern drug treatments include the GC-C agonist linaclotide in IBS with predominant constipation, the locally acting antibiotic rifaximin in IBS with bloating, and 5-HT3 antagonists in IBS with predominant diarrhea. Psychotherapy should be included in an interdisciplinary approach in refractory cases or in psychological comorbidity. PMID:24903042

de Greck, M; Layer, P; Andresen, V

2014-06-01

380

Control of Cholangiocyte Adaptive Responses by Visceral Hormones and Neuropeptides  

PubMed Central

Cholangiocytes, the epithelial cells lining the biliary tree, are the target cells in several liver diseases, termed cholangiopathies. Cholangiopathies are a challenge for clinicians and an enigma for scientists, as the pathogenetic mechanisms by which they develop, and the therapeutic tools for these diseases are still undefined. Several studies demonstrate that many visceral hormones, neuropeptides, and neurotransmitters modulate the adaptive changes of cholangiocytes to chronic cholestatic injury. The aim of this review is to present the recent findings that contributed to clarify the role of visceral hormones and neuropeptides in the regulation of the pathophysiology of cholestasis. These studies helped to shed light on some aspects of cholangiocyte pathophysiology, revealing novel perspectives for the clinical managements of cholangiopathies. PMID:18548352

Fava, Giammarco; Alvaro, Domenico; Alpini, Gianfranco; Benedetti, Antonio

2008-01-01

381

Visceral leishmaniasis in captive wild canids in Brazil.  

PubMed

Visceral leishmaniasis (VL) is endemic in Belo Horizonte (State of Minas Gerais, Brazil). Leishmania sp. can naturally infect several species of mammals, and the domestic dog is the most important reservoir of the disease in South America. This report describes five cases of visceral leishmaniasis in Brazilian canids. Among 15 animals kept in captivity in a zoo in Belo Horizonte (State of Minas Gerais, Brazil), two animals, a bush dog (Spheotos venaticos) and a hoary zorro (Lycalopex vetulus) were serologically positive and developed clinical signs of VL, whereas three other canids, including a crab-eating fox (Cerdocyon thous), a maned wolf (Chrysocyon brachyurus), and a hoary zorro (Lycalopex vetulus) had positive serological results without clinical signs. PMID:18556130

Luppi, Marcela M; Malta, Marcelo C C; Silva, Teane M A; Silva, Fabiana L; Motta, Rafael O C; Miranda, Ildikó; Ecco, Roselene; Santos, Renato L

2008-08-01

382

Visceral leishmaniasis with endobronchial involvement in an immunocompetent adult.  

PubMed

Visceral leishmaniasis is characterized by fever, cachexia, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia. Cough may be a presenting symptom as well. However, pulmonary involvement is considered rare and mainly described in immunocompromised patients. We describe a case of an immunocompetent adult whose clinical presentation was dominated by cough and hemoptysis. Bronchoscopy revealed a discreet polypoid mucosal endobronchial lesion whose biopsy yielded Leishmania amastigotes within histiocytes. Transbronchial needle biopsy of a right paratracheal lymph node was also positive. Leishmania amastigotes were also found on bone marrow and liver biopsies. Treatment with IV Amphotericin B was successful. In conclusion, cough should not be overlooked as a presenting symptom of visceral leishmaniasis and may be a sign of pulmonary involvement. PMID:21577261

Kotsifas, Konstantinos; Metaxas, Eugenios; Koutsouvelis, Ioannis; Skoutelis, Athanassios; Kara, Panayiota; Tatsis, George

2011-01-01

383

[Imported visceral leishmaniasis (kala azar) in a German infant].  

PubMed

We here report the case of a 1 4/12 year old girl with visceral leishmaniasis. Returning from a trip to Mallorca she presented with pancytopenia, splenomegaly and fever and was admitted to hospital with suspected malignancy. Diagnosis was established microscopically from bone marrow smear and confirmed by PCR-assisted amplification of leishmania-specific DNA from peripheral blood. Treatment was conducted with stibogluconate for 25 days. Defervescence and improvement of clinical symptoms was seen after 4 days of treatment. Infection due to Leishmania donovani can be acquired throughout the entire mediterranean area and should therefore be included in the differential diagnosis of suspected malignancies in patients with a history of travel to mediterranean countries. PCR proved to be a sensitive tool for establishing the diagnosis of visceral leishmaniasis. PMID:8569138

Emeis, M; Liesenfeld, O; Henze, G; Meredith, S; Schoone, G; Stück, B

1995-01-01

384

When Math Hurts: Math Anxiety Predicts Pain Network Activation in Anticipation of Doing Math  

PubMed Central

Math can be difficult, and for those with high levels of mathematics-anxiety (HMAs), math is associated with tension, apprehension, and fear. But what underlies the feelings of dread effected by math anxiety? Are HMAs’ feelings about math merely psychological epiphenomena, or is their anxiety grounded in simulation of a concrete, visceral sensation – such as pain – about which they have every right to feel anxious? We show that, when anticipating an upcoming math-task, the higher one’s math anxiety, the more one increases activity in regions associated with visceral threat detection, and often the experience of pain itself (bilateral dorso-posterior insula). Interestingly, this relation was not seen during math performance, suggesting that it is not that math itself hurts; rather, the anticipation of math is painful. Our data suggest that pain network activation underlies the intuition that simply anticipating a dreaded event can feel painful. These results may also provide a potential neural mechanism to explain why HMAs tend to avoid math and math-related situations, which in turn can bias HMAs away from taking math classes or even entire math-related career paths. PMID:23118929

Lyons, Ian M.; Beilock, Sian L.

2012-01-01

385

Control of visceral leishmaniasis in Brazil: recommendations from Brasileish  

PubMed Central

On 26 October 2012, veterinary medicine clinicians and researchers, members of Brasileish - Study Group about Animal Leishmaniasis - met at the Regional Council of Veterinary Medicine of Minas Gerais, in the city Belo Horizonte, in order to discuss many aspects of the situation of canine visceral leishmaniasis (CVL) in Brazil. In the face of recent national and international scientific evidence, we, the members of Brasileish, have elaborated some recommendations for the management and control of CVL in Brazil. PMID:23311342

2013-01-01

386

Characterization of Leishmania isolates from Nepalese patients with visceral leishmaniasis  

Microsoft Academic Search

In Nepal, visceral leishmaniasis (VL) is endemic in 13 districts of the central and eastern regions. A total of 166 bone-marrow\\u000a aspirates were obtained from patients with suspected VL. Ninety-seven were identified as positive by microscopy, and 29 of\\u000a those were successfully isolated and cultured. We characterized these isolates by molecular analysis and by their ability\\u000a to infect mice. PCR-restriction

Kishor Pandey; Testuo Yanagi; Basu Dev Pandey; Arun Kumar Mallik; Jeevan Bahadur Sherchand; Hiroji Kanbara

2007-01-01

387

Sagittal abdominal diameter as a practical predictor of visceral fat  

Microsoft Academic Search

OBJECTIVE: To evaluate the relationships between the supine sagittal abdominal diameter (SAD) and visceral fat, as well as to evaluate intra- and inter-observer reliability of sagittal diameter measurement.PATIENTS: Twenty-eight women ranging in age from 27–78 y with a body mass index (BMI) ranging from 16.9–48.1 kg\\/m2 and 23 men ranging in age from 32–75 y with BMI ranging from 20–41.6

M Zamboni; E Turcato; F Armellini; HS Kahn; A Zivelonghi; H Santana; IA Bergamo-Andreis; O Bosello

1998-01-01

388

Fast and Accurate Ultrasonography for Visceral Fat Measurement  

Microsoft Academic Search

\\u000a Visceral fat area (VFA) has close relationship with hypertension, diabetes and cardiovascular disease, and therefore serve\\u000a as a reliable indicator of these diseases. Abdominal computed tomography (CT) enables precise quantification of the VFA and\\u000a has been considered as the gold standard for VFA assessment. In this paper, we develope a novel method to quickly and accurately\\u000a measure the VFA with

You Zhou; Norihiro Koizumi; Naoto Kubota; Takaharu Asano; Kazuhito Yuhashi; Takashi Mochizuki; Takashi Kadowaki; Ichiro Sakuma; Hongen Liao

2010-01-01

389

Circulating pancreatic polypeptide concentrations predict visceral and liver fat content.  

PubMed

Context and objective: No current biomarker can reliably predict visceral and liver fat content, both of which are risk factors for cardiovascular disease. Vagal tone has been suggested to influence regional fat deposition. Pancreatic polypeptide (PP) is secreted from the endocrine pancreas under vagal control. We investigated the utility of PP in predicting visceral and liver fat. Patients and Methods: Fasting plasma PP concentrations were measured in 104 overweight and obese subjects (46 men and 58 women). In the same subjects, total and regional adipose tissue, including total visceral adipose tissue (VAT) and total subcutaneous adipose tissue (TSAT), were measured using whole body magnetic resonance imaging (MRI). Intrahepatocellular lipid content (IHCL) was quantified by proton magnetic resonance spectroscopy ((1)H-MRS). Results: Fasting plasma PP concentrations positively and significantly correlated with both VAT (r=0.57, p<0.001) and IHCL (r=0.51, p <0.001), but not with TSAT (r=0.02, p=0.88). Fasting PP concentrations independently predicted VAT after controlling for age and gender. Fasting PP concentrations independently predicted IHCL after controlling for age, gender, BMI, WHR, HOMA2-IR and serum concentrations of triglyceride (TG), total cholesterol (TC) and alanine aminotransferase (ALT). Fasting PP concentrations were associated with serum ALT, TG, TC, LDL and HDL cholesterol and blood pressure (p<0.05). These associations were mediated by IHCL and/or VAT. Fasting PP and HOMA2-IR were independently significantly associated with hepatic steatosis (p<0.01). Conclusions: Pancreatic polypeptide is a novel predictor of visceral and liver fat content, and thus a potential biomarker for cardiovascular risk stratification and targeted treatment of patients with ectopic fat deposition. PMID:25490276

Sam, Amir H; Sleeth, Michelle L; Thomas, E Louise; Ismail, Nurhafzan A; Mat Daud, Norlida; Chambers, Edward; Shojaee-Moradie, Fariba; Umpleby, A Margot; Goldstone, Anthony P; Le Roux, Carel W; Bech, Paul; Busbridge, Mark; Laurie, Rosemary; Cuthbertson, Daniel J; Buckley, Adam; Ghatei, Mohammad A; Bloom, Stephen R; Frost, Gary S; Bell, Jimmy D; Murphy, Kevin G

2014-12-01

390

Improved Outcomes in Postoperative and Pancreatitis-related Visceral Pseudoaneurysms  

Microsoft Academic Search

Pseudoaneurysm (PSA) of the visceral arterial tree is an uncommon but highly lethal complication of pancreatic surgery and\\u000a pancreatitis. Surgical and angiographic interventions are used in treatment; however, optimal therapy remains unclear. We\\u000a hypothesized that the natural history of PSA is different in these discrete clinical settings. From 1995–2005, 37 patients\\u000a with PSA were treated: 13 after pancreatic surgery and

Nicholas J. Zyromski; Carlos Vieira; Michael Stecker; Attila Nakeeb; Henry A. Pitt; Keith D. Lillemoe; Thomas J. Howard

2007-01-01

391

Selective visceral angiography in obscure postoperative gastrointestinal bleeding.  

PubMed Central

Postoperative gastrointestinal bleeding may be difficult to diagnose and treat. Selective visceral angiography localised the bleeding site in seven out of ten episodes of obscure postoperative gastrointestinal haemorrhage, and in two cases radiological embolisation was used successfully to control the bleeding. Angiography, preferably during an episode of haemorrhage, is recommended whenever possible for patients with undiagnosed postoperative gastrointestinal bleeding. Images Fig. 1 Fig. 2a Fig. 2b Fig. 3a Fig. 3b PMID:3499838

Ng, B. L.; Thompson, J. N.; Adam, A.; Spencer, J.; Hemingway, A. P.; Blumgart, L. H.; Allison, D. J.

1987-01-01

392

First Case of Visceral Leishmaniasis Caused by Leishmania martiniquensis.  

PubMed

We report the first case of visceral leishmaniasis (VL) caused by Leishmania martiniquensis in the Caribbean, which until now, was known only to cause cutaneous leishmaniasis. The disease presented with fatigue, anemia, and hepatosplenomegaly in a 61-year-old man with human immunodeficiency virus (HIV) infection who was receiving antiretroviral therapy. Diagnosis was made by bone marrow biopsy. VL is life-threatening, and its emergence in the Caribbean is of concern. PMID:25404076

Liautaud, Bernard; Vignier, Nicolas; Miossec, Charline; Plumelle, Yves; Kone, Moumini; Delta, Delphine; Ravel, Christophe; Cabié, André; Desbois, Nicole

2015-02-01

393

Central modulation of pain  

PubMed Central

It has long been appreciated that the experience of pain is highly variable between individuals. Pain results from activation of sensory receptors specialized to detect actual or impending tissue damage (i.e., nociceptors). However, a direct correlation between activation of nociceptors and the sensory experience of pain is not always apparent. Even in cases in which the severity of injury appears similar, individual pain experiences may vary dramatically. Emotional state, degree of anxiety, attention and distraction, past experiences, memories, and many other factors can either enhance or diminish the pain experience. Here, we review evidence for “top-down” modulatory circuits that profoundly change the sensory experience of pain. PMID:21041960

Ossipov, Michael H.; Dussor, Gregory O.; Porreca, Frank

2010-01-01

394

Pediatric pain management.  

PubMed

It is now recognized that from the newborn period onwards, children are capable of experiencing pain. This includes the premature infant. The challenge for healthcare providers is to incorporate methods of pain assessment and treatment into their daily practices. The child's understanding of pain closely follows the cognitive and behavioral model developed by Jean Piaget. Based on these developmental stages, pain assessment measures have been developed. Pharmacologic advances have accompanied this improved understanding of infant, child, and adolescent psychology. While acute pain accounts for the majority of children's experiences, recurrent/chronic pain states do occur (e.g. sickle cell related and neuropathic) and can be effectively treated. PMID:9037997

Lederhaas, G

1997-01-01

395

Heritability of nociception IV: neuropathic pain assays are genetically distinct across methods of peripheral nerve injury.  

PubMed

Prior genetic correlation analysis of 22 heritable behavioral measures of nociception and hypersensitivity in the mouse identified 5 genetically distinct pain types. In the present study, we reanalyzed that dataset and included the results of an additional 9 assays of nociception and hypersensitivity, with the following goals: to replicate the previously identified 5 pain types; to test whether any of the newly added pain assays represent novel genetically distinct pain types; and to test the level of genetic relatedness among 9 commonly used neuropathic pain assays. Multivariate analysis of pairwise correlations between assays shows that the newly added zymosan-induced heat hypersensitivity assay does not conform to the 2 previously identified groups of heat hypersensitivity assays and cyclophosphamide-induced cystitis, the first organ-specific visceral pain model examined, is genetically distinct from other inflammatory assays. The 4 included mechanical hypersensitivity assays are genetically distinct and do not comprise a single pain type as previously reported. Among the 9 neuropathic pain assays including autotomy, chemotherapy, nerve ligation and spared nerve injury assays, at least 4 genetically distinct types of neuropathic sensory abnormalities were identified, corresponding to differences in nerve injury method. In addition, 2 itch assays and Comt genotype were compared to the expanded set of nociception and hypersensitivity assays. Comt genotype was strongly related only to spontaneous inflammatory nociception assays. These results indicate the priority for continued investigation of genetic mechanisms in several assays newly identified to represent genetically distinct pain types. PMID:24071598

Young, Erin E; Costigan, Michael; Herbert, Teri A; Lariviere, William R

2014-05-01

396

Tryptase-PAR2 axis in experimental autoimmune prostatitis, a model for chronic pelvic pain syndrome.  

PubMed

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) affects up to 15% of the male population and is characterized by pelvic pain. Mast cells are implicated in the murine experimental autoimmune prostatitis (EAP) model as key to chronic pelvic pain development. The mast cell mediator tryptase-? and its cognate receptor protease-activated receptor 2 (PAR2) are involved in mediating pain in other visceral disease models. Prostatic secretions and urines from CP/CPPS patients were examined for the presence of mast cell degranulation products. Tryptase-? and PAR2 expression were examined in murine EAP. Pelvic pain and inflammation were assessed in the presence or absence of PAR2 expression and upon PAR2 neutralization. Tryptase-? and carboxypeptidase A3 were elevated in CP/CPPS compared to healthy volunteers. Tryptase-? was capable of inducing pelvic pain and was increased in EAP along with its receptor PAR2. PAR2 was required for the development of chronic pelvic pain in EAP. PAR2 signaling in dorsal root ganglia led to extracellular signal-regulated kinase (ERK)1/2 phosphorylation and calcium influx. PAR2 neutralization using antibodies attenuated chronic pelvic pain in EAP. The tryptase-PAR2 axis is an important mediator of pelvic pain in EAP and may play a role in the pathogenesis of CP/CPPS. PMID:24726923

Roman, Kenny; Done, Joseph D; Schaeffer, Anthony J; Murphy, Stephen F; Thumbikat, Praveen

2014-07-01

397

Association Between Visceral Adiposity and Colorectal Polyps on CT Colonography  

PubMed Central

OBJECTIVE To determine if there is an association between visceral adiposity measured on CT colonography (CTC) and colorectal polyps. MATERIALS AND METHODS The study was HIPAA-compliant and approved by our Institutional Review Board and Office of Human Subjects Research. 1186 patients who underwent CTC and same day optical colonoscopy were analyzed. Visceral adipose tissue volumes (VAV) and volume percents relative to total internal body volume (VAV%) were measured on slices in the L2–L3 regions on supine CTC scan with validated fully-automated software. Student t-test, odds ratio (OR), logistic regression and receiver operating characteristic analyses were performed. RESULTS For subjects with and without adenomatous polyps, means and s. d. of VAV% were 31.2 ± 10.8% (n=345) and 28.2% ± 11.3% (n=841) (p<0.0001), respectively. For subjects with and without hyperplastic polyps they were 31.8% ± 10.7% (n=244) and 28.3% ± 11.2% (n=942) (p<0.0001), respectively. Comparing the lowest and highest quintiles of VAV%, the ORs for having at least one adenomatous polyp or hyperplastic polyp versus no polyp were 2.06 (95% CI: 1.36–3.13) and 1.71 [1.08, 2.71] and the prevalence of having adenomatous polyps or hyperplastic polyps increased 14% and 8%, respectively. CONCLUSION Subjects with higher visceral adiposity measurements on CTC have a greater risk for the presence of colonic polyps. PMID:22733893

Summers, Ronald M.; Liu, Jiamin; Sussman, Daniel L.; Dwyer, Andrew J.; Rehani, Bhavya; Pickhardt, Perry J.; Choi, J. Richard; Yao, Jianhua

2012-01-01

398

Loin pain hematuria syndrome.  

PubMed

Loin pain hematuria syndrome is a rare disease with a prevalence of ?0.012%. The most prominent clinical features include periods of severe intermittent or persistent unilateral or bilateral loin pain accompanied by either microscopic or gross hematuria. Patients with loin pain hematuria syndrome initially present with hematuria, flank pain, or most often both hematuria and flank pain. Kidney biopsies from patients with loin pain hematuria typically reveal only minor pathologic abnormalities. Further, loin pain hematuria syndrome is not associated with loss of kidney function or urinary tract infections. Loin pain hematuria syndrome-associated hematuria and pain are postulated to be linked to vascular disease of the kidney, coagulopathy, renal vasospasm with microinfarction, hypersensitivity, complement activation on arterioles, venocalyceal fistula, abnormal ureteral peristalsis, and intratubular deposition of calcium or uric acid microcrystals. Many patients with loin pain hematuria syndrome also meet criteria for a somatoform disorder, and analgesic medications, including narcotics, commonly are used to treat loin pain hematuria syndrome-associated pain. Interventional treatments include renal denervation, kidney autotransplantation, and nephrectomy; however, these methods should be used only as a last resort when less invasive measures have been tried unsuccessfully. In this review article, we discuss and critique current clinical practices related to loin pain hematuria syndrome pathophysiology, diagnosis, treatment, and prognosis. PMID:24725981

Taba Taba Vakili, Sahar; Alam, Tausif; Sollinger, Hans

2014-09-01

399

Reflection of visceral afferentiation in unit activity in the caudate nucleus.  

PubMed

Responses of spontaneously active neurons to visceral (splanchnic nerve) stimulation were recorded extracellularly in the head of the caudate nucleus of immobilized cats. The presence of multimodal neurons responding to stimulation of visceral, somatic, and auditory sensory systems in this structure also was established. It is concluded from these facts that neurons of the caudate nucleus may play a role in the mechanisms of interaction of visceral impulses with somatic and auditory impulses. PMID:616895

Lobanova, L V; Smirnov, S I

1977-01-01

400

Increase of visceral fat area in Indonesians and Japanese with normal BMI  

Microsoft Academic Search

We compared the visceral fat accumulation between Indonesians and Japanese. Non-obese (25>BMI?18.5) men aged between their 20s and 50s were collected in Toban including moderately populated middle-sized cities of Hyogo Prefecture in Japan, and Sangsit town and Pedawa village in Indonesia. Their visceral fat accumulation was assessed by determination of visceral fat area (VFA) that was measured through bio-electrical impedance

Yoko Fuke; Shuichi Okabe; Naemi Kajiwara; Ketut Suastika; A. A. G. Budhiarta; Satoko Maehata; Hiroshi Taniguchi

2007-01-01

401

Is Visceral Fat Involved in the Pathogenesis of the Metabolic Syndrome? Human Model  

Microsoft Academic Search

Objective: To review the evidence for and against the role of visceral adipose tissue as a major contributor to the metabolic complications of obesity through abnormal regulation of lipolysis.Research Methods and Procedures: Data from investigators in the field who have studied visceral adiposity and metabolic health and\\/or regional and systemic free fatty acid (FFA) release were considered.Results: Although visceral fat

Michael D. Jensen

2006-01-01

402

Case report: a case of intractable Meniere's disease treated with autogenic training  

PubMed Central

Background Psychological stress plays an important role in the onset and course of Meniere's disease. Surgical therapy and intratympanic gentamicin treatment are options for cases that are intractable to conventional medical therapy. Psychotherapy, however, including autogenic training (AT), which can be used for general relaxation, is not widely accepted. This paper describes the successful administration of AT in a subject suffering from intractable Meniere's disease. Case presentation A 51-year-old male patient has suffered from fluctuating right sensorineural hearing loss with vertigo since 1994. In May 2002, he was first admitted to our hospital due to a severe vertigo attack accompanied by right sensorineural hearing loss. Spontaneous nystagmus toward the right side was observed. Since April 2004, he has experienced vertigo spells with right-sided tinnitus a few times per month that are intractable to conventional medical therapy. After four months, tympanic tube insertion was preformed in the right tympanic membrane. Intratympanic injection of dexamethasone was ineffective. He refused Meniett therapy and intratympanic gentamicin injection. In addition to his vertigo spells, he suffered from insomnia, tinnitus, and anxiety. Tranquilizers such as benzodiazepines and antidepressants such as serotonin selective re-uptake inhibitors (SSRIs) failed to stop the vertigo and only slightly improved his insomnia. In December 2006, the patient began psychological counseling with a psychotherapist. After brief psychological counseling along with cognitive behavior therapy (CBT), he began AT. He diligently and regularly continued his AT training in his home according to a written timetable. His insomnia, tinnitus, and vertigo spells disappeared within a few weeks after only four psychotherapy sessions. In order to master the six standard formulas of AT, he underwent two more sessions. Thereafter, he underwent follow-up for 9 months with no additional treatment. He is now free from drugs, including tranquilizers, and has continued AT. No additional treatment was performed. When we examined him six and nine months later for follow-up, he was free of vertigo and insomnia. Conclusion AT together with CBT can be a viable and palatable treatment option for Meniere's disease patients who are not responsive to other therapies. PMID:18221543

Goto, Fumiyuki; Nakai, Kimiko; Kunihiro, Takanobu; Ogawa, Kaoru

2008-01-01

403

Upregulation of cystathionine beta-synthetase expression by nuclear factor-kappa B activation contributes to visceral hypersensitivity in adult rats with neonatal maternal deprivation  

PubMed Central

Background Irritable bowel syndrome (IBS) is characterized by chronic visceral hyperalgesia (CVH) that manifested with persistent or recurrent abdominal pain and altered bowel movement. However, the pathogenesis of the CVH remains unknown. The aim of this study was to investigate roles of endogenous hydrogen sulfide (H2S) producing enzyme cystathionine beta-synthetase (CBS) and p65 nuclear factor-kappa B subunits in CVH. Results CVH was induced by neonatal maternal deprivation (NMD) in male rats on postnatal days 2–15 and behavioral experiments were conducted at the age of 7–15 weeks. NMD significantly increased expression of CBS in colon-innervating DRGs from the 7th to 12th week. This change in CBS express is well correlated with the time course of enhanced visceromoter responses to colorectal distention (CRD), an indicator of visceral pain. Administration of AOAA, an inhibitor of CBS, produced a dose-dependent antinociceptive effect on NMD rats while it had no effect on age-matched healthy control rats. AOAA also reversed the enhanced neuronal excitability seen in colon-innervating DRGs. Application of NaHS, a donor of H2S, increased excitability of colon-innervating DRG neurons acutely dissociated from healthy control rats. Intrathecal injection of NaHS produced an acute visceral hyperalgesia. In addition, the content of p65 in nucleus was remarkably higher in NMD rats than that in age-matched controls. Intrathecal administration of PDTC, an inhibitor of p65, markedly reduced expression of CBS and attenuated nociceptive responses to CRD. Conclusion The present results suggested that upregulation of CBS expression, which is mediated by activation of p65, contributes to NMD-induced CVH. This pathway might be a potential target for relieving CVH in patients with IBS. PMID:23249427

2012-01-01

404

Pain in Parkinson's Disease  

MedlinePLUS

... for increased overall health care costs. A person’s perception of pain can be affected by emotional factors. ... medications such as levodopa can affect a person’s perception of pain. People with Parkinson’s who are in ...

405

Magnets for Pain Relief  

MedlinePLUS

... our disclaimer about external links Menu Magnets for Pain Relief On this page: Introduction Key Points About ... Top What the Science Says About Magnets for Pain Scientific evidence does not support the use of ...

406

Sacroiliac joint pain.  

PubMed

The sacroiliac joint is a source of pain in the lower back and buttocks in approximately 15% of the population. Diagnosing sacroiliac joint-mediated pain is difficult because the presenting complaints are similar to those of other causes of back pain. Patients with sacroiliac joint-mediated pain rarely report pain above L5; most localize their pain to the area around the posterior superior iliac spine. Radiographic and laboratory tests primarily help exclude other sources of low back pain. Magnetic resonance imaging, computed tomography, and bone scans of the sacroiliac joint cannot reliably determine whether the joint is the source of the pain. Controlled analgesic injections of the sacroiliac joint are the most important tool in the diagnosis. Treatment modalities include medications, physical therapy, bracing, manual therapy, injections, radiofrequency denervation, and arthrodesis; however, no published prospective data compare the efficacy of these modalities. PMID:15473677

Dreyfuss, Paul; Dreyer, Susan J; Cole, Andrew; Mayo, Keith

2004-01-01

407

Communicating about Cancer Pain  

Cancer.gov

Patients with cancer may be reluctant to discuss their pain with their doctors for a variety of reasons. NCI sponsors research that examines the barriers that prevent patients from talking about pain.

408

Posttonsillectomy pain in children.  

PubMed

Tonsillectomy, used to treat a variety of pediatric disorders, including obstructive sleep apnea, peritonsillar cellulitis or abscesses, and very frequent throat infection, is known to produce nausea, vomiting, and prolonged, moderate-to-severe pain. The authors review the causes of posttonsillectomy pain, current findings on the efficacy of various pharmacologic and nonpharmacologic interventions in pain management, recommendations for patient and family teaching regarding pain management, and best practices for improving medication adherence. PMID:24445532

Sutters, Kimberly A; Isaacson, Glenn

2014-02-01

409

Molecular pain, a new era of pain research and medicine  

Microsoft Academic Search

Molecular pain is a relatively new and rapidly expanding research field that represents an advanced step from conventional pain research. Molecular pain research addresses physiological and pathological pain at the cellular, subcellular and molecular levels. These studies integrate pain research with molecular biology, genomics, proteomics, modern electrophysiology and neurobiology. The field of molecular pain research has been rapidly expanding in

Jianguo Gu; Min Zhuo; Michael Caterina; Amy B MacDermott; Annika Malmberg; Volker Neugebauer; Megumu Yoshimura

2005-01-01

410

Definitions and Types of Pain  

MedlinePLUS

... Types of Pain Defining Pain Pain is a perception that signals the individual that tissue damage has ... in the body that are involved in the perception of pain are called "nociception." Basic and clinical ...

411

Pediatric Procedural Pain  

ERIC Educational Resources Information Center

This article reviews the various settings in which infants, children, and adolescents experience pain during acute medical procedures and issues related to referral of children to pain management teams. In addition, self-report, reports by others, physiological monitoring, and direct observation methods of assessment of pain and related constructs…

Blount, Ronald L.; Piira, Tiina; Cohen, Lindsey L.; Cheng, Patricia S.

2006-01-01

412

Chest pain in children.  

PubMed Central

Chest pain is usually a benign symptom in children. The most common identifiable causes are musculoskeletal. Often, no cause can be identified. Cardiac disorders are uncommon causes of chest pain children. Most causes can be diagnosed from history and physical examination. Treatment should be directed at the underlying cause. For idiopathic chest pain, reassurance and regular follow-up examinations are important. PMID:8704491

Leung, A. K.; Robson, W. L.; Cho, H.

1996-01-01

413

Complex Regional Pain Syndrome  

MedlinePLUS

... pain reliever) into certain nerves to block the pain signals. If the injection works, it may be repeated. Physical therapy and psychological counseling are also helpful. However, a treatment that works for ... pain syndrome from getting worse. Sometimes the condition improves. ...

414

Paine Appointed Administrator  

NASA Technical Reports Server (NTRS)

President Richard M. Nixon announcing the appointment of Dr. Thomas O. Paine as Administrator for the National Aeronautics and Space Administration. The ceremony was held at the White House. Paine had been serving as acting administrator. From left to right: President Richard M. Nixon NASA Administrator Dr. Thomas O. Paine Vice President Spiro T. Agnew

1969-01-01

415

Forebrain Pain Mechanisms  

PubMed Central

Emotional-affective and cognitive dimensions of pain are less well understood than nociceptive and nocifensive components, but the forebrain is believed to play an important role. Recent evidence suggests subcortical and cortical brain areas outside the traditional pain processing network contribute critically to emotional-affective responses and cognitive deficits related to pain. These brain areas include different nuclei of the amygdala and certain prefrontal cortical areas. Their roles in various aspects of pain will be discussed. Biomarkers of cortical dysfunction are being identified that may evolve into therapeutic targets to modulate pain experience and improve pain-related cognitive impairment. Supporting data from preclinical studies in neuropathic pain models will be presented. Neuroimaging analysis provides evidence for plastic changes in the pain processing brain network. Results of clinical studies in neuropathic pain patients suggest that neuroimaging may help determine mechanisms of altered brain functions in pain as well as monitor the effects of pharmacologic interventions to optimize treatment in individual patients. Recent progress in the analysis of higher brain functions emphasizes the concept of pain as a multidimensional experience and the need for integrative approaches to determine the full spectrum of harmful or protective neurobiological changes in pain. PMID:19162070

Neugebauer, Volker; Galhardo, Vasco; Maione, Sabatino; Mackey, Sean C.

2009-01-01

416

Cannabinoids in cancer pain  

Microsoft Academic Search

This article of the month presents results of a clinical study conducted in the UK and Romania, which evaluated the efficacy of a THC:CBD cannabis extract (Sativex®) and a THC cannabis ex- tract in the treatment of 177 patients with cancer pain, who experienced inadequate pain reduction despite intake of opioids (Johnson et al. J Pain Symptom Manage, 2010, in

Franjo Grotenhermen

2010-01-01

417

A 24-year-old woman with intractable seizures: review of surgery for epilepsy.  

PubMed

Epilepsy, a recurrent seizure disorder affecting 1% of the population, can be genetic in origin and thereby affect multiple members in a family, or it can be sporadic. Many sporadic seizures come from a specific "focus" in the cortex. Focal-onset seizures account for 60% of all cases of epilepsy. Among patients with partial seizures, 35% respond poorly to available medication and may benefit from neurosurgical excisional surgery. In cases in which epilepsy is localized through different modes (electroencephalogram, magnetic resonance imaging, etc) to a specific area of the brain where there is an associated lesion, more than half of patients can expect a successful surgical outcome. In patients with consistent seizure-associated behavior but without a lesion, surgical treatment is less successful. Ms H, a young woman with a history of medically intractable partial epilepsy, does not have an anatomical lesion but wants to know if a surgical approach is a good option for her. PMID:18984876

Schomer, Donald L; Black, Peter M

2008-12-01

418

Pseudohypoparathyroidism type Ia manifesting as intractable epilepsy in a 23-year-old female  

PubMed Central

Pseudohypoparathyroidism is a rare disorder of calcium metabolism that involves target organ resistance to the action of the parathyroid hormone. As a result, calcium levels may become dangerously low, sometimes leading to seizures and other symptoms. We present a case of a 23-year-old Somalian female on antiepileptic therapy presenting with intractable epilepsy. She was subsequently found to have pseudohypoparathyroidism type Ia. She had multiple reasons accounting for loss of seizure control, including worsening hypocalcemia from resistance to the parathyroid hormone; vitamin D deficiency, which could have resulted from lack of exposure to direct sunlight and her antiepileptic medication; and extensive calcium deposition in the brain due to pseudohypoparathyroidism. The patient was stabilized with intravenous therapy and oral calcium, vitamin D, and calcitriol. Her antiepileptic therapy was changed to a medication that did not interfere with vitamin D metabolism or contribute to worsening hypocalcemia. PMID:23754923

Raghavan, Pooja; Katz, Charles M

2012-01-01

419

Homozygous nonsense mutation in SYNJ1 associated with intractable epilepsy and tau pathology.  

PubMed

The tauopathies are a heterogeneous group of neurodegenerative disorders characterized by the shared presence of tau aggregates and neurofibrillary tangles within the central nervous system. Here, we present a child with a severe neurodegenerative disorder characterized by intractable seizures and significant tau-immunoreactive neurofibrillary degeneration localized predominantly to the substantia nigra on neuropathology with absence of beta-amyloid plaques and Lewy or Pick bodies. Whole-exome sequencing identified a homozygous truncating mutation in Synaptojanin 1 (SYNJ1). Quantitative polymerase chain reaction and Western blot experiments demonstrated diminished SYNJ1 messenger RNA and protein. Knockout Synj1(-/-) mice have convulsions and die early in life. More recently, homozygous missense mutations have been reported in 2 families with early-onset parkinsonism and seizures. Our findings broaden the spectrum of disease associated with alteration of SYNJ1 and further implicate defects in synaptic vesicle recycling in the tauopathies. PMID:25316601

Dyment, David A; Smith, Amanda C; Humphreys, Peter; Schwartzentruber, Jeremy; Beaulieu, Chandree L; Bulman, Dennis E; Majewski, Jacek; Woulfe, John; Michaud, Jean; Boycott, Kym M

2015-02-01

420

HIPDM-SPECT in patients with medically intractable complex partial seizures. Ictal study  

SciTech Connect

Both interictal and ictal N,N,N'-trimethyl-N'-(2-hydroxy-3-methyl-5-iodobenzyl)-1,3,propanediamine -single photon emission computed tomography (HIPDM-SPECT) were performed in 16 patients with medically intractable complex partial seizures. Ictal HIPDM-SPECT localized epileptic foci in 13 of 14 patients with unilateral temporal focus and provided confirmative evidence of epileptic focus in 11 patients by demonstrating maximally increased regional cerebral perfusion (rCP) in epileptic foci that had shown decreased rCP in a previous interictal study. Ictal HIPDM-SPECT in two patients with bitemporal foci showed more complicated patterns consisting of slightly increased rCP in bilateral multifocal regions. Ictal HIPDM-SPECT was particularly useful for investigating epileptic foci, and correlation with simultaneously recorded ictal electroencephalograms provided further insight for localizing epileptic foci.

Lee, B.I.; Markand, O.N.; Wellman, H.N.; Siddiqui, A.R.; Park, H.M.; Mock, B.; Worth, R.M.; Edwards, M.K.; Krepshaw, J.

1988-04-01

421

Successful treatment of massive intractable pericardial effusion in a patient with systemic lupus erythematosus with tocilizumab.  

PubMed

A 51-year-old Japanese woman developed systemic lupus erythematosus (SLE) in 1995. In August 2005, she had massive pericardial effusion due to lupus pericarditis, which was compromising her circulation. Methylprednisolone pulse, intravenous cyclophosphamide pulse and pericardiocentesis were all ineffective. The pericardium was cut surgically to create a passage to drain the liquid into the pleural cavity. The procedure was temporarily effective; however, massive liquid accumulated in the pleural cavity within 1 year. Oral tacrolimus and topical betamethasone injection were ineffective. Since the interleukin-6 (IL-6) level in the effusion was markedly increased (1160 pg/ml), tocilizumab was administered intravenously at a dose of 8 mg/kg every 4 weeks. The effect was astonishing and only a residual amount of pericardial effusion remained. Prednisolone was tapered successfully from 15 to 5 mg daily. Tocilizumab is a treatment of choice when we confront an intractable serositis with massive effusion in SLE, if the IL-6 level is high. PMID:23264273

Kamata, Yasuyuki; Minota, Seiji

2012-01-01

422

Therapeutic efficacy of the Qing Dai in patients with intractable ulcerative colitis  

PubMed Central

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that may become intractable when treated with conventional medications such as aminosalicylates, corticosteroids, and azathioprine. The herbal medicine Qing Dai has traditionally been used in Chinese medicine to treat UC patients, but there is a lack of published data on the efficacy of Qing Dai in UC treatment. We report several cases of patients with intractable UC who take Qing Dai in a retrospective observational study. Furthermore, we explore the mechanisms of action of Qing Dai. Nine patients with active UC who received conventional medications but wished to receive Qing Dai as an alternative medication were included in our analysis. The UC severity level was determined based on the clinical activity index (CAI). Additionally, 5 of the 9 patients were endoscopically evaluated according to the Matts grading system. Each patient received 2 g/d of Qing Dai orally and continued taking other medications for UC as prescribed. Electron spin resonance was applied to explore the mechanisms of action of Qing Dai. After 4 mo of treatment with Qing Dai, the CAI score decreased from 8.3 ± 2.4 to 2.4 ± 3.4 (mean ± SD; P < 0.001). Similarly, the endoscopic Matts grade decreased from 3.4 ± 0.5 to 2.2 ± 0.8 (P = 0.02). Six of 7 patients who were on prednisolone upon enrollment in the study were able to discontinue this corticosteroid. Electron spin resonance revealed that Qing Dai possesses strong hydroxyl radical scavenging activity. Qing Dai showed significant clinical and endoscopic efficacy in patients who failed to respond to conventional medications. Scavenging of hydroxyl radicals appears to be a potential mechanism through which Qing Dai acts, but the significance of the scavenging ability of Qing Dai with respect to the anti-inflammatory effect in UC patients warrants further investigation. PMID:23674882

Suzuki, Hideo; Kaneko, Tsuyoshi; Mizokami, Yuji; Narasaka, Toshiaki; Endo, Shinji; Matsui, Hirofumi; Yanaka, Akinori; Hirayama, Aki; Hyodo, Ichinosuke

2013-01-01

423

Therapeutic efficacy of the Qing Dai in patients with intractable ulcerative colitis.  

PubMed

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that may become intractable when treated with conventional medications such as aminosalicylates, corticosteroids, and azathioprine. The herbal medicine Qing Dai has traditionally been used in Chinese medicine to treat UC patients, but there is a lack of published data on the efficacy of Qing Dai in UC treatment. We report several cases of patients with intractable UC who take Qing Dai in a retrospective observational study. Furthermore, we explore the mechanisms of action of Qing Dai. Nine patients with active UC who received conventional medications but wished to receive Qing Dai as an alternative medication were included in our analysis. The UC severity level was determined based on the clinical activity index (CAI). Additionally, 5 of the 9 patients were endoscopically evaluated according to the Matts grading system. Each patient received 2 g/d of Qing Dai orally and continued taking other medications for UC as prescribed. Electron spin resonance was applied to explore the mechanisms of action of Qing Dai. After 4 mo of treatment with Qing Dai, the CAI score decreased from 8.3 ± 2.4 to 2.4 ± 3.4 (mean ± SD; P < 0.001). Similarly, the endoscopic Matts grade decreased from 3.4 ± 0.5 to 2.2 ± 0.8 (P = 0.02). Six of 7 patients who were on prednisolone upon enrollment in the study were able to discontinue this corticosteroid. Electron spin resonance revealed that Qing Dai possesses strong hydroxyl radical scavenging activity. Qing Dai showed significant clinical and endoscopic efficacy in patients who failed to respond to conventional medications. Scavenging of hydroxyl radicals appears to be a potential mechanism through which Qing Dai acts, but the significance of the scavenging ability of Qing Dai with respect to the anti-inflammatory effect in UC patients warrants further investigation. PMID:23674882

Suzuki, Hideo; Kaneko, Tsuyoshi; Mizokami, Yuji; Narasaka, Toshiaki; Endo, Shinji; Matsui, Hirofumi; Yanaka, Akinori; Hirayama, Aki; Hyodo, Ichinosuke

2013-05-01

424

Long-Term Outcomes of Hemispheric Disconnection in Pediatric Patients with Intractable Epilepsy  

PubMed Central

Background and Purpose Hemispherectomy reportedly produces remarkable results in terms of seizure outcome and quality of life for medically intractable hemispheric epilepsy in children. We reviewed the neuroradiologic findings, pathologic findings, epilepsy characteristics, and clinical long-term outcomes in pediatric patients following a hemispheric disconnection. Methods We retrospectively studied 12 children (8 males) who underwent a hemispherectomy at Asan Medical Center between 1997 and 2005. Clinical, EEG, neuroradiological, and surgical data were collected. Long-term outcomes for seizure, motor functions, and cognitive functions were evaluated at a mean follow-up of 12.7 years (range, 7.6-16.2 years) after surgery. Results The mean age at epilepsy onset was 3.0 years (range, 0-7.6 years). The following epilepsy syndromes were identified in our cohort: focal symptomatic epilepsy (n=8), West syndrome (n=3), and Rasmussen's syndrome (n=1). Postoperative histopathology of our study patients revealed malformation of cortical development (n=7), encephalomalacia as a sequela of infarction or trauma (n=3), Sturge-Weber syndrome (n=1), and Rasmussen's encephalitis (n=1). The mean age at surgery was 6.5 years (range, 0.8-12.3 years). Anatomical or functional hemispherectomy was performed in 8 patients, and hemispherotomy was performed in 4 patients. Eight of our 12 children (66.7%) were seizure-free, but 3 patients with perioperative complications showed persistent seizure. Although all patients had preoperative hemiparesis and developmental delay, none had additional motor or cognitive deficits after surgery, and most achieved independent walking and improvement in daily activities. Conclusions The long-term clinical outcomes of hemispherectomy in children with intractable hemispheric epilepsy are good when careful patient selection and skilled surgical approaches are applied. PMID:24829595

Lee, Yun-Jeong; Kim, Eun-Hee; Yum, Mi-Sun; Lee, Jung Kyo; Hong, Seokho

2014-01-01

425

Interleukin-10 receptor mutations in children with neonatal-onset Crohn's disease and intractable ulcerating enterocolitis.  

PubMed

Neonatal-onset inflammatory bowel disease (IBD) accounts for only 0.25% of pediatric IBD cases. The molecular pathogenesis of IBD remains unclear. Recently, rare Mendelian mutations have been identified in children with very early-onset Crohn's disease and ulcerative colitis. In this study, we report compound heterozygous mutations in the interleukin-10 receptor A (IL-10RA) gene in children with severe neonatal-onset IBD. Patient 1 had chronic diarrhea within the first month of life and had perianal fistulae. She was diagnosed with 'intractable ulcerating enterocolitis in infancy' and underwent subtotal colectomy at the age of 24 months because of poor response to immunosuppressant therapy. Compound heterozygous mutations, c.[301C>T];[350G>A](p.[R101W];[R117H]), were discovered in IL-10RA for this patient. Patient 2 presented symptoms within the first month of life and was diagnosed with Crohn's disease. Severe colitis and perianal and enteroenteric fistulae occurred repeatedly, and he underwent surgical management involving colectomy, colostomy, and ileostomy. We identified mutations in IL-10RA, c.[272A>G];[784C>T] (p.[Y91C];[R262C]). Patient 3 had chronic diarrhea and a rectovaginal fistula at 3 days of life and was diagnosed with Crohn's disease. She underwent fistulectomy and ileostomy, but experienced frequent relapses. Mutations, c.[272A>G];[301C>T] (p.[Y91C];[R101W]), were found in IL-10RA. This report confirms the genetic defect of IL-10RA in neonatal-onset IBD including 'intractable ulcerating enterocolitis in infancy'. PMID:23839161

Shim, Jung Ok; Hwang, Solha; Yang, Hye Ran; Moon, Jin Soo; Chang, Ju Young; Ko, Jae Sung; Park, Sung Sup; Kang, Gyeong-Hoon; Kim, Woo Sun; Seo, Jeong Kee

2013-10-01

426

Immediate and long term outcome after infrathalamic and thalamic lesioning for intractable Tourette's syndrome  

PubMed Central

OBJECTIVE—The surgical treatment of intractable Tourette's syndrome is controversial. Experience with 17 consecutive patients treated between 1970 and 1998 is reviewed and the efficacy and safety of surgical treatment is assessed.?METHODS—These patients were retrospectively reclassified into subtypes according to the protocol of the Tourette's Syndrome Study Group. One patient was excluded from the study. Ventriculography based stereotactic zona incerta (ZI) and ventrolateral/ lamella medialis thalamotomy (VL/LM) were performed on all patients. The preoperative, postoperative, and late tic severities were assessed by the tic severity rating scale. The median follow up of 11 patients (65%) was 7 years (range 3.5-17 years) and six patients were lost to long term follow up.?RESULTS—Median age was 23 years (range 11-40) at the time of surgery. Median duration of illness was 14 years (range 3-33). The mean preoperative motor and vocal tic severities were estimated to be 4.44 (SD 0.63) and 3.81 (SD 0.66), respectively. Unilateral ZI lesioning and VL/LM lesioning selected by asymmetry of symptoms provide an effective control of tic severity (p motor and vocal<0.001). In attenuation of contralateral symptoms, a second surgical intervention in the relevant side could reduce tic severity sufficiently (p motor<0.01; p vocal<0.005). Transient complications occurred in 68% of patients. Only one permanent complication was registered in six patients followed up after unilateral surgery. Two out of five patients followed up after bilateral surgery had disabling side effects of surgery.?CONCLUSIONS—ZI and VL/LM lesioning provide a significant long term reduction of tic severity in intractable Tourette's syndrome. Adequate selection of the side of first intervention might prevent the patient from increased risk of bilateral surgery.?? PMID:11309463

Babel, T; Warnke, P; Ostertag, C

2001-01-01

427

Successful use of tetrabenazine in a patient with intractable hiccups after stroke.  

PubMed

A hiccup is a myoclonic jerk of the diaphragm, and cases of hiccups may last for more than 48 hours (persistent hiccups) or even more than 2 months (intractable hiccups). Current pharmacologic treatment of persistent or intractable hiccups mainly includes antidopaminergic drugs. We describe the case of a 60-year-old man with a recent diagnosis of right insular ischemic stroke who presented with frequent, intense, and disabling hiccups for more than 1 month. As diagnosis of poststroke hiccups was assumed, the patient was treated over the next 6 months with adequate doses of various antipsychotic drugs commonly used for the treatment of hiccups; however, all were discontinued because of adverse effects. Indeed, dyskinesia after chlorpromazine (up to 75 mg/day for 4 wks), as well as somnolence and dyskinesia after haloperidol (up to 6 mg/day for 6 wks), somnolence after gabapentin (up to 1800 mg/day for 8 wks), and severe somnolence and hypotension after baclofen (up to 50 mg/day for 6 wks) were reported. The patient was then prescribed tetrabenazine at a starting dose of 12.5 mg twice/day (25 mg/day), with a nearly complete remission of the hiccup symptomatology after ~6 weeks, when a daily dose of 150 mg was reached. We therefore hypothesize that a supratentorial lesion may disrupt the modulation of dopaminergic pathways involved in the regulation of medullar centers responsible for the hiccup reflex. To our knowledge, this is the first case report of poststroke hiccups responding to tetrabenazine. The dramatic response of our patient to tetrabenazine monotherapy suggests that this drug may be a valuable pharmacologic alternative for patients with hiccups after stroke who are intolerant or unresponsive to classic antipsychotic agents. PMID:25471210

Naro, Antonino; Bramanti, Placido; Calabrò, Rocco Salvatore

2014-12-01

428

Diagnostic reframing of intractable environmental problems: case of a contested multiparty public land-use conflict.  

PubMed

Intractable conflicts are omnipresent in environmental management. These conflicts do not necessarily resist resolution but need to be fundamentally transformed in order to reach agreement. Reframing, a process that allows disputants to create new alternative understandings of the problem, is one way of transforming these conflicts. Cognitive and interactional reframing are the two major approaches to conflict transformation. These approaches have some drawbacks. Cognitive reframing does not guarantee commensurate consideration of all disputants' views about the problem. Interactional reframing is prone to inter-disputant influences that interfere with presenting the problems as accurately as they exist in disputants' minds. Inadequate consideration of other disputants' views and inter-disputant influences often lead to inaccurate problem identification and definition. This in turn leads to solving the wrong problem, enabling intractability to persist. Proper problem identification and definition requires commensurate consideration of all sides of the conflict while minimizing inter-disputant influences. From a problem diagnosis perspective, we show how Q methodology is used to reframe environmental problems, rendering them more tractable to analysis while minimizing the influence of who disputants are talking with, and without ignoring the perspectives of other disputants. Using a case of contentious All-Terrain Vehicle (ATV) use in a state-administered public land, conflicting parties reframed the problem by prioritizing issues, outlining areas and levels of consensus and disagreement, and revealing inherent unrecognized and/or unspoken agendas. The reframing process surprisingly revealed several areas of common ground in disputants' diagnosis of the problem, including lack of emphasis on environmental protection and uncoordinated management factions. Emergent frames were misaligned on some issues, such as the behaviors of ATV riders and the role of management, including political and economic influences on decision making. We discuss how the reframing process enhances tractability of multiparty environmental problems. We point to some limitations of Q methodology as a tool for the diagnostic reframing of such problems. PMID:22705762

Asah, Stanley T; Bengston, David N; Wendt, Keith; Nelson, Kristen C

2012-10-15

429

Upregulation of Cystathionine ?-Synthetase Expression Contributes to Visceral Hyperalgesia Induced by Heterotypic Intermittent Stress in Rats  

PubMed Central

Background Hydrogen sulfide (H2S) functions as a neuromodulator, but whether it modulates visceral pain is not well known. This study was designed to determine the role for the endogenous H2S producing enzyme cystathionine ?-synthetase (CBS) and cystathionine ?-lyase (CSE) in a validated rat model of visceral hyperalgesia (VH). Methods VH was induced by nine-day heterotypic intermittent stress (HIS). Abdominal withdrawal reflex (AWR) scores were determined by measuring the visceromoter responses to colorectal distension (CRD). Dorsal root ganglia (DRG) neurons innervating the colon were labeled by injection of DiI (1,1'-dioleyl-3,3,3',3-tetramethylindocarbocyanine methanesulfonate) into the colon wall. Patch clamp recording techniques were employed to examine excitability and sodium channel currents of colon specific DRG neurons. Tissues from colon related thoracolumbar DRGs were analyzed for CBS, CSE and sodium channel expression. Results HIS significantly increased the visceromotor responses to CRD in association with an upregulated expression of CBS not CSE proteins in colon related DRGs. Administration of O-(Carboxymethyl)hydroxylamine hemihydrochloride (AOAA), an inhibitor of CBS, attenuated the AWR scores in HIS-treated rats, in a dose dependent fashion. In contrast, AOAA did not produce any effect on AWR scores in healthy control rats. AOAA reversed the potentiation of sodium channel current densities of colon specific DRG neurons of HIS rats. To further confirm the role for CBS-H2S signaling, NaHS was used to mimic the production of H2S by CBS. Application of NaHS significantly enhanced neuronal excitability and potentiated sodium channel current densities of colon DRG neurons from healthy control rats. Furthermore, AOAA reversed the upregulation of NaV1.7 and NaV1.8 in colon related DRGs of HIS rats. Conclusion Our results suggest that upregulation of CBS expression might play an important role in developing VH via sensitization of sodium channels in peripheral nociceptors, thus identifying a specific neurobiological target for the treatment of VH in functional bowel syndromes. PMID:23285261

Hu, Shufen; Xiao, Ying; Jiang, Xinghong; Xu, Guang-Yin

2012-01-01

430

The influence of children's pain memories on subsequent pain experience.  

PubMed

Healthy children are often required to repeatedly undergo painful medical procedures (eg, immunizations). Although memory is often implicated in children's reactions to future pain, there is a dearth of research directly examining the relationship between the 2. The current study investigated the influence of children's memories for a novel pain stimulus on their subsequent pain experience. One hundred ten healthy children (60 boys) between the ages of 8 and 12 years completed a laboratory pain task and provided pain ratings. Two weeks later, children provided pain ratings based on their memories as well as their expectancies about future pain. One month following the initial laboratory visit, children again completed the pain task and provided pain ratings. Results showed that children's memory of pain intensity was a better predictor of subsequent pain reporting than their actual initial reporting of pain intensity, and mediated the relationship between initial and subsequent pain reporting. Children who had negatively estimated pain memories developed expectations of greater pain prior to a subsequent pain experience and showed greater increases in pain ratings over time than children who had accurate or positively estimated pain memories. These findings highlight the influence of pain memories on healthy children's expectations of future pain and subsequent pain experiences and extend predictive models of subsequent pain reporting. PMID:22560288

Noel, Melanie; Chambers, Christine T; McGrath, Patrick J; Klein, Raymond M; Stewart, Sherry H

2012-08-01

431

Dancing in pain: pain appraisal and coping in dancers.  

PubMed

This study investigated the relationships between the type of pain experienced (performance pain and injury pain), the cognitive appraisal of pain and pain coping styles in dancers. Fifty-one professional ballet and contemporary dancers (17 males and 34 females), with the mean age of 25.9 years, completed a general pain questionnaire, the Pain Appraisal Inventory, the Survey of Pain Attitudes Control Subscale, and the Sports Inventory for Pain. Multivariate analyses of variance indicated that both the cognitive appraisal of the pain and pain coping styles did not differ according to the type of pain experienced or the pain severity. However, it was found that dancers with performance pain of either low or high severity were more likely to dance in pain than dancers experiencing injury pain. Multiple regression analyses indicated that the appraisal of pain as threatening was predictive of the use of avoidance and catastrophizing pain coping styles. Overall, results indicated that dancers may not differentiate between performance pain and injury pain, or modify their appraisal and coping strategies according to the characteristics of the pain experienced. The study highlighted an opportunity for increased education for dancers in recognizing the difference between pain considered to be a routine aspect of training and pain which is a signal of serious injury. PMID:19618573

Anderson, Ruth; Hanrahan, Stephanie J

2008-01-01

432

Cannabinoids for neuropathic pain.  

PubMed

Treatment options for neuropathic pain have limited efficacy and use is fraught with dose-limiting adverse effects. The endocannabinoid system has been elucidated over the last several years, demonstrating a significant interface with pain homeostasis. Exogenous cannabinoids have been demonstrated to be effective in a range of experimental neuropathic pain models, and there is mounting evidence for therapeutic use in human neuropathic pain conditions. This article reviews the history, pharmacologic development, clinical trials results, and the future potential of nonsmoked, orally bioavailable, nonpsychoactive cannabinoids in the management of neuropathic pain. PMID:25160710

Fine, Perry G; Rosenfeld, Mark J

2014-10-01

433

Effects of mu- and kappa-2 opioid receptor agonists on pain and rearing behaviors  

PubMed Central

Background Management of pain involves a balance between inhibition of pain and minimization of side effects; therefore, in developing new analgesic compounds, one must consider the effects of treatment on both pain processing and behavior. The purpose of this study was to evaluate the effects of the mu and kappa-2 opioid receptor agonists on general and pain behavioral outcomes. Methods As a general behavioral assessment, we modified the cylinder rearing assay and recorded the number and duration of rearing events. Thermal sensitivity was evaluated using either a reflexive measure of hindpaw withdrawal latency to a radiant heat source or using an orofacial operant thermal assay. Acetic acid-induced visceral pain and capsaicin-induced neurogenic inflammatory pain were used as painful stimuli. The mu-opioid receptor agonist, morphine or the kappa-2 receptor agonist GR89696 was administered 30 min prior to testing. A general linear model repeated measures analysis was completed for baseline session comparisons and an analysis of variance was used to evaluate the effects of treatment on each outcome measure (SPSS Inc). When significant differences were found, post-hoc comparisons were made using the Tukey honestly significant difference test. *P < 0.05 was considered significant in all instances. Results We found that morphine and GR89,696 dose-dependently decreased the number of reaching events and rearing duration. Rearing behavior was not affected at 0.5 mg/kg for morphine, 1.25 × 10-4 mg/kg for GR89,696. Hindpaw thermal sensitivity was significantly increased only at the highest doses for each drug. At the highest dose that did not significantly influence rearing behavior, we found that visceral and neurogenic inflammatory pain was not affected following GR89,696 administration and morphine was only partially effective for blocking visceral pain. Conclusion This study demonstrated that high levels of the opioids produced significant untoward effects and made distinguishing an analgesic versus a more general effect more difficult. Quantification of rearing behavior in conjunction with standard analgesic assays can help in gaining a better appreciation of true analgesic efficacy of experimental drugs. PMID:17883847

Neubert, John K; Rossi, Heather L; Pogar, Jonathan; Jenkins, Alan C; Caudle, Robert M

2007-01-01

434

An equine pain face  

PubMed Central

Objective The objective of this study was to investigate the existence of an equine pain face and to describe this in detail. Study design Semi-randomized, controlled, crossover trial. Animals Six adult horses. Methods Pain was induced with two noxious stimuli, a tourniquet on the antebrachium and topical application of capsaicin. All horses participated in two control trials and received both noxious stimuli twice, once with and once without an observer present. During all sessions their pain state was scored. The horses were filmed and the close-up video recordings of the faces were analysed for alterations in behaviour and facial expressions. Still images from the trials were evaluated for the presence of each of the specific pain face features identified from the video analysis. Results Both noxious challenges were effective in producing a pain response resulting in significantly increased pain scores. Alterations in facial expressions were observed in all horses during all noxious stimulations. The number of pain face features present on the still images from the noxious challenges were significantly higher than for the control trial (p = 0.0001). Facial expressions representative for control and pain trials were condensed into explanatory illustrations. During pain sessions with an observer present, the horses increased their contact-seeking behavior. Conclusions and clinical relevance An equine pain face comprising ‘low’ and/or ‘asymmetrical’ ears, an angled appearance of the eyes, a withdrawn and/or tense stare, mediolaterally dilated nostrils and tension of the lips, chin and certain facial muscles can be recognized in horses during induced acute pain. This description of an equine pain face may be useful for improving tools for pain recognition in horses with mild to moderate pain. PMID:25082060

Gleerup, Karina B; Forkman, Björn; Lindegaard, Casper; Andersen, Pia H

2015-01-01

435

Morphine modifies the cingulate-operculum network underlying painful rectal evoked potentials.  

PubMed

The effect of opioids on brain networks underlying rectal evoked potentials (EPs) has never been investigated. This study utilized brain source connectivity to explore whether morphine induced changes in brain networks underlying painful rectal EPs would reflect changes in pain scores due to morphine. Twenty healthy volunteers were included in this placebo-controlled cross-over study. Sensory and pain thresholds to electrically induced rectal stimulation were taken before (baseline) and 70 min after placebo/morphine (30 mg) administration. The stimulation intensity required to evoke moderate pain at baseline was employed for EPs. The pain score of this stimulation intensity was recorded again 70 min after placebo/morphine administration. 62-channel EPs were recorded for both arms. Amplitudes and latencies were analysed and brain source connectivity analysis was done. Changes in any of the parameters describing EPs were correlated to changes in subjective pain ratings. Morphine increased sensory and pain thresholds by 28.8% and 27.5% (P ? 0.02). The pain score corresponding to moderate pain at baseline was attenuated in both placebo and morphine arms by 14.5% and 37.5% (P < 0.05). There was a 33.9% reduction in EP amplitudes due to placebo (P < 0.05), whereas EP amplitudes remained stable due to morphine. A dominating cingulate-operculum network to rectal pain was seen. Cingulate source shifted anteriorly in the morphine arm (P < 0.001) and this shift was positively correlated to the change in the pain score (r = 0.6, P < 0.05). These findings indicate that visceral pain relief due to morphine is associated with reorganization within cingulate cortex, which may be used as a biomarker of opioid effects. PMID:24184388

Lelic, D; Olesen, A E; Gregersen, H; Dahan, A; Kolesnikov, Y; Drewes, A M

2014-02-01

436

Dialysis-related amyloidosis: visceral involvement and protein constituents.  

PubMed

beta 2-M amyloidosis mainly concerns dialysis patients and typically presents with osteoarticular symptoms. In order to precise the incidence and gravity of visceral involvement, subcutaneous abdominal fat aspirates, skin and rectal biopsies, as well as echocardiograms were performed in 26 patients with severe beta 2-M amyloidosis. Visceral amyloidosis was confirmed in 58% and the numbers were even higher when including heart abnormalities suggestive of amyloidosis (81%). Clinical manifestations of visceral involvement were usually not severe and include odynophagia, gastrointestinal haemorrhage, intestinal obstruction, kidney stones, myocardial dysfunction and subcutaneous tumours. The removal and synthesis rates of beta 2-M were assessed during dialysis. Serum 131I-beta 2-M levels decreased by 5-10% with cuprophane and by 40-45% with polysulfone and polyacrylonitrile membranes. These reduction rates were higher than those found with unlabelled beta 2-M suggesting an increased synthesis or release during dialysis. The protein constituents of amyloid deposits were studied. Two different preparative methods to extract the proteins from amyloid deposits were used. TCA precipitation showed the presence of several proteins which were n