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1

An Unusual Cause of Intractable Heel Pain  

Microsoft Academic Search

We report a case of severe heel pain that did not respond to noninvasive measures. Magnetic resonance imaging scans revealed a soft tissue mass that after complete surgical excision was found to be an epidermal cyst. The patient experienced full resolution of the symptoms after excision of the epidermal cyst. To our knowledge, intractable heel pain due to an epidermal

Samuel Ghani; Muhammad Ali Fazal

2011-01-01

2

Visceral versus Somatic Pain: Similarities and Differences  

Microsoft Academic Search

Inflammatory bowel disease and the irritable bowel syndrome are conditions characterized by chronic pain that generates persistent, hyperalgesic states in many regions of the body. It is difficult to explain the pain of conditions such as inflammatory bowel disease and irritable bowel syndrome by extrapolating directly from what is known about the mechanisms of somatic pain. Visceral and somatic pain

Fernando Cervero

2009-01-01

3

Central sensitisation in visceral pain disorders  

PubMed Central

The concepts of visceral hyperalgesia and visceral hypersensitivity have been examined in a variety of functional gastrointestinal disorders (FGIDs). Although the pathophysiological mechanisms of pain and hypersensitivity in these disorders are still not well understood, exciting new developments in research have been made in the study of the brain?gut interactions involved in the FGIDs PMID:16766744

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

2006-01-01

4

Thalamotomy for Alleviation of Intractable Pain  

Microsoft Academic Search

17 patients had thalamotomies for alleviation of pain due to malignancy since January, 1970. In 12 of them, thalamic electrodes were implanted through occipital burr holes for subsequent radiofrequency thalamotomies. In 4 cases, the lesions were made by the bifrontal approach and 1 case was approached from the left occipital and right frontal. In 13 cases, the thalamic lesions were

S. Uematsu; B. Konigsmark; A. E. Walker

1974-01-01

5

Vagus nerve stimulation modulates visceral pain-related affective memory.  

PubMed

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

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

2013-01-01

6

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

7

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

PubMed Central

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

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

2011-01-01

8

Personality differences affect brainstem autonomic responses to visceral pain.  

PubMed

Brainstem autonomic nuclei integrate interoceptive inputs including pain, with descending modulation, to produce homeostatic and defence outputs. Cardiac Vagal Control is especially implicated in psychophysiological processes for both health and disease and is indexed non-invasively by heart rate variability. The study aim was to determine the nature of psychophysiological response profiles for visceral pain. Nineteen healthy subjects had electrocardiographic recordings at rest and during 10 painful oesophageal balloon distensions. Cardiac Vagal Control originating from nucleus ambiguus (CVC(NA)) was determined by polynomial filter application to the electrocardiogram inter-beat interval series. Heart rate and 'Cardiac Sympathetic Index (CSI)' were also determined. Psychological state and trait, including neuroticism and extroversion, were assessed. Subjects who increased CVC(NA) to pain were more neurotic, anxious and sensory sensitive than those who decreased CVC(NA.) Cluster analysis identified two psychophysiological groups: Group 1 (n = 11) demonstrated lower baseline CVC(NA) (P = 0.0001), higher heart rate (P = 0.02) and CSI (P = 0.015), pain tolerance at lower balloon volumes (P = 0.04), but attenuated heart rate response to pain (P = 0.01). Group 2 (n = 8) had the converse profile. Neuroticism scores were higher (P = 0.0004) and extroversion lower (P = 0.01) for group 1 than group 2. Two distinct psychophysiological response profiles to visceral pain exist that are influenced by personality. These may reflect different psychobiological bases for active and passive defence repertoires. Prevalence and clinical relevance of these endophenotypes as vulnerability factors for pain and emotion disorders warrant further exploration. PMID:19538443

Paine, P; Worthen, S F; Gregory, L J; Thompson, D G; Aziz, Q

2009-11-01

9

Visceral pain: mechanisms of peripheral and central sensitization.  

PubMed

This paper describes the responses of peripheral and central visceral nociceptive systems to acute injury and discusses these observations in relation to the concept of 'pre-emptive analgesia'. Visceral nociceptors are known to respond to injury but are also known to become sensitized to non-noxious stimuli during the inflammatory process that follows intense noxious stimulation. The afferent barrages triggered in visceral nociceptors by the acute injury and the enhanced responses evoked in sensitized nociceptors during the repair process can, in turn, increase the excitability of central nociceptive systems. The maintenance of central hypersensitivity is, however, dependant on the continuing presence of afferent volleys from sensitized nociceptors because the central changes cannot be sustained in the absence of a peripheral drive. Therefore it is proposed that the concept of 'pre-emptive analgesia', as such, has no neurophysiological basis. Any analgesic procedure aimed at reducing postoperative pain must not only prevent the arrival in the CNS of the initial afferent barrage evoked in nociceptive endings but also reduce or eliminate the persistent discharges of sensitized nociceptors during the inflammatory repair process that are critically important for the maintenance of the central pain state. PMID:7632420

Cervero, F

1995-04-01

10

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; Luczak, Jacek; Kosicka, Katarzyna; Kotlinska-Lemieszek, Aleksandra; Sopata, Maciej; Glowka, Franciszek

2014-01-01

11

Treating Intractable Phantom Limb Pain with Ambulatory Continuous Peripheral Nerve Blocks: A Pilot Study  

PubMed Central

Background There is currently no reliable treatment for phantom limb pain (PLP). Chronic PLP and associated cortical abnormalities may be maintained from abnormal peripheral input, raising the possibility that a continuous peripheral nerve block (CPNB) of extended duration may permanently reorganize cortical pain mapping, thus providing lasting relief. Methods Three men with below-the-knee (2) or -elbow (1) amputations and intractable PLP received femoral/sciatic or infraclavicular perineural catheter(s), respectively. Subjects were randomized in a double-masked fashion to receive perineural ropivacaine (0.5%) or normal saline for over 6 days as outpatients using portable electronic infusion. Four months later, subjects returned for repeated perineural catheter insertion (“crossover”), and received an ambulatory infusion with the alternate solution. Subjects were followed for up to one year. Results By chance, all 3 subjects received saline during their initial infusion and reported little change in their PLP. One subject did not receive crossover treatment; but, the remaining 2 subjects reported complete resolution of their PLP during and immediately following treatment with ropivacaine. One subject experienced no PLP recurrence through the 52-week follow-up period; and, the other reported mild PLP occurring once each week of just a small fraction of his original pain (pre-treatment: continuous PLP rated 10/10; post-treatment: no PLP at baseline with average of 1 PLP episode each week rated 2/10) for 12 weeks (lost to follow-up thereafter). Conclusions A prolonged ambulatory CPNB may be a reliable treatment for intractable PLP. The results of this pilot study suggest that a large, randomized clinical trial is warranted. PMID:23489466

Ilfeld, Brian M.; Moeller-Bertram, Tobias; Hanling, Steven R.; Tokarz, Kyle; Mariano, Edward R.; Loland, Vanessa J.; Madison, Sarah J.; Ferguson, Eliza J.; Morgan, Anya C.; Wallace, Mark S.

2013-01-01

12

Medical management for intractable pain arising from primary sjögren syndrome involving both brain and spinal cord: a case report.  

PubMed

Primary Sjögren syndrome, which involves lesions in both the brain and spinal cord, is rarely reported. Related symptoms, such as intractable pain due to central nervous system involvement, are very rare. A 73-year-old woman diagnosed with primary Sjögren syndrome manifested with subacute encephalopathy and extensive transverse myelitis. She complained of severe whole body neuropathic pain. Magnetic resonance imaging demonstrated a non-enhancing ill-defined high intensity signal involving the posterior limb of the both internal capsule and right thalamus on a T2 fluid-attenuated inversion recovery image. Additionally, multifocal intramedullary ill-defined contrast-enhancing lesion with cord swelling from the C-spine to L-spine was also visible on the T2-weighted image. Her intractable pain remarkably improved after administration of concomitant oral doses of gabapentin, venlafaxine, and carbamazepine. PMID:25229038

Lee, Kyoung Moo; Han, Kyu Yong; Kwon, Oh Pum

2014-08-01

13

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

14

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

PubMed

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

15

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

16

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

17

Glutamatergic activation of anterior cingulate cortex mediates the affective component of visceral pain memory in rats.  

PubMed

Studies of both humans and animals suggest that anterior cingulate cortex (ACC) is important for processing pain perception. We identified that perigenul ACC (pACC) sensitization and enhanced visceral pain in a visceral hypersensitive rat in previous studies. Pain contains both sensory and affective dimensions. Teasing apart the mechanisms that control the neural pathways mediating pain affect and sensation in nociceptive behavioral response is a challenge. In this study, using a rodent visceral pain assay that combines the colorectal distension (CRD)-induced visceromotor response (VMR) with the conditioning place avoidance (CPA), we measured a learned behavior that directly reflects the affective component of visceral pain. When CRD was paired with a distinct environment context, the rats spent significantly less time in this compartment on the post-conditioning test days as compared with the pre-conditioning day. Effects were lasted for 14 days. Bilateral pACC lesion significantly reduced CPA scores without reducing acute visceral pain behaviors (CRD-induced VMR). Bilateral administration of non-NMDA receptor antagonist CNQX or NMDA receptor antagonist AP5 into the pACC decreased the CPA scores. AP5 or CNQX at dose of 400 mM produced about 70% inhibition of CRD-CPA in the day 1, 4 and 7, and completely abolished the CPA in the day 14 after conditioning. We concluded that neurons in the pACC are necessary for the "aversiveness" of visceral nociceptor stimulation. pACC activation is critical for the memory processing involved in long-term negative affective state and prediction of aversive stimuli by contextual cue. PMID:22107830

Yan, Ni; Cao, Bing; Xu, Jiahe; Hao, Chun; Zhang, Xu; Li, Ying

2012-01-01

18

Amygdala activation by corticosterone alters visceral and somatic pain in cycling female rats.  

PubMed

Irritable bowel syndrome (IBS) is often seen in women, and symptom severity is known to vary over the menstrual cycle. In addition, activation of the hypothalamic-pituitary-adrenal (HPA) axis enhances symptomology and patients with IBS have increased activation of the amygdala, a brain region known to facilitate HPA output. However, little is known about the effects of amygdala activation during different stages of the menstrual cycle. We therefore investigated the effects of amygdala activation on somatic and visceral pain perception over the rat estrous cycle. Female Wistar rats were implanted with either corticosterone (Cort) or cholesterol as a control onto the dorsal margin of the central amygdala. Visceral sensitivity was quantified by recording the visceromotor response (VMR) to colorectal distension (CRD) and somatic sensitivity was assessed via the Von Frey test. In cholesterol controls, both visceral and somatic sensitivity varied over the estrous cycle. Rats in proestrus/estrus responded to CRD with an increased VMR compared with rats in metestrus/diestrus. Somatic sensitivity followed a similar pattern with enhanced sensitivity during proestrus/estrus compared with metestrus/diestrus. Elevated amygdala Cort induced visceral hypersensitivity during metestrus/diestrus but had no effect during proestrus/estrus. In contrast, elevated amygdala Cort increased somatic sensitivity during both metestrus/diestrus and proestrus/estrous. These results suggests that amygdala activation by Cort eliminates spontaneously occurring differences in visceral and somatic pain perception, which could explain the lowered pain thresholds and higher incidence of somatic pain observed in women with IBS. PMID:21454447

Gustafsson, Jenny K; Greenwood-Van Meerveld, Beverley

2011-06-01

19

Gender differences in brain activity evoked by visceral pain in healthy subjects  

Microsoft Academic Search

IntroductionFemales are more likely than males to suffer from many chronic pain conditions, including functional gastrointestinal disorders. However, due to the limited number of studies, information available about gender-differences in normal human central processing of visceral pain is still preliminary. We investigated whether gender differences exist in brain response to visceralpain in a large cohort of healthy volunteers.MethodsSixteen males and

M Kano; S J Coen; A D Farmer; Q Aziz

2011-01-01

20

Transient receptor potential A1 mediates gastric distention-induced visceral pain in rats  

Microsoft Academic Search

Background:Transient receptor potential (TRP)A1, a member of the TRP family of ion channels, has been proposed to function in diverse sensory processes, including thermosensation and pain. However, TRPA1 has not been directly implicated in stomach mechanosensation, and its contribution to acute visceral pain from this organ is unknown. Here, we investigated the expression of TRPA1 in primary sensory afferents and

T Kondo; K Obata; K Miyoshi; J Sakurai; J Tanaka; H Miwa; K Noguchi

2009-01-01

21

Atlanto-axial subluxation syndrome and management of intractable headache, neck pain and shoulder pain with auricular stimulation: a clinical case report.  

PubMed

Atlanto-axial subluxation syndrome is a condition that is easily overlooked, misdiagnosed and mismanaged. Anatomy, neurovascular involvement and description of clinical manifestations are reviewed. Bi-Digital O-Ring Test is employed to establish an accurate diagnosis and its value and accuracy described briefly. Bi-Digital O-Ring Test has been an important diagnosis confirmation method (reconfirmed by CT or MRI in over 95% of more than 850 clinical cases) in this author's practice of spinal disorder and intractable pain management. A newly described device, the KIM-STIM, offers auricular stimulation of multiple points, using electrical microcurrent. Each unit is individually custom-molded to the patient's ear, and fitted with multiple electrodes. It was found to be very effective in managing the majority of intractable pain, especially pain requiring multiple daily treatments in order for the patient to live and function normally. The KIM-STIM device allows the patient to self-manage the pain, by day or night, thus allowing for a reduction or elimination of medication intake and diminishing the necessity for frequent doctor visits. PMID:11841111

Kim, K H

2001-01-01

22

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

PubMed Central

Summary The present report provides evidence that axons in the medial part of the posterior column at T10 convey ascending nociceptive signals from pelvic visceral organs. This evidence was obtained from human surgical case studies and histological verification of the lesion in one of these cases, along with neuroanatomical and neurophysiological findings in animal experiments. A restricted lesion in this area can virtually eliminate pelvic pain due to cancer. The results remain excellent even in cases in which somatic structures of the pelvic body wall are involved. Following this procedure, neurological testing reveals no additional neurological deficit. There is no analgesia to pinprick stimuli applied to the body surface, despite the relief of the visceral pain. Since it is reasonable to attribute the favorable results of limited midline myelotomies to the interruption of axons of visceral nociceptive projection neurons in the posterior column, we have performed experiments in rats to test this hypothesis. The results in rats indicate that the dorsal column does indeed include a nociceptive component that signals pelvic visceral pain. The pathway includes neurons of the postsynaptic dorsal column pathway at the L6-S1 segmental level, axons of these neurons in the fasciculus gracilis, and neurons of the nucleus gracilis and the ventral posterolateral nucleus of the thalamus. PMID:8951923

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

2011-01-01

23

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

24

Importance of epigenetic mechanisms in visceral pain induced by chronic water avoidance stress.  

PubMed

Epigenetic molecular mechanisms, which include DNA methylation and histone deacetylation, are implicated in the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Previously, we demonstrated that repeated water avoidance stress (WAS), a validated model of chronic psychological stress, induces heightened visceral pain behaviors in rodents that resemble irritable bowel syndrome (IBS) sequelae. However, the involvement of epigenetic molecular mechanisms in the pathophysiology of stress-induced visceral pain has not been explored. Our hypothesis is that epigenetic mechanisms within the central nervous system (CNS) are important to chronic stress-induced visceral hypersensitivity. Adult male F-344 rats with intracerebroventricular (i.c.v.) cannulae were exposed to 7 days of repeated WAS. Controls received a SHAM stress. Following the daily 1h stressor, trichostatin A (TSA; 100 ng/ml), a potent histone deacetylase inhibitor, or vehicle (VEH; 0.1% DMSO/saline,) as control was administered via the i.c.v. cannula. Visceral sensitivity was assessed 24h after the final WAS and quantified the visceromotor response (VMR) by recording the number of abdominal contractions in response to graded pressures (20-60 mmHg) of colorectal distensions (CRD). From a separate group of rats that were exposed to repeated WAS or SHAM stress, the amygdala was isolated to assess the methylation status of glucocorticoid receptor (GR) and corticotropin releasing-factor (CRF) genes via bisulfite sequencing and verified by pyrosequencing. GR and CRF gene expression was quantified via qRT-PCR. Stressed rats exhibited visceral hypersensitivity that was significantly attenuated by TSA. Compared to SHAM controls, methylation of the GR gene was increased following WAS while expression of the GR gene was decreased. Methylation of the CRF promoter was decreased with WAS with a concomitant increase in CRF expression. This study demonstrates the involvement of central epigenetic mechanisms in regulating stress-induced visceral hypersensitivity and provides a foundation for exploring the epigenetic mechanisms that may contribute to IBS-like symptomatology. PMID:23084728

Tran, L; Chaloner, A; Sawalha, A H; Greenwood Van-Meerveld, B

2013-06-01

25

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

Microsoft Academic Search

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

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

1988-01-01

26

ZD 7288, an HCN channel blocker, attenuates chronic visceral pain in irritable bowel syndrome-like rats  

PubMed Central

AIM: To investigate the effects of ZD 7288, a hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blocker, on rats with chronic visceral pain. METHODS: Rats with visceral hypersensitivity were generated using neonatal colon irritation during postnatal days 8-15 as described previously. Visceral hypersensitivity was evaluated using electromyographic (EMG) responses of abdominal external oblique muscles to 20-80 mmHg colorectal distentions (CRD). Abdominal withdrawal reflex (AWR) scores and pain thresholds were also detected in adult rats. Different doses of ZD 7288 (25, 50, and 100 nmol/L) were intrathecally administered in rats to study the role of spinal HCN channel in chronic visceral hypersensitivity. RESULTS: EMG responses to 20-80 mmHg CRD and AWR scores under 20-60 mmHg CRD significantly increased in rats with visceral hypersensitivity compared to control rats (P < 0.05). The pain threshold in rats with visceral hypersensitivity significantly decreased compared to control rats (P < 0.05). Treatment with 50-100 nmol/L ZD 7288 significantly inhibited EMG responses (16%-62%, 80-20 mmHg CRD, P < 0.05) and AWR scores (24%-37%, 40-20 mmHg CRD, P < 0.05; 12%-61%, 80-20 mmHg CRD, P < 0.05, respectively), and significantly increased pain thresholds (32%-77%, P < 0.05). CONCLUSION: Spinal HCN channels may play an important role in chronic visceral hypersensitivity. PMID:24587682

Chen, Yu; Lin, Chun; Tang, Ying; Chen, Ai-Qin; Liu, Cui-Ying; Lu, Da-Li

2014-01-01

27

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

28

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

29

Medical Management for Intractable Pain Arising From Primary Sj?gren Syndrome Involving Both Brain and Spinal Cord: A Case Report  

PubMed Central

Primary Sjögren syndrome, which involves lesions in both the brain and spinal cord, is rarely reported. Related symptoms, such as intractable pain due to central nervous system involvement, are very rare. A 73-year-old woman diagnosed with primary Sjögren syndrome manifested with subacute encephalopathy and extensive transverse myelitis. She complained of severe whole body neuropathic pain. Magnetic resonance imaging demonstrated a non-enhancing ill-defined high intensity signal involving the posterior limb of the both internal capsule and right thalamus on a T2 fluid-attenuated inversion recovery image. Additionally, multifocal intramedullary ill-defined contrast-enhancing lesion with cord swelling from the C-spine to L-spine was also visible on the T2-weighted image. Her intractable pain remarkably improved after administration of concomitant oral doses of gabapentin, venlafaxine, and carbamazepine.

Lee, Kyoung Moo; Han, Kyu Yong

2014-01-01

30

Pathological origins of trunk and neck pain: part I - pelvic and abdominal visceral disorders.  

PubMed

An important initial responsibility for a physical therapist examining a patient with back or neck pain is to determine whether the symptoms are a result of mechanical musculoskeletal dysfunction or of a pathological disorder such as visceral pathology or other diseases that would not be amenable to physical therapy management. This responsibility is magnified as direct access legislation continues to be passed. To assist the therapist in this decision making process, this article includes a neuro anatomic overview of visceral pain, along with general evaluation principles and information that suggest the presence of a variety of pathological conditions. In addition, signs and symptoms of specific gastrointestinal and urogenital diseases are presented to familiarize the therapist with conditions that may be manifested as trunk or neck pain. The two subsequent articles in this series will address additional sources of pathological pain, including disorders of the cardiovascular and pulmonary systems and diseases of the musculoskeletal system. J Orthop Sports Phys Ther 1990;12(5);192-207. PMID:18796872

Boissonnault, W G; Bass, C

1990-01-01

31

Analgesic effect of minocycline in rat model of inflammation-induced visceral pain.  

PubMed

The present study investigates the analgesic effect of minocycline, a semi-synthetic tetracycline antibiotic, in a rat model of inflammation-induced visceral pain. Inflammation was induced in male rats by intracolonic administration of tri-nitrobenzenesulphonic acid (TNBS). Visceral hyperalgesia was assessed by comparing the viscero-motor response (VMR) to graded colorectal distension (CRD) prior and post 7 days after TNBS treatment. Electrophysiology recordings from CRD-sensitive pelvic nerve afferents (PNA) and lumbo-sacral (LS) spinal neurons were performed in naïve and inflamed rats. Colonic inflammation produced visceral hyperalgesia characterized by increase in the VMRs to CRD accompanied with simultaneous activation of microglia in the spinal cord and satellite glial cells (SGCs) in the dorsal root ganglions (DRGs). Selectively inhibiting the glial activation following inflammation by araC (Arabinofuranosyl Cytidine) prevented the development of visceral hyperalgesia. Intrathecal minocycline significantly attenuated the VMR to CRD in inflamed rats, whereas systemic minocycline produced a delayed effect. In electrophysiology experiments, minocycline significantly attenuated the mechanotransduction of CRD-sensitive PNAs and the responses of CRD-sensitive LS spinal neurons in TNBS-treated rats. While the spinal effect of minocycline was observed within 5min of administration, systemic injection of the drug produced a delayed effect (60min) in inflamed rats. Interestingly, minocycline did not exhibit analgesic effect in naïve, non-inflamed rats. The results demonstrate that intrathecal injection of minocycline can effectively attenuate inflammation-induced visceral hyperalgesia. Minocycline might as well act on neuronal targets in the spinal cord of inflamed rats, in addition to the widely reported glial inhibitory action to produce analgesia. PMID:24485889

Kannampalli, Pradeep; Pochiraju, Soumya; Bruckert, Mitchell; Shaker, Reza; Banerjee, Banani; Sengupta, Jyoti N

2014-03-15

32

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

PubMed Central

Background In clinical trials, lubiprostone reduced the severity of abdominal pain. Aims The primary aim was to determine whether lubiprostone raises the threshold for abdominal pain induced by intraluminal balloon distention. A secondary aim was to determine whether changes in pain sensitivity influence clinical pain independently of changes in transit time. Methods Sixty-two patients with irritable bowel syndrome with constipation (IBS-C) participated in an 8-week crossover study. All subjects completed a 14-day baseline ending with a barostat test of pain and urge sensory thresholds. Half, randomly selected, then received 48 ug/day of lubiprostone for 14 days ending with a pain sensitivity test and a Sitzmark test of transit time. This was followed by a 14-day washout and then a crossover to 14 days of placebo with tests of pain sensitivity and transit time. The other half of the subjects received placebo before lubiprostone. All kept symptom diaries. Results Stools were significantly softer when taking lubiprostone compared to placebo (Bristol Stool scores 4.20 vs. 3.44, p<0.001). However, thresholds for pain (17.36 vs. 17.83 mmHg, lubiprostone vs. placebo) and urgency to defecate (14.14 vs. 14.53 mmHg) were not affected by lubiprostone. Transit time was not significantly different between lubiprostone and placebo (51.27 vs. 51.81 hours), and neither pain sensitivity nor transit time was a significant predictor of clinical pain. Conclusions Lubiprostone has no effect on visceral sensory thresholds. The reductions in clinical pain that occur while taking lubiprostone appear to be secondary to changes in stool consistency. PMID:21914041

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

2011-01-01

33

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

34

Central amygdala mGluR5 in the modulation of visceral pain  

PubMed Central

Painful bladder syndrome is a debilitating condition that affects 3–6% of women in the United States. Multiple lines of evidence suggest that changes in central nervous system processing are key to the development of chronic bladder pain conditions, but little is known regarding the underlying cellular, molecular, and neuronal mechanisms. Using a mouse model of distension-induced bladder pain, we found that the central nucleus of the amygdala (CeA) is a critical site of neuromodulation for processing of bladder nociception. Furthermore, we demonstrate that metabotropic glutamate receptor 5 (mGluR5) activation in the CeA induces bladder pain sensitization by increasing CeA output. Thus, pharmacological activation of mGluR5 in the CeA is sufficient to increase the response to bladder distension. Additionally, pharmacological blockade or virally-mediated conditional deletion of mGluR5 in the CeA reduced responses to bladder distention suggesting that mGluR5 in the CeA is also necessary for these responses. Finally, we used optogenetic activation of the CeA and demonstrated that this caused a robust increase in the visceral pain response. The CeA localized effects on responses to bladder distention are associated with changes in extracellular signal regulated kinases 1/2 phosphorylation in the spinal cord. Overall, these data demonstrate that mGluR5 activation leads to increased CeA output that drives bladder pain sensitization. PMID:23055491

Crock, Lara W.; Kolber, Benedict J.; Morgan, Clinton D; Sadler, Katelyn E.; Vogt, Sherri K.; Bruchas, Michael R.; Gereau, Robert W.

2012-01-01

35

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

PubMed

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

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

2011-06-01

36

Hippocampal NR2B-containing NMDA receptors enhance long-term potentiation in rats with chronic visceral pain.  

PubMed

Pain and learning memory have striking similarities in synaptic plasticity. Activation of the N-methyl-D-aspartic acid receptors 2B subunits (NR2B-NMDAs) is responsible for the hippocampal LTP in memory formation. In our previous studies, we found the significant enhancement of CA1 hippocampal long-term potentiation (LTP) induced by high-frequency stimulation (HFS) in rats with chronic visceral pain. However, it is unclear whether the NR2B-NMDAs are required for the LTP in chronic visceral pain. In this study, a rat model with irritable bowel syndrome (IBS) was established by colorectal distention (CRD). The sensitivity of visceral pain and HFS-induced LTP at SC-CA1 synapses were significantly enhanced in IBS-like rats (p<0.05). In addition, hippocampal NR2B protein levels significantly increased in IBS-like rats (p<0.05). To test whether NR2B-NMDAs are responsible for the LTP, effects of Ro 25-6981, a selective antagonist of NR2B-NMDAs, on field potential in CA1 region were investigated in vitro. Our results demonstrated that Ro 25-6981 dose-dependently inhibited the facilitation of CA1 LTP in IBS-like rats. The plausible activation mechanism of hippocampal NR2B-NMDAs in the LTP enhancement was further explored. Western blot data indicated that expression of tyrosine phosphorylated NR2B protein in hippocampus significantly enhanced in IBS-like rats. Accordingly, genistein, a specific inhibitor of tyrosine kinases, dose-dependently blocked the facilitation of hippocampal LTP in IBS-like rats. Furthermore, EMG data revealed that intra-hippocampal injection of Ro 25-6981 dose-dependently attenuated the visceral hypersensitivity. In conclusion, hippocampal NR2B-NMDAs are responsible for the facilitation of CA1 LTP via tyrosine phosphorylation, which leads to visceral hypersensitivity. PMID:24824341

Chen, Yu; Chen, Ai-qin; Luo, Xiao-qing; Guo, Li-xia; Tang, Ying; Bao, Cheng-jia; Lin, Ling; Lin, Chun

2014-06-27

37

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

PubMed Central

A history of early life adversity (ELA) has health-related consequences that persist beyond the initial maltreatment and into adulthood. Childhood adversity is associated with abnormal glucocorticoid signaling within the hypothalamic-pituitary-adrenal (HPA) axis and the development of functional pain disorders such as the irritable bowel syndrome (IBS). IBS and many adult psychopathologies are more frequently diagnosed in women, and ovarian hormones have been shown to modulate pain sensitivity. Therefore, the sexually dimorphic effects of ELA and the role of ovarian hormones in visceral pain perception represent critical research concepts to enhance our understanding of the etiology of IBS. In this review, we discuss current animal models of ELA and the potential mechanisms through which ovarian hormones modulate the HPA axis to alter nociceptive signaling pathways and induce functionally relevant changes in pain behaviors following ELA. PMID:23407595

Chaloner, Aaron; Greenwood-Van Meerveld, Beverley

2012-01-01

38

Profound reduction of somatic and visceral pain in mice by intrathecal administration of the anti-migraine drug, sumatriptan  

PubMed Central

Sumatriptan and the other triptan drugs target the serotonin receptor subtypes1B, 1D, and 1F (5-HT1B/D/F), and are prescribed widely in the treatment of migraine. An anti-migraine action of triptans has been postulated at multiple targets, within the brain and at both the central and peripheral terminals of trigeminal “pain-sensory” fibers. However, as triptan receptors are also located on “pain-sensory” afferents throughout the body, it is surprising that triptans only reduce migraine pain in humans, and experimental cranial pain in animals. Here we tested the hypothesis that sumatriptan can indeed reduce non-cranial, somatic and visceral pain in behavioral models in mice. Because sumatriptan must cross the blood brain barrier to reach somatic afferent terminals in the spinal cord, we compared systemic to direct spinal (intrathecal) sumatriptan. Acute nociceptive thresholds were not altered by sumatriptan pre-treatment, regardless of route. However, in behavioral models of persistent inflammatory pain, we found a profound anti-hyperalgesic action of intrathecal, but not systemic, sumatriptan. By contrast, sumatriptan was completely ineffective in an experimental model of neuropathic pain. The pronounced activity of intrathecal sumatriptan against inflammatory pain in mice raises the possibility that there is a wider spectrum of therapeutic indications for triptans beyond headache. PMID:18723285

Nikai, Tetsuro; Basbaum, Allan I.; Ahn, Andrew H.

2009-01-01

39

Intrathecal allograft of chromaffin cells for intractable pain treatment: A model for understanding CNS tolerance mechanisms in humans  

Microsoft Academic Search

GRAFTS of adrenal medulla tissue or chromaffin cells have been proposed for the treatment of Parkinson's disease and chronic pain.1,2 It has been shown that transplanted chromaffin cells can release analgesic neuroactive substances, including catecholamines, opioid peptides, metenkephalin, somatostatin, and so on.3,4 The subarachnoid space is a favored site for the allograft since the phenomenon of immunologic privilege is classically

J. Tkaczuk; J. C. Bes; H. de Bouet du Portal; M. Tafani; H. Duplan; M. Abbal; Y. Lazorthes; E. Ohayon

1997-01-01

40

Extracellular signal-regulated kinases 1 and 2 phosphorylated neurons in the tele- and diencephalon of rat after visceral pain stimulation: an immunocytochemical study  

Microsoft Academic Search

We aimed at verifying whether extracellular signal-regulated kinases (erks) 1 and 2 are activated, i.e. phosphorylated, in forebrain neurons after visceral pain stimulation (VPS). Ether and urethane anaesthetized rats received an intraperitoneal injection of acetic acid or were left untreated (ECT, UCT). After 2 h the animals were perfused. Paraffin embedded brain sections immunoreacted with an antibody selective for the

Magda Gioia; Stefania Galbiati; Laura Rigamonti; Claudia Moscheni; Nicoletta Gagliano

2001-01-01

41

Patients with Chronic Visceral Pain Show Sex-Related Alterations in Intrinsic Oscillations of the Resting Brain  

PubMed Central

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

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

2013-01-01

42

Antinociceptive effects of systemic tanshinone IIA on visceral and somatic persistent nociception and pain hypersensitivity in rats.  

PubMed

Previous studies showed that tanshinone IIA (TIIA), an important lipophilic component of Danshen, has been well-established to exhibit various neuroprotective actions in the nervous system. Although we previously reported that TIIA had a significant anti-nociceptive effect in complete Freund's adjuvant (CFA)-induced pain, it is surprisingly noted that few pharmacological studies have been carried out to explore the possible analgesic action of TIIA in animals and the appropriate indications for treatment of clinical pain remain unclear. Therefore, in the present study, by using both somatic and visceral pain models, the antinociceptive and antihyperalgesic effects of TIIA were evaluated by intraperitoneal administration in rats. In the bee venom (BV) test, when compared with saline controls, systemic pre- and post-treatment with TIIA resulted in an apparent antinociception against persistent spontaneous nociception (PSN) and primary heat and mechanical hypersensitivity, while for the mirror-image heat hypersensitivity, only pre-treatment was effective. Moreover, in the formalin test, the antinociception of TIIA was significant for both phases 1 and 2 in the pretreatment groups, but only effective for phase 2 in the post-treatment group. In the acetic acid writhing test, the number of writhes was effectively blocked by both pre- and post-treatment of TIIA. Taken together, these results provide a new line of evidence showing that TIIA is also able to produce analgesia against various 'phenotypes' of nociception and hypersensitivity. PMID:24823766

Cao, Fa-Le; Su, Xue-Jia; Wang, Yan; Xu, Min; Shan, Liang

2014-09-01

43

Ouch! Neuronal pathways responsible for conduction of somatosensory and visceral pain  

NSDL National Science Digital Library

This resource is part of the AAA Education and Teaching Session. In particular this resource is a summary of the presentation from the AAA Annual Meeting/EB 2010 Master Class: The Problem with Pain. MASTER CLASS: THE PROBLEM WITH PAIN

Dr. Jennifer M McBride (Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University, Surgery)

2011-08-23

44

Spinal estrogen receptor alpha mediates estradiol-induced pronociception in a visceral pain model in the rat  

PubMed Central

We previously reported that 17? – estradiol (E2) is pronociceptive in a visceral pain model in the rat. Subcutaneously (s.c.) administered E2 reversed the decrease in the colorectal distention (CRD)-evoked visceromotor response produced by ovariectomy (OVx) and CRD-induced nociceptive responses were greater in proestrous rats compared to met/diestrous rats. The site of action, the type of estrogen receptors activated and the possible intracellular signaling pathway involved are yet to be established. In the present study, intrathecal (i.t.) E2 administered to OVx rats mimicked the effects of s.c. E2, suggesting spinal E2 receptors are involved. This is further supported by the observations that the anti-estrogen ICI 182,780 injected i.t. in intact female rats significantly decreased the visceromotor response to CRD, the response of colonic afferents was not affected by OVx and colonic afferents did not label for estrogen receptor ? (ER?). The ER? selective agonist, 4,4',4"-[4-propyl-(1H)-pyrazole-1,3,5-triyl]tris-phenol (PPT; s.c. or i.t.) facilitated the visceromotor response similar to E2, suggesting ER? activation is involved in mediating the pronociceptive effect of E2. PPT (s.c. or i.t.) increased the response of spinal dorsal horn neurons to CRD, indicating a spinal site of action. In addition, s.c. E2 or PPT increased CRD-induced spinal extracellular-signal-regulated kinase (ERK) phosphorylation that was not observed in OVx rats and a mitogen-activated protein kinase (MAPK) kinase (MEK) inhibitor blocked facilitation of the visceromotor response by PPT. Taken together, the present study demonstrates that spinal ER? mediates the pronociceptive effect of E2 on visceral signal processing through activation of the MAPK pathway. PMID:21392887

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

2011-01-01

45

Pronociceptive effect of 5-HT(1A) receptor agonist on visceral pain involves spinal N-methyl-D-aspartate (NMDA) receptor.  

PubMed

The functional role of serotonergic 5-HT(1A) receptors in the modulation of visceral pain is controversial. The objective of this study was to systematically examine the mechanism and site of action of a selective 5-HT(1A) receptor agonist 8-hydroxy-2-(di-n-propylamino)-tetralin (DPAT) on visceral pain. In the behavioral model of visceral pain, systemic injection (5-250 ?g/kg) of DPAT produced a significant increase in the viscero-motor response (VMR) to colorectal distension (CRD) and this effect was blocked by the selective 5-HT(1A) receptor antagonist WAY-100135 (5 mg/kg, s.c.). Similarly, intrathecal (i.t.) injection (5 ?mol) of DPAT into the lumbo-sacral (L6-S1) spinal cord produced a significant increase in VMR. The administration of N-methyl D-aspartate (NMDA) receptor antagonist AP5 (50 ?g/kg) prior to DPAT injection completely blocked the pronociceptive effect of DPAT. Similarly, DPAT failed to increase VMR in rats chronically treated with NR1 subunit-targeted antisense oligonucleotide (ON), whereas the drug increased VMR in rats treated with mismatched-ON. Chronic i.t. injection of allylglycine (AG), a ?-amino decarboxylase (GAD) enzyme inhibitor, produced significant increase in VMRs, suggesting that the inhibition of GABA synthesis produces pronociception. In AG-treated rats, i.t. injection of DPAT failed to further increase in VMR, suggesting that the DPAT action is linked to GABA release. Similarly, WAY-100135 failed to attenuate VMR in AG-treated rats, suggesting that unlike DPAT, AG action is not via the activation of 5-HT(1A) receptors. In electrophysiology experiments, DPAT (50 ?g/kg) significantly increased the responses of spinal neurons to CRD, but did not influence the mechanotransduction property of CRD-sensitive pelvic nerve afferent fibers. The effect of DPAT on spinal neurons remained unaffected when tested in spinal-transected (C1-C2) rats. These results indicate that the 5-HT(1A) receptor agonist DPAT produces pronociceptive effects, primarily via the activation of presynaptic 5-HT(1A) receptors in GABAergic neuron to restrict GABA release and thereby disinhibits the excitatory glutamatergic neurons in the spinal cord. PMID:22626644

Mickle, A; Kannampalli, P; Bruckert, M; Miranda, A; Banerjee, B; Sengupta, J N

2012-09-01

46

Oleoylethanolamide excites vagal sensory neurones, induces visceral pain and reduces short-term food intake in mice via capsaicin receptor TRPV1.  

PubMed

Oleoylethanolamide (OEA) is an endogenous lipid that regulates feeding and body weight. Although the effects of OEA are believed to depend on activation of vagal sensory afferent neurones, the mechanisms involved in exciting these neurones are unclear. Here we show that OEA directly excited nodose ganglion neurones, the cell bodies of vagal afferents. OEA depolarized these neurones and evoked inward currents that were restricted to capsaicin-sensitive cells. These currents were fully blocked by the TRPV1 inhibitor, capsazepine, and no responses to OEA were observed in neurones cultured from TRPV1-null mice. Similarly, OEA induced a rise in Ca(+) concentration in wild-type but not TRPV1-deficient neurones, and responses to OEA were greater at 37 degrees C compared to room temperature. Significantly, OEA administration in mice induced visceral pain-related behaviours that were inhibited by capsazepine and absent in TRPV1-null animals. Further, OEA reduced 30-min food intake in wild-type but not in TRPV1-null mice. Thus, the acute behavioural effects of OEA may result from visceral malaise via the activation of TRPV1. PMID:15695242

Wang, Xiangbin; Miyares, Rosa Linda; Ahern, Gerard P

2005-04-15

47

Intractable Pruritus After Traumatic Spinal Cord Injury  

PubMed Central

Background: This report describes a young woman with incomplete traumatic cervical spinal cord injury and intractable pruritus involving her dorsal forearm. Method: Case report. Findings: Anatomic distribution of the pruritus corresponded to the dermatomal distribution of her level of spinal cord injury and vertebral fusion. Symptoms were attributed to the spinal cord injury and possible cervical root injury. Pruritus was refractory to all treatments, including topical lidocaine, gabapentin, transcutaneous electrical nerve stimulation, intravenous Bier block, stellate ganglion block, and acupuncture. Conclusions: Further understanding of neuropathic pruritus is needed. Diagnostic workup of intractable pruritus should include advanced imaging to detect ongoing nerve root compression. If diagnostic studies suggest radiculopathy, epidural steroid injection should be considered. Because the autonomic nervous system may be involved in complex chronic pain or pruritic syndromes, sympatholysis via such techniques as stellate ganglion block might be effective. PMID:19777867

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

2009-01-01

48

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

Microsoft Academic Search

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

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

2009-01-01

49

Electro-acupuncture relieves chronic visceral hyperalgesia in rats  

Microsoft Academic Search

Acupuncture treatment is one of the most desirable choices for the management of pain including chronic visceral pain, but its scientific evidence and laws of action are not very clear at this point. In this study, we examined the immediate and cumulative effects of electro-acupuncture (EA) on chronic visceral pain induced by colorectal distention (CRD) stimuli in rats using an

K. M. Cui; W. M. Li; X. Gao; K. Chung; J. M. Chung; G. C. Wu

2005-01-01

50

Visceral Leishmaniasis.  

National Technical Information Service (NTIS)

Visceral leishmaniasis (VL), a chronic disease caused by parasites of the Leishmania donovani complex, is characterized by irregular fever, enlargement of the spleen and liver, weight loss, pancytopenia, and hypergammaglobulinemia.

A. J. Magill, M. K. Klassen-Fischer, R. C. Neafie, W. M. Meyers

2011-01-01

51

Importance of Stress Receptor-Mediated Mechanisms in the Amygdala on Visceral Pain Perception in an Intrinsically Anxious Rat  

PubMed Central

Background Stress worsens abdominal pain experienced by patients with irritable bowel syndrome (IBS), a chronic disorder of unknown origin with comorbid anxiety. We have previously demonstrated colonic hypersensitivity in Wistar-Kyoto rats (WKYs), a high-anxiety strain, that models abdominal pain in IBS. In low-anxiety rats, we have demonstrated that the central nucleus of the amygdala (CeA) regulates colonic hypersensitivity and anxiety induced by selective activation of either glucocorticoid receptors (GR) or mineralocorticoid receptors (MR), which is also mediated by the corticotropin releasing factor (CRF) type-1 receptor. The goal of the present study was to test the hypothesis that the CeA through GR, MR and/or CRF-1R regulates colonic hypersensitivity in WKYs. Methods One series of WKYs had micropellets of a GR antagonist, an MR antagonist or cholesterol (control) stereotaxically implanted onto the CeA. Another series were infused in the CeA with CRF-1R antagonist or vehicle. Colonic sensitivity was measured as a visceromotor response (VMR) to graded colorectal distension (CRD). Key Results The exaggerated VMR to graded CRD in WKYs was unaffected by GR or MR antagonism in the CeA. In contrast, direct CeA infusion of CRF-1R antagonist significantly inhibited the VMR to CRD at noxious distension pressures. Conclusions & Inferences Stress-hormones in the CeA regulate colonic hypersensitivity in the rat through strain-dependent parallel pathways. The colonic hypersensitivity in WKYs is mediated by a CRF-1R mechanism in the CeA, independent of GR and MR. These complementary pathways suggest multiple etiologies whereby stress hormones in the CeA may regulate abdominal pain in IBS patients. PMID:22364507

Johnson, Anthony C.; Tran, Lee; Schulkin, Jay; Greenwood-Van Meerveld, Beverley

2012-01-01

52

Sex differences in brain activity during aversive visceral stimulation and its expectation in patients with chronic abdominal pain: A network analysis  

Microsoft Academic Search

Differences in brain responses to aversive visceral stimuli may underlie previously reported sex differences in symptoms as well as perceptual and emotional responses to such stimuli in patients with irritable bowel syndrome (IBS). The goal of the current study was to identify brain networks activated by expected and delivered aversive visceral stimuli in male and female patients with chronic abdominal

J. S. Labus; B. N. Naliboff; J. Fallon; S. M. Berman; B. Suyenobu; J. A. Bueller; M. Mandelkern; E. A. Mayer

2008-01-01

53

The involvement of the tetrodotoxin-resistant sodium channel Na(v)1.8 (PN3/SNS) in a rat model of visceral pain.  

PubMed

The present study investigated the effect of inhibiting the expression of Na(v)1.8 (PN3/SNS) sodium channels by an antisense oligodeoxynucleotide (ODN) on bladder nociceptive responses induced by intravesical acetic acid infusion in rats. Animals were injected intrathecally with either Na(v)1.8 antisense or mismatch ODN. Control cystometrograms under urethane anesthesia during intravesical saline infusion exhibited intercontraction intervals (ICIs) that were significantly longer in antisense-treated rats than in mismatch ODN-treated rats. Intravesical infusion of 0.1% acetic acid induced bladder hyperactivity as reflected by a 68% reduction in ICIs in mismatch ODN-treated rats but did not significantly reduce ICIs in antisense-treated rats. The number of Fos-positive cells after acetic acid administration were significantly reduced in the L6 spinal cord from antisense-treated animals, compared with mismatch ODN-treated animals. In addition, Na(v)1.8 immunoreactivity was reduced in L6 dorsal root ganglion neurons in the antisense-treated rat. In patch-clamp recordings, the conductance density of TTX-resistant sodium currents in dissociated bladder afferent neurons that were labeled by axonal transport of a fluorescent dye, Fast Blue, injected into the bladder wall was also smaller in antisense-treated rats than in mismatch ODN-treated rats, whereas no changes were observed in TTX-sensitive currents. These results indicate that the Na(v)1.8 TTX-resistant sodium channels are involved in the activation of afferent nerves after chemical irritation of the bladder. These channels represent a new target for the treatment of inflammatory pain from visceral organs such as the urinary bladder. PMID:11606657

Yoshimura, N; Seki, S; Novakovic, S D; Tzoumaka, E; Erickson, V L; Erickson, K A; Chancellor, M B; de Groat, W C

2001-11-01

54

How to Improve the Efficacy of Endoscopic Ultrasound-guided Celiac Plexus Neurolysis in Pain Management in Patients With Pancreatic Cancer: Analysis in a Single Center  

PubMed Central

Visceral pain secondary to pancreatic cancer is often difficult to control and poses a challenge to the physician. We retrospectively analyzed the efficacy and safety of endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) in patients with unresectable pancreatic cancer. Forty-one patients with severe pain despite treatment with opioids underwent EUS-CPN with absolute alcohol. Patients scored their pain on a scale of 0 to 10 and were interviewed after the procedure. Of the 41 patients, 33, 37, and 25 patients reported improvement in their pain within 3 days, at 1 week, and at 3 months, respectively, following the procedure. Of all the patients, 19 patients reported substantial improvement and 4 patients showed complete disappearance of pain. Complication appeared in 2 patients with transient hypotension. In our study, EUS-CPN is a safe and effective form of treatment for intractable pain secondary to advanced pancreatic cancer. PMID:24487155

Si-Jie, Hao; Wei-Jia, Xu; Yang, Di; Lie, Yao; Feng, Yang; Yong-Jian, Jiang; Ji, Li; Liang, Zhong; De-Liang, Fu

2014-01-01

55

[The role of vagal afferents in visceral hyperalgesia].  

PubMed

The visceral sensation from the abdomen are delivered continuously to the brain by the vagus nerve, the largest visceral sensory nerve in the body. Although it is commonly assumed that vagal afferents are not involved in nociception and pain, there is growing evidence that they play a complex role in these processes. Vagal afferents may contribute to the effective-emotional rather than to the sensory-disciminative aspect of pain. PMID:17252992

Zurowski, Daniel; Nowak, ?ukasz; Thor, Piotr J

2005-01-01

56

Real time network modulation for intractable epilepsy Behnaam Aazhang  

E-print Network

Real time network modulation for intractable epilepsy Behnaam Aazhang ! Electrical and Computer;Real time network modulation for intractable epilepsy Behnaam Aazhang ! Electrical and Computer;Real time network modulation for intractable epilepsy Behnaam Aazhang ! Electrical and Computer

Aazhang, Behnaam

57

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 7: lumbar fusion for intractable low-back pain without stenosis or spondylolisthesis.  

PubMed

Establishing an appropriate treatment strategy for patients presenting with low-back pain, in the absence of stenosis or spondylolisthesis, remains a controversial subject. Inherent to this situation is often an inability to adequately identify the source of low-back pain to justify various treatment recommendations, such as lumbar fusion. The current evidence does not identify a single best treatment alternative for these patients. Based on a number of prospective, randomized trials, comparable outcomes, for patients presenting with 1- or 2-level degenerative disc disease, have been demonstrated following either lumbar fusion or a comprehensive rehabilitation program with a cognitive element. Limited access to such comprehensive rehabilitative programs may prove problematic when pursuing this alternative. For patients whose pain is refractory to conservative care, lumbar fusion is recommended. Limitations of these studies preclude the ability to present the most robust recommendation in support of lumbar fusion. A number of lesser-quality studies, primarily case series, also support the use of lumbar fusion in this patient population. PMID:24980584

Eck, Jason C; Sharan, Alok; Ghogawala, Zoher; Resnick, Daniel K; Watters, William C; Mummaneni, Praveen V; Dailey, Andrew T; Choudhri, Tanvir F; Groff, Michael W; Wang, Jeffrey C; Dhall, Sanjay S; Kaiser, Michael G

2014-07-01

58

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

59

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

PubMed Central

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

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

2013-01-01

60

MicroRNA-mediated GABAA?-1 receptor subunit downregulation in adult spinal cord following neonatal cystitis-induced chronic visceral pain in rats  

PubMed Central

The nociceptive transmission under pathological chronic pain conditions involves transcriptional and/or translational alteration in spinal neurotransmitters and receptors expression, and modification of neuronal function. Studies indicate the involvement of MicroRNA (miRNA)-mediated transcriptional deregulation in pathophysiology of acute and chronic pain. In the present study, we tested the hypothesis that long-term cross-organ colonic hypersensitivity in neonatally zymosan-induced cystitis is due to miRNA-mediated posttranscriptional suppression of the developing spinal GABAergic system. Cystitis was produced by intravesicular injection of zymosan (1% in saline) into the bladder during postnatal (P) days P14 through P16 and spinal dorsal horns (L6-S1) were collected either on P60 (unchallenge groups) or on P30 following a zymosan re-challenge on P29 (re-challenge groups). miRNA arrays and Real-time reverse transcription polymerase chain reaction revealed significant, but differential, upregulation of mature miR-181a in the L6-S1 spinal dorsal horns from zymosan-treated rats compared with saline controls in both unchallenge and re-challenge groups. The target gene analysis demonstrated multiple complementary binding sites in miR-181a for GABAA receptor subunit GABAA??1 gene with a miRSVR score of ?1.83. Increase in miR-181a concomitantly resulted in significant downregulation of GABAA??1 receptor subunit gene and protein expression in adult spinal cords from neonatal cystitis rats. Intrathecal administration of GABAA receptor agonist muscimol failed to attenuate viscero-motor response (VMR) to colon distension in neonatal cystitis rats, whereas, in adult zymosan-treated rats the drug produced significant decrease in VMR. These results support an integral role for miRNA-mediated transcriptional deregulation of GABAergic system in neonatal cystitis-induced chronic pelvic pain. PMID:23273104

Sengupta, JN; Pochiraju, S; Kannampalli, P; Bruckert, M; Addya, S; Yadav, P; Miranda, A; Shaker, R; Banerjee, B

2012-01-01

61

MicroRNA-mediated GABA A?-1 receptor subunit down-regulation in adult spinal cord following neonatal cystitis-induced chronic visceral pain in rats.  

PubMed

The nociceptive transmission under pathological chronic pain conditions involves transcriptional and/or translational alteration in spinal neurotransmitters, receptor expressions, and modification of neuronal functions. Studies indicate the involvement of microRNA (miRNA) - mediated transcriptional deregulation in the pathophysiology of acute and chronic pain. In the present study, we tested the hypothesis that long-term cross-organ colonic hypersensitivity in neonatal zymosan-induced cystitis is due to miRNA-mediated posttranscriptional suppression of the developing spinal GABAergic system. Cystitis was produced by intravesicular injection of zymosan (1% in saline) into the bladder during postnatal (P) days P14 through P16 and spinal dorsal horns (L6-S1) were collected either on P60 (unchallenged groups) or on P30 after a zymosan re-challenge on P29 (re-challenged groups). miRNA arrays and real-time reverse transcription-polymerase chain reaction (RT-PCR) revealed significant, but differential, up-regulation of mature miR-181a in the L6-S1 spinal dorsal horns from zymosan-treated rats compared with saline-treated controls in both the unchallenged and re-challenged groups. The target gene analysis demonstrated multiple complementary binding sites in miR-181a for GABA(A) receptor subunit GABA(A?-1) gene with a miRSVR score of -1.83. An increase in miR-181a concomitantly resulted in significant down-regulation of GABA(A?-1) receptor subunit gene and protein expression in adult spinal cords from rats with neonatal cystitis. Intrathecal administration of the GABA(A) receptor agonist muscimol failed to attenuate the viscero-motor response (VMR) to colon distension in rats with neonatal cystitis, whereas in adult zymosan-treated rats the drug produced significant decrease in VMR. These results support an integral role for miRNA-mediated transcriptional deregulation of the GABAergic system in neonatal cystitis-induced chronic pelvic pain. PMID:23273104

Sengupta, Jyoti N; Pochiraju, Soumya; Pochiraju, Soumiya; Kannampalli, Pradeep; Bruckert, Mitchell; Addya, Sankar; Yadav, Priyanka; Miranda, Adrian; Shaker, Reza; Banerjee, Banani

2013-01-01

62

Gabapentin for intractable hiccups in palliative care.  

PubMed

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 and many of the proposed treatments are unproven or have long-term side effects. Pharmacologic treatments rather than home remedies or surgical treatments are more appropriate for the palliative care patient. Gabapentin is a promising medication for the treatment of intractable hiccups for its safety, lack of serious side effects, and rapid onset of action. Further research is indicated to determine whether gabapentin is consistently effective. PMID:18292481

Tegeler, Monica L; Baumrucker, Steven J

2008-01-01

63

Botulinum toxin-type A: could it be an effective treatment option in intractable trigeminal neuralgia?  

PubMed Central

Background Botulinum toxin type A (BTX-A) has been reported to have analgesic effects independent of its action on muscle tone, mostly by acting on neurogenic inflammatory mediators and controlling the neurotransmitter release of sensory and autonomic nerve terminals that are involved in many chronic painful conditions as chronic intractable trigeminal neuralgia (TN). The aim of our work was evaluating the efficacy, safety, and tolerability of BTX-A for the treatment of intractable idiopathic TN. Methods This was a randomized, single-blinded, placebo-control study carried out on 20 Egyptian patients with intractable TN. Patients received a one-time subcutaneous administration of BTX-A using “follow the pain” method. The primary efficacy measure was reduction in pain severity on the 10-cm VAS score as well as in paroxysms frequency from the baseline to week 12 (endpoint last observation carried forward [LOCF]). Secondary efficacy measures included QoL assessment and number of acute medications received from baseline to the endpoint. Results Pain reduction at the 12-week endpoint was significant in BTX-A group (p<0.0001); VAS scores at endpoint LOCF relative to baseline for BTX-A group showed a decrease of 6.5 compared with a decrease of 0.3 for placebo, also there was a significant decrease in the number of acute medications and an increase in QoL functioning scale. Conclusion These results indicate that BTX-A has a direct analgesic effect in patients with TN and can represent a therapeutic option for intractable cases. PMID:24251833

2013-01-01

64

Role of RVM neurons in capsaicin-evoked visceral nociception and referred hyperalgesia  

E-print Network

Role of RVM neurons in capsaicin-evoked visceral nociception and referred hyperalgesia Raul Sanoja: Capsaicin Descending facilitation Hyperalgesia AP5 NMDA a b s t r a c t Most forms of visceral pain generate hyperalgesia. Intracolonic capsaicin instillation (ICI) was applied to rats in order to create a hyperalgesic

Price, Theodore

65

Sacral nerve stimulation for intractable constipation  

Microsoft Academic Search

ObjectiveTraditional surgical procedures for intractable idiopathic constipation are associated with a variable outcome and substantial morbidity. The symptomatic response, physiological effect and effect on quality of life of sacral nerve stimulation (SNS) were evaluated in patients with constipation (slow transit and normal transit with impaired evacuation).MethodsIn a prospective study at five European sites patients who failed conservative treatment underwent 21

Michael A Kamm; Thomas C Dudding; Jarno Melenhorst; Michael Jarrett; Zengri Wang; Steen Buntzen; Claes Johansson; Søren Laurberg; Harald Rosen; Carolynne J Vaizey; Klaus Matzel; Cor Baeten

2010-01-01

66

Pain channelopathies  

PubMed Central

Pain remains a major clinical challenge, severely afflicting around 6% of the population at any one time. Channelopathies that underlie monogenic human pain syndromes are of great clinical relevance, as cell surface ion channels are tractable drug targets. The recent discovery that loss-of-function mutations in the sodium channel Nav1.7 underlie a recessive pain-free state in otherwise normal people is particularly significant. Deletion of channel-encoding genes in mice has also provided insights into mammalian pain mechanisms. Ion channels expressed by immune system cells (e.g. P2X7) have been shown to play a pivotal role in changing pain thresholds, whilst channels involved in sensory transduction (e.g. TRPV1), the regulation of neuronal excitability (potassium channels), action potential propagation (sodium channels) and neurotransmitter release (calcium channels) have all been shown to be potentially selective analgesic drug targets in some animal pain models. Migraine and visceral pain have also been associated with voltage-gated ion channel mutations. Insights into such channelopathies thus provide us with a number of potential targets to control pain. PMID:20142270

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

2010-01-01

67

Gene Therapy for Chronic Pain  

Microsoft Academic Search

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

William R. Lariviere; Doris K. Cope

68

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.

Tamura, Sumihito; Sugawara, Yasuhiko; Kokudo, Norihiro

2012-01-01

69

Chronic pain in torture survivors  

Microsoft Academic Search

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

Annemarie B Thomsen; Jørgen Eriksen; Knud Smidt-Nielsen

2000-01-01

70

Complications of Invasive Monitoring Used in Intractable Pediatric Epilepsy  

Microsoft Academic Search

Invasive monitoring for intractable epilepsy is useful when the epileptogenic focus is in question even after an extensive noninvasive presurgical evaluation, or when the epileptogenic focus is located in or near eloquent cortex. From June 1989 to June 2001 at the Children’s Hospital of Philadelphia, 64 children with intractable epilepsy underwent 67 invasive monitoring procedures as part of their presurgical

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

2003-01-01

71

Benign Lesions Accompanied by Intractable Epilepsy in Children  

Microsoft Academic Search

Epilepsy surgery has been proposed as a safe alternative treatment for intractable epilepsy in children, especially for patients with structural brain abnormalities. We studied 24 consecutive children who underwent surgery for intractable epilepsy. There were 12 males and 12 females. The mean age was 6.5 years. The seizures' duration ranged from 6 months to 2 years. The histopathological examination of

George A. Alexiou; Maria Varela; George Sfakianos; Neofytos Prodromou

2009-01-01

72

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

73

Oral bismuth for chronic intractable diarrheal conditions?  

PubMed Central

Objective Bismuth has antidiarrheal, antibacterial, and anti-inflammatory properties. We report our single-center experience with oral colloidal bismuth subcitrate (CBS) treatment for patients with chronic intractable diarrhea. Method We interrogated our web-based Inflammatory Bowel Disease Clinical and Research database to ascertain clinical details on all patients in our tertiary hospital gastroenterology service treated with CBS between 2000 and 2010. Treatment responses were based on prospective scoring of daily number of liquid stools. Responses were recorded prior to commencement of CBS and at follow-up visits over 12 months. Results Thirty-one patients, mean age 47 years (range 17–79 years) and a mean duration of diarrhea of 22 weeks (range 6–104 weeks), were prescribed CBS at doses ranging from 120 mg to 480 mg/day for ?1 month. Of these, 23 patients (74%) had an initial clinical response and 12 (39%) who continued with this treatment had a sustained clinical response at 1 year. Twelve patients with pouchitis and four patients with indeterminate colitis had initial responses of 92% and 75%, respectively, and sustained responses of 50% and 75%, respectively. Ulcerative colitis patients (n = 5) responded poorly with respect to both initial and sustained responses. Three patients with microscopic colitis showed encouraging initial response of 100% but did not have any sustained benefit. Three of four patients with diarrhea-predominant irritable bowel syndrome (dIBS) had an initial response and two (50%) had good sustained responses. There were no serious adverse events. One patient stopped therapy because of nausea. Conclusion This is the largest report of oral bismuth treatment in chronic intractable diarrhea. CBS is cheap and appears to have the potential to be effective for ameliorating diarrheal symptoms in indeterminate colitis, pouchitis, and dIBS. An appropriately powered, blinded, randomized, controlled study appears warranted to establish the position of oral bismuth in routine practice. PMID:23515887

Thazhath, Sony S; Haque, Mazhar; Florin, Timothy H

2013-01-01

74

[The visceral theory of sleep].  

PubMed

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

Pigarev, I N

2013-01-01

75

Statistical Inference for Models with Intractable Normalizing Constants  

E-print Network

In this dissertation, we have proposed two new algorithms for statistical inference for models with intractable normalizing constants: the Monte Carlo Metropolis-Hastings algorithm and the Bayesian Stochastic Approximation Monte Carlo algorithm...

Jin, Ick Hoon

2011-06-27

76

Reoperation for recurrent chronic visceral ischemia  

Microsoft Academic Search

Purpose: Recurrent visceral ischemia after a failed visceral revascularization occurs in up to one third of patients, yet no comprehensive report has described the management of this problem. The purpose of this study was to examine the presentation, surgical management, and outcome of patients with recurrent visceral ischemia. Methods: Between 1959 and 1997, 109 patients underwent primary visceral revascularization at

Darren B. Schneider; Peter A. Schneider; Linda M. Reilly; William K. Ehrenfeld; Louis M. Messina; Ronald J. Stoney

1998-01-01

77

Pain without nociception?  

PubMed

We describe a young woman with complete cervical spinal cord transsection, who developed significant abdominal pain, triggered by gastric distension and deep abdominal palpation. On the basis of the nature of her spinal cord injury, her brain-gut axis was limited to vagal pathways. Studies in mammalian models of human visceral sensation consistently showed that the subdiaphragmatic vagus contains a homogeneous population of afferents that are activated by low-intensity stimuli, which are generally believed to be important in regulating autonomic function and perhaps contributing to visceral sensory experiences triggered by such low-intensity stimuli (e.g. fullness, nausea), but not pain, although many fibers encode stimuli well into the noxious range. In contrast, spinal afferent pathways include fibers with high-activation thresholds that are thought to represent specialized nociceptors. This illustrative case argues against an exclusive role of specialized nociceptive pathways in visceral pain, but supports a concept of intensity coding with the composite of vagal and spinal input contributing to conscious perception and pain. PMID:22266836

Levinthal, David J; Bielefeldt, Klaus

2012-03-01

78

Basic and clinical aspects of visceral sensation: transmission in the CNS.  

PubMed

Pain and discomfort are the leading cause for consultative visits to gastroenterologists. Acute pain should be considered a symptom of an underlying disease, thereby serving a physiologically important function. However, many patients experience chronic pain in the absence of potentially harmful stimuli or disorders, turning pain into the primary problem rather than a symptom. Vagal and spinal afferents both contribute to the sensory component of the gut-brain axis. Current evidence suggests that they convey different elements of the complex sensory experience. Spinal afferents play a key role in the discriminatory dimension, while vagal input primarily affects the strong emotional and autonomic reactions to noxious visceral stimuli. Drugs, surgical and non-pharmacological treatments can target these pathways and provide therapeutic options for patients with chronic visceral pain syndromes. PMID:16078937

Bielefeldt, K; Christianson, J A; Davis, B M

2005-08-01

79

mGlu5 receptor antagonist decreases Fos expression in spinal neurons after noxious visceral stimulation.  

PubMed

In this study we examined the effects of the glutamate metabotropic subtype 5 (mGlu5) receptor antagonist 2-methyl-6-(phenylethynyl)-pyridine (MPEP) on Fos expression in the spinal cord in a model of visceral pain in the rat. We show that noxious stimulation increases the number of Fos-positive neurons in the dorsal horn of the thoracic and lumbar spinal cord, and that pretreatment with MPEP significantly reduces the number of Fos-positive neurons in these areas. These data indicate that mGlu5 is involved in the transmission of visceral pain in the spinal cord. PMID:12505681

Bianchi, Rossella; Rezzani, Rita; Borsani, Elisa; Rodella, Luigi

2003-01-17

80

The Neurobiology of Chronic Pelvic Pain  

Microsoft Academic Search

Chronic pelvic pain is a response of the nervous system to somatic and visceral pathology. Involving multiple pain pathways,\\u000a it is unlikely to be confined to one organ system or to one mechanism. An understanding of the complex neuroanatomy and pathophysiologic\\u000a mechanisms is essential to the treatment of patients presenting with this disorder.

Jennifer Gunter

81

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

82

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

83

Visceral artery aneurysms.  

PubMed

Visceral artery aneurysms (VAA) frequently present as life-threatening emergencies. The purpose of this study was to review our experience with VAA treatment. Between 1988 and April 2002, 31 VAA were treated in 28 patients (14 males, 14 females) with average age of 55 +/- 15 years. The most common locations were the splenic artery (16) and the hepatic artery (7). Three patients underwent emergency surgery, 22 patients had elective open surgery, and 7 patients underwent endovascular treatment. In the surgical group the perioperative mortality rate was 3.6%. The perioperative morbidity rate was 7.1% (one case of respiratory distress manifested in the immediate postoperative period and one urgent case of bilious fistula). In the endovascular group none of the patients died; the perioperative morbidity rate was of 14.3% (one case of hepatic artery thrombosis after failure of gastroduodenal artery aneurysm embolization). Failure of the procedure was 42.9% (3 cases of aneurysm recanalization). In conclusion, we believe that an aggressive surgical approach is justified, even in the case of asymptomatic VAA, because of the low morbidity and mortality rates. Endovascular treatment should be reserved for selected cases. PMID:15714366

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

2005-01-01

84

Increased visceral sensitivity to capsaicin after DSS-induced colitis in mice: spinal cord c-Fos expression and behavior.  

PubMed

During acute and chronic inflammation visceral pain perception is altered. Conflicting data exist, however, on visceral pain perception in the postinflammatory phase. The aim of the present study was to investigate whether visceral pain perception is altered after resolution of dextran sodium sulfate (DSS)-induced inflammation of the colon. Visceral sensory function in mice was assessed by monitoring behavioral responses to intracolonic capsaicin instillation. Two hours later the number of c-Fos-positive neurons in lamina I/II and X of spinal cord segments T(12/13)-S1 was determined as a measure of neuronal activation. DSS colitis was induced by adding 1% of DSS to the drinking water. The course of DSS-induced colitis was assessed by determining the disease activity index score. Animals developed a transient colitis and had recovered at day 49. At this time point, cytokine levels and colon length were similar to control animals. Importantly, after resolution of DSS-induced colitis the behavioral response to intracolonic capsaicin was increased compared with control mice. Moreover, capsaicin-induced spinal cord neuronal c-Fos expression was significantly increased. Interestingly, after colitis animals also exhibited referred somatic hyperalgesia as measured with von Frey hairs on the abdominal wall. We conclude that postinflammatory visceral hyperalgesia occurs after resolution of DSS-induced colitis and that capsaicin-induced behavioral responses and spinal cord neuronal c-Fos activation are effective readouts for determination of visceral pain perception. PMID:17656446

Eijkelkamp, Niels; Kavelaars, Annemieke; Elsenbruch, Sigrid; Schedlowski, Manfred; Holtmann, Gerald; Heijnen, Cobi J

2007-10-01

85

Epidemiology of visceral leishmaniasis.  

PubMed

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

86

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

87

Drug-induced visceral angioedema  

PubMed Central

Angioedema associated with angiotensin converting enzyme inhibitors (ACEIs) is due to the accumulation of bradykinin and its metabolites. Angiotensin receptor blockers (ARBs) produce anti-hypertensive effects by blocking the angiotensin II AT1 receptor action; hence bradykinin-related side effects are not expected. However, we notice the occurrence of ARB-induced angioedema as not a very rare side effect. Visceral drug-induced angioedema has been reported with ACEIs, not with ARBs. This underlying review will help educate readers on the pathophysiology and recent guidelines pertaining to ACEI- and ARB-induced visceral angioedema. PMID:25317271

Thalanayar, Prashanth M.; Ghobrial, Ibrahim; Lubin, Fritz; Karnik, Reena; Bhasin, Robin

2014-01-01

88

Intractability of Assembly Sequencing: Unit Disks in the Plane  

E-print Network

of scheduling with and/or precedence constraints. The Disks problem can be formulated as a scheduling problem where the order of removals is to be scheduled. Before scheduling a disk to be removed, a path mustIntractability of Assembly Sequencing: Unit Disks in the Plane Michael Goldwasser ? and Rajeev

Motwani, Rajeev

89

Successful monotherapy of severe and intractable atopic dermatitis by photopheresis  

Microsoft Academic Search

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

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

1998-01-01

90

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

91

Gastrointestinal adverse effects of antiepileptic drugs in intractable epileptic patients  

Microsoft Academic Search

Gastrointestinal (GI) discomforts are among the most common side effects of antiepileptic drugs (AEDs) that might lead to discontinuation or irregular consumption of the drugs. This study was conducted to evaluate the frequency of GI side effects of different AEDs in intractable epileptic patients treated with single or multiple drugs. GI discomfort of 100 epileptic patients (aged 35–76 years) treated

Soodeh Razeghi Jahromi; Mansoureh Togha; Sohrab Hashemi Fesharaki; Masoumeh Najafi; Nahid Beladi Moghadam; Jalil Arab Kheradmand; Hadi Kazemi; Ali Gorji

2011-01-01

92

Electro-acupuncture attenuates stress-induced defecation in rats with chronic visceral hypersensitivity via serotonergic pathway  

Microsoft Academic Search

Acupuncture has long been used for patients with irritable bowel syndrome. However, it has remained unclear. The aim of this study was to testify the effect of electro-acupuncture(EA) on (1) visceral hypersensitivity induced by the mechanical colorectal irritation during postnatal development of rats, and (2) stress-induced colonic motility changes on rats with chronic visceral hypersensitivity. The abdominal withdrawal reflex (pain

Xiao Yu Tian; Zhao Xiang Bian; Xu Guang Hu; Xiao Jun Zhang; Liang Liu; Hongqi Zhang

2006-01-01

93

Characteristics of Protracted, Intractable Conflict: Toward the Development of a Metaframework–I  

Microsoft Academic Search

Protracted, intractable conflicts mark a new research frontier in the field of conflict studies. These intense, inescapable conflicts over issues such as critical resources, identity, meaning, justice, and power are complex, traumatic, and often resist even the most serious attempts at resolution. But why are they intractable? What characteristics distinguish intractable conflicts from more tractable, resolvable conflicts? Scholars have begun

Peter T. Coleman

2003-01-01

94

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

95

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

96

Stereotactic mesencephalotomy for cancer - related facial pain.  

PubMed

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; Son, Byung-Chul

2014-07-01

97

[Basic and clinical approaches for surgical treatment of intractable epilepsies].  

PubMed

Recent reports demonstrated that patients with medically intractable epilepsy were benefited with surgical treatments. Even in pediatric patients, early surgery is effective not only in seizure control but also in verbal, intelligent and social outcomes. In the present study, basic and clinical approaches in the treatment of intractable epilepsies were studied. In chronic cat model of intractable temporal lobe epilepsy induced by a microinjection of kainic acid, temporal cortical excision with amygdala focus resection or focus and hippocampal resections were examined by means of microsurgical technics. The cats with amygdala focus resection demonstrated spontaneous hippocampal seizures while cats with focus and hippocampal resection did not show seizures in the long time course after the surgery. In a cat model of cortical focal seizures, multiple subpial transection(MST) was examined. The cortical seizures, induced by a microinjection of kainic acid into unilateral sensori-motor cortex, were suppressed immediately after the MST. Postoperative course was uneventful and seizure was not recurred. However, pathological study demonstrated subpial scar formation at the site of MST in the sensori-motor cortex. In 38 patients with medically intractable epilepsies, surgical treatments were performed in the Department of Neurosurgery. Asahikawa Medical College. The site of the epileptogenic lesion was studied with Video-EEG longterm monitorings, Neuro-imagings with CT, MRI, interictal SPECT and/or ictal SPECT. At the surgery, intraoperative electrocorticograms(ECoGs) were monitored under light neuroleptanalgesia in order to localize epileptic focus. Seizure free rate with or without postoperative medication was 72%. Remarkable improvement was observed in 7 patients (18%), but, 4 patients (10%) did not show any improvement. PMID:7774122

Tanaka, T; Yonemasu, Y

1994-12-01

98

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

99

Massive gastrointestinal bleeding: An unusual case of asymptomatic extrarenal, visceral, fibromuscular dysplasia  

PubMed Central

Extrarenal fibromuscular dysplasia causing gastro-intestinal bleeding without other manifestations and especially sparing renal vasculature is uncommon. The diagnosis of this entity is usually made by radiographic appearance and the treatment is controversial. To our knowledge only seven cases of visceral fibromuscular dysplasia as a primary manifestation of the disease have been described, symptoms range from abdominal pain to gangrene. This is the first case of visceral fibromuscular dysplasia presenting with otherwise asymptomatic gastrointestinal bleeding, without bowel necrosis or ischemic changes. We provide a review of the literature. PMID:17963307

Rodriguez Urrego, Paula Andrea; Flanagan, Mark; Tsai, Wilson S; Rezac, Craig; Barnard, Nicola

2007-01-01

100

Treatment of Mediterranean visceral leishmaniasis.  

PubMed Central

Up-to-date information is given on the epidemiological situation of zoonotic visceral leishmaniasis (ZVL) in nine Mediterranean countries, and on drug regimens adopted in the management of ZVL patients in each country. Results of experimental and clinical trials on the efficacy and tolerability of liposomal amphotericin B in laboratory animals and in patients with ZVL are presented, as well as conclusions and recommendations on drug regimens to be used in the treatment of ZVL. PMID:7743590

Gradoni, L.; Bryceson, A.; Desjeux, P.

1995-01-01

101

Portal hypertension with visceral leishmaniasis  

Microsoft Academic Search

We conducted this study to observe evidence of portal hypertension in children with visceral leishmaniasis (VL). Eighty-eight\\u000a consecutive cases (50 male) of VL were subjected to ultrasonography. Those with evidence of portal hypertension also underwent\\u000a upper gastrointestinal endoscopy and liver biopsy. Eight patients had portal hypertension as evidenced by dilated caliber\\u000a of portal and splenic veins. Two patients had periportal,

Rajniti Prasad; Utpal Kant Singh; O. P. Mishra; B. P. Jaiswal; Sunil Muthusami

2010-01-01

102

IVIG Shown to Relieve Complex Regional Pain Syndrome But Study Has Limitations, Experts Say  

E-print Network

4A small study found IVIG effective for alleviating chronic regional pain syndrome, providing evidence that modulating the immune system could help with managing pain. Asmall but intriguing study found that intravenous immunoglobulin (IVIG) can provide relief for people suffering from complex regional pain syndrome, or CRPS, which causes chronic and often intractable pain, usually in an arm or leg, long after recovery from an illness or injury.

Tom Valeo

103

Visceral hyperalgesia induced by forebrain-specific suppression of native Kv7/KCNQ/M-current in mice  

PubMed Central

Background Dysfunction of brain-gut interaction is thought to underlie visceral hypersensitivity which causes unexplained abdominal pain syndromes. However, the mechanism by which alteration of brain function in the brain-gut axis influences the perception of visceral pain remains largely elusive. In this study we investigated whether altered brain activity can generate visceral hyperalgesia. Results Using a forebrain specific ?CaMKII promoter, we established a line of transgenic (Tg) mice expressing a dominant-negative pore mutant of the Kv7.2/KCNQ2 channel which suppresses native KCNQ/M-current and enhances forebrain neuronal excitability. Brain slice recording of hippocampal pyramidal neurons from these Tg mice confirmed the presence of hyperexcitable properties with increased firing. Behavioral evaluation of Tg mice exhibited increased sensitivity to visceral pain induced by intraperitoneal (i.p.) injection of either acetic acid or magnesium sulfate, and intracolon capsaicin stimulation, but not cutaneous sensation for thermal or inflammatory pain. Immunohistological staining showed increased c-Fos expression in the somatosensory SII cortex and insular cortex of Tg mice that were injected intraperitoneally with acetic acid. To mimic the effect of cortical hyperexcitability on visceral hyperalgesia, we injected KCNQ/M channel blocker XE991 into the lateral ventricle of wild type (WT) mice. Intracerebroventricular injection of XE991 resulted in increased writhes of WT mice induced by acetic acid, and this effect was reversed by co-injection of the channel opener retigabine. Conclusions Our findings provide evidence that forebrain hyperexcitability confers visceral hyperalgesia, and suppression of central hyperexcitability by activation of KCNQ/M-channel function may provide a therapeutic potential for treatment of abdominal pain syndromes. PMID:22029713

2011-01-01

104

Transient receptor potential cation channels in visceral sensory pathways.  

PubMed

The extensive literature on this subject is in direct contrast to the limited range of clinical uses for ligands of the transient receptor potential cation channels (TRPs) in diseases of the viscera. TRPV1 is the most spectacular example of this imbalance, as it is in other systems, but it is nonetheless the only TRP target that is currently targeted clinically in bladder sensory dysfunction. It is not clear why this discrepancy exists, but a likely answer is in the promiscuity of TRPs as sensors and transducers for environmental mechanical and chemical stimuli. This review first describes the different sensory pathways from the viscera, and on which nociceptive and non-nociceptive neurones within these pathways TRPs are expressed. They not only fulfil roles as both mechano- and chemo-sensors on visceral afferents, but also form an effector mechanism for cell activation after activation of GPCR and cytokine receptors. Their role may be markedly changed in diseased states, including chronic pain and inflammation. Pain presents the most obvious potential for further development of therapeutic interventions targeted at TRPs, but forms of inflammation are emerging as likely to benefit also. However, despite much basic research, we are still at the beginning of exploring such potential in visceral sensory pathways. PMID:24641218

Blackshaw, L Ashley

2014-05-01

105

Burst Spinal Cord Stimulation for Limb and Back Pain Dirk De Ridder1,2  

E-print Network

is a common treatment for medically intractable neuropathic pain of different origins. Because tonic, tonic, and placebo) was performed on 15 consecu- tive pain patients. In contrast to tonic stimulation-localized electroencephalogram was performed under four conditions: baseline, tonic, burst, and placebo stimulation. - RESULTS

O'Toole, Alice J.

106

Fos expression in spinothalamic and postsynaptic dorsal column neurons following noxious visceral and cutaneous stimuli.  

PubMed

The spinothalamic tract (STT) has been classically viewed as the major ascending pathway for pain transmission while the dorsal column (DC) was thought to be involved primarily in signaling innocuous stimuli. Recent clinical studies have shown that limited midline myelotomy, which transects fibers in the DC, offers good pain relief in patients with visceral cancer pain. Experimental studies provided evidence that a DC lesion decreases the activation of thalamic neurons by visceral stimuli and suggested that this effect is due to transection of the axons of postsynaptic dorsal column (PSDC) neurons. In our study, Fos protein expression in retrogradely labeled STT and PSDC neurons in the lumbosacral enlargement in rats was used as an anatomical marker of enhanced activation to compare the role of these neurons in cutaneous and visceral pain. The noxious stimuli used were intradermal injection of capsaicin and distention of the ureter. Retrogradely labeled PSDC neurons were found in laminae III-IV and in the vicinity of the central canal. STT neurons were located in laminae I, III-VII and X. Ureter distention evoked Fos expression in PSDC and STT neurons located in all laminae in which retrogradely labeled cells were found, with the maximum in the L(2) spinal segment. The Fos-positive PSDC neurons represented a significantly higher percentage of the retrogradely labeled PSDC neurons (19.3+/-2.3% SEM) than of the STT Fos-positive neurons (13.2+/-1.5% SEM). Intradermal capsaicin injection also evoked Fos expression in both PSDC and STT neurons, but with no significant difference between these two, when expressed as a percentage of the retrogradely labeled cells (11.6+/-2.9% SEM, 10.8+/-1.1% SEM). These results show that both PSDC and STT neurons are activated by cutaneous and visceral noxious stimuli. Their particular role in transmission and modulation of painful stimuli needs to be investigated further. PMID:12855335

Palecek, J; Paleckova, V; Willis, W D

2003-07-01

107

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

108

Drug Resistance in Visceral Leishmaniasis  

PubMed Central

Visceral leishmaniasis remains a public health problem worldwide. This illness was included by the World Health Organization in the list of neglected tropical diseases targeted for elimination by 2015. The widespread emergence of resistance to pentavalent antimonials in India where half cases occur globally and the unavailability of a vaccine in clinical use constitute major obstacles in achieving this goal. The last decade new antileishmanials became available, including the oral agent miltefosine. However, in poor endemic countries their wide use was curtailed because of the high costs, and also due to concerns of toxicity and emergence of resistance. Various mechanisms of antileishmanial resistance were identified recently in field isolates. Their elucidation will boost the design of new drugs and the molecular surveillance of resistance. Combination regimens should be evaluated in large trials. Overall, the development of antileishmanials has been generally slow; new drugs are needed. In order to control visceral leishmaniasis worldwide, treatment advances should become affordable in the poorest countries, where they are needed most. PMID:19888437

Maltezou, Helena C.

2010-01-01

109

Ultrasound detection of visceral adhesion after intraperitoneal ventral hernia treatment: A comparative study of protected versus unprotected meshes  

Microsoft Academic Search

Intraperitoneal (IP) ventral hernia repair has been proposed with the advantages of reducing dissection, operative time, and postoperative pain. The IP position of the mesh is suspected of increasing the risk of visceral adhesion and inducing complications. To overcome these drawbacks, a mesh protected on one side by a hydrophilic resorbable film (Parietex Composite) has been validated [1]. Using a

J. P. Arnaud; S. Hennekinne-Mucci; P. Pessaux; J. J. Tuech; C. Aube

2003-01-01

110

Peritoneovenous shunting is an effective treatment for intractable ascites  

PubMed Central

Aim and methods: A retrospective review was carried out of children undergoing peritoneovenous shunting for intractable ascites. Results: 11 children, aged 3 months to 12 years (median 31 months) underwent peritoneovenous shunting over the past 17 years. The duration of ascites ranged from one month to 2.5 years (median two months). The primary pathology consisted of previous surgery in eight (three neuroblastoma, one renal carcinoma, one hepatoblastoma, one adrenal teratoma, one renal artery stenosis, and one diaphragmatic hernia), and cytomegalovirus hepatitis, lymphatic hypoplasia, and lymphohistiocytosis in one patient each. All patients had failed to respond to previous treatment including peritoneal drainage in six patients, diuretics in five, and parenteral nutrition in five. There were no intraoperative problems. Postoperative complications included pulmonary oedema in three patients, shunt occlusion in three, infection in two, and wound leakage in one. Ascites resolved after shunting in 10 patients. Five shunts were removed one to three years after insertion without recurrence of ascites. Three others are free of ascites with shunts in place for less than one year postoperatively. Three children died from their underlying disease: two after resolution of ascites (neuroblastoma) and one in whom the ascites failed to resolve (lymphohisticytosis). Conclusions: Peritoneovenous shunting is an effective treatment for symptomatic intractable ascites in children (10 of 11 successful cases in this series). Elective removal of the shunt after one year is recommended. PMID:15811892

Sooriakumaran, P; McAndrew, H; Kiely, E; Spitz, L; Pierro, A

2005-01-01

111

Motive attribution asymmetry for love vs. hate drives intractable conflict.  

PubMed

Five studies across cultures involving 661 American Democrats and Republicans, 995 Israelis, and 1,266 Palestinians provide previously unidentified evidence of a fundamental bias, what we term the "motive attribution asymmetry," driving seemingly intractable human conflict. These studies show that in political and ethnoreligious intergroup conflict, adversaries tend to attribute their own group's aggression to ingroup love more than outgroup hate and to attribute their outgroup's aggression to outgroup hate more than ingroup love. Study 1 demonstrates that American Democrats and Republicans attribute their own party's involvement in conflict to ingroup love more than outgroup hate but attribute the opposing party's involvement to outgroup hate more than ingroup love. Studies 2 and 3 demonstrate this biased attributional pattern for Israelis and Palestinians evaluating their own group and the opposing group's involvement in the current regional conflict. Study 4 demonstrates in an Israeli population that this bias increases beliefs and intentions associated with conflict intractability toward Palestinians. Finally, study 5 demonstrates, in the context of American political conflict, that offering Democrats and Republicans financial incentives for accuracy in evaluating the opposing party can mitigate this bias and its consequences. Although people find it difficult to explain their adversaries' actions in terms of love and affiliation, we suggest that recognizing this attributional bias and how to reduce it can contribute to reducing human conflict on a global scale. PMID:25331879

Waytz, Adam; Young, Liane L; Ginges, Jeremy

2014-11-01

112

Gastrointestinal adverse effects of antiepileptic drugs in intractable epileptic patients.  

PubMed

Gastrointestinal (GI) discomforts are among the most common side effects of antiepileptic drugs (AEDs) that might lead to discontinuation or irregular consumption of the drugs. This study was conducted to evaluate the frequency of GI side effects of different AEDs in intractable epileptic patients treated with single or multiple drugs. GI discomfort of 100 epileptic patients (aged 35-76 years) treated with one or multiple AEDs was assessed. Seventy six patients (76%) were treated with two or more AEDs, and 24 (24%) were on monotherapy. The most common prescribed drug for monotherapy was carbamazepine and the most frequent combination was phenytoin and carbamazepine. Patients were suffering from different GI side effects including heartburn (34.6%), nausea (33.7%), constipation (26%), vomiting (22.1%), diarrhea (21.2%) and dysphagia (19.2%). Nausea and vomiting were significantly higher in patients receiving monotherapy with carbamazepine and valproic acid, respectively. When phenytoin, gabapentine, or valproic acid was added to the other AEDs, the risk of the occurrence of diarrhea, dysphagia, or heartburn was significantly increased, respectively. Addition of gabapentine to the other AEDs in multiple drug therapy was accompanied with the highest frequency of GI complications. This study indicated that GI side effects, which can affect drug absorption and utilization, were common in intractable epileptic patients with long-term AEDs treatment. This may influence the efficacy of the therapy with AEDs and enhance the probability of further attacks. PMID:21236703

Jahromi, Soodeh Razeghi; Togha, Mansoureh; Fesharaki, Sohrab Hashemi; Najafi, Masoumeh; Moghadam, Nahid Beladi; Kheradmand, Jalil Arab; Kazemi, Hadi; Gorji, Ali

2011-05-01

113

Pharmacological pain management in chronic pancreatitis.  

PubMed

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 H G; Drewes, Asbjørn M

2013-11-14

114

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

115

Occipital nerve stimulation for intractable chronic cluster headache: new hope for a dreadful disease?  

PubMed

Chronic cluster headache (CCH) is one of the most painful primary headaches. A small percentage of CCH become intractable (iCCH) and is refractory to the majority of preventing drugs. Various invasive and sometimes destructive procedures have been tempted to help these patients, but none gave satisfactory results for the long term. Hypothalamic deep-brain stimulation (hDBS) has recently raised expectations with an average improvement of 50 to 70%, but is not a riskless procedure. Harmless methods were therefore warranted, and in this perspective occipital nerve stimulation (ONS) trials were undertaken. Up to now, nearly 38 iCCH patients benefited from ONS in the available literature and the technique appears to give results similar to hDBS, having the advantage to have much milder side effects. The mechanism by which ONS is efficient in iCCH remains unknown but preliminary results of neurophysiological and imaging studies suggest ONS is just a symptomatic treatment which does not act on the disease generator. We would however advocate ONS as first choice alternative therapy in iCCH. PMID:21510228

Magis, Delphine; Schoenen, Jean

2011-03-01

116

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

PubMed Central

Studies in healthy human subjects and patients with irritable bowel syndrome suggest sex differences in cerebral nociceptive processing. Here we examine sex differences in functional brain activation in the rat during colorectal distention (CRD), a preclinical model of acute visceral pain. [14C]-iodoantipyrine was injected intravenously in awake, nonrestrained female rats during 60-mmHg or 0-mmHg CRD while electromyographic abdominal activity (EMG) and pain behavior were recorded. Regional cerebral blood flow related tissue radioactivity was analyzed by statistical parametric mapping from autoradiographic images of 3-dimensionally reconstructed brains. Sex differences were addressed by comparing current data with our previously published data collected from male rats. While sex differences in EMG and pain scores were modest, significant differences were noted in functional brain activation. Females showed widespread changes in limbic (amygdala, hypothalamus) and paralimbic structures (ventral striatum, nucleus accumbens, raphe), while males demonstrated broad cortical changes. Sex differences were apparent in the homeostatic afferent network (parabrachial nucleus, thalamus, insular and dorsal anterior cingulate cortices), in an emotional-arousal network (amygdala, locus coeruleus complex), and in cortical areas modulating these networks (prefrontal cortex). Greater activation of the ventromedial prefrontal cortex and broader limbic/paralimbic changes in females suggest greater engagement of affective mechanisms during visceral pain. Greater cortical activation in males is consistent with the concept of greater cortical inhibitory effects on limbic structures in males, which may relate to differences in attentional and cognitive attribution to visceral stimuli. These findings show remarkable similarities to reported sex differences in brain responses to visceral stimuli in humans. PMID:19560270

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

2009-01-01

117

Neurokinin-1-receptor antagonism decreases anxiety and emotional arousal circuit response to noxious visceral distension in women with irritable bowel syndrome: a pilot study  

PubMed Central

SUMMARY Background Irritable bowel syndrome is characterised by chronic abdominal pain and frequent comorbid anxiety. The substance P/neurokinin-1 receptor system is implicated in the regulation of both pain and anxiety, suggesting a potential therapeutic target in IBS. Aim To determine whether inhibition of the neurokinin-1 receptor (NK1R) will change pain ratings and brain responses to experimental visceral pain and anxiety symptoms in women with IBS or not. Methods Rome II positive IBS women were recruited for a double-blind, placebo-controlled, cross-over study of NK1R antagonist AV608. Treatment periods were 3 weeks with a 2-week washout period. Functional MRI during a visceral distension paradigm was performed before first treatment and after treatment blocks. SPM8 was used to compare brain activity during painful and nonpainful visceral stimuli in regions associated with emotional arousal and interoception. Negative affect, anxiety symptoms and pain ratings were assessed. Results Eleven subjects completed the study and eight subjects provided fMRI data. AV608, compared with placebo, was associated with reduced anxiety, negative affect, and pain ratings. During AV608 treatment, the amygdala, hippocampus and anterior cingulate gyrus showed decreased activity during visceral distension. AV608 was also associated with decreases in activity in brain regions associated with interoception (posterior insula, anterior mid-cingulate gyrus). Conclusions Chronic treatment with AV608 in IBS is associated with improved mood and pain ratings and activity of emotional arousal related brain regions. This suggests that further exploration of NK1R antagonists is warranted in visceral pain disorders, particularly in patients with comorbid anxiety symptoms. PMID:22221140

Tillisch, K.; Labus, J.; Nam, B.; Bueller, J.; Smith, S.; Suyenobu, B.; Siffert, J.; McKelvy, J.; Naliboff, B.; Mayer, E.

2014-01-01

118

Treatment of Acute Flares of Chronic Pancreatitis Pain with Ultrasound Guided Transversus Abdominis Plane Block: A Novel Application of a Pain Management Technique in the Acute Care Setting  

PubMed Central

The use of transversus abdominis plane (TAP) block to provide either analgesia or anesthesia to the anterior abdominal wall is well described. The technique yields high analgesic effectiveness and is opioid sparing and potentially of long duration with reported analgesia lasting up to 36 hours. When compared to neuraxial analgesia, TAP blocks are associated with a lower incidence of hypotension and motor blockade. TAP blocks are typically described as providing somatic analgesia only without any effect on visceral pain. There may be, however, certain conditions in which TAP blocks can provide effective analgesia in pain of visceral or mixed somatic and visceral origin. We describe two cases in which TAP blockade provided complete control of pain considered to be of visceral origin. PMID:25328723

Smith, Daryl I.; Hoang, Kim; Gelbard, Wendy

2014-01-01

119

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 ...

120

Chronic Pain  

MedlinePLUS

... a problem you need to take care of. Chronic pain is different. The pain signals go on for ... there is no clear cause. Problems that cause chronic pain include Headache Low back strain Cancer Arthritis Pain ...

121

Intrathecal baclofen for spasticity-related pain in amyotrophic lateral sclerosis: efficacy and factors associated with pain relief.  

PubMed

Clinical signs and symptoms of spasticity include hypertonia, involuntary movements (spasms, clonus), decreased range of motion, contractures, and often spasm-related pain. When spasticity is refractory to medical management, patients may be referred for intrathecal baclofen (ITB) pump placement. We reviewed a cohort of amyotrophic lateral sclerosis (ALS) patients with intractable spasticity requiring ITB to further define the impact of ITB on pain relief in this patient population. From 2003 to 2005, eight patients (mean age 43.8 years; 5 men, 3 women) with ALS received ITB for pain associated with intractable spasticity at our institution. Mean disease duration preoperatively was 47.4 months, mean follow-up was 9.8 months, and pain was evaluated using a 0-10 scoring system. All patients experienced spasticity relief in response to a preoperative bolus test injection of ITB (25-50 microg) via lumbar puncture. Following ITB pump placement, the average reduction of pain was 54% (P = 0.0082). Six patients (75%) experienced pain score reduction, three of whom had complete pain relief. Postoperative pain reduction was predicted by the degree of pain reduction following preoperative ITB test injection. These results support ITB as a treatment modality for pain associated with spasticity in ALS. PMID:17894358

McClelland, Shearwood; Bethoux, Francois A; Boulis, Nicholas M; Sutliff, Matthew H; Stough, Darlene K; Schwetz, Kathleen M; Gogol, Danuta M; Harrison, Michelle; Pioro, Erik P

2008-03-01

122

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

123

Laryngotracheal Closure and Cricopharyngeal Myotomy for Intractable Aspiration and Dysphagia Secondary to Cerebrovascular Accident  

Microsoft Academic Search

Objective: To investigate the clinical value, technique, indications and contraindications of laryngotracheal closure (LTC) and cricopharyngeal myotomy (CPM) for intractable aspiration and dysphagia secondary to a cerebrovascular accident (CVA). Materials and Methods: Patients (n = 45) with intractable aspiration and dysphagia secondary to a CVA were treated with LTC and CPM. The LTC was performed by suturing the double cords,

Shen-Hong Qu; Min Li; Jian-Ping Liang; Zheng-Zhong Su; Shi-Qiang Chen; Xiao-Guang He

2009-01-01

124

Necessity of cooperation with government on publication of scientific research results for intractable diseases  

PubMed Central

Summary The features of intractable diseases make it an important public health issue and a challenge to medical care worldwide. Investigation of intractable diseases with the support of government is urgently expected to activate clinical and pharmaceutical research to promote diagnosis and treatment for patients with intractable diseases. Moreover, linkage to the international database for research achievement is also necessary so that both researchers and other general citizens can assess research trends in the field of intractable diseases. In Japan, supportive activities for patients and researchers of intractable diseases have been well developed with the support of the Ministry of Health, Labor and Welfare (MHLW). Furthermore, in April 2013, a specific academic communication platform on intractable diseases — the Intractable and Rare Diseases Research (IRDR) Journal — was approved to join a governmental project and receive support from the Japan Society for the Promotion of Science (JSPS) under the auspices of Ministry of Education, Culture, Sports, Science and Technology (MEXT). Cooperation with the Japanese government starting this year is hoped to promote information-sharing based on an academic communication platform and further activate research on intractable diseases. PMID:25343106

Inagaki, Yoshinori; Song, Peipei

2013-01-01

125

Neural Synchrony-Monitoring Wireless Brain Implant for Intractable Epilepsy Neuromodulation  

E-print Network

Neural Synchrony-Monitoring Wireless Brain Implant for Intractable Epilepsy Neuromodulation Karim Abstract-- A validation of a closed-loop system-on-chip (SoC) for epilepsy treatment is presented. A 12mm2 in vivo experiment validates the SoC in early seizure detection and as a closed-loop intractable epilepsy

Genov, Roman

126

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

ERIC Educational Resources Information Center

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

Bar-Tal, Daniel; Rosen, Yigal

2009-01-01

127

Necessity of cooperation with government on publication of scientific research results for intractable diseases.  

PubMed

The features of intractable diseases make it an important public health issue and a challenge to medical care worldwide. Investigation of intractable diseases with the support of government is urgently expected to activate clinical and pharmaceutical research to promote diagnosis and treatment for patients with intractable diseases. Moreover, linkage to the international database for research achievement is also necessary so that both researchers and other general citizens can assess research trends in the field of intractable diseases. In Japan, supportive activities for patients and researchers of intractable diseases have been well developed with the support of the Ministry of Health, Labor and Welfare (MHLW). Furthermore, in April 2013, a specific academic communication platform on intractable diseases - the Intractable and Rare Diseases Research (IRDR) Journal - was approved to join a governmental project and receive support from the Japan Society for the Promotion of Science (JSPS) under the auspices of Ministry of Education, Culture, Sports, Science and Technology (MEXT). Cooperation with the Japanese government starting this year is hoped to promote information-sharing based on an academic communication platform and further activate research on intractable diseases. PMID:25343106

Inagaki, Yoshinori; Song, Peipei

2013-05-01

128

Comparison of Serum Zinc and Copper levels in Children and adolescents with Intractable and Controlled Epilepsy  

PubMed Central

Objective Trace elements such as zinc and copper have physiological effects on neuronal excitability that may play a role in the etiology of intractable epilepsy. This topic has been rarely discussed in Iranian epileptic patients. This study with the analysis of serum zinc and copper levels of children and adolescents with intractable and controlled epilepsy may identifies the potential role of these two trace elements in the development of epilepsy and intractability to antiepileptic drug treatment. Materials & Methods Seventy patients between the ages of 6 months to 15 years that referred to Children’s Medical Center with the diagnosis of epilepsy, either controlled or intractable to treatment enrolled in the study. After informed parental consent the levels of serum zinc and copper were measured with atomic absorption spectrophotometer and analyzed with SPSS version 11. Results 35 patients were enrolled in each group of intractable (IE) and controlled epilepsy (CE). 71.45% of the IE and 25.72% of the CE group had zinc deficiency that was statistically significant. 48.58% of the IE and 45.72 of the CE group were copper deficient, which was not statistically significant. Conclusion Our findings showed significant low serum zinc levels of patients with intractable epilepsy in comparison with controlled epilepsy group. We recommend that serum zinc level may play a role in the etiology of epilepsy and intractable epilepsy therefore its measurement and prescription may be regarded in the treatment of intractable epilepsy. PMID:25143774

KHERADMAND, Zeynab; YARALI, Bahram; ZARE, Ahad; POURPAK, Zahra; SHAMS, Sedigheh; ASHRAFI, Mahmoud Reza

2014-01-01

129

Chronic Pain  

MedlinePLUS

MENU Return to Web version Chronic Pain Overview What is chronic pain? There are 2 types of pain: acute and chronic. Acute pain lets you know that your ... It should go away as your body heals. Chronic pain lasts much longer. Chronic pain may last months ...

130

Total lymphoid irradiation for treatment of intractable cardiac allograft rejection  

SciTech Connect

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

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

1991-03-01

131

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

132

An Acute Postoperative Intractable Hyperventilation after an Endoscopic Third Ventriculostomy  

PubMed Central

This report describes a rare case of postoperative hyperventilation attack after an endoscopic third ventriculostomy in a 46-year-old woman. About 60 min after the termination of the operation, an intractable hyperventilation started with respiratory rate of 65 breaths/min and EtCO2, 16.3 mm Hg. Sedation with benzodiazepine, thiopental sodium, fentanyl, and propofol/remifentanil infusion was tried under a rebreathing mask at a 4 L/min of oxygen. With aggressive sedative challenges, ventilation pattern was gradually returned to normal during the 22 hrs of time after the surgery. A central neurogenic hyperventilation was suspected due to the stimulating central respiratory center by cold acidic irrigation solution during the neuroendoscopic procedure. PMID:22639718

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

2012-01-01

133

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

134

Surgical outcomes for intractable epilepsy in children with epileptic spasms.  

PubMed

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

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

2012-06-01

135

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

136

Delayed complications after Gamma Knife surgery for intractable epilepsy.  

PubMed

Despite the controversy concerning the clinical usefulness of Gamma Knife surgery (GKS; Elekta AB, Stockholm, Sweden) for intractable epilepsy, this treatment modality has attracted attention due to its low invasiveness. We report the long-term outcomes of four patients, focusing particularly on the efficacy and complications of GKS. We reviewed the data of four patients with medically intractable epilepsy who underwent GKS between 1998 and 2000 at our hospital. The marginal dose to the 50% isodose line was 24 Gy in one patient and 20Gy in the remaining three patients. Two of the four patients were treated in the right temporal lobe, one was treated in the left parietal lobe, and one was treated in the right frontal lobe. The mean follow-up was 12.5 years (range 12-14 years). One patient was seizure free (Engel class IA) 24 months after GKS, and two patients failed to show any seizure reduction (Engel class IVA). However, a clear aggravation was evident in one patient (Engel class IVC). All four patients underwent resective surgery due to radiation necrosis (RN) 7, 10, 10 and 12 years after GKS. Three patients were seizure free (Engel class IA), and one was considered to have Engel class IB status following the resective surgery. GKS treatment resulted in insufficient seizure control and carried a significant risk of RN after several years. Drawbacks such as a delay in seizure control and the risk of RN should be considered when the clinical application of this treatment is evaluated. PMID:24786716

Chen, Ning; Du, Shou-Qin; Yan, Na; Liu, Chong; Zhang, Jian-Guo; Ge, Yan; Meng, Fan-Gang

2014-09-01

137

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

138

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

139

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

MedlinePLUS

... Other Headaches Headache Journal - Public Site Art Gallery Art Gallery Support the AMF American Migraine Foundation The American Migraine Foundation is a non-profit foundation supported by the American Headache Society and generous donors dedicated to the advancement of ...

140

EDICALLY intractable epilepsy develops in approx-imately 15,000 to 30,000 people each year in the  

E-print Network

EDICALLY intractable epilepsy develops in approx- imately 15,000 to 30,000 people each year in the US. Epilepsy is considered intractable when it significantly reduces the quality of a person's life.34 In most cases of surgically remediable medically intractable epilepsy, the pathological disorder

Hampton, Robert

141

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

142

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

PubMed Central

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

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

2013-01-01

143

Neuronal activation by mucosal biopsy supernatants from irritable bowel syndrome patients is linked to visceral sensitivity.  

PubMed

Based on the discomfort/pain threshold during rectal distension, irritable bowel syndrome (IBS) patients may be subtyped as normo- or hypersensitive. We previously showed that mucosal biopsy supernatants from IBS patients activated enteric and visceral afferent neurons. We tested the hypothesis that visceral sensitivity is linked to the degree of neuronal activation. Normo- and hypersensitive IBS patients were distinguished by their discomfort/pain threshold to rectal balloon distension with a barostat. Using potentiometric and Ca(2+) dye imaging, we recorded the response of guinea-pig enteric submucous and mouse dorsal root ganglion (DRG) neurons, respectively, to mucosal biopsy supernatants from normosensitive (n = 12 tested in enteric neurons, n = 9 tested in DRG) and hypersensitive IBS patients (n = 9, tested in both types of neurons). In addition, we analysed the association between neuronal activation and individual discomfort/pain pressure thresholds. The IBS supernatants evoked Ca(2+) transients in DRG neurons and spike discharge in submucous neurons. Submucous and DRG neurons showed significantly stronger responses to supernatants from hypersensitive IBS patients as reflected by higher spike frequency or stronger [Ca(2+)]i transients in a larger proportion of neurons. The neuroindex as a product of spike frequency or [Ca(2+)]i transients and proportion of responding neurons correlated significantly with the individual discomfort/pain thresholds of the IBS patients. Supernatants from hypersensitive IBS patients caused stronger activation of enteric and DRG neurons. The level of activation correlated with the individual discomfort/pain threshold pressure values. These findings support our hypothesis that visceral sensitivity is linked to activation of peripheral neurons by biopsy supernatants. PMID:24951498

Buhner, Sabine; Braak, Breg; Li, Qin; Kugler, Eva Maria; Klooker, Tamira; Wouters, Mira; Donovan, Jemma; Vignali, Sheila; Mazzuoli-Weber, Gemma; Grundy, David; Boeckxstaens, Guy; Schemann, Michael

2014-10-01

144

Chronic Pain  

MedlinePLUS

NINDS Chronic Pain Information Page Synonym(s): Pain - Chronic Condensed from Pain: Hope Through Research Table of Contents (click to jump ... Trials Organizations Additional resources from MedlinePlus What is Chronic Pain? While acute pain is a normal sensation triggered ...

145

Foetal pain?  

PubMed

The majority of commentary on foetal pain has looked at the maturation of neural pathways to decide a lower age limit for foetal pain. This approach is sensible because there must be a minimal necessary neural development that makes pain possible. Very broadly, it is generally agreed that the minimal necessary neural pathways for pain are in place by 24 weeks gestation. Arguments remain, however, as to the possibility of foetal pain before or after 24 weeks. Some argue that the foetus can feel pain earlier than 24 weeks because pain can be supported by subcortical structures. Others argue that the foetus cannot feel pain at any stage because it is maintained in a state of sedation in the womb and lacks further neural and conceptual development necessary for pain. Much of this argument rests on the definition of terms such as 'wakefulness' and 'pain'. If a behavioural and neural reaction to a noxious stimulus is considered sufficient for pain, then pain is possible from 24 weeks and probably much earlier. If a conceptual subjectivity is considered necessary for pain, however, then pain is not possible at any gestational age. Regardless of how pain is defined, it is clear that pain for conceptual beings is qualitatively different than pain for non-conceptual beings. It is therefore a mistake to draw an equivalence between foetal pain and pain in the older infant or adult. PMID:20356798

Derbyshire, Stuart W G

2010-10-01

146

Dragon's blood from Croton urucurana (Baill.) attenuates visceral nociception in mice.  

PubMed

Dragon's blood, the red sap from Croton urucurana Baill. (Euphorbiaceae) has a profound history of traditional use in conditions such as inflammation, diarrhoea and gastrointestinal distress. Previous studies established its anti-inflammatory, antidiarrhoeal and analgesic properties and in this study we verified its potential to suppress visceral pain, using capsaicin- and cyclophosphamide-induced models of visceral nociception. Mice that received intra-colonic capsaicin (0.3%, 50 microl/animal) or intraperitoneal injection of cyclophosphamide (400 mg/kg) manifested spontaneous nociceptive behaviors or crises, which were significantly suppressed in animal groups treated with red sap (200 and 400 mg/kg, p.o.) or that received N-acetylcysteine (750 mg/kg, i.p.) or morphine (7.5 mg/kg, s.c.), as positive controls. In capsaicin model, the antinociception produced by 200 mg/kg red sap was found to be naloxone-sensitive (2 mg/kg, i.p.), suggesting an opioid mechanism. In tests of open-field and pentobarbital-sleeping time, mice received 200mg/kg red sap showed no significant alterations in either locomotion frequency or on sleeping time, indicating that the observed antinociception is not a consequence of sedation or motor abnormality. These findings highlight the visceral antinociceptive property of Croton urucurana sap and further support its ethno-medical use to alleviate pain associated with gastrointestinal and other related disorders. PMID:17681724

Rao, Vietla S; Gurgel, Luilma A; Lima-Júnior, Roberto C P; Martins, Domingos T O; Cechinel-Filho, Valdir; Santos, Flávia A

2007-09-01

147

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 ...

148

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 ...

149

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 ...

150

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 ...

151

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 ...

152

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

153

Treatment of intractable rheumatoid arthritis with total lymphoid irradiation  

SciTech Connect

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

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

1981-10-01

154

Treatment of intractable rheumatoid arthritis with total lymphoid irradiation  

SciTech Connect

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

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

1981-10-22

155

Experimental human pain models in gastro-esophageal reflux disease and unexplained chest pain  

PubMed Central

Methods related to experimental human pain research aim at activating different nociceptors, evoke pain from different organs and activate specific pathways and mechanisms. The different possibilities for using mechanical, electrical, thermal and chemical methods in visceral pain research are discussed with emphasis of combinations (e.g., the multimodal approach). The methods have been used widely in assessment of pain mechanisms in the esophagus and have contributed to our understanding of the symptoms reported in these patients. Hence abnormal activation and plastic changes of central pain pathways seem to play a major role in the symptoms in some patients with gastro-esophageal reflux disease and in patients with functional chest pain of esophageal origin. These findings may lead to an alternative approach for treatment in patients that does not respond to conventional medical or surgical therapy. PMID:16718803

Drewes, Asbj?rn Mohr; Arendt-Nielsen, Lars; Funch-Jensen, Peter; Gregersen, Hans

2006-01-01

156

Efficacy of intrathecal baclofen therapy in children with intractable spastic cerebral palsy: A randomised controlled trial  

Microsoft Academic Search

BackgroundIntractable spasticity can be treated effectively with continuous infusion of intrathecal baclofen. Because evidence for its use in the treatment of children with spastic cerebral palsy is lacking, we conducted a randomised controlled trial.

Marjanke A. Hoving; Elisabeth P. M. van Raak; Geert H. J. J. Spincemaille; Liesbeth J. Palmans; Jules G. Becher; Johan S. H. Vles

2009-01-01

157

Dual role of 5-HT3 receptors in a rat model of delayed stress-induced visceral hyperalgesia.  

PubMed

Despite its beneficial effect in IBS patients, the mechanism of action of the 5-HT3 receptor (5-HT3R) antagonist alosetron is still incompletely understood. We aimed to characterize the effect and site(s) of action in a model of stress-induced sensitization of visceral nociception in rats. Adult male Wistar rats were equipped for recording of visceromotor response (VMR) to phasic colorectal distension (CRD; 10-60 mmHg). VMR to CRD was recorded 24 h after an acute session of water avoidance (WA) stress (post-WA). Baseline and post-WA responses were measured in rats exposed to WA or sham-WA, treated with alosetron at 0.3 mg/kg subcutaneously (s.c.) 25 nmol intrathecally (i.t.) or vehicle before post-WA CRD. Some rats were treated with capsaicin/vehicle on the cervical vagus nerve and received alosetron (0.3 mg/kg, s.c.) 15 min before post-WA CRD. WA stress led to visceral hyperalgesia 24 h later. Alosetron (0.3 mg/kg, s.c.), failed to inhibit WA-induced exacerbation of VMR to CRD. Stress-induced visceral hyperalgesia was abolished when alosetron was injected intrathecally (P<0.05) in intact rats or subcutaneously (0.3 mg/kg) in capsaicin-pretreated animals (P<0.05). Capsaicin-pretreatment did not affect the exacerbating effect of stress on visceral sensitivity. Alosetron had no inhibitory effect on normal visceral pain responses when administered subcutaneously or intrathecally. We demonstrated that 5-HT3Rs on central terminals of spinal afferents are engaged in the facilitatory effect of stress on visceral sensory information processing. In addition, we showed that stress-induced sensitization of visceral nociception is independent of 5-HT3R activation on vagal afferents. PMID:17161536

Bradesi, Sylvie; Lao, Lijun; McLean, Peter G; Winchester, Wendy J; Lee, Kevin; Hicks, Gareth A; Mayer, Emeran A

2007-07-01

158

Partial Internal Biliary Diversion: A Solution for Intractable Pruritus in Progressive Familial Intrahepatic Cholestasis Type 1  

PubMed Central

Biliary diversion offers a potential option for intractable pruritus in children with chronic cholestatic disorders. Progressive familial intrahepatic cholestasis (PFIC) is an inherited disorder of impaired bile acid transport and excretion, which presents with jaundice and pruritus in the first few months of life and progresses to cirrhosis by infancy or adolescence. We report a child with PFIC type 1 who underwent internal biliary diversion for intractable pruritus and was relieved of his symptoms. PMID:21546727

Ganesh, Ramaswamy; Suresh, Natarajan; Sathiyasekeran, Malathi; Ramachandran, Priya

2011-01-01

159

Ultrasound detection of visceral adhesion after intraperitoneal ventral hernia treatment: a comparative study of protected versus unprotected meshes.  

PubMed

Intraperitoneal (IP) ventral hernia repair has been proposed with the advantages of reducing dissection, operative time, and postoperative pain. The IP position of the mesh is suspected of increasing the risk of visceral adhesion and inducing complications. To overcome these drawbacks, a mesh protected on one side by a hydrophilic resorbable film (Parietex Composite) has been validated. Using a previously described ultrasound procedure, the purpose of this study was to compare the rate of visceral adhesion after intraperitoneal placement of a polyester mesh versus this protected mesh. Fifty-one patients who received a Parietex Composite mesh were prospectively compared to a retrospective series of 22 consecutive asymptomatic patients who received a Mersilene mesh. To objectively assess visceral adhesion toward the abdominal wall, an ultrasound (US) specific examination was firstly validated and secondly used to evaluate the adhesion incidence in both groups. Both groups were equivalent in terms of inclusion criteria and body mass index (BMI). Pre-operative US versus perioperative macroscopical findings determined the following parameters: sensitivity 83%, accuracy 78%, negative predictive value 81%. Using this procedure, 77% of the patients exhibited visceral adhesion to the mesh in the Mersilene group, against 18% in the Parietex Composite group (P<0.001, chi-square). US examination represents a suitable tool to evaluate postoperative adhesions to the abdominal wall. Using this procedure, a significant reduction of visceral adhesion in the Parietex Composite group was shown. PMID:12820030

Arnaud, J P; Hennekinne-Mucci, S; Pessaux, P; Tuech, J J; Aube, C

2003-06-01

160

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

161

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

Microsoft Academic Search

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

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

2002-01-01

162

[The sleep and the visceral function control].  

PubMed

The review focuses on rapidly growing body of data indicating that disturbances of the natural sleep and sleep deprivation lead to various visceral disorders. The review mentions consequences of sleep disturbances on the gastro-intestinal system, cardio-vascular and respiratory, immune, endocrine and reproductive functions. In order to establish the functional link between the sleep and the visceral health it is proposed that during sleep the central nervous system including all cortical areas switches from the processing of the exteroceptive information to the processing of the interoceptive information. Review of the studies, which offer the direct confirmation of this hypothesis, is presented. PMID:21786642

Pigarev, I N; Pigareva, M L

2011-04-01

163

Shoulder pain  

MedlinePLUS

Pain - shoulder ... changes around the rotator cuff can cause shoulder pain. You may have pain when lifting the arm above your head or ... The most common cause of shoulder pain occurs when rotator cuff tendons ... The tendons become inflamed or damaged. This condition ...

164

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 ...

165

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

Microsoft Academic Search

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

Julia S. Seng

2010-01-01

166

A life of pelvic pain Karen J. Berkley *  

E-print Network

, is a chronic pelvic pain that not only interferes with a woman's wellbeing for a large part of her life the existence of extensive cross-system, viscero­visceral interactions within the CNS, that, while organized include: (a) Bladder inflammation reduces the rate of uterine contractions and the effects of drugs

Berkley, Karen J.

167

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

Code of Federal Regulations, 2013 CFR

...current to subsurface areas of a patient's brain to treat severe intractable pain. The...electrodes that are placed within a patient's brain and an external transmitter for transmitting...or notice of completion of a product development protocol (PDP) is...

2013-04-01

168

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

Code of Federal Regulations, 2011 CFR

...current to subsurface areas of a patient's brain to treat severe intractable pain. The...electrodes that are placed within a patient's brain and an external transmitter for transmitting...or notice of completion of a product development protocol (PDP) is...

2011-04-01

169

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

Code of Federal Regulations, 2012 CFR

...current to subsurface areas of a patient's brain to treat severe intractable pain. The...electrodes that are placed within a patient's brain and an external transmitter for transmitting...or notice of completion of a product development protocol (PDP) is...

2012-04-01

170

A multisensory illusion with haptic interaction to treat phantom limb pain  

Microsoft Academic Search

Phantom limb pain (PLP) is a chronic, intractable condition that affects over 2 million Americans. PLP has been treated by pharmaceuticals, and interventional treatments, as well as psychological strategies including sensory illusions. This work develops a theoretical framework to characterize prior instantiations of sensory illusions. Each instantiation is a particular treatment protocol that consists of three design elements: stimulus modality,

Mark W. Farrington; Gregory J. Gerling; Lynn R. Kohan; Sheryl L. Johnson

2012-01-01

171

Visceral leishmaniasis (kala-azar) and pregnancy.  

PubMed Central

OBJECTIVE: The aim of the present review was to close the gap in the approach to pregnant women with visceral leishmaniasis (kala-azar) by providing up-to-date information to obstetricians about physiopathology, epidemiology, vertical transmission, drugs and treatment during pregnancy. BACKGROUND: Infection with Leishmania chagasi during pregnancy is rare and deserves special attention since little information is available regarding the occurrence of visceral leishmaniasis during gestational period and the real possibility of vertical transmission of this disease. Because specific areas in the world are endemic for the disease and considering the continuous growth of the population, cases of pregnant women with visceral leishmaniasis are becoming more frequent. Unfortunately, textbooks on infectious diseases do not include this specific group of patients, and studies in the literature on aspects related to pregnancy and visceral leishmaniasis are scarce. CONCLUSIONS: Vertical transmission of leishmaniasis is possible and the institution of treatment is imperative in cases of pregnant women with kala-azar. Amphotericin B is strongly recommended as the first choice drug due to its fewer maternal-fetal adverse effects. PMID:15460194

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

2004-01-01

172

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

173

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

174

Visceral Leishmaniasis in Rural Bihar, India  

PubMed Central

To identify factors associated with incidence of visceral leishmaniasis (VL), we surveyed 13,416 households in Bihar State, India. VL was associated with socioeconomic status, type of housing, and belonging to the Musahar caste. Annual coverage of indoor residual insecticide spraying was 12%. Increasing such spraying can greatly contribute to VL control. PMID:23017164

Singh, Shri Prakash; Malaviya, Paritosh; Picado, Albert; Gidwani, Kamlesh; Singh, Rudra Pratap; Menten, Joris; Boelaert, Marleen; Sundar, Shyam

2012-01-01

175

Revision of measures to combat intractable diseases in Japan: Three pillars will play an even greater role in the future  

PubMed Central

Summary Over the past 40 years, measures to combat intractable diseases in Japan have progressed substantially since the implementation of the “Outline of Measures to Combat Intractable Diseases” in 1972. However, many challenges remain. In order to further promote measures to combat intractable diseases, a “Revision of Measures to Combat Intractable Diseases” was approved by the Japanese Ministry of Health, Labor, and Welfare (MHLW) on January 25, 2013. The revision rests on the three pillars of development of effective strategies to treat intractable diseases and improved care for those affected, creation of fair and consistent mechanisms to reimburse medical expenses, and implementing measures to enhance public understanding and encourage the social participation of those affected. These pillars will play an even greater role in future measures to combat intractable diseases.

Song, Peipei; Kokudo, Norihiro

2013-01-01

176

Successful Management of Refractory Headache and Facial Pain due to Cavernous Sinus Meningioma with Sphenopalatine Ganglion Radiofrequency  

PubMed Central

Headaches and facial pain can be extremely difficult to manage for the patient and the clinician. In the medical literature, it has been suggested that the autonomic reflex plays an important role in the pathophysiology of facial neuralgia. The sphenopalatine ganglion is the largest parasympathetic ganglion outside the cranium. It is an easy accessible target for pain management. The application of radiofrequency nerve ablation was described in the medical literature. In this case report, we describe a 54-year-old female. She was diagnosed with a cavernous sinus meningioma. She underwent surgical resection and gamma knife radiosurgery. She was suffering from an intractable hemifacial pain for many years. Her pain started shortly after surgery and continued throughout many years. Sphenopalatine ganglion block in multiple occasions was able to provide temporary relief. The patient's intractable hemicranial headaches and hemifacial pain responded to the sphenopalatine ganglion radiofrequency nerve ablation. The pain response remained unchanged for 12 months after procedure. This case report increased our current knowledge about the sphenopalatine ganglion role in the headache and facial intractable pain management. The failure of available antalgic medications to adequately control pain in similar patients underscores the need to develop an algorithm for therapies. PMID:25343051

Ho, Kwo Wei David

2014-01-01

177

Spinal cord stimulation for relief of abdominal pain in two patients with familial Mediterranean fever.  

PubMed

Familial Mediterranean fever is a hereditary disease characterized by recurrent attacks of fever and serosal inflammation that commonly presents as severe abdominal pain. Though colchicine remains the mainstay of treatment, a significant proportion of patients are partially responsive, unresponsive or intolerant to it. We present two such cases where spinal cord stimulation (SCS) was used to manage the paroxysmal abdominal pain associated with this disease. Abdominal visceral pain pathways and the application of SCS techniques in its management are discussed. PMID:17062615

Kapur, S; Mutagi, H; Raphael, J

2006-12-01

178

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 ...

179

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 ...

180

Breast pain  

MedlinePLUS

Pain - breast; Mastalgia; Mastodynia; Breast tenderness ... There are many possible causes for breast pain. For example, hormone level changes from menstruation or pregnancy often cause breast tenderness. Some amount of swelling and tenderness just before ...

181

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)

182

Neck Pain  

MedlinePLUS

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

183

Neuropathic Pain  

MedlinePLUS

... know that it can erode quality of life. Communication Tools View All Everyday Tools During Your Visit ... tires. Video Download Transcript Pain Matters This Discovery Channel documentary explores what chronic pain is, its individual ...

184

Breastfeeding and Subsequent Maternal Visceral Adiposity  

PubMed Central

Women gain visceral fat during pregnancy. Studies examining the impact of breastfeeding on maternal body composition are inconclusive. We examined the extent to which breastfeeding was associated with visceral adiposity in a sample of US women. This was a cross-sectional analysis of 351 women aged 45–58 years, who were free of clinical cardiovascular disease and had not used oral contraceptives or hormone replacement therapy in the 3 months prior to enrollment in the Study of Women’s Health Across the Nation (SWAN)-Heart Study (2001–2003). History of breastfeeding was self-reported. Computed tomography was used to assess abdominal adiposity. Among premenopausal/early-peri-menopausal mothers, those who never breastfed had 28% greater visceral adiposity (95% confidence interval (CI): 11–49, P = 0.001), 4.7% greater waist-hip ratio (95% CI: 1.9–7.4, P < 0.001), and 6.49 cm greater waist circumference (95% CI: 3.71–9.26, P < 0.001) than mothers who breastfed all of their children for ?3 months in models adjusting for study site; age; parity; years since last birth; socioeconomic, lifestyle, and family history variables; early adult BMI; and current BMI. In comparison to women who were nulliparous, mothers who breastfed all of their children for ?3 months had similar amounts of visceral fat (P > 0.05). In contrast, premenopausal/early-peri-menopausal mothers who had never breastfed had significantly greater visceral adiposity (42% (95% CI: 17–70), P < 0.001), waist circumference (6.15 cm (95% CI: 2.75–9.56), P < 0.001), and waist-hip ratio (3.7% (95% CI: 0.69–6.8), P = 0.02) than nulliparous women. No significant relationships were observed among late peri-menopausal/postmenopausal women. In conclusion, until menopause, mothers who did not breastfeed all of their children for ?3 months exhibit significantly greater amounts of metabolically active visceral fat than mothers who had breastfed all of their children for ?3 months. PMID:21720436

McClure, Candace K.; Schwarz, Eleanor B.; Conroy, Molly B.; Tepper, Ping G.; Janssen, Imke; Sutton-Tyrrell, Kim C.

2013-01-01

185

Co-infection of visceral leishmaniasis and pulmonary tuberculosis: a case study  

PubMed Central

Co-infection of visceral leishmaniasis and pulmonary tuberculosis are increasing public health problem in eastern region of country. A large number of clinical cases of leishmaniasis and tuberculosis have been reported in Sudan. Such type of co-infections lead to decreased host's immune system. This is a case report of 48 years old male with visceral leishmaniasis and pulmonary tuberculosis. He arrived at hospital with complaints of fever with rigor, abdominal pain, weakness, loss of appetite, yellowish discoloration of urine and sclerosis at lower back. Bone marrow aspiration cytology revealed the presence of Leishmania donovani bodies (2+). His treatment was initiated with amphotericin B deoxycholate (inj. Fungizone) 15 infusions on alternate days with 5% dextrose. He had 20 years past history of pulmonary tuberculosis. His chest X-ray showed increased bronchovascular marking encysted pleural effusion on lower segment of right lung. Ultrasonography guided fine needle aspiration cytology of pleural fluid for protein, sugar, lactate dehydrogenase, adenosine deaminase, cell type and cell count. Cytological reports confirmed pulmonary tuberculosis. Antitubercular therapy (four drug regimen: rifampicin, isoniazid, ethambutal, and pyrazinamide) was started. Co-infection of visceral leishmaniasis and pulmonary tuberculosis is a real threat in developing countries. There is a need of cost effective diagnostic and therapeutic facilities for these co-infections.

Shweta; Bhatnagar, Surabhi; Gupta, Ashok Kumar; Murti, Krishna; Pandey, Krishna

2014-01-01

186

Acid sensing ion channels 2 and 3 are required for inhibition of visceral nociceptors by benzamil.  

PubMed

The Deg/ENaC family of ion channels, including ASIC1, 2 and 3, are candidate mechanotransducers in visceral and somatic sensory neurons, although each channel may play a different role in different sensory pathways. Here we determined which distinct populations of visceral sensory neurons are sensitive to the non-selective Deg/ENaC blocker benzamil, and which ASIC channels are targets for benzamil by studying its actions in knockout mice. Single afferent fiber recordings were made in vitro from mouse high threshold colonic thoracolumbar splanchnic afferents and low threshold gastroesophageal vagal afferents. mRNA expression of ASIC subtypes was compared between colonic and gastroesophageal afferents by quantitative RT-PCR of transcripts following laser capture microdissection of retrogradely labeled cell bodies. Mechanosensitivity of colonic afferents was potently reduced by benzamil (10(-6)-3 x 10(-4)M), whereas gastroesophageal afferents were marginally inhibited. Inhibition of colonic afferent mechanosensitivity by benzamil was markedly diminished in ASIC2-/- and ASIC3-/- mice, but unchanged in ASIC1a-/-. Therefore ASIC2 and 3 are targets for benzamil to inhibit colonic afferent mechanosensitivity. Conversely, gastroesophageal afferents are less sensitive to benzamil, and its action depends less on ASIC expression. mRNA for ASIC3 showed higher and ASIC1a showed lower relative expression in colonic afferents from thoracolumbar dorsal root ganglia than in gastric afferents from nodose (vagal) ganglia. These data indicate that ASICs on colonic afferents present distinct pharmacological targets for visceral pain. PMID:17467171

Page, Amanda J; Brierley, Stuart M; Martin, Christopher M; Hughes, Patrick A; Blackshaw, L Ashley

2007-12-15

187

Spinal cord stimulation: Current applications for treatment of chronic pain  

PubMed Central

Spinal cord stimulation (SCS) is thought to relieve chronic intractable pain by stimulating nerve fibers in the spinal cord. The resulting impulses in the fibers may inhibit the conduction of pain signals to the brain, according to the pain gate theory proposed by Melzack and Wall in 1965 and the sensation of pain is thus blocked. Although SCS may reduce pain, it will not eliminate it. After a period of concern about safety and efficacy, SCS is now regaining popularity among pain specialists for the treatment of chronic pain. The sympatholytic effect of SCS is one of its most interesting therapeutic properties. This effect is considered responsible for the effectiveness of SCS in peripheral ischemia, and at least some cases of complex regional pain syndrome. The sympatholytic effect has also been considered part of the management of other chronic pain states such as failed back surgery syndrome, phantom pain, diabetic neuropathy, and postherpetic neuralgia. In general, SCS is part of an overall treatment strategy and is used only after the more conservative treatments have failed. The concept of SCS has evolved rapidly following the technological advances that have produced leads with multiple contact electrodes and battery systems. The current prevalence of patients with chronic pain requiring treatment other than conventional medical management has significantly increased and so has been the need for SCS. With the cost benefit analysis showing significant support for SCS, it may be appropriate to offer this as an effective alternative treatment for these patients.

Vannemreddy, Prasad; Slavin, Konstantin V.

2011-01-01

188

Pain Assessment  

Microsoft Academic Search

In adults, pain is one of the most common physical complaints. For example, a comprehensive review of available epidemiological\\u000a studies yielded a median point prevalence of chronic benign pain of 15% in adults, with individual study values ranging from\\u000a 2–40% (Verhaak, Kerssens, Dekker, Sorbi, & Bensing, 1998). Unfortunately, pain is not limited to the adult years, as estimates\\u000a of pain

Frank Andrasik; Carla Rime

189

Managing Pain  

MedlinePLUS

... pain such as aching, burning, gnawing, grabbing • The effect of the pain on the patient and family (for example, is the family anxious or unsure about how to give the medicines; is the patient becoming irritable from lack of sleep because of the pain) What can be done? ...

190

Vagus nerve stimulation in children with intractable epilepsy: indications, complications and outcome  

Microsoft Academic Search

Purpose  To analyze the indication, complications and outcome of vagus nerve stimulation in intractable childhood epilepsy.\\u000a \\u000a \\u000a \\u000a Materials and methods  We retrospectively reviewed the data of 69 children who had insertion of vagal nerve stimulator (VNS) between June 1995 and\\u000a August 2006 for medically intractable epilepsy. Outcome was based on the Engel's classification. Statistical analysis of the\\u000a data was also done to see

S. M. R. Kabir; C. Rajaraman; C. Rittey; H. S. Zaki; A. A. Kemeny; J. McMullan

2009-01-01

191

Referred Vaginal Pain: Cause of Hypersensitivity and Performance Problems in Mares? A Clinical Case Study  

Microsoft Academic Search

In mares, pneumovagina develops because of perineal malconformation. This condition may aggravate to cause vaginitis, cervicitis, and endometritis. In animal models, visceral pain has been associated with genital infections causing hyperalgesia and allodynia in the affected organs. The pain from genital infections may be referred to dermal areas of the hindquarter.The aim of the current clinical case study was to

M. Christoffersen; H. Lehn-Jensen; I. B. Bøgh

2007-01-01

192

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

193

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

194

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

195

Pain Genes  

PubMed Central

Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors) signal the existence of tissue damage to the central nervous system (CNS), where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating pain pathways using model organisms have identified the molecular nature of the transducers, regulatory mechanisms involved in changing neuronal activity, as well as the critical role of immune system cells in driving pain pathways. In man, mapping of human pain mutants as well as twin studies and association studies of altered pain behaviour have identified important regulators of the pain system. In turn, new drug targets for chronic pain treatment have been validated in transgenic mouse studies. Thus, genetic studies of pain pathways have complemented the traditional neuroscience approaches of electrophysiology and pharmacology to give us fresh insights into the molecular basis of pain perception. PMID:18654615

Foulkes, Tom; Wood, John N.

2008-01-01

196

Metabotropic glutamate receptors as novel therapeutic targets on visceral sensory pathways.  

PubMed

Metabotropic glutamate receptors (mGluR) have a diverse range of structures and molecular coupling mechanisms. There are eight mGluR subtypes divided into three major groups. Group I (mGluR1 and 5) is excitatory; groups II (mGluR2 and 3) and III (mGluR 4, 6, and 7) are inhibitory. All mGluR are found in the mammalian nervous system but some are absent from sensory neurons. The focus here is on mGluR in sensory pathways from the viscera, where they have been explored as therapeutic targets. Group I mGluR are activated by endogenous glutamate or constitutively active without agonist. Constitutive activity can be exploited by inverse agonists to reduce neuronal excitability without synaptic input. This is promising for reducing activation of nociceptive afferents and pain using mGluR5 negative allosteric modulators. Many inhibitory mGluR are also expressed in visceral afferents, many of which markedly reduce excitability. Their role in visceral pain remains to be determined, but they have shown promise in inhibition of the triggering of gastro-esophageal reflux, via an action on mechanosensory gastric afferents. The extent of reflux inhibition is limited, however, and may not reach a clinically useful level. On the other hand, negative modulation of mGluR5 has very potent actions on reflux inhibition, which has produced the most likely candidates so far as therapeutic drugs. These act probably outside the central nervous system, and may therefore provide a generous therapeutic window. There are many unanswered questions about mGluR along visceral afferent pathways, the answers to which may reveal many more therapeutic candidates. PMID:21472028

Blackshaw, L Ashley; Page, Amanda J; Young, Richard L

2011-01-01

197

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

198

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

199

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

200

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

Microsoft Academic Search

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

Peter T. Coleman

2004-01-01

201

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

202

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

Microsoft Academic Search

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

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

2006-01-01

203

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

Microsoft Academic Search

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

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

2008-01-01

204

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

Microsoft Academic Search

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

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

1992-01-01

205

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

ERIC Educational Resources Information Center

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

Feinberg, Daniel

206

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

207

Image-Guided, Frameless Stereotactic Sectioning of the Corpus callosum in Children with Intractable Epilepsy  

Microsoft Academic Search

Corpus callosotomy is an effective neurosurgical procedure for children with intractable atonic or drop attack seizures. While this procedure has not changed significantly over the past three decades, some technical issues remain to be resolved. These include the intraoperative determination of the extent of the callosotomy, the need to stage the procedure, as well as side of approach of craniotomy.

Mojgan Hodaie; Awni Musharbash; Hiroshi Otsubo; O. Carter Snead III; Shiro Chitoku; Ayako Ochi; Stephanie Holowka; Harold J. Hoffman; James T. Rutka

2001-01-01

208

Chronic Pelvic Pain  

MedlinePLUS

... Family > Conditions & Treatments > Pain Disorders > Chronic Pelvic Pain Chronic Pelvic Pain Page Content Pelvic pain is an uncommon but ... and can be injured or weakened causing pain Chronic pain can continue long after tissue injury has healed, ...

209

Low back pain - chronic  

MedlinePLUS

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

210

Chronic Pain  

Microsoft Academic Search

\\u000a \\u000a \\u000a \\u000a \\u000a 1. \\u000a \\u000a Non-cancer-related pain that lasts longer than 3 months is considered chronic pain.\\u000a \\u000a \\u000a \\u000a 2. \\u000a \\u000a According to the National Institutes of Health, chronic pain is the third largest health problem in the world.\\u000a \\u000a \\u000a \\u000a 3. \\u000a \\u000a Approximately 25 million Americans are affected by chronic pain.\\u000a \\u000a \\u000a \\u000a 4. \\u000a \\u000a Chronic pain is one of the most common problems seen in primary care clinics. Pain-related problems account

Jim Nuovo

211

Central pain.  

PubMed

ABSTRACT 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

212

5-HT 3 receptors mediate the time-dependent vagal afferent modulation of nociception during chronic food allergen-sensitized visceral hyperalgesia in rats.  

PubMed

Converging lines of evidence demonstrate a vagally mediated antinociceptive pathway in animals undergoing acute visceral insults, the contribution of this system to visceral pain following chronic noxious stimuli is unknown. 5-HT(3) receptor (5-HT(3)Rs) on spinal afferents are crucially involved in nociceptive processing, the role of 5-HT(3)Rs on vagal afferents is unclear. The aim of the present study was to determine the contribution of vagal afferents to visceral nociception in rats undergoing chronic luminal allergen stimulation and whether it involves vagal 5-HT(3)Rs. Sensitized rats received chicken egg albumin (EA, 1 mg mL(-1)) in drinking water for 2 weeks (day 1-14). Visceromotor response (VMR) to colorectal distension [colorectal distension (CRD), 60 mmHg] and the levels of mRNA encoding 5-HT(3)R (including 3A and 3B subunits) in the nodose ganglia (NG) were evaluated on day 2, 4, 8 and 15. Chronic EA challenge induced gradually increased visceral nociception, with a peak on day 15. Subdiaphragmatic vagotomy or functional deafferentation with capsaicin abolished this time-dependent manner, inducing hyperalgesia from day 2, lasting to day 15. Intraluminal infusion of a 5-HT(3)R antagonist (granisetron), whether alone or infused after local mucosa anaesthetic with 1% lidocaine, mimicked the effects of vagotomy. The mRNA levels for 5-HT(3B) or 5-HT(3A) subunit in the NG showed an opposite time-course to that of visceral pain, which increased from day 2, then decreased gradually to levels lower than those of controls. Our results demonstrate a time-dependent vagal afferent modulation of chronic allergen-sensitized visceral hyperalgesia, which may involve a 5-HT(3)R pathway. PMID:19558425

Chen, S; Li, J; Zhang, L; Dong, X; Gao, W; Mo, J; Chen, H; Xiao, S; Li, Y

2009-11-01

213

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

214

MOTILITY AND VISCERAL SENSATION Visceral sensation and emotion: a study using hypnosis  

Microsoft Academic Search

Background and objectives: We have previously shown that hypnosis can be used to study the effect of different emotions on the motility of the gastrointestinal tract. These studies demonstrated that both anger and excitement increased colonic motility while happiness led to a reduction. The purpose of this study was to investigate the effect of hypnotically induced emotion on the visceral

L A Houghton; E L Calvert; N A Jackson; P Cooper; P J Whorwell

2002-01-01

215

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

216

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

217

Pain Genes  

Microsoft Academic Search

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

Tom Foulkes; John N. Wood

2008-01-01

218

Visceral leishmaniasis in Ethiopia: an evolving disease.  

PubMed

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

2014-09-01

219

Endemic transmission of visceral leishmaniasis in Bhutan.  

PubMed

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

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

2012-12-01

220

Genetically Modified Organisms and Visceral Leishmaniasis  

PubMed Central

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

221

Canine visceral leishmaniosis: A comparative analysis of the EIE-leishmaniose-visceral-canina-Bio-Manguinhos and the IFI-leishmaniose-visceral-canina-Bio-Manguinhos kits  

Microsoft Academic Search

This study evaluated the performance of the EIE-leishmaniose-visceral-canina-Bio-Manguinhos (EIE-LVC) kit and to compare it with that of the IFI-leishmaniose-visceral-canina-Bio-Manguinhos (IFI-LVC) kit. Four groups of dogs were studied: group 1 (G1), dogs with clinical signs indicative of CVL and testing positive for the parasite (n=25); group 2 (G2), dogs with only a presumed diagnosis of CVL (n=62); group 3 (G3), dogs

R. A. Lira; M. Paiva Cavalcanti; M. Nakazawa; A. G. P. Ferreira; E. D. Silva; F. G. C. Abath; L. C. Alves; W. V. Souza; Y. M. Gomes

2006-01-01

222

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

PubMed Central

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

Enweluzo, Chijioke; Yarra, Pradeep

2013-01-01

223

Involvement of cannabinoid receptors in gut motility and visceral perception.  

PubMed

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

2004-04-01

224

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

225

Malignant transformation of a solitary fibrous tumor of the liver and intractable hypoglycemia  

Microsoft Academic Search

Sarcomas of the liver are rare. We report a case of intractable hypoglycemia secondary to a solitary fibrous tumor that underwent\\u000a malignant transformation into a fibrosarcoma. A 70-year-old man presented with a hepatic mass and tumor-associated hypoglycemia\\u000a which was resistant to medical management. Blood tests were remarkable only for elevated serum insulin-like growth factor\\u000a (IGF)-2. The hypoglycemia resolved following resection

Gabriel Chan; Peter J. Horton; Sandra Thyssen; Marie Lamarche; Ayoub Nahal; David J. Hill; Errol B. Marliss; Peter Metrakos

2007-01-01

226

Intractable Nausea and Vomiting from Autoantibodies Against a Brain Water Channel  

PubMed Central

Background & Aims Antibodies against the water channel protein aquaporin (AQP)-4 cause a spectrum of inflammatory, demyelinating, central nervous system disorders called neuromyelitis optica spectrum disorders (NMOSDs); these primarily affect the optic nerves and spinal cord, but also the brain. Symptoms of intractable nausea, vomiting and hiccups reflect involvement of AQP4 in the brainstem area postrema and account for gastroenterologic presentations. We investigated the frequency of intractable nausea, vomiting, or hiccups in patients with NMOSD who tested positive for immunoglobulin-G against AQP4 (AQP4-IgG). We also analyzed sera from patients with idiopathic nausea or vomiting for the presence of AQP4-IgG. Methods We reviewed the Mayo Clinic AQP4-IgG positive NMOSD database (n=70) to identify patients who presented with vomiting, focusing on results from gastroenterologic evaluations. We also tested serum samples (from the Gastroparesis Clinical Research Consortium repository) from patients who presented with idiopathic nausea or vomiting for AQP4-IgG (controls n=318 with gastroparesis and 117 without gastroparesis). Results Ten AQP4-IgG-positive patients diagnosed with NMOSD (14% of patients in the database) initially presented with intractable vomiting. Extensive gastroenterological evaluation was non-informative. AQP4-IgG was not detected in any of the controls. Conclusions Though NMOSDs are rare, tests for AQP4-IgG should be considered for patients that present with unexplained, intractable vomiting. Detection of the antibody before the development of optic neuritis or transverse myelitis allows patients to receive immunosuppressive therapy before the development of neurologic disabilities. PMID:23211959

Iorio, Raffaele; Lucchinetti, Claudia F.; Lennon, Vanda A.; Farrugia, Gianrico; Pasricha, Pankaj J.; Weinshenker, Brian G.; Pittock, Sean J.

2013-01-01

227

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

228

Urination - painful  

MedlinePLUS

... atrophic vaginitis ) Herpes infection in the genital area Irritation of the vaginal tissue caused by bubble bath, perfumes, or lotions Vulvovaginitis , such as yeast or other infections of the vulva and vagina Other causes of painful urination include: ...

229

Back Pain  

MedlinePLUS

... The procedure is generally performed on an outpatient basis under a mild anesthetic. 3 Used only if ... some cases it is performed on an outpatient basis. For diskogenic low back pain (degenerative disk disease): ...

230

Abdominal Pain  

MedlinePLUS

... You could also try progressive relaxation or self-hypnosis . For more information about non-drug pain relief ... overall situation for the child. Teaching kids self-hypnosis [8] or guided imagery [8a] show great promise ...

231

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

232

Intractable diarrhea of infancy with congenital intestinal mucosa abnormalities: outcome of four cases.  

PubMed

Microvillous inclusion disease (MID) and epithelial dysplasia (ED) or tufting enteropathy are the most frequent causes of intractable diarrhea with persistent villous atrophy and indefinite dependence on total parenteral nutrition (PN) from early infancy. Since these are intractable diseases, they have been proposed to be elective indication for early bowel transplantation in order to avoid complications, such as PN-related liver disease, that would require a combined small bowel-liver transplant. We describe four cases of intractable diarrhea, two with MID and two with ED, seeking to discover whether these diseases are really elective, early indications for bowel transplant. Among our four patients, only one with ED underwent transplantation. The prognosis of small bowel transplant is still poor and worse than that of prolonged HPN. Further study is necessary to achieve a safe HPN program. Referral for transplant (small bowel only or combined with liver) should be considered when there is a venous access reduction and/or severe and irreversible liver disease. PMID:14697977

Gambarara, M; Diamanti, A; Ferretti, F; Papadatou, B; Knafelz, D; Pietrobattista, A; Castro, M

2003-12-01

233

Neonatal pain  

PubMed Central

Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback. PMID:24330444

Walker, Suellen M

2014-01-01

234

VEGF induces sensory and motor peripheral plasticity, alters bladder function, and promotes visceral sensitivity  

PubMed Central

Background This work tests the hypothesis that bladder instillation with vascular endothelial growth factor (VEGF) modulates sensory and motor nerve plasticity, and, consequently, bladder function and visceral sensitivity. In addition to C57BL/6J, ChAT-cre mice were used for visualization of bladder cholinergic nerves. The direct effect of VEGF on the density of sensory nerves expressing the transient receptor potential vanilloid subfamily 1 (TRPV1) and cholinergic nerves (ChAT) was studied one week after one or two intravesical instillations of the growth factor. To study the effects of VEGF on bladder function, mice were intravesically instilled with VEGF and urodynamic evaluation was assessed. VEGF-induced alteration in bladder dorsal root ganglion (DRG) neurons was performed on retrogradly labeled urinary bladder afferents by patch-clamp recording of voltage gated Na+ currents. Determination of VEGF-induced changes in sensitivity to abdominal mechanostimulation was performed by application of von Frey filaments. Results In addition to an overwhelming increase in TRPV1 immunoreactivity, VEGF instillation resulted in an increase in ChAT-directed expression of a fluorescent protein in several layers of the urinary bladder. Intravesical VEGF caused a profound change in the function of the urinary bladder: acute VEGF (1 week post VEGF treatment) reduced micturition pressure and longer treatment (2 weeks post-VEGF instillation) caused a substantial reduction in inter-micturition interval. In addition, intravesical VEGF resulted in an up-regulation of voltage gated Na+ channels (VGSC) in bladder DRG neurons and enhanced abdominal sensitivity to mechanical stimulation. Conclusions For the first time, evidence is presented indicating that VEGF instillation into the mouse bladder promotes a significant increase in peripheral nerve density together with alterations in bladder function and visceral sensitivity. The VEGF pathway is being proposed as a key modulator of neural plasticity in the pelvis and enhanced VEGF content may be associated with visceral hyperalgesia, abdominal discomfort, and/or pelvic pain. PMID:23249422

2012-01-01

235

Long-Term Outcome in Children With Intractable Epilepsy Showing Bilateral Diffuse Cortical Glucose Hypometabolism Pattern on Positron Emission Tomography  

Microsoft Academic Search

The objective of this study is to determine the long-term outcome of children with intractable epilepsy who have diffuse cortical hypometabolism on 2-deoxy-2-(18F)fluoro-D-glucose positron emission tomography (FDG-PET) scans. Seventeen children with intractable epilepsy showing bilateral, diffuse cortical hypometabolism on FDG-PET were followed up through telephone interview from 1 year 4 months to 11 years 4 months (mean: 5 years 7

Varun Shandal; Amy L. Veenstra; Michael Behen; Senthil Sundaram; Harry Chugani

2012-01-01

236

Intractable Chronic Vulval Ulceration Presenting as Immune Reconstitution Inflammatory Syndrome in a Treatment-Failure Patient: A Case Observation  

PubMed Central

HIV-1 treatment-failure patients are increasingly being initiated on second-line antiretroviral therapy. The case we describe is of a treatment-failure patient who developed intractable chronic vulval ulceration presenting as immune reconstitution inflammatory syndrome (IRIS), following complete viral suppression with second-line highly active antiretroviral treatment (HAART). To the best of our knowledge, this is the first reported case of intractable vulval ulceration IRIS in an HIV-1 treatment-failure patient. PMID:22567519

Katusiime, Christine; Ocama, Ponsiano; Kambugu, Andrew

2011-01-01

237

Visceral leishmaniasis in immunosuppressed Caucasian patient  

PubMed Central

A 64-year-old man was admitted with fever, weight loss, fatigue and night sweats. He was known to have rheumatoid arthritis and had been taking methotrexate for 1 year. He had worked in Saudi Arabia until 1994 and had been living in Spain for 6 months every year. Clinical examination showed an enlarged spleen. Routine investigations showed pancytopaenia. Serial blood cultures were negative. CT scan confirmed splenomegaly and was otherwise unremarkable. Bone marrow biopsy revealed Leishmania amastigote consistent with a diagnosis of visceral leishmaniasis. After discussing with the hospital for tropical diseases (HTD), he was started on liposomal amphotericin B. Following two infusions of amphotericin B, he started improving as his fever, night sweats and weakness had settled. He was then discharged and followed up in HTD clinic 4 weeks later where he was found to be consistently improving. PMID:22605859

TOQEER, Muhammad; Rahman, Nadeem; Whitehead, Mark W; Lockwood, Diana

2012-01-01

238

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

239

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

240

Cancer pain (classification and pain syndromes).  

PubMed

Inspite the new informations about the physiology and biochemistry of pain, it remains true that pain is only partially understood. Cancer pain is often experienced as several different types of pain, with combined somatic and neuropathic types the most frequently. If the acute cancer pain does not subside with initial therapy, patients experience pain of more constant nature, the characteristics of wich vary with the cause and the involved sites. Chronic pain related to cancer can be considered as tumor-induced pain, chemotherapy-induced pain, and radiation therapy-induced pain. Certain pain mechanisms are present in cancer patients. These include inflammation due to infection, such as local sepsis or the pain of herpes zoster, and pain due to the obstruction or occlusion of a hollow organ, such as that caused by large bowel in cancer of colon. Pain also is commonly due to destruction of tissue, such as is often seen with bony metastases. Bony metastases also produce pain because of periostal irritation, medullary pressure, and fractures. Pain may be produced by the growth of tumor in a closed area richly supplied with pain receptors (nociceptors). Examples are tumors growing within the capsule of an organ such as the pancreas. Chest pain occurring after tumor of the lung or the mediastinum due to invasion of the pleura. Certain tumors produce characteristic types of pain. For example, back pain is seen with multiple myeloma, and severe shoulder pain and arm pain is seen with Pancoast tumors. PMID:16018403

Slavik, E; Ivanovi?, S; Grujici?, D

2004-01-01

241

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

242

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

243

The management of multi-site, bleeding, visceral artery pseudoaneurysms, secondary to necrotising pancreatitis.  

PubMed

We present the case of a 45-year-old man, who presented to his local casualty department with severe epigastric pain following an alcohol binge, and was subsequently diagnosed with acute pancreatitis. Pancreatic necrosis with multiple collections ensued, necessitating transfer to an intensive care unit (ITU) in a tertiary hepatopancreaticobiliary centre. Initially, the patient appeared to slowly improve and was discharged to the ward, albeit following a prolonged ITU admission. However, during his subsequent recovery, he suffered multiple episodes of haematemesis and melaena associated with haemodynamic instability and requiring repeat admission to the ITU. Computerised tomographic angiography, followed by visceral angiography, was used to confirm the diagnosis of multisite visceral artery pseudoaneurysms, secondary to severe, necrotising pancreatitis. Pseudoaneurysms of the splenic, left colic and gastroduodenal arteries were sequentially, and successfully, radiologically embolised over a period of 9 days. Subsequent sequelae of radiological embolisation included a clinically insignificant splenic infarct, and a left colonic infarction associated with subsequent enterocutaneous fistula formation. The patient made a prolonged, but successful, recovery and was discharged from hospital after 260 days as an in-patient. This case illustrates the rare complication of three separate pseudoaneurysms, secondary to acute pancreatitis, successfully managed radiologically in the same patient. This case also highlights the necessity for multidisciplinary involvement in the management of pseudoaneurysms, an approach that is often most successfully achieved in a tertiary setting. PMID:19220939

Skipworth, J; Raptis, D; Brennand, D; Imber, C; Shankar, A

2009-04-01

244

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

PubMed

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

245

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

PubMed

Irritable bowel syndrome is characterized by colorectal hypersensitivity and contributed to by sensitized mechanosensitive primary afferents and recruitment of mechanoinsensitive (silent) afferents. Neurotrophic factors are well known to orchestrate dynamic changes in the properties of sensory neurons. Although pain modulation by proteins in the glial cell line-derived neurotrophic factor (GDNF) family has been documented in various pathophysiological states, their role in colorectal hypersensitivity remains unexplored. Therefore, we investigated the involvement of the GDNF family receptor ?-3 (GFR?3) signaling in visceral hypersensitivity by quantifying visceromotor responses (VMR) to colorectal distension before and after intracolonic treatment with 2,4,6-trinitrobenzene sulfonic acid (TNBS). Baseline responses to colorectal distension did not differ between C57BL/6 and GFR?3 knockout (KO) mice. Relative to intracolonic saline treatment, TNBS significantly enhanced the VMR to colorectal distension in C57BL/6 mice 2, 7, 10, and 14 days posttreatment, whereas TNBS-induced visceral hypersensitivity was significantly suppressed in GFR?3 KO mice. The proportion of GFR?3 immunopositive thoracolumbar and lumbosacral colorectal dorsal root ganglion neurons was significantly elevated 2 days after TNBS treatment. In single fiber recordings, responses to circumferential stretch of colorectal afferent endings in C57BL/6 mice were significantly increased (sensitized) after exposure to an inflammatory soup, whereas responses to stretch did not sensitize in GFR?3 KO mice. These findings suggest that enhanced GFR?3 signaling in visceral afferents may contribute to development of colorectal hypersensitivity. PMID:21193524

Tanaka, T; Shinoda, M; Feng, B; Albers, K M; Gebhart, G F

2011-03-01

246

Focused suggestion with somatic anchoring technique: rapid self-hypnosis for pain management.  

PubMed

This article details a self-hypnosis technique designed to teach patients how to manage acute or chronic pain through directed focus. The focused suggestion with somatic anchoring technique has been used with various types of pain, including somatic pain (arthritis, post-injury pain from bone breaks, or muscle tears), visceral pain (related to irritable bowel disease), and neuropathic pain (related to multiple sclerosis). This technique combines cognitive restructuring and mindfulness meditation with indirect and direct suggestions during hypnosis. The case examples demonstrate how the focused suggestion with somatic anchoring technique is used with both acute and chronic pain conditions when use of long-term medication has been relatively ineffective. PMID:23724568

Donatone, Brooke

2013-04-01

247

Visceral leishmaniasis in a soldier returning from Operation Enduring Freedom.  

PubMed

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

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

2004-09-01

248

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

249

Bone Marrow Negative Visceral Leishmaniasis in an Adolescent Male  

PubMed Central

Visceral Leishmaniasis or Kala Azar is endemic in certain regions of India. In endemic areas, the constellation of fever, progressive weight loss, weakness, pronounced splenomegaly, anemia, leukopenia, and hypergammaglobulinemia is highly suggestive of visceral leishmaniasis. Demonstration of the parasite in liver, splenic or bone marrow aspirates is confirmatory. We present a case in which Leishmania donovani (LD) bodies were demonstrated on splenic aspirate. We were unable to demonstrate LD bodies on bone marrow aspiration. PMID:23682278

Jetley, S; Rana, S; Khan, S; Zeeba, JS; Hassan, MJ; Kapoor, P

2013-01-01

250

Congenitally transmitted visceral leishmaniasis: report of two Brazilian human cases.  

PubMed

Visceral leishmaniasis is a relevant public health problem worldwide. Most of the reported cases in Latin America are from Brazil. Herein we report two human cases of congenitally transmitted visceral leishmaniasis in two patients who developed symptoms during pregnancy. The diagnosis was made by visual examination of Leishmania parasites in bone marrow aspirates of the mothers and by detecting parasite kDNA in bone marrow samples of the newborn children using polymerase chain reaction. PMID:23453409

Mescouto-Borges, Myrlena Regina Machado; Maués, Érika; Costa, Dorcas Lamounier; Pranchevicius, Maria Cristina da Silva; Romero, Gustavo Adolfo Sierra

2013-01-01

251

Burning mouth syndrome as a trigeminal small fibre neuropathy: Increased heat and capsaicin receptor TRPV1 in nerve fibres correlates with pain score  

Microsoft Academic Search

Burning mouth syndrome (BMS) is often an idiopathic chronic and intractable pain condition, affecting 1.5–5.5% of middle-aged and elderly women. We have studied the heat and capsaicin receptor TRPV1, and its regulator nerve growth factor (NGF), in BMS. Patients with BMS (n=10) and controls (n=10) were assessed for baseline and post-topical capsaicin pain scores, and their tongue biopsies immunostained for

Z. Yilmaz; T. Renton; Y. Yiangou; J. Zakrzewska; I. P. Chessell; C. Bountra; P. Anand

2007-01-01

252

Central sympathetic innervations to visceral and subcutaneous white adipose tissue.  

PubMed

There is a link between visceral white adipose tissue (WAT) and the metabolic syndrome in humans, with health improvements produced with small visceral WAT reduction. By contrast, subcutaneous WAT provides a site for lipid storage that is rather innocuous relative to ectopic lipid storage in muscle or liver. The sympathetic nervous system (SNS) is the principal initiator for lipolysis in WAT by mammals. Nothing is known, however, about the central origins of the SNS circuitry innervating the only true visceral WAT in rodents, mesenteric WAT (MWAT), which drains into the hepatic portal vein. We tested whether the central sympathetic circuits to subcutaneous [inguinal WAT (IWAT)] and visceral WAT (MWAT) are separate or shared and whether they possess differential sympathetic drives with food deprivation in Siberian hamsters. Using two isogenic strains of pseudorabies virus, a retrograde transneuronal viral tract tracer within the same hamsters, we found some overlap (?20-55% doubly infected neurons) between the two circuitries across the neural axis with lesser overlap proximal to the depots (spinal cord and sympathetic chain) and with more neurons involved in the innervation of IWAT than MWAT in some brain regions. Food deprivation triggered a greater sympathetic drive to subcutaneous (IWAT) than visceral (MWAT) depots. Collectively, we demonstrated both shared and separate populations of brain, spinal cord, and sympathetic chain neurons ultimately project to a subcutaneous WAT depot (IWAT) and the only visceral WAT depot in rodents (MWAT). In addition, the lipolytic stimulus of food deprivation only increased SNS drive to subcutaneous fat (IWAT). PMID:24452544

Nguyen, Ngoc Ly T; Randall, Jessica; Banfield, Bruce W; Bartness, Timothy J

2014-03-15

253

Visceral analgesic effect of 5-HT(4) receptor agonist in rats involves the rostroventral medulla (RVM).  

PubMed

The 5-HT(4) 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-HT(4) 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-HT(4) 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

2014-04-01

254

Neurolytic block of ganglion of Walther for the management of chronic pelvic pain  

PubMed Central

Here we report on the use of neurolytic block of ganglion impar (ganglion of Walther) for the management of intractable chronic pelvic pain, which is common enough to be recognized as a problem by gynecologists, likely to be difficult to diagnose and even more challenging to manage. Following failure in controlling the symptoms with pharmacological management, nine women underwent neurolysis of the ganglion impar in our Pain Clinic from 2009 to March 2013. The indication for the procedure was chronic pelvic pain (CPP) of either malignancy-related (4) or other origin (5). The Numeric Rating Scale (NRS) and duration of pain relief were employed to assess effectiveness of the procedure. Neurolysis was efficacious in patients with both malignancy-related CPP and CPP of non-malignant origin. Reported relief time varied from 4 weeks to 3 years, while in 4 cases complete and permanent cessation of pain was achieved. No complications were noted. PMID:25337174

Horosz, Bartosz; Koleda, Iwona; Sekowska, Agnieszka; Kucia, Hanna; Kosson, Dariusz; Jakiel, Grzegorz

2014-01-01

255

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.

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

2014-01-01

256

Treatment options for chronic abdominal pain in children and adolescents.  

PubMed

Chronic abdominal pain is a common feature of most functional gastrointestinal disorders in children, including functional abdominal pain (FAP) and irritable bowel syndrome (IBS). FAP can impair a child's life and often leads to significant school absences. Although the underlying mechanism is likely multifactorial, early pain experiences during a vulnerable period in the developing nervous system can cause long-term changes in the brain-gut axis and ultimately may result in altered pain pathways and visceral hyperalgesia. Care providers often feel uncomfortable managing patients with chronic abdominal pain, as the pathophysiology is poorly understood, and limited data exist regarding safety and efficacy of therapeutic options in children. The primary goal of therapy in FAP is to alleviate pain symptoms and to help the child return to normal daily activities. Treatment should be individualized and chosen based on the severity of symptoms, the existence of comorbid psychological disorders, and the impact the disorder has on the child's school attendance and normal functioning. Various psychological interventions, such as cognitive-behavioral therapy, hypnosis, and guided imagery, have been successfully used in children with chronic abdominal pain. Pharmacologic therapies such as H(2) blockers, proton-pump inhibitors, tricyclic antidepressants, and various serotonergic drugs have been used, but good controlled trials are lacking. More studies are clearly needed to investigate the benefits and safety of pharmacologic therapy in children. Newer pharmacologic agents that target specific receptors involved in nociception, stress, and neurogenic inflammation currently are being developed. Future targets for visceral hyperalgesia should not only be aimed at alleviating symptoms but also should include prevention, particularly in cases with a suspected sensitizing event such as neonatal pain and postinfectious IBS. PMID:16942666

Miranda, Adrian; Sood, Manu

2006-09-01

257

[Social pain].  

PubMed

This chapter focuses on what social pain is and how it should be managed. In order to understand social pain in a cancer patient, it is necessary to recognize the change in the patient's daily life after the diagnosis of cancer. Because the degree of suffering and the relationships with family members and the people he or she worked with differ from patient to patient, it is important to note that the context of social pain is different in each patient. Five points shown below are essential in managing social pain. 1. Economical suffering may be alleviated by utilization of the social security system while taking into account each patient's standard of living. 2. Burdens on family members should be lessened, such as by not having them stay at the patient's bedside every day and letting them go home occasionally. 3. The normal patterns of communication, support, and conflict in the family should be identified, and the extent to which they have been disrupted by the illness should be assessed. 4. It is important to understand the ethnic, cultural, and religious background of the patient and the potential impact of their influence on the individual and the illness. 5. Practical or emotional unfinished business that the patient has needs to be identified, and efforts should be made to support fulfillment. PMID:21950034

Shimoyama, Naohito; Shimoyama, Megumi

2011-09-01

258

Heel Pain  

MedlinePLUS

... or other soft-tissue growth. Prevention A variety of steps can be taken to avoid heel pain and accompanying afflictions: Wear shoes that fit well—front, back, and sides—and have shock-absorbent soles, rigid shanks, and supportive heel counters Wear the proper shoes for each activity Do not wear ...

259

Chest Pain  

MedlinePLUS

Having a pain in your chest can be scary. It does not always mean that you are having a heart attack. There can be many other causes, ... embolism Costochondritis - an inflammation of joints in your chest Some of these problems can be serious. Get ...

260

Fetal pain?  

Microsoft Academic Search

During the last few years a vivid debate, both scientifically and emotionally, has risen in the medical literature as to whether a fetus is able to feel pain during abortion or intrauterine surgery. This debate has mainly been inspired by the demonstration of various hormonal or motor reactions to noxious stimuli at very early stages of fetal development. The aims

Sampsa Vanhatalo; Onno van Nieuwenhuizen

2000-01-01

261

Chemotactic and mitogenic stimuli of neuronal apoptosis in patients with medically intractable temporal lobe epilepsy.  

PubMed

To identify the upstream signals of neuronal apoptosis in patients with medically intractable temporal lobe epilepsy (TLE), we evaluated by immunohistochemistry and confocal microscopy brain tissues of 13 TLE patients and 5 control patients regarding expression of chemokines and cell-cycle proteins. The chemokine RANTES (CCR5) and other CC-chemokines and apoptotic markers (caspase-3, -8, -9) were expressed in lateral temporal cortical and hippocampal neurons of TLE patients, but not in neurons of control cases. The chemokine RANTES is usually found in cytoplasmic and extracellular locations. However, in TLE neurons, RANTES was displayed in an unusual location, the neuronal nuclei. In addition, the cell-cycle regulatory transcription factor E2F1 was found in an abnormal location in neuronal cytoplasm. The pro-inflammatory enzyme cyclooxygenase-2 and cytokine interleukin-1? were expressed both in neurons of patients suffering from temporal lobe epilepsy and from cerebral trauma. The vessels showed fibrin leakage, perivascular macrophages and expression of IL-6 on endothelial cells. In conclusion, the cytoplasmic effects of E2F1 and nuclear effects of RANTES might have novel roles in neuronal apoptosis of TLE neurons and indicate a need to develop new medical and/or surgical neuroprotective strategies against apoptotic signaling by these molecules. Both RANTES and E2F1 signaling are upstream from caspase activation, thus the antagonists of RANTES and/or E2F1 blockade might be neuroprotective for patients with medically intractable temporal lobe epilepsy. The results have implications for the development of new medical and surgical therapies based on inhibition of chemotactic and mitogenic stimuli of neuronal apoptosis in patients with medically intractable temporal lobe epilepsy. PMID:22444245

Fiala, Milan; Avagyan, Hripsime; Merino, Jose Joaquin; Bernas, Michael; Valdivia, Juan; Espinosa-Jeffrey, Araceli; Witte, Marlys; Weinand, Martin

2013-02-01

262

Chemotactic and mitogenic stimuli of neuronal apoptosis in patients with medically intractable temporal lobe epilepsy  

PubMed Central

To identify the upstream signals of neuronal apoptosis in patients with medically intractable temporal lobe epilepsy (TLE), we evaluated by immunohistochemistry and confocal microscopy brain tissues of 13 TLE patients and 5 control patients regarding expression of chemokines and cell-cycle proteins. The chemokine RANTES (CCR5) and other CC-chemokines and apoptotic markers (caspase-3, -8, -9) were expressed in lateral temporal cortical and hippocampal neurons of TLE patients, but not in neurons of control cases. The chemokine RANTES is usually found in cytoplasmic and extracellular locations. However, in TLE neurons, RANTES was displayed in an unusual location, the neuronal nuclei. In addition, the cell-cycle regulatory transcription factor E2F1 was found in an abnormal location in neuronal cytoplasm. The pro-inflammatory enzyme cyclooxygenase-2 and cytokine interleukin-1? were expressed both in neurons of patients suffering from temporal lobe epilepsy and from cerebral trauma. The vessels showed fibrin leakage, perivascular macrophages and expression of IL-6 on endothelial cells. In conclusion, the cytoplasmic effects of E2F1 and nuclear effects of RANTES might have novel roles in neuronal apoptosis of TLE neurons and indicate a need to develop new medical and/or surgical neuroprotective strategies against apoptotic signaling by these molecules. Both RANTES and E2F1 signaling are upstream from caspase activation, thus the antagonists of RANTES and/or E2F1 blockade might be neuroprotective for patients with medically intractable temporal lobe epilepsy. The results have implications for the development of new medical and surgical therapies based on inhibition of chemotactic and mitogenic stimuli of neuronal apoptosis in patients with medically intractable temporal lobe epilepsy. PMID:22444245

Fiala, Milan; Avagyan, Hripsime; Merino, Jose Joaquin; Bernas, Michael; Valdivia, Juan; Espinosa-Jeffrey, Araceli; Witte, Marlys; Weinand, Martin

2012-01-01

263

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 ...

264

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 ...

265

Pain in Parkinson's Disease  

MedlinePLUS

... ways to manage it. Causes of Pain in Parkinson’s Researchers classify pain based on the separation of ... syndrome involving both nociceptive and neuropathic pain. Your Parkinson’s specialist, working with a pain specialist, may select ...

266

Complex Regional Pain Syndrome  

MedlinePLUS

... Syndrome? Complex regional pain syndrome (CRPS) is a chronic pain condition. The key symptom of CRPS is continuous, ... Institute of Neurological Disorders and Stroke (NINDS). NINDS Chronic Pain Information Page Chronic pain information page compiled by ...

267

Pain Management Programs  

MedlinePLUS

... Resource Guide to Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going to the ER ... Resource Guide to Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going to the ER ...

268

[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

269

[Analgesics in pediatrics. Drugs for pain relief in children].  

PubMed

FUNDAMENTAL: Analgesia is a fundamental part of management as it helps avoid the morbid effects of pain itself and improves confidence so the child and his parents can accept more easily the diagnosis and proposed treatment. The World Health Organization has established a classification of analgesics. USE OF PLACEBOS: The placebo effect depends on several factors including anxiety, confidence, and the patient's- and prescriber's-expectations and convictions). It is observed early in the first years of childhood. Use of placebos is not recommended as a favorable reaction can be interpreted wrongly, disqualifying the complaint. EFFICACY LEVELS: For level 1, paracetamol has little toxicity and is easily managed for first line use; aspirin and nonsteroid antiinflammatory drugs can also be used if there are no contraindications. Level 2 drugs, codeine or dextropropoxyphene (which is not available in a pediatric formulation) are required for any manifestation of pain not relieved by level 1 drugs. Level 3 corresponds to strong central analgesics, mainly morphine. SPECIFIC PAIN: Antispasmodic agents in combination with paracetamol give partial relief of visceral pain without masking symptoms. Local anesthetics improve comfort without compromising safety. Neurogenic pain does not respond to usual analgesics and can be relieved with tricyclic antidepressors for burning sensations or antiepileptic drugs for fulgurant pain. TREATMENT-RELATED PAIN: Iatrogenic pain, by definition, must be systematically anticipated and prevented. PMID:9232067

Fournier-Charrière, E; Dommergues, J P

1997-06-01

270

[Microinjection of L-NAME into dorsal raphe nucleus inhibits nociceptive response in sigmoid pain model of rats].  

PubMed

By means of Fos immunocytochemistry, nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) histochemistry and microinjection methods, the role of nitric oxide synthase (NOS) of dorsal raphe (DR) neurons in the modulation of rats sigmoid pain was studied. The results showed: (1) Rats exhibited aversive behavioral responses related to visceral pain after injecting formalin into the sigmoid wall. NOS neurons in DR were up-regulated, in addition, about 8% of NOS-labeled neurons were Fos positive. By contrast, there were no Fos/NOS double-labeled neurons in the control group. (2) Formalin-induced sigmoid pain scores and the expression of Fos in the spinal cord at S1 segment were decreased after microinjecting L-NAME into the DR. These findings suggest that NOS neurons are involved in the modulation of formalin-induced sigmoid pain and that NO may play an important role in the transmission of visceral nociceptive message in the midbrain. PMID:14566407

Yang, Bin; Zhang, Li-Cai; Zeng, Yin-Ming

2003-10-25

271

Shoulder pain  

PubMed Central

Introduction Shoulder pain is a common problem with an estimated prevalence of 4% to 26%. About 1% of adults aged over 45 years consult their GP with a new presentation of shoulder pain every year in the UK. The aetiology of shoulder pain is diverse and includes pathology originating from the neck, glenohumeral joint, acromioclavicular joint, rotator cuff, and other soft tissues around the shoulder girdle. The most common source of shoulder pain is the rotator cuff, accounting for over two-thirds of cases. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatment, topical drug treatment, local injections, non-drug treatment, and surgical treatment? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 71 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, arthroscopic subacromial decompression, autologous whole blood injection, corticosteroids (oral, subacromial injection, or intra-articular injection), electrical stimulation, excision of distal clavicle, extracorporeal shock wave therapy, ice, laser treatment, manipulation under anaesthesia, suprascapular nerve block, non-steroidal anti-inflammatory drugs (oral, topical or intra-articular injection), opioid analgesics, paracetamol, physiotherapy (manual treatment, exercises), platelet-rich plasma injection, rotator cuff repair, shoulder arthroplasty, and ultrasound. PMID:21418673

2010-01-01

272

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

273

Pain Management: Post-Amputation Pain  

MedlinePLUS

Pain Management Post-Amputation Pain Volume 8 · Issue 2 · March/April 1998 Text size Larger text Smaller text Java Required Print ... Yahoo MyWeb by G. Edward Jeffries, MD, FACS Post-Amputation Pain Post-amputation pain is one of ...

274

A change in the management of intractable obstetrical hemorrhage over 15 years in a tertiary care center  

PubMed Central

Context: Peripartum hysterectomy was the gold standard to save a woman with persistent obstetrical bleeding, but compromised the menstrual and reproductive functions. Bilateral internal iliac artery ligation (BIAL) is a potentially effective, fertility preserving means of controlling pelvic hemorrhage, but with surgical and anesthetic risks and low success. Angiographic embolization has the potential to arrest severe pelvic hemorrhage without removing the uterus and without hazarding general anesthesia in a hemodynamically unstable patient. Aims: The aim of this study is to discuss change in the management of intractable obstetrical hemorrhage from removing to conserving the uterus over 15 years. Settings and Design: A retrospective analysis of 122 cases of intractable obstetrical hemorrhage over a period of 15 years (January 1997 to December 2011) was done. We started uterine artery embolization (UAE) in 2007 for obstetrical hemorrhage. The patients were analyzed for maternal characteristics, indications, treatment modality, maternal morbidity, and mortality. Statistical Analysis Used: Descriptive. Results: We analyzed 12,055 deliveries, (6029 cesarean sections; 6026 vaginal deliveries). One hundred and twenty-two cases of intractable obstetrical hemorrhage were managed with obstetrical hysterectomies in 63, UAE in 53 cases and BIAL in six cases. During the period between 1997 and 2006 intractable obstetrical hemorrhage was managed by hysterectomy/internal iliac artery ligation. The last 5 years of the study period had 80 patients with intractable obstetrical hemorrhage, 53 patients underwent arterial embolization and 35 had a hysterectomy and two had internal artery ligation. There was no mortality and significantly less morbidity in embolization group in our study. Conclusions: Embolization should be tried in patients with intractable obstetrical hemorrhage before proceeding for surgical intervention. PMID:25298935

Juneja, Sunil K; Tandon, Pooja; Mohan, Bishav; Kaushal, Sandeep

2014-01-01

275

Expression of the TRPV1 receptor differs in quiescent inflammatory bowel disease with or without abdominal pain  

Microsoft Academic Search

ObjectiveTransient receptor potential vanilloid type 1 (TRPV1) has been shown to play an important role in visceral hypersensitivity. A significant proportion of patients with inflammatory bowel disease (IBD) continue to complain of abdominal pain despite their disease being otherwise quiescent. We investigated TRPV1-immunoreactive fibres in rectosigmoid biopsies taken from such patients with correlation to abdominal pain severity.MethodsRectosigmoid biopsies were collected

Ayesha Akbar; Yiangos Yiangou; Paul Facer; W. G. Brydon; Julian R F Walters; Praveen Anand; Subrata Ghosh

2010-01-01

276

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

277

Pulsed radiofrequency to the great occipital nerve for the treatment of intractable postherpetic itch: a case report  

PubMed Central

A patient with intractable postherpetic itch lasting for 1 year was reported. The itch was mainly from the left vertex, frontal and ophthalmic regions and extended to the left neck area. The patient had negative response to the ophthalmic nerve block. Under the initial positive response to the great occipital nerve block, pulsed radiofrequency (PRF) was performed on the position of the great occipital nerve. After 4 months treatment, the itch was completely vanished. This case study demonstrates the effectiveness of PRF for intractable postherpetic itch originating in the head and neck. However, more samples needed to verify this management.

Ding, De-Fang; Li, Rong-Chun; Xiong, Qiu-Ju; Zhou, Ling; Xiang, Hong-Bing

2014-01-01

278

Modulation of adipocyte lipoprotein lipase expression as a strategy for preventing or treating visceral obesity  

Microsoft Academic Search

As compared to subcutaneous adipocytes, visceral adipocytes have high basal lipolysis, are highly sensitive to catecholamines, and are poorly sensitive to insulin; these traits are amplified when visceral adipocytes hypertrophy. As a result, enlarged visceral fat stores tend to flood the portal circulation with free fatty acids at metabolically inappropriate times when fatty acids are unlikely to be oxidized, thus

M. F. McCarty

2001-01-01

279

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

PubMed Central

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.

2014-01-01

280

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

281

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

282

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

283

Epidemiology of visceral leishmaniasis in Georgia.  

PubMed

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

2014-03-01

284

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

285

An evaluation of serum paraoxonase together with arylesterase activities and oxidative stress in children with intractable epilepsy: A cross-sectional study.  

PubMed

Epilepsy is the most common chronic neurological illness in childhood and adolescence. The aim of this study was to investigate paraoxonase and arylesterase activities along with oxidative status parameters in children with intractable epilepsy. The study comprised 42 subjects with intractable epilepsy and a control group of 35 healthy subjects. Serum paraoxonase and arylesterase activities, and lipid hydroperoxide levels were determined. All paraoxonase and arylesterase activities were significantly lower in the intractable epilepsy subjects than in the controls (P<0.001), whereas lipid hydroperoxide levels were significantly higher (P<0.05). In conclusion, paraoxonase and arylesterase activities were decreased and the lipid hydroperoxide level was increased in patients with intractable epilepsy. These results showed that intractable epilepsy subjects may be more prone to the development of atherosclerosis. PMID:25218892

Calik, Mustafa; Oguz, Elif; Sarikaya, Suna; Kocaturk, Ozcan; Koca, Bulent; Gungor, Hatice Eke; Aksoy, Nurten; Yoldas, Tah?r Kurtulus; Iscan, Akin

2014-11-01

286

Gabapentin in Pain Management  

Microsoft Academic Search

role of gabapentin in pain treatment will be discussed with an attempt to identify pain symptoms that are likely to be responsive to gabapentin; 2) animal stud- ies of gabapentin on neuropathic pain and other pain behaviors will be evaluated; and 3) possible mecha- nisms of gabapentin actions will be considered in re- lation to mechanisms of neuropathic pain in

Jianren Mao; Lucy L. Chen

2000-01-01

287

Low Back Pain  

MedlinePLUS

... 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 ...

288

The psychology of pain  

Microsoft Academic Search

Discusses the aspect theory of pleasure and pain. Aspect theory regards pain as the highest degree of displeasure, and holds that it is always felt with reference to a tactile or temperature sensation. Several experiences of cutaneous pain were examined in order to test the theory. The neurological facts and theories on the psychology of pain indicate that: (1) pain

C. A. Strong

1895-01-01

289

[Case of intractable hemoptysis controlled by bronchial occlusion with an Endobronchial Watanabe Spigot (EWS)].  

PubMed

A man in his eighties with massive hemoptysis was referred to our hospital in order to control the bleeding. Chest computed tomography (CT) indicated that the hemoptysis originated from the right upper lobe. We performed arterial embolization twice, but failed to stop it. A surgical lobectomy was considered to be very difficult to perform because of his poor general condition and the strong adhesions between the right upper lobe and parietal pleura. We therefore performed fiberoptic bronchoscopy and plugged 4 EWS (Endobronchial Watanabe Spigot) into his right B1b, B1, B2, B3, and this procedure was able to successfully and completely control the hemoptysis. Bronchial occlusion with EWS has been developed in order to treat patients with intractable pneumothorax, pyothorax with bronchial fistula and similar problems. Our findings suggest that this method is also highly effective in controlling hemoptysis in cases in which arterial embolization is unable to stop the bleeding or surgery is difficult to perform. PMID:18517020

Fujii, Akiko; Misumi, Yukihiro; Hiyama, Junichiro; Koshizuka, Hiromasa; Miyakawa, Yosuke; Hayashi, Akihiro

2008-05-01

290

A 9-month-old phosphaturic mesenchymal tumor mimicking the intractable rickets.  

PubMed

Phosphaturic mesenchymal tumor is an extremely rare disease and is frequently associated with oncogenic osteomalacia showing paraneoplastic syndrome, which is characterized by phosphaturia, hypophosphatemia, normocalcemia, and decreased levels of 1,25-dihydroxyvitamin D3 associated with a tumor. A 2-year-old boy, who had a soft tissue tumor on his right thigh and previously diagnosed as myositis ossificans at 9-months-old, was presented with rachitic rosary and mildly enlarged tumor. Biochemical investigations showed hypophosphatemia, hyperphosphaturia, and an increased alkaline phosphatase level of 440 U/l (25-100 U/l), suggesting rickets, which was resistant to vitamin D dietary supplementation. We were certain of intractable rickets because of oncogenic hypophosphatemia and thus decided to excise the soft tissue mass. We observed laboratory improvement of rickets after 2 weeks. On the basis of surgical and histopathological examinations, the tumor was finally diagnosed as the phosphaturic mesenchymal tumor. PMID:19801953

Jung, Gu-Hee; Kim, Jae-Do; Cho, Yool; Chung, So-Hak; Lee, Jung-Hyun; Sohn, Kyung-Rak

2010-01-01

291

Melanosomal sequestration of cytotoxic drugs contributes to the intractability of malignant melanomas  

NASA Astrophysics Data System (ADS)

Multidrug resistance mechanisms underlying the intractability of malignant melanomas remain largely unknown. In this study, we demonstrate that the development of multidrug resistance in melanomas involves subcellular sequestration of intracellular cytotoxic drugs such as cis-diaminedichloroplatinum II (cisplatin; CDDP). CDDP is initially sequestered in subcellular organelles such as melanosomes, which significantly reduces its nuclear localization when compared with nonmelanoma/KB-3-1 epidermoid carcinoma cells. The melanosomal accumulation of CDDP remarkably modulates melanogenesis through a pronounced increase in tyrosinase activity. The altered melanogenesis manifested an 8-fold increase in both intracellular pigmentation and extracellular transport of melanosomes containing CDDP. Thus, our experiments provide evidence that melanosomes contribute to the refractory properties of melanoma cells by sequestering cytotoxic drugs and increasing melanosome-mediated drug export. Preventing melanosomal sequestration of cytotoxic drugs by inhibiting the functions of melanosomes may have great potential as an approach to improving the chemosensitivity of melanoma cells. cancer | melanosomes | skin | tumor therapy | multidrug resistance

Chen, Kevin G.; Valencia, Julio C.; Lai, Barry; Zhang, Guofeng; Paterson, Jill K.; Rouzaud, François; Berens, Werner; Wincovitch, Stephen M.; Garfield, Susan H.; Leapman, Richard D.; Hearing, Vincent J.; Gottesman, Michael M.

2006-06-01

292

Intractable diseases treated with intra-bone marrow-bone marrow transplantation  

PubMed Central

Bone marrow transplantation (BMT) is used to treat hematological disorders, autoimmune diseases (ADs) and lymphoid cancers. Intra bone marrow-BMT (IBM-BMT) has been proven to be a powerful strategy for allogeneic BMT due to the rapid hematopoietic recovery and the complete restoration of T cell functions. IBM-BMT not only replaces hematopoietic stem cells (HSCs) but also mesenchymal stromal cells (MSCs). MSCs are multi-potent stem cells that can be isolated from bone marrow (BM), umbilical cord blood (UCB), and adipose tissue. MSCs play an important role in the support of hematopoiesis, and modify and influence the innate and adaptive immune systems. MSCs also differentiate into mesodermal, endodermal and ectodermal lineage cells to repair tissues. This review aims to summarize the functions of BM-derived-MSCs, and the treatment of intractable diseases such as rheumatoid arthritis (RA) and malignant tumors with IBM-BMT. PMID:25364755

Li, Ming; Guo, Kuquan; Ikehara, Susumu

2014-01-01

293

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

294

Duodenal adenocarcinoma might be the cause of intractable nausea and vomiting in patient with coeliac disease  

PubMed Central

Coeliac disease (CD) is an autoimmune disorder which leads to chronic inflammation of the gut. Untreated CD is associated with upper gastrointestinal malignancies, Small-bowel lymphoma and adenocarcinoma are recognized complications of untreated coeliac disease (CD). We report the case of a 43-year-old male suffering from CD who was treated with a gluten-free diet one year, presenting with complaints of intractable nausea and vomiting. After several studies, He underwent push enteroscopy, which identified one large mass lesion in the third part of duodenum. However, histopathological examination showed adenocarcinoma. Subsequently, a duodenal segment resection was performed. After surgery, the patient recovered well and left our hospital in good condition. Clinicians should take into small bowel adenocarcinoma is rare but associated with CD particularly in CD patients with worrying symptoms such as nausea and vomiting unresponsiveness to treatment and these patients should be screened for long term complications like malignancy. PMID:24834228

Rajabalinia, Hassan; Dabiri, Reza; Shahbazi, Shahin; Ghobakhlou, Mehdi; Bahreiny, Rasoul; Molaei, Mahsa; Nejad, Mohammad Rostami

2012-01-01

295

Duodenal adenocarcinoma might be the cause of intractable nausea and vomiting in patient with coeliac disease.  

PubMed

Coeliac disease (CD) is an autoimmune disorder which leads to chronic inflammation of the gut. Untreated CD is associated with upper gastrointestinal malignancies, Small-bowel lymphoma and adenocarcinoma are recognized complications of untreated coeliac disease (CD). We report the case of a 43-year-old male suffering from CD who was treated with a gluten-free diet one year, presenting with complaints of intractable nausea and vomiting. After several studies, He underwent push enteroscopy, which identified one large mass lesion in the third part of duodenum. However, histopathological examination showed adenocarcinoma. Subsequently, a duodenal segment resection was performed. After surgery, the patient recovered well and left our hospital in good condition. Clinicians should take into small bowel adenocarcinoma is rare but associated with CD particularly in CD patients with worrying symptoms such as nausea and vomiting unresponsiveness to treatment and these patients should be screened for long term complications like malignancy. PMID:24834228

Rajabalinia, Hassan; Dabiri, Reza; Shahbazi, Shahin; Ghobakhlou, Mehdi; Bahreiny, Rasoul; Molaei, Mahsa; Rostami Nejad, Mohammad; Fatemi, Seyed Reza

2012-01-01

296

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

297

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

298

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

PubMed

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

1992-12-01

299

Intractable Gelastic Seizures During Infancy: Ictal Positron Emission Tomography (PET) Demonstrating Epileptiform Activity Within the Hypothalamic Hamartoma  

Microsoft Academic Search

Gelastic seizures comprise a very rare form of epilepsy. They present with recurrent bursts of laughter voices without mirth and are most commonly associated with the evolution of a hypothalamic hamartoma. The purpose of this article is to describe the second reported ictal fluorodeoxyglucose-positron emission tomography study in a unique case of an infant with intractable gelastic seizures since the

Eli Shahar; Dorit Goldsher; Jacob Genizi; Sarit Ravid; Zohar Keidar

2008-01-01

300

Transcending Intractable Conflict in Health Care: An Exploratory Study of Communication and Conflict Management Among Anesthesia Providers  

Microsoft Academic Search

This paper explores the contrast between the longstanding, intractable conflict between two anesthesia providers and the cooperation of many individual nurse anesthetists and anesthesiologists working side-by-side to provide safe, effective anesthesia. Analysis of interview transcripts reveals that communication among anesthesia nurses and anesthesiologists may enact or transcend the conflict. This article proposes recommendations for improving communication between anesthesiologists and certified

JESSICA KATZ JAMESON

2003-01-01

301

Disability Evaluation of the Pain : The Present and Prospect in Korea  

PubMed Central

Objective Pain has long been regarded as a subjective symptom. Recently, however, some regard a type of intractable chronic pain as a disease. Furthermore, chronic persistent pain becomes a cause of permanent impairment (PI). In 6th edition, the American Medical Association (AMA) Guides has rated the pain as a PI. In Korea, pain has been already been rated as a PI. Here, we examined the present status and the prospect of disability evaluation for the pain in Korea. Methods Pain can be rated as a PI by the Workmen's Compensation Insurance Act (WCIA) and Patriots and Veterans Welfare Corporation Act (PVWCA) in Korea. We examined the definition, diagnostic criteria and grades of the pain related disability (PRD) in these two acts. We also examined legal judgments, which were made in 2005 for patients with severe pain. We also compared the acts and the judgments to the criteria of the 6th AMA Guides. Results The PRD can be rated as one of the 4 grades according to the WCIA. The provisions of the law do not limit the pain only for the complex regional pain syndrome (CRPS). The PRD can be rated as one of the 3 grades by the PVWCA. If there were objective signs such as osteoporosis, joint contracture and muscle atrophy corresponding to the CRPS, the grade is rated as 6. When the pain always interferes with one's job except easy work, the grade is rated as high as 5. In Korea, judicial precedents dealt the pain as a permanent disability in 2005. Conclusion Although there were no objective criteria for evaluation of the PRD, pain has been already rated as a PI by the laws or judicial precedents, in Korea. Thus, we should regulate the Korean criteria of PRD like the AMA 6th edition. We also should develop the objective tools for evaluation of the PRD near in future. PMID:19516947

Shim, Jai-Joon; Yoon, Seok-Mann; Doh, Jae-Won; Yun, Il-Gyu; Bae, Hack-Gun

2009-01-01

302

Visceral larva migrans in immigrants from latin america.  

PubMed

To determine whether increased migration is associated with an increase in incidence of toxocariasis (visceral larva migrans), we analyzed clinical data obtained from immigrants from Latin America. Although infection with Toxocara sp. roundworm larvae is distributed worldwide, seroprevalence is highest in tropical and subtropical areas. PMID:21762582

Turrientes, Maria-Carmen; Perez de Ayala, Ana; Norman, Francesca; Navarro, Miriam; Perez-Molina, Jose-Antonio; Rodriquez-Ferrer, Mercedes; Garate, Teresa; Lopez-Velez, Rogelio

2011-07-01

303

Larger Amounts of Visceral Adipose Tissue in Asian Americans  

Microsoft Academic Search

Objective: Excess visceral adipose tissue (VAT) is recognized as an important risk factor for the development of coronary heart disease and type 2 diabetes. Several studies have reported less VAT in African Americans compared with whites. As little is known about the levels of VAT in Asians, we compared whole-body VAT in Asian Americans with European Americans.Research Methods and Procedures:

Yong-Woo Park; David B. Allison; Steven B. Heymsfield; Dympna Gallagher

2001-01-01

304

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

305

Evaluation of PCR for diagnosis of visceral leishmaniasis  

Microsoft Academic Search

An evaluation of Leishmania PCR was performed with bone marrow, lymph node, and blood samples from 492 patients, 60 positive controls, and 90 negative controls. Results were compared with microscopy results for Giemsa-stained smears. PCR and microscopy of lymph node and bone marrow aspirates from patients with microscopically confirmed visceral leishmaniasis (VL) were equally sensitive. However, in patients clinically suspected

OMRAN F. OSMAN; LINDA OSKAM; ED E. ZIJLSTRA; NEL C. M. KROON; GERARD J. SCHOONE; EL-TAHIR A. G. KHALIL; AHMED M. EL-HASSAN; PIET A. KAGER

1997-01-01

306

Evolution of Visceral Sensitivity in Patients with Irritable Bowel Syndrome  

Microsoft Academic Search

Irritable bowel syndrome (IBS) has been associated with visceral hypersensitivity. Here we examined the evolution of rectal sensitivity and of gastrointestinal symptomatology in IBS patients over time, to verify if the clinical and biological parameters showed parallel behavior. Patients complaining of IBS, identified by Rome 1 criteria, were included in this study. The severity of the gastrointestinal (Gastrointestinal) symptoms was

Pierre Poitras; Monique Riberdy Poitras; Victor Plourde; Michel Boivin; Pierre Verrier

2002-01-01

307

Evaluating Eve: Visceral States Influence the Evaluation of Impulsive Behavior  

Microsoft Academic Search

Impulsive behavior is a common source of stigma. The authors argue that people often stigmatize impulsive behavior because they fail to appreciate the influence visceral impulses have on behavior. Because people tend to underestimate the motivational force of cravings for sex, drugs, food, and so forth, they are prone to stigmatize those who act on these impulses. In line with

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

2007-01-01

308

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 .

309

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 ...

310

Complex regional pain syndrome  

MedlinePLUS

Complex regional pain syndrome (CRPS) is a chronic pain condition that can affect any area of the ... Bailey A, Audette JF. Complex regional pain syndrome. In: Frontera ... of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, ...

311

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 ...

312

Somatoform pain disorder  

MedlinePLUS

The main symptom of somatoform pain disorder is chronic pain that lasts for several months and limits a ... effects, and may carry the risk for abuse. Chronic pain syndromes of all types can often be treated ...

313

Pain and your emotions  

MedlinePLUS

Chronic pain can limit your everyday activities and make it hard to work. It can also affect how ... Depression is very common among people who have chronic pain. Pain can cause depression or make existing depression ...

314

Managing Chronic Pain  

MedlinePLUS

... perform household chores. What can a person with chronic pain do? ? Develop and practice a lifestyle based on ... mind and reduce tensions that aggravate pain. Managing Chronic Pain ® Tips for Living Occupational Therapy: Skills for the ...

315

Risk factors and early pharmacological interventions to prevent chronic postsurgical pain following cardiac surgery.  

PubMed

Chronic postsurgical pain (CPSP) after cardiac surgery represents a significant clinical problem. The prevalence of CPSP varies widely between studies, but severe CPSP is present in less than 10 % of the patients. Important differential diagnoses for CPSP after cardiac surgery are myocardial ischemia, sternal instability and mediastinitis. CPSP after cardiac surgery may be thoracic pain present at the site of the sternotomy or leg pain due to vein-graft harvesting. The CPSP can be neuropathic pain, visceral pain, somatic pain or mixed pain. Potential risk factors for CPSP are young age, female gender, overweight, psychological factors, preoperative pain, surgery-related factors and severe postoperative pain. In addition to standard postoperative analgesics, the use of N-methyl-D-aspartate (NMDA) antagonists, alpha-2 agonists, local anesthetics, gabapentinoids, and corticosteroids are all proposed to reduce the risk for CPSP after cardiac surgery. Still, no specific pharmacological therapy, cognitive therapy or physical therapy is established to protect against CPSP. The only convincing prevention of CSPS is adequate treatment of acute postoperative pain irrespective of method. Hence, interventions against acute pain, preferably in a step-wise approach titrating the interventions for each patient's individual needs, are essential concerning prevention of CPSP after cardiac surgery. It is also important that surgeons consider the risk for CPSP as a part of the basis for decision-making around performing a surgical procedure and that patients are informed of this risk. PMID:24934698

Gjeilo, Kari Hanne; Stenseth, Roar; Klepstad, Pål

2014-10-01

316

Chronic Pain and Adherence  

Microsoft Academic Search

\\u000a Chronic pain of non-malignant etiology is a significant problem. Chronic non-malignant pain is typically defined as pain that\\u000a persists for 3 months or longer and that is non-life threatening [1, 2]. Among the most common chronic pain conditions are\\u000a chronic back pain, migraine headaches, and tension headaches. Chronic pain is very common. In the United States, 17% of patients\\u000a seen

Rebecca A. Shelby; Francis J. Keefe

317

Pain drawings and sickle cell disease pain.  

PubMed

This study examined the relationship of pain drawings to somatization in patients with sickle cell disease (SCD). Sixty-nine adult patients with SCD completed a pain drawing in which they shaded in areas of the body in which they experienced pain and also completed the symptom checklist (SCL) 90-R as an index of psychological distress. Analysis of variance indicated that patients who were categorized as having pain drawings with sites inconsistent with expected SCD pain patterns had somatization scores in the clinically significant range. The results suggest that health care professionals who treat SCD patients need to consider pain patterns. In individuals with pain patterns atypical for SCD, the psychological status of the patient may need to be evaluated to facilitate optimal pain management. PMID:2135002

Gil, K M; Phillips, G; Abrams, M R; Williams, D A

1990-06-01

318

[Treatment of visceral pathology in patients with trauma].  

PubMed

The problem of visceral pathology in patients with trauma that was intensively investigated by the scientists during the period of Great Patriotic War and in post-war period remains actual in our days. The purpose of investigation is to study the possibilities, peculiarities and efficiency of diagnosis, treatment, rehabilitation and medical examination of the casualties suffering from visceral pathology in different periods after trauma in conditions of therapeutic hospital as well as the peculiarities of their regular medical checkup at the post-hospital stage. It will allow to use more widely the therapeutic beds for the complex medical support of this patient group. 692 patients admitted in different periods after mild mechanical trauma complicated by different visceral diseases were investigated in conditions of therapeutic hospital. After the complex investigation the following conclusion was drawn: the casualties with mild closed injury complicated by visceral pathology even in the early posttraumatic period can be send to the therapeutic hospital where the adequate medical care will be rendered. It is especially important during the simultaneous mass admission of the casualties in the time of natural disaster and catastrophes, in conditions of military operations when the surgical subunits of medical evacuation stages will be full of persons who require the active resuscitation and surgical intervention. Complex medical support of the casualties with visceral changes in the late periods after trauma is the many-sided process connected with solution of therapeutic, rehabilitation, expert-and-diagnostic problems that are fully in the sphere of specialists of therapeutic institutions. PMID:12722361

Shepelenko, A F; Shepelenko, N D; Khatskevich, V L; Stukov, V I

2003-02-01

319

Ultrasound-Guided Infraorbital Nerve Pulsed Radiofrequency Treatment for Intractable Postherpetic Neuralgia - A Case Report -  

PubMed Central

A 60-year-old man presented with pain on the left cheek and lateral nose. The patient had been diagnosed with facial herpes zoster in the left V2 area 6 months previously. Medical treatment was prescribed for 6 months but it had little effect. We blocked the left infraorbital nerve under ultrasound guidance, but pain relief was short term. Therefore, we performed pulsed radiofrequency treatment on the left infraorbital nerve under ultrasound guidance. Six months after the procedure, the reduction of pain was still maintained, and there was no need for further management. PMID:23342215

Lim, Seung Mo; Park, Hae Lang; Moon, Hyong Yong; Kang, Kyung Ho; Kang, Hyun; Baek, Chong Hwa; Jung, Yong Hun; Kim, Jin Yun; Koo, Gill Hoi

2013-01-01

320

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

321

Antinociceptive effects of novel melatonin receptor agonists in mouse models of abdominal pain  

PubMed Central

AIM: To characterize the antinociceptive action of the novel melatonin receptor (MT) agonists, Neu-P11 and Neu-P12 in animal models of visceral pain. METHODS: Visceral pain was induced by intracolonic (ic) application of mustard oil or capsaicin solution or by intraperitoneal (ip) administration of acetic acid. Neu-P11, Neu-P12, or melatonin were given ip or orally and their effects on pain-induced behavioral responses were evaluated. To identify the receptors involved, the non-selective MT1/MT2 receptor antagonist luzindole, the MT2 receptor antagonist 4-P-PDOT, or the ?-opioid receptor antagonist naloxone were injected ip or intracerebroventricularly (icv) prior to the induction of pain. RESULTS: Orally and ip administered melatonin, Neu-P11, and Neu-P12 reduced pain responses in a dose-dependent manner. Neu-P12 was more effective and displayed longer duration of action compared to melatonin. The antinociceptive effects of Neu-P11 or Neu-P12 were antagonized by ip or icv. administered naloxone. Intracerebroventricularly, but not ip administration of luzindole or 4-P-PDOT blocked the antinociceptive actions of Neu-P11 or Neu-P12. CONCLUSION: Neu-P12 produced the most potent and long-lasting antinociceptive effect. Further development of Neu-P12 for future treatment of abdominal pain seems promising. PMID:24574803

Chen, Chunqiu; Fichna, Jakub; Laudon, Moshe; Storr, Martin

2014-01-01

322

Electromyographic findings in patients with low back pain due to unsuspected primary and metastatic spinal or paraspinal muscle disease.  

PubMed

Electromyographic studies were performed on 16 patients with intractable low back pain and no antecedent history of malignancy or metastatic disease. In each case, electromyographic evidence of severe segmental denervation limited to the paraspinal muscles innervated by the posterior primary rami was found. Subsequent diagnostic studies in each patient revealed a primary neoplasm or tumor metastasis as the source of pain. Applying current knowledge of neuromuscular physiology, the electromyograph may prove to be a valuable aid to the early detection of remote metastasis to the spine and paraspinal muscle structures. PMID:6458439

Boruta, P M; LaBan, M M

1981-01-01

323

Oxytocin increases thresholds of colonic visceral perception in patients with irritable bowel syndrome.  

PubMed Central

AIM: The effects of oxytocin on colonic perception of intraluminal distension were evaluated in 26 patients with irritable bowel syndrome (IBS), using a flaccid bag placed in the descending colon and connected to a computerised barostat. METHOD: Symptomatic responses (first sensation and pain) were evaluated during isobaric distensions (4 mm Hg increments, five minute duration, five minute interval with return to zero pressure between each step), performed automatically by the barostat, during a continuous infusion of placebo or various doses of oxytocin (10, 20, 30, and 50 mU/min). RESULTS: The distension pressure (mean (SD)) required to induce a first abdominal sensation was 17.3 (5.5) mm Hg on placebo, 19.9 (5.8) on oxytocin 10 mU/min (NS), 22.3 (6.0) mm Hg on oxytocin 20 mU/min (p < 0.01), 23.1 (6.6) mm Hg on oxytocin 30 mU/min (p < 0.01), and 24.0 (7.1) mm Hg on oxytocin 50 mU/min (p < 0.01). The distension pressure required to induce pain was 24.8 (6.3) mm Hg on placebo, 26.0 (5.8) on oxytocin 10 mU/min (NS), 33.3 (7.8) mm Hg on oxytocin 20 mU/min (p < 0.01), 34.2 (7.6) mm Hg on oxytocin 30 mU/min (p < 0.01), and 34.3 (7.9) mm Hg on oxytocin 50 mU/ min (p < 0.01). Compliance curves were not different after placebo and oxytocin injection at the different doses. Naloxone did not inhibit the effect of oxytocin. Oxytocin also did not alter somatic perception, characterised by the RIII reflex at the level of the biceps femori. CONCLUSIONS: Oxytocin significantly increases thresholds for visceral perception in IBS patients at doses equal or to greater than 20 mU/min, possibly by acting at the level of visceral afferents. PMID:9014776

Louvel, D; Delvaux, M; Felez, A; Fioramonti, J; Bueno, L; Lazorthes, Y; Frexinos, J

1996-01-01

324

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

325

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, Melissa; Leboeuf, Mathieu; Blackburn, Line; Tchernof, Andre

2014-01-01

326

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

PubMed

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

2014-07-01

327

Unmyelinated visceral afferents exhibit frequency dependent action potential broadening while myelinated visceral afferents do not.  

PubMed

Sensory information arising from visceral organ systems is encoded into action potential trains that propagate along afferent fibers to target nuclei in the central nervous system. These information streams range from tight patterns of action potentials that are well synchronized with the sensory transduction event to irregular, patternless discharge with no clear correlation to the sensory input. In general terms these afferent pathways can be divided into unmyelinated and myelinated fiber types. Our laboratory has a long standing interest in the functional differences between these two types of afferents in terms of the preprocessing of sensory information into action potential trains (synchrony, frequency, duration, etc.), the reflexogenic consequences of this sensory input to the central nervous system and the ionic channels that give rise to the electrophysiological properties of these unique cell types. The aim of this study was to determine whether there were any functional differences in the somatic action potential characteristics of unmyelinated and myelinated vagal afferents in response to different rates of sensory nerve stimulation. Our results showed that activity and frequency-dependent widening of the somatic action potential was quite prominent in unmyelinated but not myelinated vagal afferents. Spike broadening often leads to increased influx of Ca(2+) ions that has been associated with a diverse range of modulatory mechanisms both at the cell body and central synaptic terminations (e.g. increased neurotransmitter release.) We conclude that our observations are indicative of fundamentally different mechanisms for neural integration of sensory information arising from unmyelinated and myelinated vagal afferents. PMID:17555875

Li, Bai-Yan; Feng, Bin; Tsu, Hwa Y; Schild, John H

2007-06-21

328

Differences in brain responses to visceral pain between patients with irritable bowel syndrome and ulcerative colitis  

Microsoft Academic Search

Patients with mild chronic inflammation of the rectum or ileum have reduced perceptual responses to rectosigmoid distension compared to patients with irritable bowel syndrome (IBS). The current study sought to identify differences in regional cerebral blood flow (rCBF) during rectal distension, which might correspond to these perceptual differences. In 8 male ulcerative colitis (UC) patients with quiescent disease, 7 male

Emeran A. Mayer; Steven Berman; Brandall Suyenobu; Jennifer Labus; Mark A. Mandelkern; Bruce D. Naliboff; Lin Chang

2005-01-01

329

Taking narcotics for back pain  

MedlinePLUS

... Narcotics can provide short-term relief of severe back pain. This can allow you to return to your ... Nonspecific back pain - narcotics; Backache - chronic - narcotics; Lumbar pain - chronic - narcotics; Pain - back - chronic - narcotics; Chronic back pain - low - narcotics

330

Pain: You Can Get Help  

MedlinePLUS

... face that shows how you feel. Acute And Chronic Pain There are two kinds of pain. Acute pain ... or years is called chronic (or persistent) pain. Chronic pain may last long after the body has healed. ...

331

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

332

Gene Therapy for the Treatment of Chronic Peripheral Nervous System Pain  

PubMed Central

Chronic pain is a major health concern affecting 80 million Americans at some time in their lives with significant associated morbidity and effects on individual quality of life. Chronic pain can result from a variety of inflammatory and nerve damaging events that include cancer, infectious diseases, autoimmune-related syndromes and surgery. Current pharmacotherapies have not provided an effective long-term solution as they are limited by drug tolerance and potential abuse. These concerns have led to the development and testing of gene therapy approaches to treat chronic pain. The potential efficacy of gene therapy for pain has been reported in numerous pre-clinical studies that demonstrate pain control at the level of the spinal cord. This promise has been recently supported by a Phase-I human trial in which a replication-defective herpes simplex virus (HSV) vector was used to deliver the human pre-proenkephalin (hPPE) gene, encoding the natural opioid peptides met- and leu-enkephalin (ENK), to cancer patients with intractable pain resulting from bone metastases (Fink et al., 2011). The study showed that the therapy was well tolerated and that patients receiving the higher doses of therapeutic vector experienced a substantial reduction in their overall pain scores for up to a month post vector injection. These exciting early clinical results await further patient testing to demonstrate treatment efficacy and will likely pave the way for other gene therapies to treat chronic pain. PMID:22668775

Goins, William F.; Cohen, Justus B.; Glorioso, Joseph C.

2012-01-01

333

Tips for Chronic Pain  

MedlinePLUS

Chronic pain is defined as “persistent pain” and is a common complaint in Sjögren’s syndrome. For example, Sjögren’s ... mental well-being. Some tips for dealing with chronic pain: Continue caring for the condition causing your pain. • ...

334

Thai perspectives on pain.  

PubMed

This qualitative research aimed to study the meaning, the characteristics, and the dimensions of pain from a Thai point of view. It was conducted under the research project on the development of the quality of pain management for people in the hospital. The subjects were 62 patients, experiencing pain and receiving treatment in 4 hospitals in northeast Thailand. Data were analyzed through content analysis. The findings included: 1) concept from experience of pain, perceived pain as suffering physically and psychologically, 2) different characteristics between acute and chronic pain, 3) four levels of pain intensity: mild, moderate, high and severe, 4) pain effects on four dimensions: physical, psychological, behavioral and societal (family-social-economy), 5) two factors related to pain: alleviating factor and predisposing factor, and 6) pain management relies on beliefs, culture and religion i.e. good deeds in Buddhism affected six dimensions: physical, psychological, social, spiritual, treatment seeking and asking health personnel for help. The results of the present study revealed the influence of culture beliefs on the meaning of pain, pain characteristics, and the effects of pain as well as pain management in terms of cultural contexts. The findings may be implemented for the development of pain assessment and the model development of pain management more appropriately according to cultural contexts. PMID:24386747

Mongkhonthawornchai, Siriporn; Sangchart, Bumpenchit; Sornboon, Ariya; Chantarasiri, Jongkolnee

2013-09-01

335

Neuropathic pain characteristics in patients from Curitiba (Brazil) with spinal cord injury.  

PubMed

This was a descriptive cross-sectional study on patients with spinal cord injuries living in Curitiba, Paraná, Brazil. The aim was to evaluate the pain characteristics among such patients seen at referral care centers for spinal cord injury patients in Curitiba. A total of 109 adults with spinal cord injury in this city were evaluated regarding the presence of pain, especially neuropathic pain. Neuropathic pain was evaluated using the DN4 questionnaire, a universal instrument that has been translated and validated for Portuguese. A visual analog scale (VAS) was used to evaluate the intensity of pain. The prevalence of pain among these 109 patients was 31.2% (34 patients). The nociceptive pain presented was classified as musculoskeletal pain (nine patients), visceral pain (four patients) and mixed pain (one patient), thus totaling 14 patients (12.8%). Another 20 patients (18.3%) showed symptoms of neuropathic pain and fulfilled the criteria for neuropathic pain with scores greater than 4 out 10 in the DN4 questionnaire. Regarding the characteristics of the patients with neuropathic pain, most of them were male, younger than 40 years of age and paraplegic with incomplete lesions. They had become injured from 1 to more than 5 years earlier. The predominant etiology was gunshot wounds, and the intensity of their pain was high, with VAS scores greater than 5. This study partially corroborates other studies conducted on this subject. Studies of this type are important for understanding the profile of these patients, for the purpose of designing strategies for their rehabilitation, with a focus on the appropriate treatment and management of pain. PMID:21359425

Vall, Janaína; Costa, Carlos Mauricio de Castro; Santos, Terezinha de Jesus Teixeira; Costa, Samuel Bovy de Castro

2011-02-01

336

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

337

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

338

Hypoadiponectinemia: A Link between Visceral Obesity and Metabolic Syndrome  

PubMed Central

Metabolic syndrome (MetS) represents a combination of cardiometabolic risk factors, including visceral obesity, glucose intolerance or type 2 diabetes, elevated triglycerides, reduced HDL cholesterol, and hypertension. MetS is rapidly increasing in prevalence worldwide as a consequence of the “epidemic” obesity, with a considerable impact on the global incidence of cardiovascular disease and type 2 diabetes. At present, there is a growing interest on the role of visceral fat accumulation in the occurrence of MetS. In this review, the effects of adipocytokines and other proinflammatory factors produced by fat accumulation on the occurrence of the MetS have been also emphasized. Accordingly, the “hypoadiponectinemia” has been proposed as the most interesting new hypothesis to explain the pathophysiology of MetS. PMID:22013516

Di Chiara, Tiziana; Argano, Christiano; Corrao, Salvatore; Scaglione, Rosario; Licata, Giuseppe

2012-01-01

339

[Experience of successful treatment for a case of intractable chronic empyema with a bronchopleural fistula].  

PubMed

We report an experience of successful treatment for a case of intractable chronic empyema complicated by bronchopleural fistula (BPF). A 75-year-old woman who had severe diabetes mellitus complained of general fatigue and anorexia. A lung abscess in the right upper lobe was diagnosed and treated with antibiotics. Regrettably, it ruptured into a pyopneumothorax. The BPF was closed primarily and covered with intercostal muscle, but the procedure was not effective. The pyopneumothorax led to the development of chronic empyema with BPF. The patient was admitted to our hospital for treatment and the BPF was managed with a Dumon stent and endobronchial Watanabe spigot (EWS) but failed to heal. Therefore, open drainage was chosen as a 1st stage treatment. After healing the infected space, closure of the BPF and a bronchial embolization by EWS was performed with a closeire of space by pediculed omentum and muscle flap and with a thoracoplasty as a 2nd stage treatment. The postoperative course was uneventful, and the patient was discharged on post-operative day 51. PMID:20214353

Nagata, Toshiyuki; Nakamura, Yoshihiro; Kariatsumari, Kouta; Fukumori, Kazuhiko

2010-03-01

340

Radical Surgical Excision and Use of Lateral Thoracic Flap for Intractable Axillary Hidradenitis Suppurativa  

PubMed Central

Current treatments for hidradenitis suppurativa (HS) include prolonged courses of antibiotics, retinoids, immunosuppressants, and biologics. Severe cases that are resistant to prolonged medical treatment pose a therapeutic challenge. We propose radical excision and lateral thoracic flap reconstruction as a treatment option for such cases. In our experience with two patients, good aesthetic and functional outcomes were achieved, with a high level of patient satisfaction. The availability of suitable flap coverage allows for wide resection of all of the hair-bearing skin, leading to a low incidence of residual disease and subsequent recurrence. Following excision of the affected tissue, the ideal reconstructive method in the axilla provides suitable coverage without unacceptable donor site morbidity and also avoids axillary contractures. A long lateral thoracic flap with delay has excellent coverage with minimal donor tissue sacrifice. With a suitable flap coverage option, the management paradigm of intractable HS should shift from prolonged medical treatment to allow decisive radical excision, which will improve the quality of life for patients. PMID:23233895

Teo, Wan-Lin; Ong, Yee-Siang

2012-01-01

341

Amoeba-inspired nanoarchitectonic computing: solving intractable computational problems using nanoscale photoexcitation transfer dynamics.  

PubMed

Biologically inspired computing devices and architectures are expected to overcome the limitations of conventional technologies in terms of solving computationally demanding problems, adapting to complex environments, reducing energy consumption, and so on. We previously demonstrated that a primitive single-celled amoeba (a plasmodial slime mold), which exhibits complex spatiotemporal oscillatory dynamics and sophisticated computing capabilities, can be used to search for a solution to a very hard combinatorial optimization problem. We successfully extracted the essential spatiotemporal dynamics by which the amoeba solves the problem. This amoeba-inspired computing paradigm can be implemented by various physical systems that exhibit suitable spatiotemporal dynamics resembling the amoeba's problem-solving process. In this Article, we demonstrate that photoexcitation transfer phenomena in certain quantum nanostructures mediated by optical near-field interactions generate the amoebalike spatiotemporal dynamics and can be used to solve the satisfiability problem (SAT), which is the problem of judging whether a given logical proposition (a Boolean formula) is self-consistent. SAT is related to diverse application problems in artificial intelligence, information security, and bioinformatics and is a crucially important nondeterministic polynomial time (NP)-complete problem, which is believed to become intractable for conventional digital computers when the problem size increases. We show that our amoeba-inspired computing paradigm dramatically outperforms a conventional stochastic search method. These results indicate the potential for developing highly versatile nanoarchitectonic computers that realize powerful solution searching with low energy consumption. PMID:23565603

Aono, Masashi; Naruse, Makoto; Kim, Song-Ju; Wakabayashi, Masamitsu; Hori, Hirokazu; Ohtsu, Motoichi; Hara, Masahiko

2013-06-18

342

Efficacy of total lymphoid irradiation in intractable rheumatoid arthritis. A double-blind, randomized trial  

SciTech Connect

Twenty-six patients participated in a randomized, double-blind study of the efficacy of total lymphoid irradiation in the treatment of intractable rheumatoid arthritis. All 26 patients, for whom therapy with gold compounds and penicillamine had failed, would ordinarily have been considered candidates for cytotoxic or antimetabolite drug therapy. Thirteen patients randomly assigned to receive full-dose total lymphoid irradiation (2000 rad) and 11 patients assigned to receive control low-dose total lymphoid irradiation (200 rad) completed radiotherapy. Alleviation of joint disease activity was significantly greater in the high-dose group as judged by morning stiffness, joint tenderness, and functional assessment (global composite score) at 3 and 6 months after radiotherapy. The high-dose group had a marked reduction in both T-lymphocyte function and numbers, but this finding was not observed in the low-dose group. Complications seen in the high-dose but not low-dose group included transient neutropenia, thrombocytopenia, pericarditis, and pleurisy.

Strober, S.; Tanay, A.; Field, E.; Hoppe, R.T.; Calin, A.; Engleman, E.G.; Kotzin, B.; Brown, B.W.; Kaplan, H.S.

1985-04-01

343

Adjuvant single-fraction radiotherapy is safe and effective for intractable keloids  

PubMed Central

The aim of this study was to assess the feasibility and efficacy of high-dose, single-fraction electron beam radiotherapy for therapy-resistant keloids. Before 2010, intractable keloids were treated at our institution with post-operative irradiation of 6–15 Gy in 3–5 fractionations. For convenience and cost effectiveness, we have changed our treatment protocol to high-dose single-fraction radiotherapy. A total of 12 patients with 16 keloid lesions were treated from January 2010 to January 2013 in our department. A 10-Gy dose of electron irradiation was given within 72 h of the surgical excision. The mean follow-up period was 20 months. Treatments were well tolerated, and there was no recurrence in any of the patients. Severe adverse effects were not observed. Surgical excision of the keloid, followed by immediate, single-fraction, high-dose radiotherapy, is both safe and effective in preventing recurrence of therapy-resistant keloids. PMID:24801475

Song, Changhoon; Wu, Hong-Gyun; Chang, Hak; Kim, Il Han; Ha, Sung W.

2014-01-01

344

A pilot study of the effect of Direct Instruction programming on the academic performance of students with intractable epilepsy.  

PubMed

Fifty-five students with intractable epilepsy and learning difficulties, aged 6.5 to 14.1 years with a mean IQ of 71.25 (SD=13.56), attended a hospital-based classroom of no more than eight students where they received Direct Instruction programming for 3 to 4.5 days a week, typically for up to 16 weeks. Pretest-posttest academic gains were evaluated in comparison to normative test performance. At pretest the students were achieving below test means in reading and mathematics, particularly in calculation. Direct Instruction was associated with significant improvement in all academic areas except word identification in reading. IQ level was related to certain academic gains, but gains were not associated with seizure variables or the number of days students spent in the program. Despite severe learning difficulties, students with intractable epilepsy can make academic gains when taught by highly structured teaching methods such as Direct Instruction. PMID:15820350

Humphries, Tom; Neufeld, Michelle; Johnson, Christine; Engels, Katie; McKay, Roseanne

2005-05-01

345

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

346

Somatic and visceral nervous systems - an ancient duality  

PubMed Central

The vertebrate nervous system is deeply divided into ‘somatic’ and ‘visceral’ subsystems that respond to external and internal stimuli, respectively. Molecular characterization of neurons in different groups of mollusks by Nomaksteinsky and colleagues, published in this issue of BMC Biology, reveals that the viscero-somatic duality is evolutionarily ancient, predating Bilateria. See research article: http://www.biomedcentral.com/1741-7007/11/53 PMID:23631570

2013-01-01

347

Blood pressure rhythmicity and visceral fat in children with hypertension.  

PubMed

Primary hypertension is associated with disturbed activity of the sympathetic nervous system and altered blood pressure rhythmicity. We analyzed changes in cardiovascular rhythmicity and its relation with target organ damage during 12 months of antihypertensive treatment in 50 boys with hypertension (median, 15.0 years). The following parameters were obtained before and after 12 months of antihypertensive treatment: 24-hour ambulatory blood pressure, left ventricular mass, carotid intima-media thickness, and MRI for visceral and subcutaneous adipose tissue. Amplitudes and acrophases of mean arterial pressure and heart rate rhythms were obtained for 24-, 12-, and 8-hour periods. After 1 year of treatment, 68% of patients were normotensive, and left ventricular mass and carotid intima-media thickness decreased in 60% and 62% of patients, respectively. Blood pressure and heart rate rhythmicity patterns did not change. Changes in blood pressure amplitude correlated with the decrease of waist circumference (P=0.035). Moreover, the decrease of visceral fat correlated with the decrease of 24-hour mean arterial pressure and heart rate acrophases (both P<0.05). There were no differences in changes of blood pressure and heart rate rhythms between patients who achieved or did not achieve normotension and regression of left ventricular mass and carotid intima-media thickness. It was concluded that abnormal cardiovascular rhythmicity persists in children with primary hypertension despite effective antihypertensive treatment, which suggests that it may be the primary abnormality. The correlation between changes in cardiovascular rhythmicity and visceral obesity may indicate that the visceral fat plays an important role in the sympathetic activity of adolescents with hypertension. PMID:23959553

Niemirska, Anna; Litwin, Mieczys?aw; Feber, Janusz; Jurkiewicz, El?bieta

2013-10-01

348

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

349

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

350

Glycosylation of Erythrocyte Spectrin and Its Modification in Visceral Leishmaniasis  

Microsoft Academic Search

Using a lectin, Achatinin-H, having preferential specificity for glycoproteins with terminal 9-O-acetyl sialic acid derivatives linked in ?2-6 linkages to subterminal N-acetylgalactosamine, eight distinct disease-associated 9-O-acetylated sialoglycoproteins was purified from erythrocytes of visceral leishmaniaisis (VL) patients (RBCVL). Analyses of tryptic fragments by mass spectrometry led to the identification of two high-molecular weight 9-O-acetylated sialoglycoproteins as human erythrocytic ?- and ?-spectrin.

Sajal Samanta; Devawati Dutta; Angana Ghoshal; Sumi Mukhopadhyay; Bibhuti Saha; Shyam Sundar; Saulius Jarmalavicius; Michael Forgber; Chhabinath Mandal; Peter Walden; Chitra Mandal

2011-01-01

351

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

352

The problem of pain.  

PubMed

Pain problems, especially posttraumatic headache, are very common following head trauma. Pain may be the most significant problem, more disabling than any brain or other injuries, and interfering with aspects of cognition or other function. However, posttraumatic headache and most other chronic posttraumatic pain problems remain poorly understood. This article reviews fundamental issues that should be considered in understanding the nature of chronic pain including the distinction between acute and chronic pain; neurobiological distinctions between the lateral and medial pain system; nociceptive versus neuropathic or other central pain; sensitization effects; the widely accepted view of chronic pain as a multidimensional subjective experience involving sensory, motivational-affective and cognitive-behavioral components; the problem of mind-body dualism; the role of psychosocial factors in the onset, maintenance, exacerbation or severity of pain; plus issues of response bias and malingering. PMID:14732827

Nicholson, Keith; Martelli, Michael F

2004-01-01

353

[The pain from burns].  

PubMed

The painful events associated with the treatment of a severe burn can, because of their long-lasting and repetitive characteristics, be one of the most excruciating experiences in clinical practice. Moreover, burn pain has been shown to be detrimental to burn patients. Although nociception and peripheral hyperalgesia are considered the major causes of burn pain, the study of more hypothetical mechanisms like central hyperalgesia and neuropathic pain may lead to a better understanding of burn pain symptoms and to new therapeutic approaches. Continuous pain and intermittent pain due to therapeutic procedures are two distinct components of burn pain. They have to be evaluated and managed separately. Although continuous pain is by far less severe than intermittent pain, the treatment is, in both cases, essentially pharmacological relying basically on opioids. Because of wide intra- and inter-individual variations, protocols will have to leave large possibilities of adaptation for each case, systematic pain evaluation being mandatory to achieve the best risk/benefit ratio. Surprisingly, the dose of medication decreases only slowly with time, a burn often remaining painful for long periods after healing. Non pharmacological treatments are often useful and sometimes indispensable adjuncts; but their rationale and their feasibility depends entirely on previous optimal pharmacological control of burn pain. Several recent studies show that burn pain management is inadequate in most burn centres. PMID:11933833

Latarjet, J

2002-03-01

354

Genome-Wide Association for Abdominal Subcutaneous and Visceral Adipose Reveals a Novel Locus for Visceral Fat in Women  

Microsoft Academic Search

Body fat distribution, particularly centralized obesity, is associated with metabolic risk above and beyond total adiposity. We performed genome-wide association of abdominal adipose depots quantified using computed tomography (CT) to uncover novel loci for body fat distribution among participants of European ancestry. Subcutaneous and visceral fat were quantified in 5,560 women and 4,997 men from 4 population-based studies. Genome-wide genotyping

Caroline S. Fox; Yongmei Liu; Charles C. White; Mary Feitosa; Albert V. Smith; Nancy Heard-Costa; Kurt Lohman; Andrew D. Johnson; Meredith C. Foster; Danielle M. Greenawalt; Paula Griffin; Jinghong Ding; Anne B. Newman; Fran Tylavsky; Iva Miljkovic; Stephen B. Kritchevsky; Lenore Launer; Melissa Garcia; Gudny Eiriksdottir; J. Jeffrey Carr; Vilmunder Gudnason; Tamara B. Harris; L. Adrienne Cupples; Ingrid B. Borecki

2012-01-01

355

Visceral and subcutaneous fat have different origins and evidence supports a mesothelial source  

PubMed Central

Fuelled by the obesity epidemic, there is considerable interest in the developmental origins of white adipose tissue (WAT) and the stem/progenitor cells from which it arises. While increased visceral fat mass is associated with metabolic dysfunction, increased subcutaneous WAT is protective. There are 6 visceral fat depots: perirenal, gonadal, epicardial, retroperitoneal, omental and mesenteric and it is a subject of much debate whether these have common developmental origins and whether this differs from subcutaneous WAT. Here we show that all 6 visceral WAT depots receive a significant contribution from cells expressing Wt1 late in gestation. Conversely, no subcutaneous WAT or brown adipose tissue (BAT) arises from Wt1 expressing cells. Postnatally, a subset of visceral WAT continues to arise from Wt1 expressing cells, consistent with the finding that Wt1 marks a proportion of cell populations enriched in WAT progenitors. We show all visceral fat depots have a mesothelial layer like the visceral organs with which they are associated and provide several lines of evidence that Wt1 expressing mesothelium can produce adipocytes. These results: reveal a major ontogenetic difference between visceral and subcutaneous WAT; pinpoint the lateral plate mesoderm as a major source of visceral WAT; support the notion that visceral WAT progenitors are heterogeneous; and suggest that mesothelium is a source of adipocytes. PMID:24609269

Chau, You-Ying; Bandiera, Roberto; Serrels, Alan; Martinez-Estrada, Ofelia M; Qing, Wei; Lee, Martin; Slight, Joan; Thornburn, Anna; Berry, Rachel; McHaffie, Sophie; Stimson, Roland H; Walker, Brian R; Chapuli, Ramon Munoz; Schedl, Andreas; Hastie, Nick

2014-01-01

356

Visceral and subcutaneous fat have different origins and evidence supports a mesothelial source.  

PubMed

Fuelled by the obesity epidemic, there is considerable interest in the developmental origins of white adipose tissue (WAT) and the stem and progenitor cells from which it arises. Whereas increased visceral fat mass is associated with metabolic dysfunction, increased subcutaneous WAT is protective. There are six visceral fat depots: perirenal, gonadal, epicardial, retroperitoneal, omental and mesenteric, and it is a subject of much debate whether these have a common developmental origin and whether this differs from that for subcutaneous WAT. Here we show that all six visceral WAT depots receive a significant contribution from cells expressing Wt1 late in gestation. Conversely, no subcutaneous WAT or brown adipose tissue arises from Wt1-expressing cells. Postnatally, a subset of visceral WAT continues to arise from Wt1-expressing cells, consistent with the finding that Wt1 marks a proportion of cell populations enriched in WAT progenitors. We show that all visceral fat depots have a mesothelial layer like the visceral organs with which they are associated, and provide several lines of evidence that Wt1-expressing mesothelium can produce adipocytes. These results reveal a major ontogenetic difference between visceral and subcutaneous WAT, and pinpoint the lateral plate mesoderm as a major source of visceral WAT. They also support the notion that visceral WAT progenitors are heterogeneous, and suggest that mesothelium is a source of adipocytes. PMID:24609269

Chau, You-Ying; Bandiera, Roberto; Serrels, Alan; Martínez-Estrada, Ofelia M; Qing, Wei; Lee, Martin; Slight, Joan; Thornburn, Anna; Berry, Rachel; McHaffie, Sophie; Stimson, Roland H; Walker, Brian R; Chapuli, Ramon Muñoz; Schedl, Andreas; Hastie, Nick

2014-04-01

357

Inhibitor of Differentiation-3 mediates high fat diet-induced visceral fat expansion  

PubMed Central

Objective Inhibitor of differentiation-3 (Id3) has been implicated in promoting angiogenesis, a key determinant of high fat diet (HFD)-induced visceral adiposity. Yet the role of Id3 in high fat diet (HFD)-induced angiogenesis and visceral adipose expansion is unknown. Methods and Results Id3?/? mice demonstrated a significant attenuation of HFD-induced visceral fat depot expansion compared to WT littermate controls. Importantly, unlike other Id proteins, loss of Id3 did not affect adipose depot size in young mice fed chow diet or differentiation of adipocytes in vitro or in vivo. Contrast enhanced ultrasound revealed a significant attenuation of visceral fat microvascular blood volume in HFD-fed mice null for Id3 compared to WT controls. HFD induced Id3 and VEGFA expression in the visceral stromal vascular fraction (SVF) and Id3?/? mice had significantly lower levels of VEGFA protein in visceral adipose tissue compared to WT. Furthermore, HFD-induced VEGFA expression in visceral adipose tissue was completely abolished by loss of Id3. Consistent with this effect, Id3 abolished E12-mediated repression of VEGFA promoter activity. Conclusions Results identify Id3 as an important regulator of HFD-induced visceral adipose VEGFA expression, microvascular blood volume, and depot expansion. Inhibition of Id3 may have potential as a therapeutic strategy to limit visceral adiposity. PMID:22075252

Cutchins, Alexis; Harmon, Daniel B.; Kirby, Jennifer L.; Doran, Amanda C.; Oldham, Stephanie N.; Skaflen, Marcus; Klibanov, Alexander L.; Meller, Nahum; Keller, Susanna R.; Garmey, James; McNamara, Coleen A.

2011-01-01

358

Pain as a channelopathy  

PubMed Central

Mendelian heritable pain disorders have provided insights into human pain mechanisms and suggested new analgesic drug targets. Interestingly, many of the heritable monogenic pain disorders have been mapped to mutations in genes encoding ion channels. Studies in transgenic mice have also implicated many ion channels in damage sensing and pain modulation. It seems likely that aberrant peripheral or central ion channel activity underlies or initiates many pathological pain conditions. Understanding the mechanistic basis of ion channel malfunction in terms of trafficking, localization, biophysics, and consequences for neurotransmission is a potential route to new pain therapies. PMID:21041956

Raouf, Ramin; Quick, Kathryn; Wood, John N.

2010-01-01

359

[Temporal disconnection as an alternative treatment for intractable temporal lobe epilepsy: techniques, complications and results].  

PubMed

Temporal lobe epilepsy (TLE) is the most common form of intractable partial epilepsy in adults. Surgery (lobectomy or amygdalohippocampectomy) is effective in most patients. However, some complications can occur and brain shift, hematoma into the post operative cavity and occulomotor nerve palsy have been reported due to the surgical technic. We report the technique, safety and efficacy of temporal disconnection in nonlesional TLE. Forty-seven patients (18 males, 29 females; handedness: 12 left, 33 right; aged 35 years+/-10; mean duration of epilepsy: 24+/-10 years) underwent temporal disconnection (20 left, 27 right) guided by neuronavigation. Sixteen patients (35 %) underwent additional presurgical evaluation with SEEG. The outcome was assessed using Engel's classification. At the two-year follow-up, 85 % of the patients were seizure-free (Engel I), 26 (58 %) of whom were Ia. Postoperative persistent morbidity included mild hemiparesis (n=1), mild facial paresis (n=1), quadranopsia (n=23) and hemianopia (n=1). Verbal memory worsened in 13 % of cases when the disconnection was performed in the dominant lobe. MRI follow-up showed two cases of nonsymptomatic thalamic or pallidal limited ischemias, two cases of temporal horn-cystic dilatation, one requiring surgical reintervention without sequelae. There was one case of postoperative phlebitis. In the seizure-free patient group, postoperative EEG showed interictal temporal spikes at three months, one year and two years located in the anterior temporal region. Temporal disconnection is effective, prevents the occurrence of subdural cyst and hematomas in the temporal cavity, prevents the occurrence of oculomotor palsy, and limits the occurrence of quadranopsia. However, comparative studies are required to evaluate temporal disconnection as an alternative to lobectomy in nonlesional TLE. PMID:18417163

Chabardès, S; Minotti, L; Hamelin, S; Hoffmann, D; Seigneuret, E; Carron, R; Krainik, A; Grand, S; Kahane, P; Benabid, A-L

2008-05-01

360

Functional Connectivity Estimated from Intracranial EEG Predicts Surgical Outcome in Intractable Temporal Lobe Epilepsy  

PubMed Central

This project aimed to determine if a correlation-based measure of functional connectivity can identify epileptogenic zones from intracranial EEG signals, as well as to investigate the prognostic significance of such a measure on seizure outcome following temporal lobe lobectomy. To this end, we retrospectively analyzed 23 adult patients with intractable temporal lobe epilepsy (TLE) who underwent an invasive stereo-EEG (SEEG) evaluation between January 2009 year and January 2012. A follow-up of at least one year was required. The primary outcome measure was complete seizure-freedom at last follow-up. Functional connectivity between two areas in the temporal lobe that were sampled by two SEEG electrode contacts was defined as Pearson’s correlation coefficient of interictal activity between those areas. SEEG signals were filtered between 5 and 50 Hz prior to computing this correlation. The mean and standard deviation of the off diagonal elements in the connectivity matrix were also calculated. Analysis of the mean and standard deviation of the functional connections for each patient reveals that 90% of the patients who had weak and homogenous connections were seizure free one year after temporal lobectomy, whereas 85% of the patients who had stronger and more heterogeneous connections within the temporal lobe had recurrence of seizures. This suggests that temporal lobectomy is ineffective in preventing seizure recurrence for patients in whom the temporal lobe is characterized by weakly connected, homogenous networks. This pilot study shows promising potential of a simple measure of functional brain connectivity to identify epileptogenicity and predict the outcome of epilepsy surgery. PMID:24205027

Antony, Arun R.; Alexopoulos, Andreas V.; Gonzalez-Martinez, Jorge A.; Mosher, John C.; Jehi, Lara; Burgess, Richard C.; So, Norman K.; Galan, Roberto F.

2013-01-01

361

Clearance of continuous intravenous morphine for severe cancer pain.  

PubMed

Four cancer patients with intractable pain received continuous morphine infusions in doses of 15-275 mg/h for a time period ranging from 4 to 27 days. Serum morphine concentrations were determined periodically following adjustments in infusion rates. As doses were changed and continued at static hourly rates, serum morphine concentrations were relatively constant 20 hours and beyond the time of the respective change, thus suggesting morphine elimination half-lives of less than or equal to 4 hours. High doses did not influence the time required to achieve steady-state concentrations. Steady serum morphine concentrations corresponded with hourly morphine doses in a parallel manner. High interpatient variabilities in clearances and steady-state serum morphine concentrations were noted. These data suggest that at morphine infusions up to 275 mg/h elimination pathways permit handling of increasing concentrations of morphine without nonlinear blood level increases. Also, marked interpatient and intrapatient variations in patient dose requirements were noted. PMID:3428164

Citron, M L; Reynolds, J R; Lin, W N; Frade, P D; Schemansky, M; Cohen, M H; Krasnow, S H; Johnston-Anderson, A; Seltzer, V L

1987-12-01

362

Managing pain during labor  

MedlinePLUS

... a childbirth class. Childbirth classes teach breathing and relaxation techniques. The techniques can help you relieve pain ... to childbirth classes and learn about breathing and relaxation techniques, even if you plan to get pain ...

363

American Chronic Pain Association  

MedlinePLUS

... of their pain. To raise awareness among the health care community, policy makers, and the public at large about issues of living with chronic pain. Recent News View All News OTC ... Verify here Certified by: Independent Charities of ...

364

Abdominal Pain Syndrome  

MedlinePLUS

... most helpful information that a doctor uses to determine the cause of abdominal pain. The characteristics of the pain (sharp, dull, cramping, burning, twisting, tearing, penetrating), its location and relation to eating or to having a bowel movement are important ...

365

Treatments for Managing Pain  

MedlinePLUS

... pain by stimulating nerve fibers through the skin. Acupuncture - This ancient Chinese practice uses very thin needles ... skin to treat disease and pain. Practitioners of acupuncture undergo specialized training in these techniques and may ...

366

What's wrong with pain?  

E-print Network

are quickly confronted with difficult questions. This thesis, through an examination of a particular feature of moral language and a description of recent research on pain, provides an analysis of how pain fits into ethical theory. It is argued...

Shriver, Adam Joseph

2006-10-30

367

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.

368

Fighting Chronic Pain  

MedlinePLUS

... Navigation Bar Home Current Issue Past Issues Fighting Chronic Pain Past Issues / Fall 2007 Table of Contents For ... diagnose, health care professionals and scientists know that chronic pain is very complex. Below are some of the ...

369

Modulation of adipocyte lipoprotein lipase expression as a strategy for preventing or treating visceral obesity.  

PubMed

As compared to subcutaneous adipocytes, visceral adipocytes have high basal lipolysis, are highly sensitive to catecholamines, and are poorly sensitive to insulin; these traits are amplified when visceral adipocytes hypertrophy. As a result, enlarged visceral fat stores tend to flood the portal circulation with free fatty acids at metabolically inappropriate times when fatty acids are unlikely to be oxidized, thus exposing tissues to excessive free fatty acid levels and giving rise to the insulin resistance syndrome. A logical approach to preventing or correcting visceral obesity is to down-regulate the lipoprotein lipase (LPL) activity of visceral adipocytes relative to that expressed in subcutaneous adipocytes and skeletal muscle. IGF-I activity appears to be a primary determinant of visceral LPL activity in humans; systemic IGF-I activity is decreased when diurnal insulin secretion is low, when hepatocytes detect a relative paucity of certain essential amino acids, and when estrogens are administered orally. The ability of alpha-glucosidase inhibitor therapy to selectively reduce visceral adiposity suggests that down-regulation of diurnal insulin secretion and/or IGF-I activity may indeed have a greater impact on LPL activity in visceral fat than in subcutaneous fat. Thus, low-glycemic-index, vegan, high-protein, or hypocaloric diets can be expected to decrease visceral LPL activity, as can postmenopausal estrogen therapy. Furthermore, estrogen enhances the LPL activity of non-pathogenic gluteofemoral fat cells, whereas testosterone decreases visceral LPL activity in men; this may explain why sex hormone replacement in middle-aged people of both sexes has a favorable impact on visceral fat and insulin sensitivity. Beta-adrenergic activity suppresses transcription of LPL in adipocytes; this phenomenon may contribute to the favorable impact of exercise training on visceral obesity; conceivably, preadministration of safe drugs that boost catecholamine activity (caffeine, yohimbine) could potentiate this beneficial effect of exercise. Glucocorticoids selectively increase the LPL activity of visceral adipocytes; while there is currently no convincing evidence that psychological stress is a major determinant of visceral adiposity, or that stress management techniques can help to correct visceral obesity, reports that anxiolytic therapy can improve glycemic control in type 2 diabetes should encourage further research along these lines. PMID:11461172

McCarty, M F

2001-08-01

370

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

371

Neuropathic low back pain  

Microsoft Academic Search

In this discussion, we hope to advance a clinical approach to low back pain that is more in line with our modern understanding\\u000a of neuropathic pain. We review the current understanding of normal and pathologic neuroanatomy of the lumbar spine and then\\u000a outline how pathology in the different structures can lead to neuropathic pain and cause common pain patterns seen

Joseph F. Audette; Emmanuel Emenike; Alec L. Meleger

2005-01-01

372

Managing Chemotherapy Side Effects: Pain  

MedlinePLUS

... services national institutes of health Managing Chemotherapy Side Effects Pain “I was worried about getting addicted to ... to pay for pain medicine. Managing Chemotherapy Side Effects: Pain Keep track of the pain. Each day, ...

373

Psychology and chronic pain  

Microsoft Academic Search

This article will explore some specific psychological responses to pain and outline the historical developments that have led to current treatments. The recognition and treatment of maladaptive psychological responses to pain can lessen distress and the progression of chronic pain states.

Jennifer K. Dietrich

2011-01-01

374

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

375

Ethnic differences in pain and pain management.  

PubMed

Considerable evidence demonstrates substantial ethnic disparities in the prevalence, treatment, progression and outcomes of pain-related conditions. Elucidating the mechanisms underlying these group differences is of crucial importance in reducing and eliminating disparities in the pain experience. Over recent years, accumulating evidence has identified a variety of processes, from neurophysiological factors to structural elements of the healthcare system, that may contribute to shaping individual differences in pain. For example, the experience of pain differentially activates stress-related physiological responses across various ethnic groups, members of different ethnic groups appear to use differing coping strategies in managing pain complaints, providers' treatment decisions vary as a function of patient ethnicity and pharmacies in predominantly minority neighborhoods are far less likely to stock potent analgesics. These diverse factors, and others may all play a role in facilitating elevated levels of pain-related suffering among individuals from ethnic minority backgrounds. Here, we present a brief, nonexhaustive review of the recent literature and potential physiological and sociocultural mechanisms underlying these ethnic group disparities in pain outcomes. PMID:23687518

Campbell, Claudia M; Edwards, Robert R

2012-05-01

376

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

377

An Introduction Significance of Pain  

E-print Network

An 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 was killing his buddies all around him. When a shell burst nearby, he felt an excruciating pain

Meagher, Mary

378

Moving with the beat: heart rate and visceral temperature of free-swimming and feeding  

E-print Network

Moving with the beat: heart rate and visceral temperature of free-swimming and feeding bluefin tuna (Thunnus maccoyii ) to measure changes in the heart rate ( fH) and visceral temperature (TV) during a two, greater relative heart masses, elevated metabolic rates, and are more difficult to handle than tropical

Schluter, Dolph

379

Development of automated quantification of visceral and subcutaneous adipose tissue volumes from abdominal CT scans  

Microsoft Academic Search

This contribution describes a novel algorithm for the automated quantification of visceral and subcutaneous adipose tissue volumes from abdominal CT scans of patients referred for colorectal resection. Visceral and subcutaneous adipose tissue volumes can accurately be measured with errors of 1.2 and 0.5%, respectively. Also the reproducibility of CT measurements is good; a disadvantage is the amount of radiation. In

Sanne D. Mensink; Jarich W. Spliethoff; Ruben Belder; Joost M. Klaase; Roland Bezooijen; Cornelis H. Slump

2011-01-01

380

Heightened visceral sensation in functional gastrointestinal disease is not site-specific  

Microsoft Academic Search

Alteration in visceral sensation locally at the site of presumed symptom origin in the gastrointestinal tract has been proposed as an important etiopathological mechanism in the so-called functional bowel disorders. Patients presenting with one functional gastrointestinal syndrome, however, frequently have additional symptoms referable to other parts of the gut, suggesting that enhanced visceral nociception may be a panintestinal phenomenon. We

K. C. Trimble; R. Farouk; A. Pryde; S. Douglas; R. C. Heading

1995-01-01

381

Mechanisms of Disease: adipocytokines and visceral adipose tissue—emerging role in nonalcoholic fatty liver disease  

Microsoft Academic Search

There is increasing evidence that visceral adipose tissue is a causative risk factor for fatty liver and nonalcoholic steatohepatitis. Adipose tissue-derived secretory proteins are collectively named adipocytokines. Obesity and mainly visceral fat accumulation impair adipocyte function and adipocytokine secretion and the altered release of these proteins contributes to hypertension, impaired fibrinolysis and insulin resistance. This review summarizes recent findings on

Andreas Schäffler; Jürgen Schölmerich; Christa Büchler

2005-01-01

382

Thoughts provoked by pain.  

PubMed

Despite the growing interest in the cognitive component of chronic pain, little information has been collected on the variety of thoughts provoked by pain experience. A new assessment instrument (the Cognitive Evaluative Questionnaire--CEQ) has been utilized with 127 chronic pain patients and their cognitions classified into seven discrete clusters. The results confirm the heterogeneity of pain cognitions, the majority of which are likely to play a role in enhancing or perpetuating chronic pain. The relationship of these cognitions to chronic avoidance behavior is discussed. PMID:2775158

Philips, H C

1989-01-01

383

Chloroplast phylogenomic analyses resolve deep-level relationships of an intractable bamboo tribe arundinarieae (poaceae).  

PubMed

The temperate woody bamboos constitute a distinct tribe Arundinarieae (Poaceae: Bambusoideae) with high species diversity. Estimating phylogenetic relationships among the 11 major lineages of Arundinarieae has been particularly difficult, owing to a possible rapid radiation and the extremely low rate of sequence divergence. Here, we explore the use of chloroplast genome sequencing for phylogenetic inference. We sampled 25 species (22 temperate bamboos and 3 outgroups) for the complete genome representing eight major lineages of Arundinarieae in an attempt to resolve backbone relationships. Phylogenetic analyses of coding versus noncoding sequences, and of different regions of the genome (large single copy and small single copy, and inverted repeat regions) yielded no well-supported contradicting topologies but potential incongruence was found between the coding and noncoding sequences. The use of various data partitioning schemes in analysis of the complete sequences resulted in nearly identical topologies and node support values, although the partitioning schemes were decisively different from each other as to the fit to the data. Our full genomic data set substantially increased resolution along the backbone and provided strong support for most relationships despite the very short internodes and long branches in the tree. The inferred relationships were also robust to potential confounding factors (e.g., long-branch attraction) and received support from independent indels in the genome. We then added taxa from the three Arundinarieae lineages that were not included in the full-genome data set; each of these were sampled for more than 50% genome sequences. The resulting trees not only corroborated the reconstructed deep-level relationships but also largely resolved the phylogenetic placements of these three additional lineages. Furthermore, adding 129 additional taxa sampled for only eight chloroplast loci to the combined data set yielded almost identical relationships, albeit with low support values. We believe that the inferred phylogeny is robust to taxon sampling. Having resolved the deep-level relationships of Arundinarieae, we illuminate how chloroplast phylogenomics can be used for elucidating difficult phylogeny at low taxonomic levels in intractable plant groups. PMID:25092479

Ma, Peng-Fei; Zhang, Yu-Xiao; Zeng, Chun-Xia; Guo, Zhen-Hua; Li, De-Zhu

2014-11-01

384

Common medical pains  

PubMed Central

Pain in infancy and childhood is extremely common. Sources of pain include illness, injury, and medical and dental procedures. Over the past two decades, tremendous progress has been made in the assessment, prevention and treatment of pain. It is important for the paediatric health care provider to be aware of the implications and consequences of pain in childhood. A multitude of interventions are available to reduce or alleviate pain in children of all ages, including neonates. These include behavioural and psychological methods, as well as a host of pharmacological preparations, which are safe and effective when used as indicated. Many complementary and alternative treatments appear to be promising in treating and relieving pain, although further research is required. The present article reviews the most common sources of pain in childhood and infancy, as well as current treatment strategies and options. PMID:19030348

Jacobson, Sheila

2007-01-01

385

Pain syndromes in children.  

PubMed

The pediatric rheumatologist cares for children who may have a wide variety of causes of musculoskeletal pain. These include such diverse conditions as arthritis, low-back pain, hypermobility, metabolic bone pain, and amplified pain syndromes such as complex regional pain syndrome and fibromyalgia. This review examines the recent literature on these and other conditions causing musculoskeletal pain in children and adolescents. Overall, headway is being made, but differentiating soma from psyche remains a problem. This is perhaps due to the marked and unique effect pain brings to each of us. Children are different from adults in causes, presentations, and outcome. Vigilance in history, physical examination, and judicious use of laboratory investigations are usually sufficient in establishing a diagnosis, as well as an appreciation for the variety of presentations each condition can manifest. PMID:11123080

Sherry, D D

2000-08-01

386

Risk Assessment of Opioid Misuse in Italian Patients with Chronic Noncancer Pain  

PubMed Central

Objective. Opioid therapy in patients with chronic noncancer pain must be preceded by evaluation of the risk of opioid misuse. The aim of this study was to evaluate the predictive validity of the Italian translation of the Pain Medication Questionnaire (PMQ) and of the Diagnosis Intractability Risk and Efficacy Score (DIRE) in chronic pain patients. Design. 75 chronic noncancer pain patients treated with opioids were enrolled and followed longitudinally. Risk of opioid misuse was evaluated through PMQ, DIRE, and the physician's clinical evaluation. Pain experience and psychological characteristics were assessed through specific self-report instruments. At follow-ups, pain intensity, aberrant drug behaviors, and presence of the prescribed opioid and of illegal substances in urine were also checked. Results. PMQ demonstrated good internal consistency (Cronbach's ? = 0.77) and test-retest reliability (r = 0.86). Significant correlations were found between higher PMQ scores and the number of aberrant drug behaviors detected at 2-, 4-, and 6-month follow-ups (P < 0.01). Also the DIRE demonstrated good predictive validity. Conclusions. The results obtained with specific tools are more reliable than the clinician's evaluation alone in predicting the risk of opioid misuse; regular monitoring and psychological intervention will contribute to improving compliance and outcome of long-term opioid use. PMID:25177499

Ferrari, Renata; Duse, Genni; Capraro, Michela; Visentin, Marco

2014-01-01

387

Experimental spinal cord stimulation and neuropathic pain: mechanism of action, technical aspects, and effectiveness.  

PubMed

Spinal cord stimulation (SCS) is a valuable treatment for chronic intractable neuropathic pain. Although SCS has gone through a technological revolution over the last four decades, the neurophysiologic and biochemical mechanisms of action have only been partly elucidated. Animal experimental work has provided some evidence for spinal as well as supraspinal mechanisms of neuropathic pain relief of SCS. A SCS computer model of the electrical properties of the human spinal cord revealed many basic neurophysiologic principles that were clinically validated later on. The main question in clinical SCS is how to further improve the effectiveness of SCS as there is still a significant failure rate of 30%. In this context, experimental studies are needed to elucidate which target pain neuron(s) are involved, as well as with what exact electrical stimulation this target neuron can be influenced to produce an optimal supapression of neuropathic pain. This article reviews the basic clinical and experimental technical aspects in relation to the effectiveness of SCS in view of recent understanding of the dorsal horn pain circuit involved. These data may then result in experiments needed for an improved understanding of the mechanisms underlying SCS and consequently lead to improvement and increased effectiveness of SCS in neuropathic pain as a clinical therapy. PMID:22780956

Smits, Helwin; van Kleef, Maarten; Holsheimer, Jan; Joosten, Elbert A J

2013-02-01

388

Culture and the body: East-West differences in visceral perception.  

PubMed

This research investigated cross-cultural differences in the accuracy of individuals' perceptions of internal visceral states. We conducted 4 studies to test the hypothesis that Asians are less sensitive to internal physiological cues relative to European Americans. Studies 1 and 2 assessed cultural differences in visceral perception via tests of misattributions of arousal: Study 1 involved false heart rate feedback during an emotionally evocative slideshow and examined subsequent self-reported affective changes; Study 2 manipulated apparent physiological arousal and measured its effects on attraction via an immersive virtual environment. Study 3 directly assessed visceral perception using a heartbeat detection task. All 3 studies found Asians to be less viscerally perceptive than European Americans. Study 4 examined one possible cultural mechanism for the observed difference and found evidence for contextual dependency as a mediator of the culture-visceral perception link. PMID:22309028

Ma-Kellams, Christine; Blascovich, Jim; McCall, Cade

2012-04-01

389

Postsurgical pain outcome assessment.  

PubMed

Reliable and valid measures of pain are essential for conducting clinical trials of pain treatments. Perhaps the most important aspect of a pain measure's validity is its sensitivity, or ability to detect changes in pain over time and due to treatment. Several factors may affect a measure's sensitivity, including the complexity of the rating task for the measure, the number of pain intensity levels assessed by the measure, the dimension of pain assessed (e.g. pain intensity vs. pain relief), and the number of individual ratings (e.g. single rating vs. composite score) used to create the measure. The purpose of this study was to compare the relative sensitivity of three measures of outcome and a composite made up of all three measures for detecting analgesic effects in two samples of persons participating in a randomized controlled trial. One hundred and twenty-three patients who had undergone knee surgery and 124 women who had undergone a laparotomy were given one of three medications in the day after their surgery: morphine, ketorolac, or placebo. Two measures of pain intensity (a visual analog scale (VAS) and a 4-point verbal rating scale (VRS)) were administered at baseline, and these measures plus a 5-point VRS of pain relief were administered at 16 additional time points up to 24 h following surgery. As predicted, we found variability in the sensitivity of the outcome measures used in these studies, with the 4-point VRS showing less sensitivity than the VAS or relief ratings. However, contrary to our prediction, a composite measure of outcome made up of all three measures was not consistently superior to the individual measures for detecting treatment effects. Finally, we found that pain relief ratings were related to, but also distinct from, change in pain intensity as measured by changes in pain intensity ratings from baseline to each postmedication assessment point. These findings have important implications for the assessment of pain in clinical trials. PMID:12237188

Jensen, Mark P; Chen, Connie; Brugger, Andrew M

2002-09-01

390

Accepting Pain Management or Seeking Pain Cure: An Exploration of Patients’ Attitudes to Chronic Pain  

Microsoft Academic Search

This article explores the differing attitudes of patients toward chronic pain. Because pain is a subjective experience, individuals react to living with chronic pain in varying ways. Some patients successfully manage their chronic pain, whereas others continue to seek a pain cure. A convenience sample (n = 8) was generated from a district general hospital’s nurse-led pain clinic. The sample

Kathryn A. Clarke; Ron Iphofen

2007-01-01

391

Pain Control After Surgery: Pain Medicines  

MedlinePLUS

... pain medicine given? Medicines can be given by mouth (liquid or pill), through the rectum (suppository) or injected ... Aspirin, ibuprofen or codeine can be taken by mouth. Pills and liquids cause less discomfort than shots into a muscle ...

392

Electroacupuncture alleviates stress-induced visceral hypersensitivity through an opioid system in rats  

PubMed Central

AIM: To investigate whether stress-induced visceral hypersensitivity could be alleviated by electroacupuncture (EA) and whether EA effect was mediated by endogenous opiates. METHODS: Six to nine week-old male Sprague-Dawley rats were used in this study. Visceral hypersensitivity was induced by a 9-d heterotypic intermittent stress (HIS) protocol composed of 3 randomly stressors, which included cold restraint stress at 4?°C for 45 min, water avoidance stress for 60 min, and forced swimming stress for 20 min, in adult male rats. The extent of visceral hypersensitivity was quantified by electromyography or by abdominal withdrawal reflex (AWR) scores of colorectal distension at different distention pressures (20 mmHg, 40 mmHg, 60 mmHg and 80 mmHg). AWR scores either 0, 1, 2, 3 or 4 were obtained by a blinded observer. EA or sham EA was performed at classical acupoint ST-36 (Zu-San-Li) or BL-43 (Gao-Huang) in both hindlimbs of rats for 30 min. Naloxone (NLX) or NLX methiodide (m-NLX) was administered intraperitoneally to HIS rats in some experiments. RESULTS: HIS rats displayed an increased sensitivity to colorectal distention, which started from 6 h (the first measurement), maintained for 24 h, and AWR scores returned to basal levels at 48 h and 7 d after HIS compared to pre-HIS baseline at different distention pressures. The AWR scores before HIS were 0.6 ± 0.2, 1.3 ± 0.2, 1.9 ± 0.2 and 2.3 ± 0.2 for 20 mmHg, 40 mmHg, 60 mmHg and 80 mmHg distention pressures, respectively. Six hours after termination of the last stressor, the AWR scores were 2.0 ± 0.1, 2.5 ± 0.1, 2.8 ± 0.2 and 3.5 ± 0.2 for 20 mmHg, 40 mmHg, 60 mmHg and 80 mmHg distention pressures, respectively. EA given at classical acupoint ST-36 in both hindlimbs for 30 min significantly attenuated the hypersensitive responses to colorectal distention in HIS rats compared with sham EA treatment [AWRs at 20 mmHg: 2.0 ± 0.2 vs 0.7 ± 0.1, P = 4.23?711 E-4; AWRs at 40 mmHg: 2.6 ± 0.2 vs 1.5 ± 0.2, P = 0.00?163; AWRs at 60 mmHg: 3.1 ± 0.2 vs 1.9 ± 0.1, P = 0.003; AWRs at 80 mmHg: 3.6 ± 0.1 vs 2.4 ± 0.2, P = 0.0023; electromyographic (EMG) at 20 mmHg: 24 ± 4.7 vs 13.8 ± 3.5; EMG at 40 mmHg: 60.2 ± 6.6 vs 30 ± 4.9, P = 0.00?523; EMG at 60 mmHg: 83 ± 10 vs 39.8 ± 5.9, P = 0.00?029; EMG at 80 mmHg: 94.3 ± 10.8 vs 49.6 ± 5.9, P = 0.00?021]. In addition, EA at the acupuncture point BL-43 with same parameters did not alleviate visceral hypersensitivity in HIS rats. EA in healthy rats also did not have any effect on AWR scores to colorectal distention at distention pressures of 20 and 40 mmHg. The EA-mediated analgesic effect was blocked by pretreatment with NLX in HIS rats [AWR scores pretreated with NLX vs normal saline (NS) were 2.0 vs 0.70 ± 0.20, 2.80 ± 0.12 vs 1.50 ± 0.27, 3 vs 2.00 ± 0.15 and 3.60 ± 0.18 vs 2.60 ± 0.18 for 20 mmHg, 40 mmHg, 60 mmHg and 80 mmHg; P = 0.0087, 0.0104, 0.0117 and 0.0188 for 20, 40, 60 and 80 mmHg, respectively]. Furthermore, EA-mediated analgesic effect was completely reversed by administration of m-NLX, a peripherally restricted opioid antagonist (EMG pretreated with m-NLX vs NS were 30.84 ± 4.39 vs 13.33 ± 3.88, 74.16 ± 9.04 vs 36.28 ± 8.01, 96.45 ± 11.80 vs 50.19 ± 8.28, and 111.59 ± 13.79 vs 56.42 ± 8.43 for 20 mmHg, 40 mmHg, 60 mmHg and 80 mmHg; P = 0.05?026, 0.00?034, 0.00?005, 0.000?007 for 20 mmHg, 40 mmHg, 60 mmHg and 80 mmHg, respectively). CONCLUSION: EA given at classical acupoint ST-36 alleviates stress-induced visceral pain, which is most likely mediated by opioid pathways in the periphery. PMID:23326125

Zhou, Yuan-Yuan; Wanner, Natalie J; Xiao, Ying; Shi, Xuan-Zheng; Jiang, Xing-Hong; Gu, Jian-Guo; Xu, Guang-Yin

2012-01-01

393

Direct agglutination test for early diagnosis of Indian visceral leishmaniasis.  

PubMed

In a prospective study, 80 cases of fever with hepatosplenomegaly, anemia and leucopaenia coming from the hyperendemic zones for visceral leishmaniasis of North-Bihar, India were screened and subjected to bone marrow or splenic puncture for demonstration of Leishman-donovan bodies (LDB) and DIRECT AGGLUTINATION TEST (DAT) with antigen prepared by Harith et al. 59 cases were confirmed for Visceral Leishmaniasis (VL) by demonstration of LDB in which DAT was also positive in different titres ranging from 1:1600 onwards. Out of 21 cases in which the bone marrow was negative for parasite, DAT was positive in 10 cases. 8 Out of 10 cases responded to WHO regimen of treatment with sodium stibogluconate (SSG). Remaining two cases who did not respond to this therapy became positive for parasites on subsequent splenic aspirate. They were treated with pentamidine isethionate and were cured. 11 out of 80 cases showing a titre of 1:400 or lower in DAT, 6 proved to be cases of enteric fever and 5 of malaria. Thus DAT using Harith's antigen was found to be 100% sensitive and specific in detection of early cases of Indian VL. PMID:9251370

Jha, T K; Thakur, C P; Singh, I J; Singh, T K; Jha, S

1996-09-01

394

Effects of xylitol on metabolic parameters and visceral fat accumulation.  

PubMed

Xylitol is widely used as a sweetener in foods and medications. Xylitol ingestion causes a small blood glucose rise, and it is commonly used as an alternative to high-energy supplements in diabetics. In previous studies, a xylitol metabolite, xylulose-5-phosphate, was shown to activate carbohydrate response element binding protein, and to promote lipogenic enzyme gene transcription in vitro; however, the effects of xylitol in vivo are not understood. Here we investigated the effects of dietary xylitol on lipid metabolism and visceral fat accumulation in rats fed a high-fat diet. Sprague-Dawley rats were fed a high-fat diet containing 0 g (control), 1.0 g/100 kcal (X1) or 2.0 g/100 kcal (X2) of xylitol. After the 8-week feeding period, visceral fat mass and plasma insulin and lipid concentrations were significantly lower in xylitol-fed rats than those in high-fat diet rats. Gene expression levels of ChREBP and lipogenic enzymes were higher, whereas the expression of sterol regulatory-element binding protein 1c was lower and fatty acid oxidation-related genes were significantly higher in the liver of xylitol-fed rats as compared with high-fat diet rats. In conclusion, intake of xylitol may be beneficial in preventing the development of obesity and metabolic abnormalities in rats with diet-induced obesity. PMID:21765599

Amo, Kikuko; Arai, Hidekazu; Uebanso, Takashi; Fukaya, Makiko; Koganei, Megumi; Sasaki, Hajime; Yamamoto, Hironori; Taketani, Yutaka; Takeda, Eiji

2011-07-01

395

Epidemiology of visceral leishmaniasis in Algeria: an update.  

PubMed

Visceral leishmaniasis (VL), a zoonotic disease caused by Leishmania infantum, is endemic in Algeria. This report describes a retrospective epidemiological study conducted on human VL to document the epidemiological profile at national level. All human VL cases notified by the National Institute of Public Health between 1998 and 2008 were investigated. In parallel all VL cases admitted to the university hospitals of Algiers were surveyed to estimate the underreporting ratio. Fifteen hundred and sixty-two human VL cases were reported in Algeria between 1998-2008 with an average annual reported incidence rate of 0.45 cases per 100,000 inhabitants, of which 81.42% were in the age range of 0-4 years. Cases were detected year-round, with a peak notification in May and June. One hundred and seventy patients were admitted to the university hospitals in Algiers in the same period, of which less than one in ten had been officially notified. Splenomegaly, fever, pallor and pancytopenia were the main clinical and laboratory features. Meglumine antimoniate was the first-line therapy for paediatric VL whereas the conventional amphotericin B was used for adult patients. Visceral leishmaniasis in Algeria shows the epidemiological profile of a paediatric disease with a decrease of the annual reported incidence rate. However, vigilance is required because of huge underreporting and an apparent propagation towards the south. PMID:24949958

Adel, Amel; Boughoufalah, Amel; Saegerman, Claude; De Deken, Redgi; Bouchene, Zahida; Soukehal, Abdelkrim; Berkvens, Dirk; Boelaert, Marleen

2014-01-01

396

Canine visceral leishmaniasis as a systemic fibrotic disease  

PubMed Central

We propose that canine visceral leishmaniasis (CVL) is a systemic fibrotic disease, as evidenced by the wide distribution of fibrosis that we have found in the dogs suffering from chronic condition. The inflammatory cells apparently direct fibrosis formation. Twenty-four cases (symptomatic dogs) were identified from a total of one hundred and five cases that had been naturally infected with Leishmania chagasi and had been documented during an epidemiological survey of CVL carried out by the metropolitan area of the municipality of Belo Horizonte, MG, Brazil. The histological criterion was intralobular liver fibrosis, as has been described previously in dogs with visceral leishmaniasis. In addition to the findings in the liver, here we describe and quantify conspicuous and systemic deposition of collagen in other organs, including spleen, cervical lymph nodes, lung and kidney of all the infected symptomatic dogs. Thus we report that there is a systematic fibrotic picture in these animals, where inflammatory cells appear to direct fibrosis in all organs that have been studied. Therefore we propose that CVL is a systemic fibrotic disease. PMID:23419132

Silva, Lucelia C; Castro, Rodrigo S; Figueiredo, Maria M; Michalick, Marilene S M; Tafuri, Washington L; Tafuri, Wagner L

2013-01-01

397

Regulation of PKC Mediated Signaling by Calcium during Visceral Leishmaniasis  

PubMed Central

Calcium is an ubiquitous cellular signaling molecule that controls a variety of cellular processes and is strictly maintained in the cellular compartments by the coordination of various Ca2+ pumps and channels. Two such fundamental calcium pumps are plasma membrane calcium ATPase (PMCA) and Sarco/endoplasmic reticulum calcium ATPase (SERCA) which play a pivotal role in maintaining intracellular calcium homeostasis. This intracellular Ca2+ homeostasis is often disturbed by the protozoan parasite Leishmania donovani, the causative organism of visceral leishmaniasis. In the present study we have dileneated the involvement of PMCA4 and SERCA3 during leishmaniasis. We have observed that during leishmaniasis, intracellular Ca2+ concentration was up-regulated and was further controlled by both PMCA4 and SERCA3. Inhibition of these two Ca2+-ATPases resulted in decreased parasite burden within the host macrophages due to enhanced intracellular Ca2+. Contrastingly, on the other hand, activation of PMCA4 was found to enhance the parasite burden. Our findings also highlighted the importance of Ca2+ in the modulation of cytokine balance during leishmaniasis. These results thus cumulatively suggests that these two Ca2+-ATPases play prominent roles during visceral leishmaniasis. PMID:25329062

Roy, Nivedita; Chakraborty, Supriya; Paul Chowdhury, Bidisha; Banerjee, Sayantan; Halder, Kuntal; Majumder, Saikat; Majumdar, Subrata; Sen, Parimal C.

2014-01-01

398

[Osteoporosis and pain or is osteoporosis painful?].  

PubMed

Osteoporosis as a disease is characterized by skeletal quantitative and qualitative abnormalities, leading to an increased fragility. Classically the disease is painless. The complications of the disease, that is bone fractures, cause a well-known acute symptomatology. Subsequent chronic pain is the consequence of skeletal deformities, joint incongruences and tensions on musculo-tendineous structures. Pain management includes pharmacological, physio- and ergo-therapeutical measures and stabilisation maneuvers. PMID:16117031

Uebelhart, B; Rizzoli, R

2005-06-22

399

The genetics of pain and pain inhibition.  

PubMed Central

The present review summarizes the current state of knowledge about the genetics of pain-related phenomena and illustrates the scope and power of genetic approaches to the study of pain. We focus on work performed in our laboratories in Jastrzebiec, Poland; Portland, OR; and Los Angeles, which we feel demonstrates the continuing usefulness of classical genetic approaches, especially when used in combination with newly available molecular genetic techniques. PMID:8610166

Mogil, J S; Sternberg, W F; Marek, P; Sadowski, B; Belknap, J K; Liebeskind, J C

1996-01-01

400

The adjuvant use of lansoprazole, clonazepam and dimenhydrinate for treating intractable hiccups in a patient with gastritis and reflux esophagitis complicated with myocardial infarction: a case report  

PubMed Central

Background Hiccup (Singultus) is a sudden and involuntary contraction of the diaphragm followed by a sharp closure of the epiglottis which results in the production of a specific “hic” sound. Normally, hiccups are treated without intervention. Intractable hiccups occur rarely but are a disturbing symptom underlying other health related disorders. Case presentation We report the clinical case of a 67-year-old male patient with myocardial infarction accompanied by intractable hiccups during the course of 8 months, and who was non-responsive to chlorpromazine or metoclopramide, and baclofen; drugs routinely used to treat this condition. This sustained hiccup had severely restricted the patient's ability to intake food and sleep. To explore alternative treatments, we investigated the adjuvant administration of lansoprazole, dimenhydrinate and clonazepam in this patient. We discovered that this drug combination was capable of successfully terminating his intractable hiccups, with no further evidence of recurrence. No similar treatment is previously reported for intractable hiccups. We further suggest a hypothesis concerning a potential mechanism on the anti-hiccup effect of dimenhydrinate. Conclusion We identified that the adjuvant use of lansoprazole, clonazepam and dimenhydrinate was capable of attenuating the symptoms of our patient with intractable hiccups. PMID:23954069

2013-01-01

401

Advancements in pain research.  

PubMed

After the publication of the First Edition of this book in the series of Methods in Molecular Medicine (volume 99 in the series) in 2004, pain research continues its rapid acceleration until 2009, during which it experienced a plateau of growth that likely resulted from the economic downturn started in 2008 (Fig. 1.1). This rapid growth in pain research could be the driving force for an impressive 66% increase in new randomized, double-blind, placebo-control trials for neuropathic pain medications in the past 5 years compared with the last four decades. Unfortunately, little improvement in pain medications has been obtained [1] due to primarily our limited understanding of mechanisms mediating different pain states, especially that for chronic pain. It is highly possible that the growth in pain research will continue for decades to come due to three main reasons. First, there is an urgent need for more efficacious and safer pain medications that are necessary for better and individualized pain management. The increase in life expectancy of the general population and patients due to improvements in quality of health care and medicine is likely to increase the demand for better pain medications for improving the quality of daily life of those living with pain. It is estimated that the continuous increase in percentage of patients suffering from chronic pain (pain conditions lasting more than 6 months) arranges from 11 to 47% between 40 and 75 years of age [2], which will inevitably and continually increase the demand for better pain medications. Second, the cost of pain conditions to our society is high, estimated $55 billion per year in loss of productivity from full-time workers alone [3], so better pain management can significantly help economic growth and stability. Third, the swift advancement in technologies and our better understanding of sensory circuitries and pain pathways serves as a driving force for timely drug discovery research and development at an unprecedented pace to meet the demand for better pain medications. PMID:22351079

Luo, Z David

2012-01-01

402

Vagal anandamide signaling via cannabinoid receptor 1 contributes to luminal 5-HT modulation of visceral nociception in rats.  

PubMed

Serotonin (5-HT) plays pivotal roles in the pathogenesis of postinfectious irritable bowel syndrome (PI-IBS), and luminal 5-HT time-dependently modulates visceral nociception. We found that duodenal biopsies from PI-IBS patients exhibited increased 5-HT and decreased anandamide levels and that decreased anandamide was associated with abdominal pain severity, indicating a link between 5-HT and endocannabinoid signaling pathways in PI-IBS. To understand this, we investigated the role of endocannabinoids in 5-HT modulation of visceral nociception in a rat model. Acute intraduodenally applied 5-HT attenuated the visceromotor response (VMR) to colorectal distention, and this was reversed by the cannabinoid receptor 1 (CB1) antagonist AM251. Duodenal anandamide (but not 2-arachidonoylglycerol) content was greatly increased after luminal 5-HT treatment. This effect was abrogated by the 5-HT 3 receptor (5-HT3R) antagonist granisetron, which was luminally delivered to preferentially target vagal terminals. Chemical denervation of vagal afferents blocked 5-HT-evoked antinociception and anandamide release. Chronic luminal 5-HT exposure for 5 days increased baseline VMR and VMR post-5-HT (days 4 and 5). Duodenal levels of anandamide and N-acyl-phosphatidylethanolamine-specific phospholipase D (NAPE-PLD, the anandamide-synthesizing enzyme) protein gradually declined from day 1 to 5. The time-dependent effects of 5-HT were abolished by daily granisetron pretreatment. Daily pretreatment with CB1 agonists or anandamide from day 3 attenuated 5-HT-induced hyperalgesia. These data suggest that vagal 5-HT3R-mediated duodenal anandamide release contributes to acute luminal 5-HT-induced antinociception via CB1 signaling, whereas decreased anandamide is associated with hyperalgesia upon chronic 5-HT treatment. Further understanding of peripheral vagal anandamide signaling may provide insights into the mechanisms underlying 5-HT-related IBS. PMID:24813296

Feng, Chen-Chen; Yan, Xiu-Juan; Chen, Xin; Wang, Er-Man; Liu, Qing; Zhang, Li-Yan; Chen, Jun; Fang, Jing-Yuan; Chen, Sheng-Liang

2014-08-01

403

Pain in cancer survivors.  

PubMed

Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed. PMID:24799477

Glare, Paul A; Davies, Pamela S; Finlay, Esmé; Gulati, Amitabh; Lemanne, Dawn; Moryl, Natalie; Oeffinger, Kevin C; Paice, Judith A; Stubblefield, Michael D; Syrjala, Karen L

2014-06-01

404

A 44 year-old lady with chronic renal disease and intractable ulcers: a case report  

PubMed Central

Calciphylaxis is a rare but potentially fatal condition occurring in patients with end stage renal disease on dialysis. Due to interplay of various factors, disturbances occur in the metabolism of calcium and phosphate leading to calcification within the vessel walls. The net result is tissue ischemia and necrosis. Clinically this presents as painful non-healing skin ulcers, which contribute to significant morbidity and mortality due to septic progression of the lesion. In this case report, we highlight the rapidly progressive nature of this disease, its etiopathogenesis and the role of early diagnosis in preventing life-threatening complications. PMID:19646226

Pujar, Thejeswi; Spinello, Irene M

2009-01-01

405

Ultrasonographic visceral fat thickness in the first trimester can predict metabolic syndrome and gestational diabetes mellitus.  

PubMed

The aim of this study is to evaluate whether ultrasonographic visceral fat thickness measurement in the early gestational period is useful for predicting the development of gestational diabetes mellitus (GDM) and metabolic syndrome (MS). The visceral fat thickness and subcutaneous fat thickness were measured via ultrasound at the first prenatal visit. The correlation between visceral and subcutaneous fat thickness and MS parameters, such as dyslipidemia, hypertension, and insulin resistance, was assessed. We also compared the use of visceral fat thickness measurement with body mass index (BMI) and waist circumference (WC) measurements for predicting the development of GDM. The subcutaneous fat thickness was found to be similar in the normal glucose metabolism and GDM groups at the first visit, whereas the visceral fat thickness was found to be considerably higher in the GDM groups (p = 0.04). The visceral fat thickness in the early stage of the gestation was correlated with hyperglycemia, dyslipidemia, high diastolic blood pressure, and insulin resistance. In contrast to subcutaneous fat thickness, BMI, and WC, only the visceral fat thickness was correlated with insulin resistance. The subcutaneous and visceral fat thicknesses at the first visit were significantly higher in the MS group (p = 0.02). There was a good correlation between visceral and subcutaneous fat thicknesses (r = 0.492, p < 0.001); however, there were poor correlations between visceral fat thickness and BMI and WC (r = 0.338, p = 0.01; r = 0.312, p = 0.02). The visceral fat thickness seemed to be a more sensitive predictor of GDM than WC and BMI. The optimal cutoff points for predicting GDM were visceral fat thickness 19.5 mm [area under curve (AUC) = 0.66, p = 0.043], WC 103.5 cm (AUC = 0.64, p = 0.079), and BMI 34.5 (AUC = 0.64, p = 0.069). Ultrasonographic visceral fat thickness measurement in the early period of gestation may be an easy, safe, and cost-effective scan test for predicting the development of metabolic diseases and GDM. PMID:24452873

Gur, Esra Bahar; Ince, Ozlem; Turan, Guluzar Arzu; Karadeniz, Muammer; Tatar, Sumeyra; Celik, Esin; Yalcin, Murat; Guclu, Serkan

2014-11-01

406

Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity  

PubMed Central

Objective The aim was to determine whether lower visceral pain thresholds in irritable bowel syndrome (IBS) primarily reflect physiological or psychological factors. Methods Firstly, 121 IBS patients and 28 controls underwent balloon distensions in the descending colon using the ascending methods of limits (AML) to assess pain and urge thresholds. Secondly, sensory decision theory analysis was used to separate physiological from psychological components of perception: neurosensory sensitivity (p(A)) was measured by the ability to discriminate between 30?mm?Hg vs 34?mm?Hg distensions; psychological influences were measured by the report criterion—that is, the overall tendency to report pain, indexed by the median intensity rating for all distensions, independent of intensity. Psychological symptoms were assessed using the Brief Symptom Inventory (BSI). Results IBS patients had lower AML pain thresholds (median: 28?mm?Hg vs 40?mm Hg; p<0.001), but similar neurosensory sensitivity (median p(A): 0.5 vs 0.5; p?=?0.69; 42.6% vs 42.9% were able to discriminate between the stimuli better than chance) and a greater tendency to report pain (median report criterion: 4.0 (“mild” pain) vs 5.2 (“weak” pain); p?=?0.003). AML pain thresholds were not correlated with neurosensory sensitivity (r?=??0.13; p?=?0.14), but were strongly correlated with report criterion (r?=?0.67; p<0.0001). Report criterion was inversely correlated with BSI somatisation (r?=??0.26; p?=?0.001) and BSI global score (r?=??0.18; p?=?0.035). Similar results were seen for the non?painful sensation of urgency. Conclusion Increased colonic sensitivity in IBS is strongly influenced by a psychological tendency to report pain and urge rather than increased neurosensory sensitivity. PMID:17483191

Dorn, Spencer D; Palsson, Olafur S; Thiwan, Syed I M; Kanazawa, Motoyori; Clark, W Crawford; van Tilburg, Miranda A L; Drossman, Douglas A; Scarlett, Yolanda; Levy, Rona L; Ringel, Yehuda; Crowell, Michael D; Olden, Kevin W; Whitehead, William E

2007-01-01

407

Major white matter fiber changes in medically intractable neocortical epilepsy in children: a diffusion tensor imaging study.  

PubMed

This study aimed to investigate the extent of microstructural changes in the major white matter fibers and to evaluate whether diffusion tensor imaging (DTI) adds any lateralizing information in children with medically intractable neocortical epilepsy secondary to focal cortical dysplasia. Patient group included twenty-three consecutively enrolled patients with medically intractable focal neocortical epilepsy and focal cortical dysplasia histopathologically confirmed. Thirteen patients (56.5%) had no visible lesion on the conventional magnetic resonance imaging (MRI). Fractional anisotropy (FA) was measured for regions of interest (ROIs) in each major white matter fiber. FA in patients was compared with eighteen age-matched healthy controls. Patient group had lower FA values at corpus callosum, bilateral inferior frontooccipital fasciculus (IFO), bilateral inferior longitudinal fasciculus (ILF) and left superior longitudinal fasciculus (SLF) compared to controls (p<0.05). In the left-side surgery group, the left SLF FA value was lower than controls, while in the right-side surgery group, the right SLF FA values were lower than controls (p<0.05). In the patient group as a whole, ipsilateral SLF FA was significantly lower than the contralateral SLF (p<0.05). Widespread decrease in FA values in the patients compared with the controls suggests that the pathologic changes extend diffusely to most major white matter tracts. In the patient group, the ipsilateral SLF to the seizure focus had greater change compared to the contralateral SLF. These data suggest that the detection of DTI abnormality has an added value to lateralization. PMID:22917916

Kim, H; Harrison, A; Kankirawatana, P; Rozzelle, C; Blount, J; Torgerson, C; Knowlton, R

2013-02-01

408

Management of Pain in the Cancer Patient.  

National Technical Information Service (NTIS)

Contents: Cancer pain management--diagnosis and evaluation; Cancer pain management--multidisciplinary pain clinics; Cancer pain management--psychologic technics; Cancer pain management--pharmacologic technics; Cancer pain management--neurosurgical technic...

1984-01-01

409

Selected Gamma Aminobutyric Acid (GABA) Esters may Provide Analgesia for Some Central Pain Conditions  

PubMed Central

Central pain is an enigmatic, intractable condition, related to destruction of thalamic areas, resulting in likely loss of inhibitory synaptic transmission mediated by GABA. It is proposed that treatment of central pain, a localized process, may be treated by GABA supplementation, like Parkinson’s disease and depression. At physiologic pH, GABA exists as a zwitterion that is poorly permeable to the blood brain barrier (BBB). Because the pH of the cerebral spinal fluid (CSF) is acidic relative to the plasma, ion trapping may allow a GABA ester prodrug to accumulate and be hydrolyzed within the CSF. Previous investigations with ester local anesthetics may be applicable to some GABA esters since they are weak bases, hydrolyzed by esterases and cross the BBB. Potential non-toxic GABA esters are discussed. Many GABA esters were investigated in the 1980s and it is hoped that this paper may spark renewed interest in their development. PMID:20703328

Goldberg, Joel S.

2010-01-01

410

Selected Gamma Aminobutyric Acid (GABA) Esters may Provide Analgesia for Some Central Pain Conditions.  

PubMed

Central pain is an enigmatic, intractable condition, related to destruction of thalamic areas, resulting in likely loss of inhibitory synaptic transmission mediated by GABA. It is proposed that treatment of central pain, a localized process, may be treated by GABA supplementation, like Parkinson's disease and depression. At physiologic pH, GABA exists as a zwitterion that is poorly permeable to the blood brain barrier (BBB). Because the pH of the cerebral spinal fluid (CSF) is acidic relative to the plasma, ion trapping may allow a GABA ester prodrug to accumulate and be hydrolyzed within the CSF. Previous investigations with ester local anesthetics may be applicable to some GABA esters since they are weak bases, hydrolyzed by esterases and cross the BBB. Potential non-toxic GABA esters are discussed. Many GABA esters were investigated in the 1980s and it is hoped that this paper may spark renewed interest in their development. PMID:20703328

Goldberg, Joel S

2010-01-01

411

Programmable intrathecal pumps for the management of chronic pain: recommendations for improved efficiency  

PubMed Central

The management of chronic pain can be very challenging. Often, physicians employ intrathecal (IT) drug delivery systems as a last resort to relieve intractable pain. The system consists of an implantable pump that stores and delivers medication through a catheter to the IT space. Programmability is achieved by positioning an external devise over the implanted pump to change the mode of drug delivery. The innovations in programmable IT drug delivery systems are expanding more rapidly than ever before. Unfortunately, the rapid expansion is accompanied by a lack of prospective randomized trials examining these new options. In an effort to improve results and reduce side effects, publications by experts or expert consensus panels provide guidance for the community. The purpose of this article is to provide a summary of high interest topics in recent publications. PMID:25336986

Wilkes, Denise

2014-01-01

412

Gender role expectations of pain: relationship to experimental pain perception  

Microsoft Academic Search

The primary purpose of this study was to investigate the influence of an individual's Gender Role Expectations of Pain (GREP) on experimental pain report. One hundred and forty-eight subjects (87 females and 61 males) subjects underwent thermal testing and were asked to report pain threshold, pain tolerance, VAS ratings of pain intensity and unpleasantness, and a computerized visual analogue scales

Emily A Wise; Donald D Price; Cynthia D Myers; Marc W Heft; Michael E Robinson

2002-01-01

413

Painful diabetic polyneuropathy: epidemiology, pain description, and quality of life  

Microsoft Academic Search

A prospective survey study was performed in patients with painful diabetic polyneuropathy (PDN) to assess the nature and scope of their pain. Pain associated with diabetic neuropathy is commonly encountered in clinical practice. Yet, little is known regarding the pain experience and impact on quality of life in persons with painful diabetic neuropathy. These 105 patients noted an average of

Bradley S. Galer; Ann Gianas; Mark P. Jensen

2000-01-01

414

Painful Peripheral Neuropathies  

PubMed Central

Peripheral neuropathies are a heterogeneous group of diseases affecting peripheral nerves. The causes are multiple: hereditary, metabolic, infectious, inflammatory, toxic, traumatic. The temporal profile includes acute, subacute and chronic conditions. The majority of peripheral neuropathies cause mainly muscle weakness and sensory loss, positive sensory symptoms and sometimes pain. When pain is present, however, it is usually extremely intense and among the most disabling symptoms for the patients. In addition, the neurological origin of the pain is often missed and patients receive inadequate or delayed specific treatment. Independently of the disease causing the peripheral nerve injury, pain originating from axonal pathology or ganglionopathy privileges neuropathies affecting smaller fibres, a clinical observation that points towards abnormal activity within nociceptive afferents as a main generator of pain. Natural activation of blood vessels or perineurial nociceptive network by pathology also causes intense pain. Pain of this kind, i.e. nerve trunk pain, is among the heralding symptoms of inflammatory or ischemic mononeuropathy and for its intensity represents itself a medical emergency. Neuropathic pain quality rekindles the psychophysical experience of peripheral nerves intraneural microstimulation i.e. a combination of large and small fibres sensation temporally distorted compared to physiological perception evoked by natural stimuli. Pins and needles, burning, cramping mixed with numbness, and tingling are the wording most used by patients. Nociceptive pain instead is most often described as aching, deep and dull. Good command of peripheral nerve anatomy and pathophysiology allows timely recognition of the different pain components and targeted treatment, selected according to intensity, type and temporal profile of the pain. PMID:18615140

Marchettini, P; Lacerenza, M; Mauri, E; Marangoni, C

2006-01-01

415

Pain of urogenital origin  

Microsoft Academic Search

Chronic nonmalignant pain syndromes (longer than 6 months duration) of urogenital origin are well described but poorly understood\\u000a focal pain syndromes. Pain in these areas of the body is usually very embarrassing for the male and female patient, who may\\u000a be afraid to discuss his or her symptoms with family members, friends, and health care providers. Except in those cases

Ursula Wesselmann; Peter P. Czakanski

1999-01-01

416

Postpartum Lower Abdominal Pain  

Microsoft Academic Search

Pains after labor can be as severe as those experienced during labor, particularly the commonly occurring lower abdominal\\u000a “after-pains” that are associated with prolonged uterine contractions during breast feeding. Other causes of lower abdominal\\u000a pain may not be physiologically based but are either direct complications of parturition, such as genital infection, or fortuitous,\\u000a such as appendicitis. Although the focus of

Anita Holdcroft

1999-01-01

417

Acceptance of chronic pain  

Microsoft Academic Search

The experience of chronic pain can be associated with significant distress and disability; however, this is not always the\\u000a case. Although attempts to control or reduce pain can be helpful for many pain sufferers, on some occasions this is not an\\u000a effective option and a different response is required. This different response can include a fiexible mix of control and

Lance M. McCracken; Kevin E. Vowles

2006-01-01

418

Personalized treatment of pain.  

PubMed

Despite advances made in its understanding and treatment, chronic pain remains an unsolved and all too common problem. One of the main obstacles to successful management of pain is the high variability of many patients regarding both response to treatment and susceptibility to adverse effects, which curtails the utility of therapeutic intervention. Understanding the causes of this variability is an important challenge which may lead to a new era in rational pain management. As described in this review, however, there currently seems to be more than one possible explanation of this variability. Rational personalized pain management must take into consideration both ever-increasing knowledge of pharmacogenetics and pharmacokinetics and a broad, clinically based attitude incorporating co-morbidities, both physical and psychiatric, and concomitant medications. Novel models for testing in-vivo pain processing, for example assessment of conditioned pain modulation (CPM), are also promising approaches to use of rational data for empirical treatment of pain. Last, listening to the patient and understanding the context in which pain has affected his or her life is an important part of maintaining the personal nature of therapeutic interaction with patients suffering from pain. PMID:23292814

Ablin, Jacob N; Buskila, Dan

2013-01-01

419

NECK AND SHOULDER PAIN  

PubMed Central

Neck and shoulder pains are presenting or incidental symptoms in a large variety of conditions. There may be similarities in the anatomicophysiological mechanism of pain production and in the clinical picture in many of these conditions. Many of the vague and refractory cases of neck and shoulder pain and of migraine may be due to cervical disc disease. Scalenus anticus syndrome and cardiac disease can be diagnosed or differentiated from cervical disc syndrome only by thorough investigation. Proper treatment of neck and shoulder pain is dependent upon correct diagnosis through complete history, physical examination and laboratory tests, as described in this presentation. PMID:18131684

Fields, Albert; Hoesley, John

1949-01-01

420

Alternative medicine - pain relief  

MedlinePLUS

... for: After surgery or labor Arthritis Cancer Fibromyalgia Irritable bowel syndrome Migraine headache Tension headache Both acupuncture and hypnosis are often offered by pain management centers in ...

421

Increased peroxisome proliferator?activated receptor ? expression levels in visceral adipose tissue, and serum CCL2 and interleukin-6 levels during visceral adipose tissue accumulation.  

PubMed

This study was conducted to determine the mRNA and protein expression levels of peroxisome proliferator?activated receptors (PPARs) in visceral adipose tissue, as well as serum adipokine levels, in Sprague Dawley rats. The rats were fed either a normal (control rats) or excessive (experimental rats) intake of food for 8 or 16 weeks, then sacrificed, at which time visceral and subcutaneous adipose tissues, as well as blood samples, were collected. The mRNA and protein expression levels of PPARs in the visceral adipose tissues were determined using reverse transcription-polymerase chain reaction and Western blotting, respectively. In addition, the levels of adipokines in the serum samples were determined using commercial ELISA kits. The results revealed that at 8 weeks, the mass of subcutaneous adipose tissue was higher than that of the visceral adipose tissue in the experimental rats, but the reverse occurred at 16 weeks. Furthermore, at 16 weeks the experimental rats exhibited an upregulation of PPAR? mRNA and protein expression levels in the visceral adipose tissues, and significant increases in the serum levels of CCL2 and interleukin (IL)-6 were observed, compared with those measured at 8 weeks. In conclusion, this study demonstrated that the PPAR? expression level was likely correlated with serum levels of CCL2 and IL-6, molecules that may facilitate visceral adipose tissue accumulation. In addition, the levels of the two adipokines in the serum may be useful as surrogate biomarkers for the expression levels of PPAR? in accumulated visceral adipose tissues. PMID:25324014

Yogarajah, Thaneswary; Bee, Yvonne-Tee Get; Noordin, Rahmah; Yin, Khoo Boon

2015-01-01

422

Visceral Fat Accumulation Is Associated with Colorectal Cancer in Postmenopausal Women  

PubMed Central

Background Obesity is a known risk factor for colorectal cancer (CRC), and emerging data suggest that this association is mediated by visceral fat rather than total body fat. However, there is a lack of studies evaluating the association between visceral fat area and the prevalence of CRC. Methods To investigate the relationship between visceral adiposity and prevalence of CRC, data of 497 women diagnosed with CRC and 318 apparently healthy women were analysed and data of well-balanced 191 pairs of women with CRC and healthy women matched based on propensity scores were additionally analysed. Diagnosis of CRC was confirmed by colonoscopy and histology. Metabolic parameters were assessed, along with body composition, using computed tomography. Results The median visceral fat area was significantly higher in the CRC group compared with the control group before and after matching. The prevalence of CRC increased significantly with increasing visceral fat tertiles after matching (p for trend <0.01). A multivariate analysis showed that mean visceral fat area of individuals in the 67th percentile or greater group was associated with an increased prevalence of CRC (adjusted odds ratio: 1.80; 95% confidence interval: 1.12–2.91 before matching and adjusted odds ratio: 2.96; 95% confidence interval: 1.38–6.33) compared with that of individuals in the 33th percentile or lower group. Conclusion Thus, we conclude that visceral fat area is positively associated with the prevalence of CRC. Although we could not determine the causality, visceral adiposity may be associated with the risk of CRC. Further prospective studies are required to determine the benefits of controlling visceral obesity for reducing CRC risk. PMID:25402501

Lee, Jee-Yon; Lee, Hye-Sun; Lee, Duk-Chul; Chu, Sang-Hui; Jeon, Justin Y.

2014-01-01

423

TRPA1 channels mediate acute neurogenic inflammation and pain produced by bacterial endotoxins  

NASA Astrophysics Data System (ADS)

Gram-negative bacterial infections are accompanied by inflammation and somatic or visceral pain. These symptoms are generally attributed to sensitization of nociceptors by inflammatory mediators released by immune cells. Nociceptor sensitization during inflammation occurs through activation of the Toll-like receptor 4 (TLR4) signalling pathway by lipopolysaccharide (LPS), a toxic by-product of bacterial lysis. Here we show that LPS exerts fast, membrane delimited, excitatory